International Journal for Equity in Health最新文献

{"title":"Maternal and newborn health inequality among Syrian refugees in Turkey: a systematic review and meta-analysis.","authors":"Sevil Hakimi, Esin Ceber Turfan, Leila Allahqoli, Mohadeseh Ahmadi, Neriman Sogukpinar, Mahide Demirelöz Akyüz, Esmat Mehrabi, Azam Rahmani, Ibrahim Alkatout","doi":"10.1186/s12939-025-02506-2","DOIUrl":"10.1186/s12939-025-02506-2","url":null,"abstract":"<p><strong>Objective: </strong>In this meta-analysis we explore significant health disparities in maternal and newborn health among Syrian refugees residing in Turkey.</p><p><strong>Method: </strong>The study protocol was registered in PROSPERO. We conducted a comprehensive literature search across six databases, including sources in English and Turkish, as well as relevant UN agencies, covering the period from 2011 (the onset of the Syrian conflict) to September 2024. This research specifically targets Syrian mothers aged 15 to 49 who were either pregnant or had recently given birth in Turkey, including studies with observational cross-sectional or retrospective designs. The quality of the included studies was evaluated using the JBI Critical Appraisal Checklist. Statistical analyses were performed using R version 4.4.1.</p><p><strong>Result: </strong>Of 382 studies in English and Turkish, 29 papers, 2 reports and 1 postgraduate thesis were selected for full-text evaluation. Syrian migrants were more at risk of anemia in the third trimester of pregnancy [RR: 2.27 (95% CI: 1.57 to 3.32)], and had less access to antenatal care [RR: 0.39 (95% CI: 0.26 to 0.58)] and iron supplementation during pregnancy [RR: 0.69 (95% CI: 0.46 to 0.96)] compared to the native population. The risks of adolescent pregnancy [RR: 3.78 (95% CI: (3.06 to 4.88)] and home birth [RR: 3.68 (95% CI: (2.53 to 5.27)] were higher among migrants [RR: 3.78 (95% CI: (3.06to 4.88)]. Conversely, migration was an important factor in gestational diabetes [RR: 0.44 (95% CI: (0.21 to 0.90)] and newborn macrosomia [RR: 0.54 (95% CI: (0.50 to 0.58)] as well as preeclampsia [RR: 0.56 (95% CI: (0.32 to 0.98)].</p><p><strong>Conclusion: </strong>Our data revealed that Syrian migrant mothers face a higher risk of anemia, limited access to antenatal care and iron supplements, and higher rates of adolescent pregnancies and home births compared to their native counterparts. However, migration appears to have a protective effect on gestational diabetes and preeclampsia. The results underscore the need for targeted health interventions and policies that address access to maternal healthcare services.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"160"},"PeriodicalIF":4.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Counting the savings: impact of Georgia's drug policy interventions on households.","authors":"Tsotne Gorgodze, Akaki Zoidze, George Gotsadze","doi":"10.1186/s12939-025-02535-x","DOIUrl":"10.1186/s12939-025-02535-x","url":null,"abstract":"<p><strong>Introduction: </strong>Access to essential medicines is crucial for achieving the Sustainable Development Goals and Universal Health Coverage. In Georgia, as in many low- and middle-income countries, out-of-pocket payments (OOPs) for medicines remain a major financial burden, particularly for low-income households. Despite the launch of Georgia's Universal Health Coverage Program in 2013, medicines still constitute the largest share of OOP health expenditures, increasing the risk of impoverishment. This study, therefore, aims to assesses the impact of three pharmaceutical policy interventions introduced between 2017 and 2023 on monthly household drug expenditures.</p><p><strong>Methodology: </strong>The analysis utilizes pooled data from Georgia's Household Income and Expenditure Surveys (2015-2023), covering over 88,000 households. Interrupted Time Series (ITS) analysis was employed to evaluate the effects of three policy actions: the 2017 drug reimbursement plan, the 2022 introduction of parallel imports from Turkey, and the 2023 implementation of external reference pricing. Regression models accounted for seasonality and complex survey design, including weights and clustering. Monthly median drug expenditures were adjusted to January 2015 prices.</p><p><strong>Results: </strong>Only after the introduction of external reference pricing policy in 2023 a significant reduction was observed - an immediate drop of 6.96 GEL (2.51 USD) per household (p = 0.016) and a monthly decline of 1.28 GEL (0.46 USD) (p = 0.002), representing a 29% decrease and saving Georgian households approximately 43.3 million GEL (15.59 million USD) in 2023. The 2022 parallel import policy led to an initial decrease (2.26 GEL; p = 0.39) but was followed by a significant increase over time (coefficient = 1.43, p < 0.001).