COVID-19: from hospitals to courts

Anesthetist-intensivists who treat patients with coronavirus disease 19 (COVID-19) are exposed to significant biological and psychosocial risks. Our study investigated the occupational and health conditions of anesthesiologists in a COVID-19 hub hospital in Latium, Italy. Ninety out of a total of 155 eligible workers (59%; male 48%) participated in the cross-sectional survey. Occupational stress was assessed with the Effort Reward Imbalance (ERI) questionnaire, organizational justice with the Colquitt Scale, insomnia with the Sleep Condition Indicator (SCI), and mental health with the Goldberg Anxiety and Depression Scale (GADS). A considerable percentage of workers (71.1%) reported high work-related stress, with an imbalance between high effort and low rewards. The level of perceived organizational justice was modest. Physical activity and meditation—the behaviors most commonly adopted to increase resilience—decreased. Workers also reported insomnia (36.7%), anxiety (27.8%), and depression (51.1%). The effort made for work was significantly correlated with the presence of depressive symptoms (r = 0.396). Anesthetists need to be in good health in order to ensure optimal care for COVID-19 patients. Their state of health can be improved by providing an increase in individual resources with interventions for better work organization.

Background. Although there is a large literature examining the relationship between a wide range of political economy exposures and health outcomes, the extent to which the different aspects of political economy influence health, and through which mechanisms and in what contexts, is only partially understood. The areas in which there are few high-quality studies are also unclear. Objectives. To systematically review the literature describing the impact of political economy on population health. Search Methods. We undertook a systematic review of reviews, searching MEDLINE, Embase, International Bibliography of the Social Sciences, ProQuest Public Health, Sociological Abstracts, Applied Social Sciences Index and Abstracts, EconLit, SocINDEX, Web of Science, and the gray literature via Google Scholar. Selection Criteria. We included studies that were a review of the literature. Relevant exposures were differences or changes in policy, law, or rules; economic conditions; institutions or social structures; or politics, power, or conflict. Relevant outcomes were any overall measure of population health such as self-assessed health, mortality, life expectancy, survival, morbidity, well-being, illness, ill health, and life span. Two authors independently reviewed all citations for relevance. Data Collection and Analysis. We undertook critical appraisal of all included reviews by using modified Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria and then synthesized narratively giving greater weight to the higher-quality reviews. Main Results. From 4912 citations, we included 58 reviews. Both the quality of the reviews and the underlying studies within the reviews were variable. Social democratic welfare states, higher public spending, fair trade policies, extensions to compulsory education provision, microfinance initiatives in low-income countries, health and safety policy, improved access to health care, and high-quality affordable housing have positive impacts on population health. Neoliberal restructuring seems to be associated with increased health inequalities and higher income inequality with lower self-rated health and higher mortality. Authors’ Conclusions. Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health, and there is a need for higher-quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts. Public Health Implications. Policymakers should be aware that social democratic welfare state types, countries that spend more on public services, and countries with lower income inequalities have better self-rated health and lower mortality. Research funders and researchers should be aware that there remain substantial gaps in the available evidence base. One such area concerns the interrelationship between governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes and forms of discrimination that have a differential impact across social groups. This includes the influence of patterns of ownership (of land and capital) and tax policies. For some areas, there are many lower-quality reviews, which leave uncertainties in the relationship between political economy and population health, and a high-quality review is needed. There are also areas in which the available reviews have identified primary research gaps such as the impact of changes to housing policy, availability, and tenure.

Widespread reports of disproportionate impact of the COVID-19 pandemic among already vulnerable communities worldwide, from New York City to New Orleans and Chicago, to the shocking pictures of bodies lying in the streets in Ecuador, represent a prelude of the impact in low-income and middle-income countries, home to more than 80% of the world's population. Disadvantaged people are at higher risk of infection and death from COVID-19, and they have less access to care due to systems that treat health as a commodity and not a human right. Furthermore, most health-care systems are not prepared to handle a pandemic of this magnitude. Overwhelmed European and US systems are ominous reminders of the challenges faced in poor countries. Despite widespread acts of solidarity, we are witnessing unconscionable stockpiling by wealthy countries and attempts by many to extract profits from the crisis. Hoarding and speculation should be condemned in the strongest terms and measures taken globally to ensure equitable access for countries with fewer resources. On April 21, 2020, we submitted an open letter to the UN calling for ethical global leadership to mitigate the unfair additional health and socioeconomic burden of this pandemic on disadvantaged populations. We proposed to create a multisector Global Health Equity Task Force, housed within WHO, charged with taking necessary steps for a comprehensive, equity-focused response. This Task Force would develop strategies for fair allocation of resources; including legislation to trigger coordinated production of and access to quality generic diagnostics, medicines, vaccines, supplies, and equipment, abolishing any pandemic-related patents. It would also support the development of enhanced recommendations on preparedness and response for our most vulnerable populations, and tailored, secure de-confinement strategies. Additionally, it would promote steps to strengthen universal health-care systems globally and to address the economic disparities that have led to this appalling inequity. The open letter to the UN has been cosigned by more than 120 diverse entities, representing more than 5 million public health practitioners, scientists, academics, health-care professionals, and advocates, including the World Federation of Public Health Associations, Latin American Alliance for Global Health, InterAcademy Partnership, World Federation of Critical Care Nurses, and American Academy of Pediatrics. The letter has also been endorsed by former heads of state and ministers, as well as an array of advocates for the right to health from more than 50 countries and a wide spectrum of cultures, contexts, and ideologies, echoing the plea for an equitable response to the pandemic.