Health and Non-Health Benefits and Equity Impacts — Ogunbameru et al., BMC Public Health (2024)
Summary
A scoping review by Adeteju Ogunbameru and co-authors, published as an Open Access research article in BMC Public Health (2024) 24:2106, on health and non-health benefits and equity impacts of individual-level economic relief programs during epidemics and pandemics in high income settings. The abstract says the authors searched eight electronic databases from January 01, 2001, to April 3, 2023, and identified 27,263 de-duplicated records, of which 50 were eligible. It reports that the included studies were on COVID-19 and Influenza and that seven program types were identified, with cash transfer (n = 12) and vaccination or testing incentive (n = 9) most common. The abstract states that expanding paid sick leave programs had the highest number of studies reporting health-related outcomes.
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Ogunbameru et al. BMC Public Health (2024) 24:2106 BMC Public Health
https://doi.org/10.1186/s12889-024-19493-8
RESEARCH Open Access
Health and non‑health benefits and equity
impacts of individual‑level economic relief
programs during epidemics/pandemics in high
income settings: a scoping review
Adeteju Ogunbameru1,2*, Gebremedhin Beedemariam Gebretekle1,2, Adrianna Perryman2,3, Marian Hassan2,
Ashley Farrell4, Kuan Liu1,5, Sharmistha Mishra1,5,6,7,9 and Beate Sander1,2,8,9
Abstract
Background Economic relief programs are strategies designed to sustain societal welfare and population health dur-
ing a regional or global scale infectious disease outbreak. While economic relief programmes are considered essential
during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health
benefits and their impact on promoting equity.
Methods We conducted a scoping review, searching eight electronic databases from January 01, 2001, to April 3,
2023, using text words and subject headings for recent pathogens (coronavirus (COVID-19), Ebola, Influenza, Mid-
dle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), HIV, West Nile, and Zika), and eco-
nomic relief programs; but restricted eligibility to high-income countries and selected diseases due to volume. Title
and abstract screening were conducted by trained reviewers and Distiller AI software. Data were extracted in dupli-
cates by two trained reviewers using a pretested form, and key findings were charted using a narrative approach.
Results We identified 27,263 de-duplicated records, of which 50 were eligible. Included studies were on COVID-19
and Influenza, published between 2014 and 2023. Zero eligible studies were on MERS, SARS, Zika, Ebola, or West Nile
Virus. We identified seven program types of which cash transfer (n = 12) and vaccination or testing incentive (n = 9)
were most common. Individual-level economic relief programs were reported to have varying degrees of impact
on public health measures, and sometimes affected population health outcomes. Expanding paid sick leave pro-
grams had the highest number of studies reporting health-related outcomes and positively impacted public health
measures (isolation, vaccination uptake) and health outcomes (case counts and the utilization of healthcare services).
Equity impact was most often reported for cash transfer programs and incentive for vaccination programs. Positive
effects on general well-being and non-health outcomes included improved mental well-being and quality of life, food
security, financial resilience, and job security.
Conclusions Our findings suggest that individual-level economic relief programs can have significant impacts
on public health measures, population health outcomes and equity. As countries prepare for future pandemics,
*Correspondence:
Adeteju Ogunbameru
adeteju.ogunbameru@mail.utoronto.ca
Full list of author information is available at the end of the article
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Ogunbameru et al. BMC Public Health (2024) 24:2106 Page 2 of 22
our findings provide evidence to stakeholders to recognize health equity as a fundamental public health goal
when designing pandemic preparedness policies.
Keywords Pandemic preparedness, Epidemics, COVID-19, Infectious disease, Equity
Background effectiveness of public health measures, individual and
Infectious disease epidemics and pandemics can result population health, non-health outcomes, and health
in catastrophic economic collapse and disastrous human, equity during regional or global scale infectious disease
social, and health consequences [1]. Populations experi- outbreaks. Our review questions are:
encing social and economic marginalization have con-
sistently experienced the highest risk of infection, disease 1. What are the types of individual-level economic relief
severity and death [2–4]. Across high-income settings, programs implemented during an infectious disease
racially minoritized individuals experienced dispro- outbreak?