</p><p><strong>Conclusion: </strong>Addition of external reference pricing policy significantly reduced household pharmaceutical spending and shows promise as a policy tool for other low- and middle-income countries. However, sustained impact requires continued monitoring and complementary measures to ensure equitable access and long-term benefits.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"161"},"PeriodicalIF":4.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are tailored primary care services for social inclusion good value for money? A health economics evaluation with Monte-Carlo probabilistic sensitivity analysis comparing tailored social inclusion primary care services to mainstream primary care services for socially excluded people.","authors":"Síle Kelly, Anne Dee, Patrick O'Donnell","doi":"10.1186/s12939-025-02532-0","DOIUrl":"10.1186/s12939-025-02532-0","url":null,"abstract":"<p><strong>Background: </strong>Socially excluded groups of people (SEP) live with resources so inadequate that it precludes them from participating fully in the normal acceptable living standards of society. They often have complex health and social care needs yet face structural and attitudinal barriers accessing mainstream healthcare. This can result in ambulatory-care sensitive conditions being left untreated in the community and contributes to the higher use of costly acute services in crisis mode by SEP. Tailored social inclusion primary care (SIPC) services can provide a flexible approach to engage with and meet the needs of this marginalised population. There is little evidence on the economic benefit of these services from the perspective of the publicly-funded health and social services. The aim of this study is to conduct an economic evaluation (cost-consequence analysis) of a single-centre SIPC clinic in the Mid-West region of Ireland over a 12-month period and to determine its value for money. The analysis compares cost outcomes between SEP who have access to a tailored SIPC service with those who do not.</p><p><strong>Methods: </strong>A cost analysis of the part-time SIPC service, based on available Irish-sourced data on the usage and costs of acute care in the Health Service Executive (HSE), and a literature review were used to identify the cost and outcome parameters of the economic framework. A multi-variate probabilistic sensitivity analysis using Monte Carlo Simulation methodology was used to assess model uncertainty.</p><p><strong>Results: </strong>The cost savings of investing in the part-time SIPC service providing care to 292 individuals, were estimated to be €718,890.90 with an estimated 658 bed days saved over a 12-month period. This represented a return of investment of €3.71 for every €1 spent. The sensitivity analysis supported the estimates with just a 2.2% likelihood of a negative return of investment.</p><p><strong>Conclusion: </strong>This study found that investment in SIPC services, that can meet the needs of a marginalised population, represents good value for money from the perspective of the publicly funded health service. The findings are valuable in supporting stakeholders, policy-makers, and budget holders to make evidence-informed equitable decisions for optimal funding allocation within health and social services.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"159"},"PeriodicalIF":4.5,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulation of artificial intelligence in Uganda's healthcare: exploring an appropriate regulatory approach and framework to deliver universal health coverage.","authors":"Kalule Grancia Mugalula","doi":"10.1186/s12939-025-02513-3","DOIUrl":"10.1186/s12939-025-02513-3","url":null,"abstract":"<p><strong>Background: </strong>Uganda, like other United Nations (UN) member states, has undertaken to achieve Universal Health Coverage (UHC) by 2030 in line with Sustainable Development Goal (SDG) 3 targets. However, if this target is to be achieved, efforts will need to be increased, as full coverage of essential services remains an issue. Access to quality, acceptable and affordable healthcare remains an illusion for many Ugandans. Artificial Intelligence can be a valuable tool in achieving UHC as it can increase access to health facilities in hard-to-reach areas. AI tools have also been reported to perform faster than humans at certain key health tasks like diagnosis. However, for AI to be effective in delivering its benefits, context-specific regulatory approaches are key, as needs and opportunities differ. In this paper, I argue that the regulation of AI can help make it an effective tool for achieving UHC in Uganda if the right regulatory approach and framework are adopted, as regulation shapes outcomes. This will tackle the risk of poor regulation hindering AI development and AI reinforcing inequalities.