Covid-19 policies and inequities in adult wellbeing: Building back fairer from the pandemic in Switzerland

The Covid-19 pandemic has revealed the stark interconnections between social and economic inequality, health equity and population health. The pandemic has also made it obvious that despite their effectiveness in reducing transmission, Covid-19 measures have broader societal impacts on multiple dimensions of wellbeing including income, social participation, and mental health. Some studies have shown that the health and socioeconomic impacts of the pandemic are unequally distributed across income, education, ethnicity, and gender, and studies suggest complex impacts on income inequality. However, there is limited understanding of the causal mechanisms by which specific Covid-19 legal and policy instruments increase social vulnerability, reinforce pre-existing inequalities, and generate new forms of inequities in wellbeing. In addition, few studies have explored the effectiveness of government relief programmes to address these impacts in Switzerland.This project aims to address this gap by examining the equity impact of policies adopted in response to the Covid-19 pandemic and exploring the complex trade-off between public health policies, social policy responses and inequities in wellbeing. Our goals are to understand the causal impact of Covid-19 policies and government relief programmes on indicators of wellbeing, identify inequities in these impacts across socioeconomic groups, and carry out in-depth research with policymakers, health care professionals and vulnerable populations to understand these impacts and their integration in practice. To achieve this goal, we propose an interdisciplinary research programme involving law, economics, socio-anthropology, social policy, epidemiology, and social medicine. The project proposes to integrate quantitative and qualitative approaches across three levels: the legal and policy framework, professionals and institutions, and the general adult population. The project aims to provide policy-relevant evidence and tools to help decision makers account for the potential equity impacts of policies in response to major epidemics and societal shocks. The combination of disciplines and methodological approaches will offer a unique lens to understand the complexity of mechanisms by which Covid-19 policies influence inequities in wellbeing. The specific objectives of the project are:•To adopt an equity lens to analyse key laws in response to the Covid-19 pandemic at the national, cantonal, and international level;•To assess the causal impact of Covid-19 policies and government relief programmes on inequities in wellbeing and underlying causal mechanisms using quasi-experimental methods, by linking data on policies and laws at the national, cantonal and international level to longitudinal data of working-age and older adults;•To understand how Covid-19 policies influenced the wellbeing of highly vulnerable populations through in-depth qualitative interviews with health professionals and vulnerable individuals attending social and health services in the Canton of Vaud;•To examine societal preferences on the trade-off between competing objectives associated with the Covid-19 pandemic (e.g., reduction of transmission vs. overall wellbeing goals of the welfare state);•To understand how vulnerability was detected and managed in practice and ultimately propose concrete actions to improve future pandemic response.The project is structured around four interdependent, interdisciplinary work packages (WPs). In the first two WPs, we will use legal analysis (WP1) and quasi-experimental methods (WP2) to analyse the impact of health and social policy responses to the Covid-19 pandemic with an equity lens. This is complemented by a socio-anthropological study on the impact of measures in specific populations (WP3), and a qualitative examination of the trade-offs and triage logics underlying the detection and management of vulnerabilities among healthcare professionals, policy makers, and the general population (WP4). These activities will inform the development of an equity framework and toolbox for policy assessment and design, in close collaboration with our policy and implementation partners.The project is designed to contribute to the following programme objectives: 1) explicitly consider and transparently report the complex consequences of policies; 2) contribute to the better proactive management of future pandemics; 3) understand to what extent individual and societal wellbeing is affected by a pandemic and identify the best solutions to preserve them.