The COVID-19 Israeli tapestry: the intersectionality health equity challenge.

BACKGROUND: COVID-19 is disproportionately affecting disadvantaged populations, with greater representation and worse outcomes in low socioeconomic and minority populations, and in persons from marginalized groups. General health care system approaches to inequity reduction (i.e., the minimization of differences in health and health care which are considered unfair or unjust), address the major social determinants of health, such as low income, ethnic affiliation or remote place of residents. Yet, to effectively reduce inequity there is a need for a multifactorial consideration of the aspects that intersect and generate significant barriers to effective care that can address the unique situations that people face due to their gender, ethnicity and socioeconomic situation. MAIN BODY: To address the health equity challenges of diverse population groups in Israel, we propose to adopt an intersectional approach, allowing to better identify the needs and then better tailor the infection prevention and control modalities to those who need them the most. We focus on the two main ethnic - cultural-religious minority groups, that of Arab Palestinian citizens of Israel and Jewish ultra-orthodox (Haredi) communities. Additionally, we address the unique needs of persons with severe mental illness who often experience an intersection of clinical and sociodemographic risks. CONCLUSIONS: This perspective highlights the need for responses to COVID-19, and future pandemic or global disasters, that adopt the unique lens of intersectionality and equity. This requires that the government and health system create multiple messages, interventions and policies which ensure a person and community tailored approach to meet the needs of persons from diverse linguistic, ethnic, religious, socioeconomic and cultural backgrounds. Under-investment in intersectional responses will lead to widening of gaps and a disproportionate disease and mortality burden on societies' most vulnerable groups.

Differential Influence of COVID-19 pandemic on Life-Space Mobility of older adults

Life-space mobility (LSM) is critical to aging successfully since it is essential to maintain independence, affecting the health and quality of life of older adults. During the COVID-19 pandemic older adults, who are at high-risk of serious illness and complications, are restricted by stay-at-home orders, limiting their outdoor activities. This study evaluated differences in LSM before and during the pandemic and factors related to limited pre-hospitalization mobility. We used a natural experiment design comparing LSM one month prior to hospitalization and its related factors on two subsamples of hospitalized older adults: recruited before and after February 2020 (pandemic outbreak). No significant differences were observed in LSM between pre-pandemic (N=141, M(SD)=54.9(33,5)) and during-pandemic (N=186, M(SD)=55.3(32.9)) samples, even after adjustment for cognitive, functional, and demographic characteristics (F=2.281, p=0.13). Of those who participated during the pandemic, a total of 94 (50.5%) declared that their mobility was strongly affected by the pandemic and had significantly lower LSM (F=4.626, p<0.01) comparing both to those who declared not being affected (N=92) and to the pre-pandemic group, controlling for potential cofounders. In the "during-pandemic" group older adults with higher basic physical functioning, higher economic status, and those with lower levels of education were more likely to indicate that their pre-hospital mobility was affected by the pandemic. These results show that the pandemic period has a differential effect on life-space mobility of older adults. Functional, socio-economic, and educational factors need to be considered in planning how to maintain older adults’ mobility during the ongoing pandemic.

Health equity and COVID-19: global perspectives.

The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.