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Abstract Background Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada). Methods Part of the multicountry study HoSPiCOVID, this article reports on a qualitative case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo. Results Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population. Conclusions These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health.
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Flooding has only relatively recently been considered as an environmental justice issue. In this paper we focus on flooding as a distinct form of environmental risk and examine some of the key evidence and analysis that is needed to underpin an environmental justice framing of flood risk and flood impacts. We review and examine the UK situation and the body of existing research literature on flooding to fill out our understanding of the patterns of social inequality that exist in relation to both flood risk exposure and vulnerability to the diverse impacts of flooding. We then consider the various ways in which judgements might be made about the injustice or justice of these inequalities and the ways in which they are being sustained or responded to by current flood policy and practice. We conclude that there is both evidence of significant inequalities and grounds on which claims of injustice might be made, but that further work is needed to investigate each of these. The case for pursuing the framing of flooding as an environmental justice issue is also made.