Background:
A local health district in Sydney, Australia undertook a concurrent, equity-focused health impact assessment (EFHIA) of the potential health equity impacts resulting from COVID-19 and associated responses. The EFHIA took as its starting point, the time at which the first evidence emerged that the COVID-19 virus had reached Australia, and focused on the health and health equity impacts of the virus and of the government and health responses (in particular) over the following two years.

Methods:
Following standard HIA steps, the EFHIA focused on three areas: risks and consequences of COVID-19 infection, changes to health services and changes to work. Data collection involved: developing a community profile; using local date analysing how the risks and consequences of COVID-19 infection varied across population groups within the area; 18 semi-structured interviews; five focus groups with a mix of health professionals and service users; five literature reviews; six evidence briefs/checks; and a grey literature and policy review. We triangulated, synthesised and critically assessed the evidence to describe health equity impacts. Impacts were characterised according to direction of impact, likelihood, severity, level, and timeframes of impact. Findings were reviewed and validated by topic specialists, participants and steering group, as well as experts on HIA and health equity.

Results:
The EFHIA identified multiple health and health equity impacts arising from the pandemic and associated responses. This EFHIA report concludes with 22 equity-focussed recommendations directed at what worked well, what the health district needs to do more of and what to do differently to support health equity within the health district and more widely.

Conclusion:
This case study demonstrates how utilising a concurrent HIA approach using evidence and data as it emerged to predict future health equity consequences can inform response and planning processes.