Sharpening our public health lens: advancing im/migrant health equity during COVID-19 and beyond

Abstract

Background Differential impacts of the COVID-19 pandemic have brought deeply rooted inequities to the forefront, where increasing evidence has shown that racialized immigrant and migrant (im/migrant) populations face a disproportionate burden of COVID-19. Im/migrant communities may be worst affected by lockdowns and restrictive measures, face less opportunity to physically distance or stay home sick within ‘essential’ jobs, and experience severe barriers to healthcare. Insufficient attention to experiences of racialized im/migrants in current pandemic responses globally highlights an urgent need to more fulsomely address unmet health needs through an anti-racist, equity-oriented lens. This commentary aims to highlight the need for public health and clinical training, research, and policy to thoughtfully prioritize im/migrant health equity during and beyond the COVID-19 pandemic. Main text Global pandemic responses have neglected im/migrants by continuing to ignore or insufficiently address inequities, exacerbating COVID transmission, xenophobia, and occupational injustice. Deaths, illness, stress, and other negative outcomes of the overlapping epidemics of COVID-19 and structural racism disproportionately borne by racialized im/migrants suggest the urgent need for action. As evidence mounts about how im/migrants have been left behind in times of crises, we need enhanced focus on health equity within COVID-19 research and interventions, including research that examines and pursues structural interventions necessary to mitigate these impacts, and that identifies patterns and harms of xenophobic policy, structural racism, and white supremacy in shaping im/migrant health outcomes. We must also strengthen anti-racist and equity-oriented curriculum within health education, and ensure sufficient attention to the needs of im/migrant communities within public health, clinical, and research training. Conclusion The COVID-19 pandemic has exacerbated and rendered more visible the deeply rooted health and social inequities faced by racialized im/migrants across diverse settings. We argue for a greater emphasis on equity-focused and anti-racist im/migrant health research, interventions, and training. Policymakers and practitioners must ensure that healthcare policies and practices do not exacerbate inequities, and instead meaningfully address unmet needs of communities, including racialized im/migrants. Ethical and respectful community engagement, commitment and collaboration with global, national, and local communities, policymakers, academics, and educators, as well as accountability across sectors, is critical.

COVID-19 Pandemic and Im/migrants’ Elevated Health Concerns in Canada: Vaccine Hesitancy, Anticipated Stigma, and Risk Perception of Accessing Care

“…To a broader scale, there is an urgent need to grapple with root causes of the longstanding im/migration-based inequities by pursuing structural interventions on xenophobic migration policy, occupational injustice, structural racism, and white supremacy [72].…”

American Indian/Alaska Native, Black, and Hispanic dentists' experiences of discrimination

“…Because Hispanic people account for 51% of the nation's population increase from 2010 to 2020 [28], it is worth considering the degree to which language discrimination reflects larger biases and systems of oppression related to xenophobia and white racial supremacy. From an antiracist lens, the experiences of Hispanic dentists may reflect experiences among populations, especially for immigrant and migrant populations and may suggest the need for health equity‐based solutions [29].…”

Covid-19 and pathways to health inequities for families in a socioeconomically disadvantaged area of Sweden – qualitative analysis of home visitors’ observations

“…This is well exemplified through the restricted delivery of Rinkeby’s home visiting programme during 2020, where the partial interruptions of the programme due to risk assessments led to fewer visits on the whole, but also the closing of an important channel for families to reach other services, such as social services and the open day-care. Studies of Covid-19 and health inequalities, so far seem to have focused principally on the consequences in terms of barriers to healthcare access [ 12 , 28 , 39 ]. This aspect was also mentioned in our study, but with regards to the CHC it is contradicted by a report from March–May 2020 of the Regional CHC Programme in Stockholm, which assessed that overall, the CHC services had been maintained to a large degree during the first wave of the pandemic [ 40 ].…”