portionate burden of COVID-19, H1N1 influenza, and 2. How and to what extent do pandemic/epidemic
tuberculosis [3, 5, 6]; driven by how systemic racism has individual-level economic relief programs impact the
shaped occupational risks, housing, and health care [6]. effectiveness of public health measures during epi-
Individual-level economic relief programs are eco- demics?
nomic interventions implemented by governments, 3. How and to what extent do changes in public health
institutions, or private sources during an epidemic or measures associated with pandemic/epidemic indi-
pandemic to limit the disproportional health and eco- vidual-level economic relief programs impact health
nomic consequences often experienced by populations at outcomes?
higher risk of the disease (e.g., low- and modest-income 4. Do health benefits associated with pandemic/epi-
families, families with children, homeless population, demic individual-level economic relief programs dif-
and indigenous persons), support public measures and fer across demographic and social groups, and place
improve population health [7]. Programs implemented of residence? If so, how?
during the COVID-19 pandemic included paid sick leave, 5. What are the non-health outcomes assessed in eligi-
caregiver and childcare benefits, unemployment com- ble studies identified?
pensations for furloughed workers, and food supply and 6. What are the limitations associated with pandemic/
direct cash payments to low-income earners [7]. epidemic individual-level economic relief programs?
Pandemic-informed individual level economic relief 7. What are the knowledge gaps in the literature in rela-
policies are intended to encourage changes in human tion to the questions above?
behaviour and motivate individuals to make healthy
choices that impact health and overall well-being [8–10]. Methods
In a 2020 survey, 94% of respondents indicated compli- We followed the updated Arksey and O’Malley’s frame-
ance to a proposed two-week self -quarantine during work on conducting scoping review [12, 13] and the
the COVID-19 outbreak if financial compensation for Preferred Reporting Items in Systematic Reviews and
lost wages is guaranteed; however, when the financial Meta-Analyses extension for Scoping Reviews (PRISMA-
compensation option was removed, the compliance rate ScR) reporting guideline [14].
dropped to 57% [9]. Nevertheless, we found very limited Our protocol is available at https://doi.org/10.1136/
evidence on the health-related benefits of individual level bmjopen-2021-057386 [15]. We made the following
economic relief programs in our exploratory review, con- changes to the protocol: We excluded HIV publications,
ducted in few electronic databases in September 2020 to publications from low- and middle-income countries,
assess the feasibility of a broader review. and non-English publications due to their volume, con-
Because the implementation individual level economic strained resources, and differences in health systems
relief programs are often costly [7] and there is often a structure. Also, jurisdictional differences in the health
debate about their impact during outbreaks [11], we sys- benefits associated with pandemic/epidemic individual-
tematically chart their health and non-health benefits, level economic relief programmes were assessed by place
and equity impacts to inform pandemic preparedness of residence (e.g., urban or rural), not by country type.
planning.
Our objective is to map the current state of the litera- Search strategy
ture on individual-level economic relief programs dur- An information specialist developed our comprehensive
ing infectious disease outbreaks and their impact on the search strategy using text words and Medical Subject
Ogunbameru et al. BMC Public Health (2024) 24:2106 Page 3 of 22
Headings (MeSH) terms. In the original search strategy, Full text screening and data extraction were conducted
from January 1, 2001, to October 8, 2021, we searched in duplicates by two trained reviewers using Microsoft
concepts relating to pandemic/epidemic infectious dis- Excel software. Disagreements were resolved through
eases (specifically, coronaviruses, influenza A, SARS, discussions until consensus was reached. Data abstrac-
MERS, HIV/AIDS, Zika, Ebola and West Nile) and eco- tion was conducted using a pre-tested template. Data
nomic relief programs (e.g., government financing, public elements included study and population characteristics
assistance, food assistance, medical assistance, workers (study objective, study design, study population), infec-
compensation, social welfare, charities, and childcare). tious disease outbreak description (name of outbreak and
We restricted our search to post-2001 because of the time of outbreak), economic relief program description
global changes observed in living standards and health (eligible population, program and equity considerations
care delivery (now focused on primary health care) since used in assessing eligibility and program implementation
countries implemented the Millennium Development time period), public health measure outcomes, popula-
Goals in 2001 [16]. We updated our search on April 3, tion health outcomes, general health outcomes, equity
2023. For the updated search, we excluded HIV terms impacts (by variables such as demographics, social and
from the search strategy due to the volume of HIV/AIDS jurisdiction), and non-health outcomes.