</p><p><strong>Methods: </strong>The paper employs a doctrinal methodology to analyse the two prominent regulatory approaches to AI in the EU and UK, which have adopted a risk-based and principles-based approach, respectively. It investigates whether these approaches are suitable for regulating AI in Uganda's healthcare and achieving UHC. The strengths and weaknesses of each approach are examined. The paper advocates for considering a human rights-based approach that can be integrated with the principles-based approach.</p><p><strong>Results: </strong>Regulation is a double-edged tool that can positively or negatively shape health outcomes. Good regulation has the potential to emancipate ordinary people's lives. Therefore, Uganda should leverage the positive aspects of principles-based and human rights-based approaches to regulation to ensure that AI's potential to achieve UHC is effective.</p><p><strong>Conclusion: </strong>The hybrid approach to AI regulation is best suited to serve Uganda's healthcare needs. The foremost priority for Uganda is to attain Universal Health Coverage. A hybrid approach will contribute to this however, it is not the silver bullet. Uganda needs to supplement efforts to achieve UHC with other non-regulatory strategies.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"158"},"PeriodicalIF":4.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gendered experience of people living with type 2 diabetes in rural and urban Mexico: an ethnographic study.","authors":"Ileana B Heredia-Pi, Emanuel Orozco-Núñez, Carlos M Guerrero-López, Nadia Cerecer-Ortiz, Enai Ojeda-Arroyo, Betania Allen-Leigh, Stephen Jan, Laura Downey, Edson Serván-Mori","doi":"10.1186/s12939-025-02523-1","DOIUrl":"10.1186/s12939-025-02523-1","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the gendered experience of women and men living with type 2 diabetes mellitus (T2D) related to diagnosis, treatment, and control in rural and urban contexts of Mexico.</p><p><strong>Methodology: </strong>Qualitative ethnographic study. Thirty-six adults (21 women and 15 men) with a confirmed diagnosis of T2D for more than five years residing in urban and rural localities in Baja California and Morelos participated in this qualitative study between November 2022 and February 2023. A semi-structured interview guide was used to explore lifestyle changes, social and community networks, work and living conditions, experience with the disease, health services and associated economic burden. The analysis was guided by four conceptual domains of gender influence: identity, norms and roles, relationships and institutionalised gender.</p><p><strong>Results: </strong>Women were more likely to report difficulty in accepting the diagnosis of T2D and stress in coping with the disease and related lifestyle changes. Men were more likely to report impact of T2D on their job and role as household providers, and their inability to contribute to the care of other family members. Women were more likely to report leaving their jobs, taking on caregiving responsibilities for family members, experiencing difficulty in accessing healthcare, and prioritizing their health in comparison to men. Men reported receiving more support from their partners, faced fewer financial barriers to care access, and had more freedom to pay for their medications and seek treatment in private care. However, they were also less adherent to treatment and disease care measures.</p><p><strong>Conclusions: </strong>Gender appears to substantially influence experience of living with T2D. Women were more likely to provide family support and less likely to receive it and reported greater financial barriers to care access in comparison to men. Men were more likely to experience stress in relation to their employment as primary providers for their family, and less likely to adhere to prescribed medical management of their condition. These findings should be considered in more targeted health policy interventions to promote greater gender equity in the care of those with T2D in Mexico.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"157"},"PeriodicalIF":4.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How narration could unfold oppression: insights from the experiences of the Kurds in access to Turkish healthcare services.","authors":"Tevfik Bayram","doi":"10.1186/s12939-025-02510-6","DOIUrl":"10.1186/s12939-025-02510-6","url":null,"abstract":"<p><strong>Background: </strong>Uncovering the nuances of oppression in qualitative research can be challenging, as oppression often manifests in subtle, implicit ways. In such contexts, individuals from oppressed groups may share their experiences in ways that reveal embedded meanings. As such, when interpreting interviews with people from oppressed groups, it is crucial to look beyond what is explicitly stated to uncover their true experiences. This paper examines how the way non-Turkish-speaking Kurds narrate their experiences reveals the effects of language-related oppression and internalized oppression within Turkish healthcare services.