Ethics and equity in the time of COVID-19

23 July 2020

“We’re all in this together” was the advertising slogan and battle cry of the Government’s COVID-19 response, but was that really the case?

A group of researchers, which included College Fellows Dr Katherine H. Hall (pictured left) and Dr Ben Gray, found through studying articles, web-feeds and blog items that ‘togetherness’ didn’t really work out for many Māori, Pasifika, migrant and refugee people and families. 

They found that during lockdown, inequities were not only revealed within New Zealand society but amplified, ‘resulting in people already at risk of poor health outcomes carrying greater burdens during this time.’ While some aspects of the pandemic are unique to our time many are not. The use of contact tracing, self-isolation, and physical distancing to prevent infectious diseases were well described by English physician John Hargarth in the 1790s (in relation to smallpox).

The researchers paper, written in collaboration with seven colleagues, and titled Ethics and equity in the time of Coronavirus was a guest editorial for the most recent issue of the Journal of Primary Health Care. The research group came together over lockdown via Zoom to discuss shared research interests and how they could capture the rapidly evolving nature of the challenges that COVID-19 was creating.

Their research showed that ‘ethnicity is a risk factor for both contracting the disease and dying from it and that crisis planning rarely takes underlying inequities sufficiently into account.’ Asked if there was anything GPs could especially consider for vulnerable patients if there are future lockdowns, Katherine said, “Be mindful that if patients were in vulnerable groups beforehand e.g. Māori, Pasifika, homeless, rural, impoverished, that COVID-19 makes their vulnerability much, much worse.”

“The more that GPs can understand the political and social determinants of vulnerability and health care need, the better they can imaginatively find solutions to these issues for their individual patients.” 

At the most basic level that might include making sure important information is available in a patient’s first language, or people knowing how to contact their GP during all levels of a lockdown, so they don’t become confused by media messages. The group’s research found that, ‘Government responses and lockdowns, even done well, caused increased morbidity and mortality by a reduction in patients seeking treatment for non-COVID-19 conditions.’ This was mirrored by the College’s media enquiries during lockdown, where journalists regularly asked about a drop in patient numbers despite the promotion of clear, consistent messaging that ‘GPs are open for business’ you just need to call first.

“The more that GPs can understand the political and social determinants of vulnerability and health care need, the better they can imaginatively find solutions to these issues for their individual patients.”

Katherine says that the study, “emphasised how healthcare and the determinants of health do not operate in a vacuum but are all interconnected to the wider community and to other dimensions, such as political influences. 

“This has always been the case, but the pandemic has made it much more obvious. 

“To regard health care as some sort of apolitical entity is falsely naïve and as a lecturer, I’m sure the work I’ve done during lockdown will flavour my undergraduate and postgraduate teaching more.”

Katherine says that a willingness and ability to engage with bigger issues like equity and ethics is essential. However, “that’s very hard for individual GPs who are already highly pressured and stressed. Organisations like the College have a duty of care to take up these issues. 

“The ‘take-home’ message here is that in a pandemic those who have less will lose more (and lose out more) than those better off, generally speaking, so directing more resources to those who have the least makes both economic and ethical sense,” she says.

About Dr Katherine Hall

Dr Katherine Hall is Associate Dean for Medical Admissions and a senior lecturer at The University of Otago’s Department of General Practice and Rural Health (Dunedin) and a Fellow of the College. She’s known for her ever-changing bright hair colour and has a love of classics and archaeology, having recently completed a BA majoring in Classics. 

Her dream was to be an archaeologist, but her mother impressed upon her to choose medicine because it had better employment options.