publications during the original screening. The origi- Equity-impact of a disease and implemented interven-
nal search strategy was developed in the Ovid Medline tions are often measured among groups or settings that
and then translated to other databases. Both MEDLINE are likely to be disadvantaged by the outbreak [5]. Fac-
search strategies are reported in the appendix. tors that may be considered when measuring inequities
We searched eight databases—MEDLINE, OVID include income, employment, and gender [5]. In our
E-pub Ahead of Print In-Process & Other Non-Indexed review, data extraction and synthesis on equity impact
Citations, EMBASE, Cochrane CENTRAL, all on the was guided by the PROGRESS-Plus framework to ensure
OvidSP platform; EconLit, CINAHL, on the EBSCO plat- that we systematically consider health equity under rel-
form; ISI Web of Science on the Clarivate platform, and evant dimensions, including demography, social factors,
Global Index Medicus from the World Health Organiza- disability, and sexual orientation [18].
tion (WHO). We manually searched the reference lists of Individual level economic relief programs were cat-
eligible studies to ensure we do not miss relevant articles. egorized by the nature of the program and intended
Our search excluded clinical conferences, comments, population. For examples, monetary incentive programs
editorials, letters, and animal studies. No study design, directed to increase vaccine uptake or testing were cate-
language or country restriction was employed in our gorized as “incentive for vaccination or testing” program;
search strategy. fiscal stimulus directed to workers when ill/exposed to
encourage quarantine/isolation was termed “expanded
Study screening and data extraction paid sick leave”; employment insurance payment to fur-
De-duplication, and title and abstract screening were loughed workers or unemployed individuals was termed
conducted using the Distiller SR software, including the “unemployed assistance”; direct cash payment to support
artificial intelligence (AI) simulation tool that automates individuals and households was termed “cash transfer”
the title and abstract screening process [17]. Four trained food supply programs to communities, schools, house-
reviewers conducted the title and abstract screening in holds was categorized as “food assistance”; two or more
parallel without using Distiller AI. Distiller AI was used individual-level economic relief program groups simul-
at the end of the screening process to check for screening taneously was termed “mixed program” and “others”
errors among excluded records. Retrieved records were program category which included subsidy program and
tagged by country type (high-income or low-and-middle- expanded child tax credit program.
income) and disease (HIV, COVID-19, Zika, Ebola, West Full details of the data elements extracted is described
Nile, MERS, SARS, or influenza A (H1N1 and H2N2). in our protocol [13].
We excluded commentaries, book chapters, conference
abstracts with no full text, study protocols, and business
targeted economic relief programs. Data charting
Following title and abstract screening, we restricted We summarized public health measures, health, non-
study eligibility to COVID-19, Zika, Ebola, West Nile, health measures and equity impact associated with
MERS, SARS, or influenza A (H1N1 and H2N2) and individual-level economic programs using a narrative
high-income settings due to volume (see Fig. 1 for details approach and visual plots. In the equity-impact analysis,
on the excluded studies). We also excluded non-English we provided details on how outcomes differed by equity
articles due to limited translation resources. variables.
Ogunbameru et al. BMC Public Health (2024) 24:2106 Page 4 of 22
Fig. 1 Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) flowchart
Results Studies and program characteristics
Our initial and updated search yielded 27,263 de- Eligible studies were published between 2014 and 2023.