</p><p><strong>Methods: </strong>This paper is a methodological reflection on a prior qualitative study examining how the exclusion of the Kurdish language from Turkish healthcare system impacts access. Through semi-structured interviews conducted in 2018-2019 with 12 non-Turkish-speaking Kurds, the primary study revealed that language barriers extended beyond miscommunication and were deeply rooted in systemic oppression. In this paper, we reanalysed the data using the concepts of the narrated, nonnarrated, and disnarrated, developed by Vindrola-Padros and Johnson, to reveal how narration could unfold oppression.</p><p><strong>Results: </strong>We found that non-Turkish-speaking Kurds seeking healthcare in Turkey often excluded (nonnarrated) government services due to the lack of services in Kurdish. They indirectly mentioned (disnarrated) the political conflict as the root cause of their negative experiences; and portrayed themselves as the ones who must adjust to the system, rather than the system accommodating their needs which implied internalized oppression (circumnarrated). As a result of this complexity, the individual often disappeared from their own narrative, relying heavily on family involvement (conarrated) as their primary means of access.</p><p><strong>Conclusion: </strong>Applying the concepts of the narrated, nonnarrated, and disnarrated to the healthcare access experiences of Kurds in Turkey has revealed important insights into the structural and internalized oppression. By extending the original framework to include the concepts of conarration and circumnarration, we have provided a more comprehensive understanding of the complexities of oppression in healthcare access. Additionally, we found that one form of narration often acts as a response, replacement, or justification for another, urging researchers to consider the dynamism and the intricate relationship between different forms of narration.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"156"},"PeriodicalIF":4.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transphobia in the United Kingdom: a public health crisis.","authors":"Dean J Connolly, Catherine Meads, Alanna Wurm, Chay Brown, Jacob Bayliss, T C Oakes-Monger, Alison M Berner","doi":"10.1186/s12939-025-02509-z","DOIUrl":"10.1186/s12939-025-02509-z","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"155"},"PeriodicalIF":4.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decomposing socioeconomic differences in self-rated health and healthcare expenditure by chronic conditions and social determinants.","authors":"Iris Meulman, Tessa Jansen, Ellen Uiters, Mariëlle Cloin, Johan Polder, Niek Stadhouders","doi":"10.1186/s12939-025-02518-y","DOIUrl":"10.1186/s12939-025-02518-y","url":null,"abstract":"<p><strong>Background: </strong>Lower socioeconomic status is associated with lower self-rated health and higher healthcare expenditure. This study identifies which chronic conditions and social determinants contribute most to socioeconomic differences in self-rated health and healthcare expenditure.</p><p><strong>Methods: </strong>Registry and survey data combining 3 socioeconomic indicators (income, education, and financial welfare), 26 social determinants, 20 chronic conditions, age, sex, self-rated health, and healthcare expenditure for 135,183 Dutch individuals aged 25-65, were linked at individual level. Oaxaca-Blinder decomposition analyses were conducted to quantify the relative contributions of chronic conditions and social determinants to socioeconomic differences in self-rated health and healthcare expenditure.</p><p><strong>Results: </strong>Poorer self-rated health and higher healthcare expenditure among lower income groups were partly attributable to a higher prevalence of chronic conditions (33% and 70%, respectively). Acid-related disorders, cardiovascular diseases and psychological disorders contributed most to both differences in self-rated health and healthcare expenditure. Social determinants almost completely accounted for income differences in self-rated health. Social determinants explained more than the observed difference in healthcare expenditure between income groups, suggesting that, when adjusted for social determinants, lower income groups would have lower healthcare expenditure than higher income groups. Including both chronic conditions and social determinants in a single decomposition indicated that income security & social protection (28%), social & human capital (26%), and chronic conditions (23%) were equally important to income differences in self-rated health. For healthcare expenditure, chronic conditions and social determinants each accounted for approximately half of the socioeconomic differences.