Abstract
The Coronavirus pandemic of 2019–20 (COVID-19) affected multiple social determinants of health (SDH) across the globe, including in New Zealand, exacerbating health inequities. Understanding these system dynamics can support decision making for the pandemic response and recovery measures. This study combined a scoping review with a causal loop diagram to further understanding of the connections between SDH, pandemic measures, and both short- and long-term outcomes in New Zealand. The causal loop diagram showed the reinforcing nature of structural SDH, such as colonization and socio-economic influences, on health inequities. While balancing actions taken by government eliminated COVID-19, the diagram showed that existing structural SDH inequities could increase health inequities in the longer term, unless the opportunity is taken for socio-economic policies to be reset. Such policy resets would be difficult to implement, as they are at odds with the current socio-economic system. The causal loop diagram highlighted that SDH significantly influenced the dynamics of the COVID-19 impact and response, pointing to a need for purposeful systemic action to disrupt the reinforcing loops which increase health inequities over time. This will require strong systems leadership, and coordination between policy makers and implementation at local level.
Highlights
The infectious disease caused by the coronavirus SARS-CoV-2 triggered a global pandemic in 2020 ( ‘COVID-19’) with profound consequences for millions of people
The literature was taken from a wide range of journals and websites, mostly only one article or report from each source except for 4 articles from a special COVID-19 issue of The Policy Quarterly [17,38,41,47], a New Zealand journal aimed at government policy makers
The range of social determinants included an emphasis on the health system [16, 20,23,35,39,40,45,47,49,53], society and culture [17,19,38,43,52,54,55], economy [37,46,48], environment [18] and education [50]
Summary
The infectious disease caused by the coronavirus SARS-CoV-2 triggered a global pandemic in 2020 ( ‘COVID-19’) with profound consequences for millions of people. When community transmission was first detected in March 2020, the government implemented strict measures designed to eliminate the virus, including a stringent lockdown with most of the population staying at home for six weeks. During this period there were 1503 cases of COVID-19, 95 hospital admissions and 22 deaths [1]. Measures were relaxed after this first wave, and less stringent measures were temporarily applied on a regional basis when an outbreak occurred in August. Since that time there have been several other, smaller outbreaks, with more regionally focused response measures applied
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