Introduction

The COVID-19 pandemic, which has caused the death of over 6.9 million people and led to more than 700 million infections globally as of December 2023, has introduced unprecedented challenges in health equity across the world. Since its onset nearly five years ago, efforts to promote health equity—and specifically in research—have been significantly undermined by global health governance (GHG) and national public health policies that have amplified already existing social disparities.

Global Health Governance

Global health governance refers to the arrangements necessary to achieve globally agreed health goals such as equity, access to medicines, and social justice. During the pandemic, these policies resulted in multifaceted disruptions across economic, social, educational, health, and environmental systems. Citizens in every nation were impacted by lockdown measures, business closures, and movement restrictions, leading to severe mental health ramifications.

Disproportionate Impact on Vulnerable Groups

Distinct groups, particularly those already facing vulnerabilities—such as frontline workers, the elderly, women, children, Black, Indigenous and People of Color (BIPOC), individuals with disabilities, and migrants—have been disproportionately affected. Many governance decisions overlooked the complex nature of these vulnerabilities, a failure that raises critical questions about health equity norms worldwide.

Shift in Research Focus

The pandemic has not only exacerbated existing disparities but also altered health research agendas, increasingly focusing resources and attention on COVID-19-related studies. This phenomenon, termed "covidization" by Canadian researcher Madhukar Pai, has seen a surge of funding directed primarily towards COVID-19, overshadowing other critical research areas. The Canadian Institutes of Health Research (CIHR) shifted its priorities, reallocating substantial funding—approximately $79 million (CAD)—to 140 COVID-19 research projects, resulting in a reorientation of health research focus.

Research Objectives and Methodology

This qualitative study aimed to understand how the GHG structure impacts population health research priorities in Canada, especially regarding the objectives that focus on health equity. By employing Intersectionality-Based Policy Analysis (IBPA) alongside Multiple Streams frameworks, we gained insights into how different social identities affect health outcomes, particularly amidst the pandemic.

Key Findings

Over the duration of our research, which involved in-depth interviews with scholars and experts in global public health, we uncovered several critical themes. First, the GHG architecture during COVID-19 has proven to be complicated and fraught with equity failures, leading researchers to shift their attention away from longstanding health issues such as maternal health and inequalities in healthcare access.

Interconnected Drivers of Equity

Second, funding, equity, and accountability emerged as interconnected drivers vital for advancing equitable population health research in Canada. Respondents reported that the emphasis on funding for COVID-19 research often came at the expense of other critical non-communicable disease research efforts. Most importantly, equity was echoed as an ethical imperative demanding solidarity across both local and global spectrums.

Opportunities Amid Challenges

Interestingly, amid these challenges, the COVID-19 crisis presented unique opportunities to reshape public health discourse. The elevated demand for evidence-based information highlighted the critical role that rigorous research plays in navigating health crises, thus expanding the perceived value of public health research.

Concerns for the Future

However, as restrictions eased, the immediate focus began shifting back toward "business as usual." Many respondents expressed concern that the urgency to address equity and health disparities may dissipate, leading to a retraction of equity-focused research initiatives.

Positive Outcomes from the Crisis

As we explored the varying repercussions of the pandemic, both negative and unforeseen positives emerged. While the pandemic intensified vulnerabilities and challenges for marginalized groups, it also rekindled recognition of the importance of population health and public health research, promoting collaboration among sectors previously kept apart.

Recommendations for Systematic Change

Lessons learned from this crisis compel us to reevaluate our approach moving forward, emphasizing the need for systematic changes in health governance. Recommendations include enhancing funding mechanisms that prioritize equity, fostering collaborations among diverse stakeholders, and embedding equity within the principles governing health research.

Conclusion

This exploration reveals an urgent call to action: as Canada's GHG navigates the fallout of the pandemic, it must center equity in its research priorities and governance frameworks to build a healthier and more equitable society for all. The lessons learned from COVID-19 are invaluable reminders of the systemic nature of health inequities; thus, real change requires not just acknowledgement but also concrete action to ensure that no one is left behind in the face of future health crises.