</p><p><strong>Conclusions: </strong>Social determinants outside the healthcare sector accounted for almost all of the socioeconomic differences in self-rated health. This highlights the need for integrated policies across multiple domains, such as the social, economic and healthcare sector, to reduce avoidable health inequalities. Given that socioeconomic differences in healthcare expenditure were primarily associated with chronic conditions, prioritizing prevention of chronic conditions among lower socioeconomic groups can potentially reduce healthcare spending within this group and improve the healthcare system's sustainability and affordability.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"154"},"PeriodicalIF":4.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unseen barriers: addressing racism in European healthcare.","authors":"Amel Filali, Lindsay Osei, Nicolas Vignier","doi":"10.1186/s12939-025-02534-y","DOIUrl":"10.1186/s12939-025-02534-y","url":null,"abstract":"<p><p>Structural racism in healthcare is largely unexplored in the European context. When studied, racism is explored as an individual opinion and not as a structural problem. Very little data exists for European populations belonging to minority groups. Most of the data available focus on migration and healthcare. The increased risk of infectious diseases among migrant populations in Europe is well documented, linked to the epidemiology of their countries of origin, migratory pathways and vulnerabilities acquired on the European continent. However, the impact of racism on access to health care for racially marginalised migrants remains underexplored compared to other barriers. Most studies on the health of different categories of migrants focus on migration status as a determinant, without addressing the effects of racism in the context of migration. It is therefore crucial to generate contextual data in Europe to study the potential existence of these biases and their influence on the management of health care of minorities.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"153"},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"They wanted to, but they just couldn't get there\": GBA + implementation and gaps during the COVID-19 pandemic in Canada.","authors":"Muhammad Haaris Tiwana, Lara Hollmann, Julia Smith","doi":"10.1186/s12939-025-02522-2","DOIUrl":"10.1186/s12939-025-02522-2","url":null,"abstract":"<p><strong>Purpose: </strong>To improve understanding of the barriers and enablers to implementing gender and intersectional analysis during the COVID-19 pandemic in Canada.</p><p><strong>Methods: </strong>We conducted a policy document analysis (n = 70) of equity-focused policies of the Canadian government published between March 2020 and August 2023. This analysis was complemented with 16 semi-structured key informant interviews with federal policy actors and leadership of civil society organizations.</p><p><strong>Results: </strong>Pandemic policy documents demonstrated multiple commitments to address pandemic related inequities, with key informants describing collaborative approaches to implementing these policies, but also limits in terms of the urgent and diffused nature of pandemic response. Implementation gaps related to accessible information, health services and vaccinations were noted and attributed to a reliance on civil society actors who lacked sufficient and sustainable resources, and the behaviors of priority populations whose capacity to comply was limited by the same inequities the policies sought to address.</p><p><strong>Conclusion: </strong>The Canadian federal government made concerted efforts to address the needs of a range of priority populations and equity issue areas within its pandemic response, with mixed results. Having a pre-established framework to guide implementation and related relationships overcame some of the urgency challenges related with pandemic response. However, implementation gaps reflected preexisting inequities shaped by broader economic, social and political systems which were infrequently addressed in pandemic policies. There is a need for greater understanding of policy implementation gaps during emergency and crisis response.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"152"},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}