Local Public Health Unit Priorities, Actions, and Barriers in Addressing Inequities During the COVID-19 Pandemic in Ontario, Canada

CONTEXT: The COVID-19 pandemic required a major response from local public health to reduce infections and manage inequities in COVID-19 outcomes. It is important to consider lessons learned from the COVID-19 pandemic response across local public health in order to prepare for future public health emergencies. OBJECTIVE: This study examined how local public health units (PHUs) in Ontario, Canada, addressed inequities in COVID-19 outcomes in their pandemic response. DESIGN: We contacted all 34 Ontario PHUs to participate in a survey on priorities, actions, and barriers to address health inequities in their COVID-19 response and conducted inductive content analysis on responses to identify themes. SETTING: Ontario, Canada. PARTICIPANTS: A total of 25 out of 34 local Ontario PHUs completed the survey. MAIN OUTCOME MEASURE: Public health unit-reported priorities and actions in addressing health inequities in their COVID-19 response. RESULTS: PHUs reported varied priorities in addressing health inequities. PHUs played a key role in coordinating an equity-focused response, including data analysis and reporting, engaging with community groups, and making cross-sector connections. However, important barriers remained, including a lack of community trust, frequent changes in guidance, lack of access to data on the social determinants of health, and a shortage of staffing and resources. CONCLUSION: Findings suggest ways to prioritize health equity in a public health emergency, including through properly resourcing PHUs, early planning and trust building, and improved equity-based data collection.