duplicated records from the eight databases. After Ninety percent (90%) were COVID-19 related (n = 45)
title and abstract screening, we retrieved 415 records and others were on influenza (n = 5). We did not iden-
for full-text screening. Following the amended eligi- tify eligible studies on MERS, SARS, Zika, Ebola, or
bility criteria, we excluded 227 studies from low- and West Nile virus. Seventy-three percent of included
middle-income countries and 45 studies on HIV from studies were conducted in the United States of Amer-
high-income countries. We assessed the full text of 143 ica (n = 36) [19–53], followed by Japan [54–56], South
studies and excluded 93 records. The reasons for exclu- Korea [46, 57, 58], Australia [59, 60], Canada [61, 62],
sions included: no quantitative assessment of the indi- Chile, Israel, Spain, and Singapore [63–66]. Two-third
vidual-level economic relief program (n = 33), not an of eligible studies used a survey study design [20, 22,
individual-level economic relief program (n = 23), and 25, 31, 32, 35–39, 46–50, 53–57, 43, 60, 62, 64, 66–69];
book/commentary/report/opinion/ research letters/ others included quasi-experiment [28, 44], simulation
conference abstract/media release (n = 25). Fifty studies [23, 25, 30, 58, 63, 70], observational [29, 41, 52, 59],
were found eligible for final review. The PRISMA flow and randomized control trial design [45, 51, 61, 65].
diagram is shown in Fig. 1.
Ogunbameru et al. BMC Public Health (2024) 24:2106 Page 5 of 22
We identified 28 unique individual-level economic a Coxcomb chart of study outcomes by individual-level
relief programs among eligible studies and categorized economic relief program type.
them into seven groups.
Of the 50 eligible studies, three sets of seven studies Health impacts
reported on COVID-19 related unemployment assis- Thirty-six of the 50 eligible studies were designed to
tance programs [21, 22, 25, 26, 29, 33, 50], COVID-19 evaluate the health impact of an economic relief program
food assistance programs [25, 27, 31, 43, 46, 47, 49], and [19–21, 28, 32, 35–45, 48, 52, 54, 56–58, 60, 61, 65, 66].
expanded paid sick leave [22, 25, 37–39, 42, 52] in the Impact on public health measures. Fifteen out of 50
context of COVID-19 pandemic and Influenza epidemic. studies were designed to examine the effect of economic
Eleven eligible studies reported on COVID-19 cash relief programs on public health measures [28, 32, 36, 37,
transfer programs [20, 23, 48, 51, 53, 55, 57, 59, 61, 70, 39–42, 45, 56, 60, 61, 65, 66, 71].
71]; nine studies evaluated vaccine and testing incentives Three studies, reporting on programs of expanded
during COVID-19 pandemic and Influenza epidemic [32, paid sick leave (n = 1), domestic travel subsidy (n = 1),
36, 40, 41, 45, 58, 60, 65, 66]; seven assessed mixed pro- and cash transfer (n = 1), found that economic relief pro-
grams [30, 34, 35, 54, 62–64], three of which combined grams could have a positive, neutral, or negative impact
unemployment assistance and cash transfer programs on social distancing, depending on program type [42, 56,
[30, 34, 62]. Two COVID-19 studies reported on pro- 61]. In two studies, expanded paid sick leave was asso-
grams in the “other “category [44, 56]. Figure 2 presents ciated with an increased probability of workers isolat-
the program and study characteristics as a heat map. ing when sick by 15% [28] and an increased amount of
time spent away from work when sick by 1.10 days [38].
Health, non‑health, and equity outcomes Expanding paid sick leave was linked to an increase in
of individual‑level economic relief programs vaccination rates during influenza disease outbreaks by
All eligible studies reported on at least one review out- 10–15% [37, 39]. Vaccine incentives were reported to sig-
come. Studies on expanding paid sick leave programs nificantly increase vaccination rates by 7%—23.2% [32,
reported the most health-related outcomes (n = 7) [19, 40, 65] in the context of COVID-19 and influenza out-
28, 37–39, 42, 52]. The impact on non-health outcomes breaks. A domestic travel subsidy program had no impact
was commonly assessed for cash transfer programs on masking practice, respiratory hygiene practice & sur-
(n = 10) [20, 23, 51, 53, 55, 57, 59, 61, 70, 71]. Incentive face disinfection [56].
