Abstract
ContextThe Covid-19 pandemic hit the developed world differentially due to accidental factors, and countries had to respond rapidly within existing resources, structures, and processes to manage totally new health challenges. This study aimed to identify which pre-existing structural factors facilitated better outcomes despite different starting points, as understanding of the relative impact of structural aspects should facilitate achieving optimal forward progress.MethodsDesk study, based on selecting and collecting a range of measures for 48 representative characteristics of 42 countries’ demography, society, health system, and policy-making profiles, matched to three pandemic time points. Different analytic approaches were employed including correlation, multiple regression, and cluster analysis in order to seek triangulation.FindingsPopulation structure (except country size), and volume and nature of health resources, had only minor links to Covid impact. Depth of social inequality, poverty, population age structure, and strength of preventive health measures unexpectedly had no moderating effect. Strongest measured influences were population current enrolment in tertiary education, and country leaders’ strength of seeking scientific evidence. The representativeness, and by interpretation the empathy, of government leadership also had positive effects.ConclusionStrength of therapeutic health system, and indeed of preventive health services, surprisingly had little correlation with impact of the pandemic in the first nine months measured in death- or case-rates. However, specific political system features, including proportional representation electoral systems, and absence of a strong single party majority, were consistent features of the most successful national responses, as was being of a small or moderate population size, and with tertiary education facilitated. It can be interpreted that the way a country was lead, and whether leadership sought evidence and shared the reasoning behind resultant policies, had notable effects. This has significant implications within health system development and in promoting the population’s health.
Highlights
The Covid-19 pandemic exploding on the world from early 2020 gave a new and severe challenge to nations’ health systems
Strength of therapeutic health system, and of preventive health services, surprisingly had little correlation with impact of the pandemic in the first nine months measured in death
While much critical narrative is being written about the pandemic from public health practice and health policy viewpoints, little has been reported about the effects of different health resource structures of countries when first hit by the pandemic, and which characteristics were associated with successful control in the early months
Summary
The Covid-19 pandemic exploding on the world from early 2020 gave a new and severe challenge to nations’ health systems. While much critical narrative is being written about the pandemic from public health practice and health policy viewpoints, little has been reported about the effects of different health resource structures of countries when first hit by the pandemic, and which characteristics were associated with successful control in the early months. Though most unwelcome in its nature, the pandemic can be considered as providing a real-world stress-testing of health systems’ public health active response and emergency reconfiguration capacities, and a unique opportunity to seek to identify the most beneficial characteristics of health systems, populations, and health policy making. It might be hypothesised that countries which had most resources and health system spend would be the most powerful and nimble to respond effectively to a new health threat at scale, and that those with effective preventive health programmes and salutogenic public behaviour would be most likely to elicit the strongest practical population responses and preventive behaviour compliance, and would be best placed to respond effectively to the first impact of the virus
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