This health crisis of unprecedented scale has not affected the population in France in the same way, depending on socioeconomic status, geographic origin, gender, or age group. The lessons learned from this period call for public health policies that are more protective and inclusive.

The Social Dimension of the Health Crisis: Inequalities Exacerbated by the COVID-19 Pandemic

Five years after the onset of the Covid-19 pandemic, the aim of this issue of La Santé en action is to shed light on the social dimension of the health crisis. Numerous scientific studies, discussed in several articles, demonstrate how the pandemic has exacerbated inequalities in living and working conditions across social groups, regions, between women and men, and across age groups, among others. For instance, the first wave in the spring of 2020 was deadlier for immigrants, even though their mortality rate is typically lower than that of the host country’s population. In socially disadvantaged and densely populated residential areas, the incidence of infection was higher, while testing rates were lower.

The children of “essential workers”—a term used to describe bakers, garbage collectors, delivery drivers, home care workers, food industry workers, etc.—who kept society functioning during lockdowns, suffered more from psychological distress than those of executives working from home. Lower-income households experienced more sleep disturbances and symptoms of anxiety or depression than affluent households. Women were at greater risk than men of contracting COVID-19, not so much because of their biological sex but because of the roles they play in the professional and domestic spheres.

Reaching Vulnerable Populations: The "Last Mile"

In the second part, the focus is on initiatives by on-the-ground actors aimed at integrating vulnerable people living in poverty or facing social exclusion into the strategy to combat the epidemic. The city of Grenoble has relied on resident participation through a “Covid Citizens’ Committee,” where concerns and needs were voiced—regarding food insecurity among certain families, the breakdown of social ties, vaccination, and more.

In Marseille, a team from the European Hospital, composed of nurses and health mediators, traveled through poor neighborhoods to conduct testing, identify close contacts, help those who tested positive adhere to isolation protocols, and administer vaccines. In Seine-Saint-Denis, the primary health insurance fund experimented with various outreach strategies to address the vaccination gap in the region: prevention counselors made phone calls to elderly insured individuals and/or recipients of the Solidarity Health Supplement, set up temporary clinics at the base of high-rise buildings in priority urban policy zones, and organized drive-through vaccination sites.

Not all of these “windows of opportunity” opened up by the crisis have closed. Today, in Marseille and Seine-Saint-Denis, we are building on these experiences in outreach and community engagement to advance preventive care, whether through screening for certain cancers or routine vaccinations. This lays the groundwork for new approaches to combating health inequalities. As a public health specialist puts it in these pages, these approaches would make it possible to “cover the last mile”—geographically, socially, and culturally (and even digitally, given unequal access to communication technologies)—to reach people who are disconnected from the healthcare and prevention systems.

Young People: A Vulnerable Group

Finally, the report examines the short- and medium-term effects of the pandemic on people’s health, both physical and mental. While lockdowns do not appear to have hindered children’s neurological development, studies show communication difficulties among infants born during the health crisis; and it is in low-income families, facing difficult daily lives, that maternal stress has weighed most heavily on parent-child interactions.

Undoubtedly, adolescents have paid a heavy price for the health crisis, which struck at a crucial stage of their lives, leaving them with impaired mental health today. An article discusses the testing of an online app designed to give young people the tools to identify signs of psychological distress or manage anxiety-inducing situations; this tool was co-developed with adolescents, parents, and teachers from France, Germany, Spain, and Romania.

The Covid period has also revealed the food insecurity faced by students, which impacts their mental health. Since then, projects have been tested on several campuses, such as at the University of Bordeaux: for low-income students, “food security” allows them to eat more healthily and reduce the mental burden associated with difficulties in obtaining food.

Meanwhile, concerns are emerging about a “public health debt,” which is said to affect those over 45 in particular; this is the result of underutilization of healthcare services while hospitals were overwhelmed by patients severely affected by SARS-CoV-2, and it is struggling to be resolved.