for vaccination program studies contributed majorly Population health outcomes based on programs’
to the equity data (n = 3) [32, 45, 65]. Figure 3 presents impact on public health measures were evaluated by
Fig. 2 Heat map depicting program and studies characteristics of included studies. Footnotes: [The number of studies by individual-level
economic relief program type and country are ordered from highest to lowest (left to right). We assigned dark to light colours to depict a no study
scenario to having more than 6 studies scenarios]
Ogunbameru et al. BMC Public Health (2024) 24:2106 Page 6 of 22
Fig. 3 Coxcomb Chart depicting study outcomes by individual-level economic relief program type Footnotes: [The different colours of the ray
indicate the various components of the review outcomes. The width of the ray indicates the impact of the individual-level economic relief program
type on the components of the review outcomes. A wide width implies that the individual-level economic relief program type has a positive impact
on the specific review outcome assessed and a narrow width denotes a negative impact.]
eight studies [32, 39, 41, 42, 56, 58, 61]. Health out- eating and improved intention to seek medical care
comes reported on included symptom and case counts, when ill [37, 43].
infection transmission, healthcare visits and herd
immunity. Herd immunity was measured by a multi- Non‑health impacts
nomial model regressing the effect COVID-19 vaccine Thirty-three of the 50 (60%) eligible studies reported
incentive on US population vaccination level. [32] The non-health outcomes [20–23, 25, 26, 29, 31, 34, 39, 44,
economic relief programs were cash transfers [61], 55, 57, 61–64, 68–70, 72]. Economic relief programs
expanded paid sick leave [19, 38, 39, 42], incentives for had a positive impact on non-health measures including
vaccination/testing [32, 58], and domestic travel sub- food security, financial resilience/savings/financial secu-
sidy [56]. Expanded paid sick leave and incentive for rity, consumption spending and debt payment, housing/
vaccination/testing were associated with positive health mortgage payment and job security. Programs included
outcomes [19, 32, 38, 39, 42, 58] while cash transfer and cash transfer (n = 10), unemployment assistance (n = 10),
domestic travel subsidy were linked to neutral [61] and incentive for vaccination (n = 1), food assistance (n = 6),
negative health outcomes [56] respectively. mixed (n = 4) and expanded paid sick leave (n = 2).
General well-being outcomes were reported in thir-
teen studies [20, 21, 35, 37, 39, 43, 44, 46, 48, 52, 54, Equity impacts
61, 66]. The economic relief program types assessed Nine of the 50 (18%) eligible studies reported on the
included cash transfer (n = 4), unemployment assis- equity impact of the individual level economic relief pro-
tance (n = 1), paid sick leave (n = 1), food assistance grams [32, 35, 39, 44, 45, 48, 56, 61, 65]. Program types
program (n = 2) and expanded child tax credit (n = 1). assessed included cash transfer (n = 2), incentive for vac-
Cash transfer, unemployment assistance, food assis- cination (n = 3), mixed (n = 1), expanded paid sick leave
tance, and expanded child tax credit were reported to (n = 1), and “other” (n = 2). The equity factors considered
have a positive impact on mental well-being in seven were demographics (age, and race), socioeconomic status
studies [20, 21, 35, 44, 46, 48, 43]. Paid sick leave was (employment), and jurisdiction.
associated with intention to seek medical care; food Health outcomes associated with cash transfer pro-
assistance programs were associated with healthier grams differed across demographic factors (race and age)
Ogunbameru et al. BMC Public Health (2024) 24:2106 Page 7 of 22
in two studies [48, 61]. Cash transfer was association studies reported on the equity impact. None of the eight
with reduced incidence of COVID-19 symptoms among studies that assessed the equity impact of unemployment
50 years or older [48] and improved financial savings (a assistance programs, vaccine incentive programs, “other”
proxy for improved mental health) among Hispanics [61]. programs, and cash transfer programs reported the pro-
In three studies assessing the effect of incentive for gram’s effect on relevant equity variables. The impact of
vaccination, health outcomes significantly differed by expanded paid sick leave programs and food assistance
race, age, and employment [32, 45, 65]. Vaccine incentive programs on equity remains undetermined.
increased vaccination rates among Blacks and non-work- Lack of evidence on the long-term effect of individual-
ing elderly in COVID-19 pandemic and influenza epi- level economic relief programs on health outcomes,
demic [32, 65]. Vaccine incentive reduced vaccine uptake which were not considered in the 36 eligible studies
among 40 years and older in a COVID-19 study [45]. that reported health outcomes. Assessing the long-term
Expanded child tax credit program was linked to health effects of individual-level economic relief policies,
reduced anxiety symptoms among Blacks and Hispan- particularly post-pandemic during the recovery stage,
ics [44]. Domestic travel subsidy was associated with an could provide insight into the importance of the pro-
increase in the incidence of COVID-19 symptoms among grams to equity and societal well-being.
