Protecting the Public's Health in Pandemics: Reflections on Policy Deliberation and the Role of Civil Society in Democracy

Abstract

The COVID-19 pandemic (“the pandemic”) has magnified the critical importance of public policy deliberation in public health emergency circumstances when normal health care operations are disrupted, and crisis conditions prevail. Adopting the lens of syndemic theory, the disproportionate impact of the pandemic on vulnerable older adults suggests that the pandemic has heightened pre-existing precarities and racial inequities across diverse older adult populations, underlining the urgency of needed policy reforms. While the pandemic has called attention to systemic failures in U.S. public health emergency planning at both federal and state levels of government, the important role of civil society in influencing policy decision making and advocating for legal and ethics reforms and social change in a democracy calls for more open dialogue in aging, public health and legal communities and constituencies. To foster this dialogue, one public health lawyer, who is also a bioethicist and gerontological social work researcher and served as chair of the New York State Bar Association Health Law Section COVID Task Force in 2020 (“Task Force”), shares her first-person perspectives on the process of leading the development of a statewide bar's recommendations for policy reforms, including the challenges and conflicts encountered. A hospital-based attorney and clinical bioethicist brings a clinical ethics perspective to the discussions. This first-person contribution discusses the power of constituencies to influence policy deliberation in a democracy, and the implications of the Task Force recommendations for future aging and public health policy, particularly in view of the high suffering burdens and trauma older persons and older people of color have borne during the pandemic.

Using a Syndemics Perspective to (Re)conceptualize Vulnerability during the COVID-19 Pandemic: A Scoping Review

“…Disparities were described for racial minorities and immigrants employed in crucial sectors such as healthcare [52], hospitality services [42], and transportation [30]. Black women and birthing people (BWBP) and older adults experiencing preexisting precarities and racial inequities were also presented as populations at risk of severe symptoms and worse COVID-19 outcomes due to their limited access to health care and interruption of services caused by control measures [41,53]. The pervasive effect of racism, race-associated social and health inequities, and racial injustice on health outcomes was extensively described in these publications.…”

“…This absence not only predisposed them to particularly negative disease outcomes but also subjected them to substandard services during the pandemic [34,47,52,59]. As a consequence, several authors emphasized the need to think of health systems beyond the criteria of clinical cost-efficiency to enable systems that provide special protection to particularly at-risk populations as a way to break discriminatory and marginalizing healthcare practices [50,52,53].…”

“…This position was deemed critically relevant to understand the impacts of COVID-19. Power structures conferring and sustaining privilege during the pandemic based on race [45,49], age [53], socio-economic position [36], productive sector [32,42,58], and health conditions [37,38,48,59] were extensively described. The structural role of racism, as a socio-political force underlying the conditions of marginalization experienced by racial and ethnic minorities, was mentioned in all publications dealing with this topic [42,52].…”

“…These specific forms of damage derived from government and health systems' responses to the emergency were considered a form of programmatic vulnerability [56]. Importantly, authors who engaged in discussions on this topic mentioned the importance of using a syndemic approach to identify populations and regions that should be prioritized in the response to pandemic threats [25,27,33,37,42,48,53,[57][58][59]. c) 'COVID-19 as a syndemic' or "the syndemic nature of the pandemic" An important feature of the scientific literature produced around the pandemic was the rapid spread of the expression "the COVID-19 syndemic".…”

Health inequities and social determinants of health in refugee and immigrant communities.

“…Syndemic theory brings a heightened focus to bear on clustered epidemics at the population level and their underlying structural conditions. The framing of the pandemic as a syndemic takes into account the intersections of the COVID virus, racism, and other structural inequities (Morrissey & Rivera-Agosto, 2021). Meaningful responses to syndemics and hypercomplex emergencies require outside support, significant allocation of resources, and structural interventions, as well as advance planning.…”