Beyond the devastating direct impacts of the covid-19 pandemic, there is an additional threat to the health of minority and Indigenous peoples. The covid-19 pandemic is stretching health and social systems worldwide, leading to reduced access to care and support for non-covid-19 health concerns. These significant health gaps will increase morbidity and mortality unrelated to covid-19 infections. Covid-19 health gaps will have a greater impact on Indigenous and minority peoples in high-income countries because they already experience reduced access to healthcare and poorer health outcomes because of systemic racism. The pandemic has added the cumulative burdens of unemployment, reduced connectivity and housing, and food insecurity.
Potential covid-19 health gaps include, but are not limited to:
- cancer screening and treatment
- maternity care
- chronic disease management
- childhood vaccination.
Urgent planning, action, and investment could lessen the negative impact of these health gaps and avert substantial personal and public health costs. Just as there are “shovel-ready” projects identified by governments around the world for investment to stimulate economies in response to the pandemic, we should be identifying and using innovative “ready-to-go” pathways and equitable approaches to reduce avoidable harm and death.
Key to this is the health system working in partnership with Indigenous and minority communities to achieve common goals. The partnership must define the health pathway,
The health care pathway could be as simple as introducing HPV self-testing to prevent cervical cancer. This safe, effective test has high acceptability for Indigenous and minority women, is contactless, and will enable screening to catch up and increase coverage.
We have used this proactive framework to address covid-19 maternity care gaps for Māori, the Indigenous peoples of Aotearoa/ New Zealand. As a result of the stay-at home edicts, pregnant women are not connecting to essential maternity care.
Time-sensitive maternity care in the first trimester of a pregnancy is essential to avoid later morbidity and mortality for women and babies. When we went into countrywide lockdown, we immediately formed a community / tribal and clinician partnership to improve access to time-sensitive care for pregnant Māori women (hapū māmā) and their families. This collaboration produced the first trimester maternity care toolkit – Hapū Māmā Connecting (HMC) – which is endorsed by the Royal New Zealand College of General Practitioners.
The toolkit can be used by GPs, nurses, and midwives to triage care and further assessment over the phone, guiding time-sensitive, evidence-based care. As a single-page form covering clinical care and wraparound support prompts, such as housing and food security, the tool can “sort” pregnancies and families that need timely intervention, provide treatment support, and connect women to their next stage in the maternity pathway. For example, if a woman has previous pre-eclampsia the toolkit prompts the health worker to ensure she receives aspirin and calcium at the critical point in her pregnancy and then referred to a specialist service.
An integral part of the HMC approach is increasing community awareness. In this example, we deliver messages about timely care to Māori women who might be pregnant through tribal networks and organisations, Māori health providers and tribal partners who are active members of the research team. Māori social media ambassadors are sharing messages to increase the spread of information and encourage women to access time-sensitive care.
In this model general practice is central, representing a trusted carer with expertise paired with local tribal or minority peoples’ networks and messages, to enhance access to under-served families.
Also key to policy changes to improving equity is the voice of Indigenous peoples. Some of the nation’s leading Māori medical and health experts including Primary Care Specialists, Public Health experts, Public Health Physicians, Māori Nurses and iwi leaders came together to form Te Rōpū Whakakaupapa Urutā (Māori Pandemic committee) to inform, address and innovate for Māori as we face these unique times.
As well as the devastating direct impact of the covid-19 virus, the potential health gaps associated with reduced access to care and support threaten already underserved communities. Health systems and providers need to take this as an opportunity to do things differently to improve outcomes—to be innovative—and to share what is working. There are no excuses for waiting until after the pandemic to count the costs of covid-19 health gaps for Indigenous and minority peoples.
Bev Lawton (ONZM), from the Māori (Indigenous peoples of New Zealand) tribal group Te-Aitanga-a-Hauiti, is the founder/director of Te Tātai Hauora o Hine (the Centre for Women’s Health Research) at Victoria University of Wellington, New Zealand. The mission of the centre is to eliminate avoidable harm with a focus on Indigenous health and wellbeing.
Contributing authors include Hapū Māmā Connecting Rōpū, an expert advisory group of Iwi (tribal) Elders and leaders, clinicians, and researchers, including Bev Lawton (Chair), Francesca Storey, Dr Liza Edmonds, Matthew Bennett, Charles Lambert, Professor Stacie Geller, Dr John McMenamin, Professor Peter Stone, Anna Adcock, Potace Bennett, Dr E Jane MacDonald, Wendy Dallas-Katoa, Jordy Hermens & Tarra McNally.
Competing interests: None declared.