Chapter 9 272 Once infected, individuals with a non-Western/European migration background may also be at higher risk of COVID-19 hospitalisation due to a higher prevalence of noncommunicable diseases such as diabetes[15] and cardiovascular disease[16, 17], factors which increase the risk for development of severe disease. In addition, an extensive body of evidence outlines the association between lower socio-economic status and various adverse health outcomes in both the Netherlands[18, 19] and elsewhere [20, 21]. This highlights that pre-pandemic health inequalities have laid the foundation for a disproportionate susceptibility to severe COVID-19 among communities with lower incomes and with a migration background. It is therefore clear why the COVID-19 pandemic has been described as a ‘syndemic’[22, 23]: a term which describes the interaction between disease and established social, environmental and economic characteristics that worsen disease outcomes. Going forward, it is crucial that tackling the determinants of (inter-)national, regional, and local health inequalities features prominently on the pandemic preparedness agenda. Intriguingly, several studies in Amsterdam suggest that, when restricting comparisons to hospitalised individuals only, no differences in ICU admission or mortality rate remain between ethnic groups[24, 25]. A similar observation was made in a recent global metaanalysis which found that although South Asian, East Asian, Black, and Mixed individuals were more likely to be admitted to ICU compared to individuals with White ethnicity, these differences were smaller than the relative risks of SARS-CoV-2 infection[26]. Worryingly, however, the authors also observed that differences in prognosis following hospitalisation between majority and minority ethnic groups were greater in LMICs compared to HICs. These observations emphasize two crucial points. First, that tackling differences in COVID-19 burden can be largely achieved outside of the hospital setting through combatting the socio-economic factors that result in increased risk of both SARSCoV-2 infection and severe disease. This includes lifting communities out of poverty as a central component to any pandemic preparedness plan. Second, that accessing highquality healthcare services can act as an equaliser. Therefore, eradicating structural barriers to accessing health services and resources among migrant communities and those of lower socio-economic status is paramount. 9.1.2 The importance of effective, equitable and inclusive public health interventions Numerous efforts in the Netherlands and globally have been made to decrease exposure to infection and reduce the risk of severe disease among susceptible populations
RkJQdWJsaXNoZXIy MTk4NDMw