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@techreport{Winskill:2020:10.25561/78965,
author = {Winskill, P and Whittaker, C and Walker, P and Watson, O and Laydon, D and Imai, N and Cuomo-Dannenburg, G and Ainslie, K and Baguelin, M and Bhatt, S and Boonyasiri, A and Cattarino, L and Ciavarella, C and Cooper, L and Coupland, H and Cucunuba, Perez Z and van, Elsland S and Fitzjohn, R and Flaxman, S and Gaythorpe, K and Green, W and Hallett, T and Hamlet, A and Hinsley, W and Knock, E and Lees, J and Mellan, T and Mishra, S and Nedjati, Gilani G and Nouvellet, P and Okell, L and Parag, K and Thompson, H and Unwin, H and Wang, Y and Whittles, L and Xi, X and Ferguson, N and Donnelly, C and Ghani, A},
doi = {10.25561/78965},
title = {Report 22: Equity in response to the COVID-19 pandemic: an assessment of the direct and indirect impacts on disadvantaged and vulnerable populations in low- and lower middle-income countries},
url = {http://dx.doi.org/10.25561/78965},
year = {2020}
}

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TY  - RPRT
AB  - The impact of the COVID-19 pandemic in low-income settings is likely to be more severe due to limited healthcare capacity. Within these settings, however, there exists unfair or avoidable differences in health among different groups in society – health inequities – that mean that some groups are particularly at risk from the negative direct and indirect consequences of COVID-19. The structural determinants of these are often reflected in differences by income strata, with the poorest populations having limited access to preventative measures such as handwashing. Their more fragile income status will also mean that they are likely to be employed in occupations that are not amenable to social-distancing measures, thereby further reducing their ability to protect themselves from infection. Furthermore, these populations may also lack access to timely healthcare on becoming ill. We explore these relationships by using large-scale household surveys to quantify the differences in handwashing access, occupation and hospital access with respect to wealth status in low-income settings. We use a COVID-19 transmission model to demonstrate the impact of these differences. Our results demonstrate clear trends that the probability of death from COVID-19 increases with increasing poverty. On average, we estimate a 32.0% (2.5th-97.5th centile 8.0%-72.5%) increase in the probability of death in the poorest quintile compared to the wealthiest quintile from these three factors alone. We further explore how risk mediators and the indirect impacts of COVID-19 may also hit these same disadvantaged and vulnerable the hardest. We find that larger, inter-generational households that may hamper efforts to protect the elderly if social distancing are associated with lower-income countries and, within LMICs, lower wealth status. Poorer populations are also more susceptible to food security issues - with these populations having the highest levels under-nourishment whilst also being
AU  - Winskill,P
AU  - Whittaker,C
AU  - Walker,P
AU  - Watson,O
AU  - Laydon,D
AU  - Imai,N
AU  - Cuomo-Dannenburg,G
AU  - Ainslie,K
AU  - Baguelin,M
AU  - Bhatt,S
AU  - Boonyasiri,A
AU  - Cattarino,L
AU  - Ciavarella,C
AU  - Cooper,L
AU  - Coupland,H
AU  - Cucunuba,Perez Z
AU  - van,Elsland S
AU  - Fitzjohn,R
AU  - Flaxman,S
AU  - Gaythorpe,K
AU  - Green,W
AU  - Hallett,T
AU  - Hamlet,A
AU  - Hinsley,W
AU  - Knock,E
AU  - Lees,J
AU  - Mellan,T
AU  - Mishra,S
AU  - Nedjati,Gilani G
AU  - Nouvellet,P
AU  - Okell,L
AU  - Parag,K
AU  - Thompson,H
AU  - Unwin,H
AU  - Wang,Y
AU  - Whittles,L
AU  - Xi,X
AU  - Ferguson,N
AU  - Donnelly,C
AU  - Ghani,A
DO  - 10.25561/78965
PY  - 2020///
TI  - Report 22: Equity in response to the COVID-19 pandemic: an assessment of the direct and indirect impacts on disadvantaged and vulnerable populations in low- and lower middle-income countries
UR  - http://dx.doi.org/10.25561/78965
UR  - https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-05-12-COVID19-Report-22.pdf
UR  - http://hdl.handle.net/10044/1/78965
ER  -

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