Differential impacts of health systems and sociocultural environment on vulnerable populations during the COVID-19 pandemic: lessons from four Asia-Pacific countries

• Published in: BMC public health Vol. 24; no. 1; pp. 1501 - 13
• Main Authors: Lee, Jakyung, Park, Susan, Jang, Soong-Nang, Reyes, Katherine Ann, Garcia, Jr, Fernando, Canila, Carmelita, Oraño, Joseph, Ballesteros, Alfredo Jose, Muhartini, Tri, Frans, Sandra, Marthias, Tiara, Putri, Likke Prawidya, Mahendradhata, Yodi, De Foo, Chuan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05-06-2024; BioMed Central; BMC
• Subjects: Adult; Aged; Asia; Consortia; Control; COVID-19; COVID-19 - epidemiology; Delivery of Health Care - organization & administration; Demographic aspects; Discrimination in medical care; Disease control; Economic aspects; Epidemics; Female; Health care; Health care disparities; Health care industry; Health equity; Health policy; Health promotion; Health services; Health Services Accessibility; Health Status Disparities; Healthcare Disparities; Humans; Indonesia; Indonesia - epidemiology; Infectious diseases; International policy; Job stress; Male; Medical personnel; Medical policy; Middle Aged; Migrant labor; Migrant workers; National health insurance; Occupational exposure; Older people; Pandemics; Philippines; Philippines - epidemiology; Population density; Prevention; Public health; Republic of Korea - epidemiology; Sanitation; Singapore; Singapore - epidemiology; Slums; Social aspects; Social Environment; Socioeconomic factors; South Korea; Vulnerable population; Vulnerable Populations; Womens health; Working conditions; World health; Young Adult; Singapore; Philippines; Republic of Korea; Indonesia; South Korea; Asia; Asia-Pacific region; COVID-19; Health equity; Health policy; Vulnerable population
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-024-18949-1

This study aims to evaluate healthcare systems and pandemic responses in relation to marginalized and vulnerable groups, identify populations requiring urgent care, and assess the differential impacts on their health during the pandemic.
Data were collected by the Asia-Pacific Observatory on Health Systems and Policies (APO)-National University of Singapore and APO-International Health Policy Program consortium members: Korea, Indonesia, Philippines, and Singapore. Data were collected through a combination of semi-structured interviews, policy document reviews, and analysis of secondary data.
Our findings reveal that the pandemic exacerbated existing health disparities, particularly affecting older adults, women, and children. Additionally, the study identified LGBTI individuals, healthcare workers, slum dwellers, and migrant workers as groups that faced particularly severe challenges during the pandemic. LGBTI individuals encountered heightened discrimination and limited access to health services tailored to their needs. Healthcare workers suffered from immense stress and risk due to prolonged exposure to the virus and critical working conditions. Slum dwellers struggled with healthcare access and social distancing due to high population density and inadequate sanitation. Migrant workers were particularly hard hit by high risks of virus transmission and stringent, often discriminatory, isolation measures that compounded their vulnerability. The study highlights the variation in the extent and nature of vulnerabilities, which were influenced by each country's specific social environment and healthcare infrastructure. It was observed that public health interventions often lacked the specificity required to effectively address the needs of all vulnerable groups, suggesting a gap in policy and implementation.
The study underscores that vulnerabilities vary greatly depending on the social environment and context of each country, affecting the degree and types of vulnerable groups. It is critical that measures to ensure universal health coverage and equal accessibility to healthcare are specifically designed to address the needs of the most vulnerable. Despite commonalities among groups across different societies, these interventions must be adapted to reflect the unique characteristics of each group within their specific social contexts to effectively mitigate the impact of health disparities.