young participants [56]. Table 1 presents the health,
equity impact and non-health outcomes reported in eli- Discussion
gible studies. Our review charts the current state of the literature on
the types of individual-level economic relief programs
Limitations associated with individual‑level implemented during infectious disease outbreaks.
economic relief programs Expanded paid sick leave was found to have a consist-
Three studies discussed the limitations of their respective ent pattern of improved health outcomes. Our findings
programs [21, 30, 57]. Limitations associated with unem- corroborate the findings of a recent meta-analysis study
ployment assistance programs in two studies included of 12 studies, reporting that paid sick leave was associ-
state-level variability in unemployment insurance ben- ated with increased odds of following public health direc-
efits [21], the complexity of the unemployment insurance tives (vaccine uptake) and seeking medical care [73].
program structure, the presence of barriers that prevent Individual-level economic relief programs improved
eligible individuals from receiving program benefits [21], population health outcomes among equity-deserving
and issues related to eligibility and implementation chal- populations. The improved health outcomes observed
lenges, such as erroneous data on unemployment rate among equity seeking populations is likely due to their
[30]. In a COVID-19 cash transfer program study, the improved adherence to public health measures enabled
authors suggested that the implemented consumption by economic relief programs. [74].
voucher program could constrain consumer choice and Furthermore, most individual-level economic relief
possibly harm consumer welfare and economic efficiency program types positively impacted mental health, re-
in the long run because beneficiaries could only redeem affirming the long-established evidence of the relation-
the vouchers at small business stores [57]. ship between financial well-being and psychological
well-being [72, 75]. Non-health outcomes associated with
Knowledge gap the programs had beneficial impact on key domains of
Our review identified four key knowledge gaps: social determinants of health i.e., economic stability and
Limited disease focus. All eligible studies were on healthcare access and quality. Addressing social determi-
COVID-19 and influenza. Despite the occurrence of nants of health is fundamental for improving health and
SARS, H1N1 influenza, MERS, Ebola, Zika and West Nile reducing longstanding inequities in societal health [76].
Virus outbreaks during eligibility period, we did not iden- Lastly, we identified four knowledge gaps which could
tify any eligible study on these outbreaks in our review. help in priority setting of future research. Tailoring future
Lack of evidence on the effect of unemployment assis- research to address gaps would provide a more wholistic
tance programs and food assistance programs on public view to the robust and comprehensive impact of individ-
health measures (such as physical distancing, quarantine/ ual-level economic relief programs on health and equity
isolation, vaccination). Among the unemployment assis- during pre- and post-pandemic periods.
tance programs and food assistance programs studies Our review has some limitations. First, we restricted our
included in our review, none reported on public health search strategy to studies in high-income countries due to
measure impact. the high volume of studies. Future reviews should synthesize
Limited evidence of the impact of individual-level eco- the impact of similar programs in low-and middle-income
nomic relief programs on equityOnly 16% of eligible countries. Second, due to the volume of studies identified
Table 1 Summary of the health and non-health outcomes, and equity-impact reported in included studies
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Persaud 2021 [61] Canada Randomized con- Cash transfer No difference No difference Self-reported Cash transfers did Incidence of COVID-
trolled trial in the number in symptom count health did not dif- not reduce food 19 like symptoms
of close contacts after 2 weeks (ratio fer between groups insecurity (80%vs reduced in those
outside of the of means 0.83; 95% after 2 weeks 71%) aged 50 years or older,
Ogunbameru et al. BMC Public Health
household CI 0.56 to 1.24, but not in those < 50
