Publications des membres du Ceped

2023



  • Gagnon-Dufresne Marie-Catherine, Gautier Lara, Beaujoin Camille, Boivin Pauline, Coulibaly Abdourahmane, Richard Zoé, Gomes DE Medeiros Stéphanie, Dutra Da Nóbrega Raylson Emanuel, DE Araujo Oliveira Sydia Rosana, Cloos Patrick, Chabrol Fanny, Ridde Valéry et Zinszer Kate (2023) « Did the design and planning of testing and contact tracing interventions for COVID-19 consider social inequalities in health? A multiple case study from Brazil, Canada, France & Mali », Social Science & Medicine (septembre 9), p. 116230. DOI : 10.1016/j.socscimed.2023.116230. https://www.sciencedirect.com/science/article/pii/S0277953623005877.
    Résumé : The COVID-19 pandemic has led to an unprecedented global crisis. It has exposed and exacerbated weaknesses in public health systems worldwide, particularly with regards to reaching the most vulnerable populations, disproportionately impacted by the pandemic. The objective of our study was to examine whether and how social inequalities in health (SIH) were considered in the design and planning of public health responses to COVID-19 in jurisdictions of Brazil, Canada, France, and Mali. This article reports on a qualitative multiple case study of testing and contact tracing interventions in regions with high COVID-19 incidence in each country, namely: Manaus (Brazil), Montréal (Canada), Île-de-France (France), and Bamako (Mali). We conducted interviews with 108 key informants involved in these interventions in the four jurisdictions, focusing on the first and second waves of the pandemic. We analyzed our data thematically using a theoretical bricolage framework. Our analysis suggests that the lack of a common understanding of SIH among all actors involved and the sense of urgency brought by the pandemic eclipsed the prioritization of SIH in the initial responses. The pandemic increased intersectoral collaboration, but decision-making power was often unequal between Ministries of Health and other actors in each jurisdiction. Various adaptations to COVID-19 interventions were implemented to reach certain population groups, therefore improving the accessibility, availability, and acceptability of testing and contact tracing. Our study contributes to identifying lessons learned from the current pandemic, namely that the ways in which SIH are understood shape how interventions are planned; that having clear guidelines on how to integrate SIH into public health interventions could lead to more inclusive pandemic responses; that for intersectoral collaboration to be fruitful, there needs to be sufficient resources and equitable decision-making power between partners; and that interventions must be flexible to respond to emerging needs while considering long-standing structural inequalities.


  • Richard Zoé, Chabrol Fanny, Gautier Lara, Zinszer Kate et Ridde Valéry (2023) « Considering social inequalities in health in COVID-19 response: insights from a French case study », Health Promotion International, 38 (1) (février 1), p. daac173. DOI : 10.1093/heapro/daac173. https://doi.org/10.1093/heapro/daac173.
    Résumé : The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.The COVID-19 pandemic has highlighted the importance of social inequalities in health (SIH) and the disproportionate burden of the pandemic and its consequences related to socioeconomic status, ethnicity and race, among other determinants of health. Public health interventions are likely to increase SIH when they are not considered in the design phase. Through a qualitative case study, we analyzed the design of one of the first local initiative providing testing and contact tracing offer to the general population in the Île-de-France region (Paris region, France) in response to the COVID-19 pandemic. This article discusses the uncertainty and challenges associated with consideration for SIH in the intervention design. It explores the diverse understandings of SIH among the actors and the complexities of cross-sectoral partnerships addressing SIH in times of health crisis. Despite a consensual concern for this issue among the respondents, an epidemiological frame of reference dominated the intervention design. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission.

2022



  • Lamothe Ashley Savard, Gabet Morgane, Richard Zoé, Oliveira Sydia Rosana de Araujo, Coulibaly Abdouramane, Cazarin Gisèle, Zacarias Amanda, Gautier Lara, Ridde Valéry et Zinszer Kate (2022) « A Descriptive Comparison of Mass Testing During the COVID-19 Pandemic in Montreal, Paris, Bamako, and Recife », International Journal of Public Health, 67 (septembre 23). DOI : 10.3389/ijph.2022.1604992. https://hal.science/hal-04149605.
    Résumé : Objective: The aim of this descriptive article was to compare mass testing for SARS-CoV-2 during the first wave of the COVID-19 pandemic in Montreal, Canada; Bamako, Mali; Paris, France; and Recife, Brazil. Methods: Data was collected through interviews with key informants involved in the testing response and a review of the grey literature. The TIDieR-PHP checklist was then used to provide the basis of the intervention descriptions and to compare the data between cities. Results: Descriptive comparisons revealed that the type of test, the testing process, and materials used were similar between the cities during the first wave of the pandemic. In addition, all cities experienced similar material and personnel resource shortages, directly affecting testing accessibility and capacity. The main differences were related to testing capacity and implementation timelines, which were dependent on the state of the health care systems, governance, and access to resources. Conclusion: Results of this study highlight the similarities and differences in testing between the cities and demonstrate the importance of comprehensive intervention descriptions to highlight lessons learned, increase knowledge sharing, and inform policy decisions.
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