Environmental public health professionals can support health equity in the time of COVID-19

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Friday, April 17, 2020
Karen Rideout

The world has changed dramatically in recent weeks. COVID-19 has disrupted economies, social interactions, and how (or whether) we do our jobs. Environmental public health (EPH) professionals are playing an essential role to help control the spread of the SARS-CoV-2 virus, but roles have shifted. Essential grocery and food service operations are implementing new hygiene and physical distancing measures for staff and customers. Personal services establishments have closed. Businesses of all kinds are introducing online sales, virtual consultations, curbside pickup, or delivery options. Measures continue to change as we learn more about how the virus spreads. Nobody knows how long physical distancing measures will remain in place. When businesses eventually re-open, there will likely be more changes to how and when they operate, and some may struggle to adjust.

Immediate health impacts aside, COVID-19 raises important equity issues now and for the future. Employment opportunities and access to goods and services are likely to remain prohibited or be curtailed for some time. While financially secure people tend to have more resources at their disposal and hence be more resilient to disruption, the socio-economic impacts of this pandemic are manifesting in new ways. Urban dwellers across income strata may lack personal space at home or access to safe, open, green spaces outside. Some typically precarious service industry jobs are now essential (think grocery store clerks or food delivery drivers). Jobs that used to be stable have been eliminated or cut back. Essential roles in industries such as food production face new complications. These changes affect business operators, staff, the public, and their families in different ways. The burden will not be borne evenly across all sectors of the population.

While attention is redirected to containing COVID-19, the social determinants of health (SDOH) continue to affect people’s life circumstances and their ability to reach their full health potential. Existing inequities among people disadvantaged by things such as low income, social isolation, racism, homelessness or unstable housing, mental health challenges, limited access to social and health services, lack of access to green space, or poor community infrastructure may be intensified or become more widespread. Whereas income and housing support are receiving additional (and essential) attention from governments, other SDOH may be overlooked. At the same time, new inequities may emerge from changes in the economy, loss of access to services such as child- or elder-care, or the effects of physical distancing and social isolation.

EPH professionals have already been working to support vulnerable populations by championing health equity.* These efforts are particularly salient in the face of COVID-19 and existing approaches can be applied during this crisis response phase.

  • Relationships with operators and the public: Trust built over time can make it easier to implement new requirements and support operators to overcome current challenges to staying open. Listen carefully to their concerns to identify how best to help them work safely.
  • Risk prioritization: Critical risks are different today than they were a month or two ago. Prioritize populations or geographical areas that are vulnerable. Identify the riskiest settings and help people focus on what is most important.
  • Clear, concise communication: Information in multiple languages and easy to understand formats is even more important now. This will facilitate timely access to critical resources.
  • Networks: Borrow and disseminate any translated or visual tools that are available. Find out what others are doing and share new knowledge widely.
  • Collaboration: Try to find out what services are available to respond to local needs. 2-1-1 services across Canada have expanded to help with COVID-19 response (call 2-1-1 or visit 211.ca).
  • Health Equity Impact Assessment (HEIA): HEIA can help identify vulnerabilities and gaps. Use rapid or desktop HEIA to plan and make decisions about targeted responses.

In times of crisis it can be difficult to think very far into the future. The combination of increased workload and uncertainty about how to respond or what will happen may be overwhelming. There are things that EPH professionals working at the frontlines and in decision-making roles can do to empower themselves, improve EPH ability to respond, and increase community resilience now and in the future.

  • Track successful tools, processes, and approaches. Use this data to acknowledge achievements, identify best practices, and build capacity moving forward.
  • There will be gaps in resources, services, and tools. Flag them now for future response and advocacy efforts.
  • Proactive thinking is one way to empower oneself and others to adapt to the changing reality. Consider what vulnerabilities exist in the community that might affect resilience to both expected and unanticipated changes. The National Collaborating Centre for Determinants of Health (NCCDH) is continually updating a comprehensive list of resources and information for Equity-informed responses to COVID-19.
  • Keep health equity at the forefront when preparing for physical distancing restrictions to be lifted. We don’t know when that will be, how fast it will happen, or what new requirements will be in place. EPH professionals will have a key role to support essential services return to some new normal and to help other businesses re-open. Plan for different scenarios and how they might affect different people in different ways.
  • As society emerges from this pandemic there will likely be new public health standards rather than a return to pre-COVID-19 practices. Think about how food and personal services operations may need to maintain some level of physical distancing, implement lower contact workflows, or increase hand hygiene and surface disinfection schedules.
  • The COVID-19 pandemic will have implications for building infrastructure and community design. EPH professionals who work on healthy built environment (HBE) issues may need to reconsider what makes a built environment healthy. Think about how this will affect planning for sidewalk width, car and bike sharing, public transit, or frequently touched surfaces in public spaces, as well as the design of buildings, elevators, and ventilation systems. Find ways to connect with colleagues from public health and planning. Multiple sectors will need to work collectively to build knowledge and plan for action. (The NCCEH HBE Forum is a great place to do this!)
  • Community engagement processes are useful to learn more about needs, gaps, and what might work. Management can engage staff to learn from their experience during this public health crisis.

Finally, consider how all these changes affect the EPH profession. Recent years have seen gradual shifts to include more education and health promotion. Some EPH professionals work to create healthier communities, healthy built environments, and health equity. EPH experience on the front lines of the COVID-19 response might highlight new ways to use those skills.

*For more information about how to support health equity through EPH practice, visit the NCCEH Health Equity and EPH Practice topic page, the National Collaborating Centre for Determinants of Health (NCCDH) Resource Library, and the BC Centre for Disease Control.

About the author:

Dr. Karen Rideout is a food systems and environmental health specialist whose work focuses on the social, cultural, and environmental influences on health. Through her company, Karen Rideout Consulting, she facilitates cross-sector engagement with diverse professionals to support healthier built environments, create healthier food systems, and integrate health equity considerations into public health practice. Using her experience in research and policy analysis, she creates practical evidence-based tools and facilitates creativity and collaboration.