An equity lens on COVID-19 transmission policies in Catalonia, Spain: a PROGRESS-PLUS analysis

Abstract

Abstract COVID-19 pandemic has affected all individuals, but especially vulnerable populations. In Spain, Catalonia has been the most affected region by the infection, with higher incidence rates among foreigners, certain occupations, and neighborhoods. Interventions addressing differential vulnerability to infection are crucial in addressing the impact of social factors on pandemics. I aimed to describe the presence of social factors in the formulation of policies to address COVID-19 transmission in Catalonia, Spain. For this, a descriptive policy analysis on the frequency of the presence of social factors was carried out using the PROGRESS-PLUS framework, from the Campbell and Cochrane Equity Methods Group. It represents 8 dimensions of inequalities: Place of residence, Race, Occupation, Gender/sex, Religion, Education and Socioeconomic status. ‘Plus’ refers to other dimensions that may imply inequality. For the production of results, 29 policies were analyzed. Only policies formulated between the two states of alarm and the de-escalation phase were included (March 14, 2020-May 9, 2021). Of these, 72.4% (n = 21) mention at least one component of the framework. ‘Age’ was the most mentioned component 37.9% (n = 11); followed by ‘Occupation’ (27.6%, n = 8); ‘Place of residence’ (10.3%, n = 3). ‘Gender’ and ‘Income’ were mentioned once (3.4%). ‘Educational level’ and ‘Race’ were not mentioned in any policy. For ‘Plus’ component, 18 policies (62.1%) mention some dimension of vulnerability, such as disability, mental disorders, immigration, deficient housing conditions or ‘vulnerable groups’ but without specifying who these groups are. To conclude, it is necessary to increase the relevance of health equity when formulating policies to face future pandemics. It is needed to establish protocols that consider inequality in pandemics, in conjunction with investing in public health and healthcare. Further research on this issue is also relevant to draw lessons learned for future pandemics. Key messages • Despite the mention of axes of inequality in most of the policies studied, it is necessary to increase the priority of health equity in its formulation, especially for future pandemics. • Since inequality is a structural issue, protocols should be implemented before health emergencies occur in order to increase their effectiveness in terms of equity and health outcomes.