Multi-level policy responses to tackle socioeconomic inequalities in the incidence of COVID-19 in a European urban area

Conchita Peña-Gallardo,Glòria Pérez,Elia Diez,Marc Marí-Dell’Olmo,Carme Borrell,Sara Tolosa,Maica Rodríguez-Sanz,Lucía Artazcoz,Davide Malmusi,M Isabel Pasarín

doi:10.1186/s12939-022-01628-1

Abstract

BackgroundSpain has been hit hard by COVID-19 since March 2020, especially in its metropolitan areas. We share experiences from Barcelona in measuring socioeconomic inequalities in the incidence of COVID-19 in the different waves, and in implementing coordinated and equity-oriented public health policy responses.MethodsWe collected daily data on confirmed COVID-19 cases, geocoded the address of residence to assign each case to one of the 73 neighborhoods and 1068 census tracts, and calculated the cumulative incidence of COVID-19 by neighborhood and five income groups (quintiles of census tracts) by sex across four waves of the pandemic. We adjusted hierarchical Bayesian spatial models to obtain the relative risk (RR) of cumulative incidences in each quintile compared with the richest areas. A variety of public health policies implemented to tackle the pandemic and especially these inequalities in COVID-19 incidence and vaccination are selected and described.ResultsArea-level income inequalities in the incidence of COVID-19 were present at different degree in all four waves. In the second wave (10/1/2020 to 12/6/2020), RR for the poorest income quintile census tracts compared with the richest was 1.43 (95% credible interval-CI-: 1.22–1.67) for men and 1.58 (95% CI: 1.35–1.83) for women. Later, inequalities in vaccination coverage also arose. Equity-oriented policy responses included: “health hotels” or home delivery of basic products for individuals with COVID-19 and without adequate conditions for isolation; new emergency facilities for homeless people, including those with active drug use; mass screening in high incidence areas; contingency plans for nursing homes and schools; adapting community health programs for their early reactivation; digital self-appointment support points and community vaccination days.ConclusionCOVID-19 hit Barcelona neighborhoods unequally, with variations between waves. The rapid availability of geolocalized data and by socioeconomic level helped public authorities to implement targeted policies and collaborative interventions for the most vulnerable populations. Further studies would be needed to evaluate their impact.

Highlights

Spain has been hit hard by COVID-19 since March 2020, especially in its metropolitan areas
This article aimed to describe the trend in socioeconomic inequalities in the incidence of COVID19 in Barcelona across its different waves, and to explain different multisectoral, equity-oriented policy responses delivered by public health and municipal services
Equity‐oriented policy responses to COVID‐19 Among a very wide range of local responses to tackle the pandemic and its social and economic consequences, we describe in the Results section nine local interventions selected by the authors considering the following criteria: a) a leading or important collaborative role of public health services; b) including policies that were either: 1) addressed to specific settings or the general population but with an orientation to equity; or (2) directly addressing socioeconomic inequalities or socially deprived populations; and/or (3) designed as a response to socioeconomic inequalities related to COVID-19

Summary

Introduction

Spain has been hit hard by COVID-19 since March 2020, especially in its metropolitan areas. We share experiences from Barcelona in measuring socioeconomic inequalities in the incidence of COVID-19 in the different waves, and in implementing coordinated and equity-oriented public health policy responses. COVID-19 has spread worldwide and across all levels of society and, as such, has required a population-based and universal approach, involving various levels of governance, such as supranational bodies, country, regional governments and local governments, and community movements. It is at this local level, where specific needs have been identified in all phases of the pandemic. COVID-19 has shown social inequalities in its incidence, which has been reported to be higher in people with lower socioeconomic position and in ethnic minorities [2]

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