When an evidence-based approach entrenches inequalities

The curfew and further COVID control measures that were announced today have had me thinking about how a narrow approach to what constitutes evidence can exacerbate health inequalities.

As Prof Catherine Bennett points out, reducing the reproduction rate of the Delta variant to 1.2-1.3 has itself been a major achievement.


However, because COVID spreads based on inequalities – insecure work, where people live, housing conditions, inability to isolate – a targeted approach based on epidemiological data alone can lead to interventions that reinforce inequities. Interventions like curfews, limiting people to one hour outside the home, and increased policing are unlikely to have an influence on COVID transmission. If anything, they’re only likely to lead to increased criminal justice engagement and charges. They’re also not based on public health evidence.

Because these measures are only being imposed in the poorer parts of Sydney where COVID is circulating most, they’re entrenching determinants of health inequity.

Eighteen months ago, when I was still trying to figure what COVID was all about, I wrote:

There is likely to be a social gradient in transmission, i.e. the poor are more likely to get COVID-19, at least at first. This is a concern that some have already flagged in the U.S.

If there is a social gradient in the disease, there needs to be a social gradient in our response. The most affected locations and communities should be the focus of the health system’s initial response (we can’t just assume this will be the case). If antiviral therapies are found to be effective, or if a vaccine is eventually developed, consideration should be given to deploying them to poorer areas first.

“The first wave hits the poor, the second wave hits the rich”: Lessons from the 1918 pandemic

Now is the time for that social gradient in the response to finally start.

To change the pandemic control, listen to the communities in western and south western Sydney

Thanks to Cate Carrigan and Croakey for the chance to chat about COVID and compliance theatre in Western Sydney – and what might make a difference.

“The thing that gives me hope is that if you look at the numbers, they really peaked in Fairfield a month ago and have come down. This is because of the huge efforts by community groups there,” says Harris-Roxas.

The Assyrian, Lebanese, Sudanese and Syrian communities are providing material assistance and information to their networks, using Zoom and social media, he says.

The value of these community ties has been evident in the strong response to the vaccine clinic set up by the Lebanese Muslim Association at Lakemba in south west Sydney.

Read more at To improve pandemic control, listen to the community leaders of western and south west Sydney