Placing health equity at the heart of the COVID-19 recovery: data analysis from the first Welsh Health Equity Status Report initiative

Abstract Background The Welsh Health Equity Status Report initiative (WHESRi) applies an innovative WHO framework to map the wider impacts of COVID-19 on health equity. The framework is a mechanism to promote policy action and commitment for health equity and identifies five essential conditions needed to live a healthy life; namely, health services, income security, living conditions, social and human capital, and working conditions. We used the framework to assess the immediate health equity impacts of COVID-19 in Wales. Methods Ten relevant variables from Public Health Wales' public engagement survey on health and wellbeing during COVID-19 (captured April 3–July 25, 2020) were mapped to each of the five essential conditions, as defined by the European Health Equity Status Report initiative. Variables were chosen based on alignment to the essential conditions, research objectives and data quality. Estimated marginal means were disaggregated by sociodemographic factors on a nationally representative study sample ranging from 862 to 4747 participants (dependent on duration for which question was asked). Ethical approval was not required as per guidance from the National Health Service Health Research Association ethics decision tool. Findings The WHESRi framework allowed the assessment and quantification of the immediate impacts of COVID-19 on the wider determinants of health through the lens of the five essential conditions. For example, in relation to income security, a significantly higher proportion (181 [50·6%] of 358; p Interpretation Application of the WHESRi framework allowed us to draw a holistic picture of health and its determinants at the population level. This application has highlighted quantifiable differences in impacts between population groups, and encouraged the dialogue around policy action. A priority moving forward is to apply the framework to vulnerable population groups and population health priorities to assess the health equity impacts according to factors such as rurality, disability, and ethnicity. Our findings resulting from the application of this WHO framework can be used to enable an equitable and sustainable recovery from the pandemic; they form part of a European initiative for health equity and provide learning to other countries from Wales' role as an innovation site. Funding None.