The Surgical EQUITY initiative: Establishing equitable access to surgery following the pandemic

COVID-19 has disproportionately impacted marginalized populations. Not only were these patients at higher risk of becoming infected, but hospitals that cared for these patients prior to the pandemic were also disproportionately affected. Existing gradients in access to care were likely worsened. The dearth of research examining inequities in access to surgical care in Canada may stem from a belief that our universal healthcare system generally succeeds at its mission of ensuring all services are triaged according to need rather than socioeconomic status. Yet, there exists Canadian data that suggest the existence of gradients in access to other areas of care across many measures of marginalization. At the patient level, we will measure gradients in access to surgery across measures of marginalization prior to and during the pandemic. At the hospital level, we will examine whether hospitals with more COVID-19 admissions had larger surgical backlogs and how this impacted marginalized groups. At a system level, we will use mathematical modeling to examine provincial funding strategies proposed to clear the surgical backlog and assess how different strategies affect access and equity for the most marginalized populations. This will be the largest study to date to evaluate whether COVID-19 worsened access to surgical conditions across gradients of marginalization in Canada. This work will set the stage for further research directed at elucidating the consequences of socioeconomic position on patient-centered surgical outcomes, as well as specific mechanisms by which marginalization impacts surgical care. Moreover, this research is expected to have an impact beyond clinical care and research by contributing to ongoing, high-profile policy debates about the causes, consequences, and solutions to socioeconomic inequality in Canada. By framing inequality as a health issue, the proposed study has the potential to motivate public engagement on the issue.