between groups p = 0.34) years (p = 0.005)
(Rate ratio 1.10 95%
CI 0.83 to 1.46)
Tsai 2020 [20] USA Survey Cash transfer NA NA Economic Impact Economic Impact NA
Payment recipients Payment was asso-
(2024) 24:2106
were more likely ciated with fewer
to have tested problems paying
positive or been daily expenses
untested for COVID-
19 and less likely
to screen positive
for current major
depression, general-
ized anxiety disorder,
past 2-week suicidal
ideation, COVID-19
era-related stress,
and any illicit drug
use compared
to those who did
not receive the pay-
ment
Pichler 2020 [19] USA Survey (differ- Expanded paid sick NA Relative to the mean NA NA NA
ence in difference leave number of new
analysis) cases for the control
group, the study
model predicted
a decrease of 417
new COVID-19 cases
(56%) after the intro-
duction of Families
First Coronavirus
Response Act
Page 8 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Berkowitz 2020 [21] USA Survey (differ- Unemployment NA NA Receiving unem- The risk of food NA
ence in difference assistance ployment insurance insufficiency
analysis) benefits was associ- was lower for those
ated with lower risk who received unem-
Ogunbameru et al. BMC Public Health
for unmet health- ployment insurance
related social needs, compared to those
and depressive who did not. (
and anxiety symp- p < 0.0001)
toms
Lee 2021 [57] South Korea Simulation Incentive for testing NA Study epidemiologi- NA NA NA (2024) 24:2106
cal model predicted
an increase
in the propor-
tion of confirmed
infected patients
out of unidentified
infected people
in the susceptible-
unidentified
infected-confirmed
stimulated popula-
tion
Schneider 2021 [28] USA Quasi-experimental Expanded paid sick 15% reduction NA NA NA NA
leave in the proportion
of workers who
reported working
while sick
Ikeda 2021[54] Japan Survey Mixed NA NA the Special Cash Pay- NA NA
ment was associated
with better health
related quality of life
(95% CI): 0.05 (0.03
to 0.08)
Page 9 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Robertson 2021 [32] USA Survey Incentive for vac- Coupled incentives Program could bring NA NA Moderate incentive
cination increase estimated the US vaccination ($1500) increased
vaccination rates levels from 58% vaccine uptake
by 7–8%. (P = 0.03) to more than 65% — among Black respond-
Ogunbameru et al. BMC Public Health
substantially closer ents to 68 per cent
to the rates needed (± 16%). Similar trend
to reach herd was found for Latino
immunity respondents
Low income was asso-
ciated with low (2024) 24:2106
vaccine uptake.
The middle-income
groups appeared most
responsive to the vac-
cine incentive
Miyawaki 2020 [56] Japan Survey Domestic travel Program par- Program participants NA NA Higher incidence
subsidy ticipants were more exhibited higher rates of COVID-19
likely than non- incidence of high like symptoms
participants fever (adjusted were more sali-
to engage in risky OR: 1.83; 95% CI ent among young
behaviour (visiting 1.34 to 2.48), sore program participants
restaurants, bars/ throat (aOR 2.09; compared to non-
nightclubs, at least 95% CI 1.37 to 3.19), participants
once); no impact cough (aOR 1.96;
on masking practice, 95% CI 1.26 to 3.01),
respiratory hygiene headache (aOR 1.24;
practice & surface 95% CI 1.08 to 1.44)
disinfection and smell and taste
disorder aOR 1.98;
95% CI 1.15 to 3.40)
compared with non-
participants
Page 10 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Fan 2020 [35] USA Survey Mixed The unemployed NA Unemployed working-
working-age popula- age population
tion receiving govern- with government
ment assistance had assistance residing
Ogunbameru et al. BMC Public Health
a higher frequency in urban areas showed
of feeling nervous, significantly higher fre-
lonely, and hopeless quency feeling nerv-
compared to those ous, lonely, and hope-
without assistance less compared to their
non-urban counter- (2024) 24:2106
parts
Acharya 2021 [40] USA Survey Incentive for vac- lottery programs NA NA NA NA
cination were associated
with an increase
of an average
23.12% increment
in the new daily vac-
cination rate
Algara 2023 [41] USA Retrospective obser- Incentive for vac- positively influence NA NA NA NA
vational cination vaccine preferences
among the mass
public and all parti-
san groups
Andersen 2023 [42] USA Survey Expanded paid sick reduced the number Weekly COVID-19 NA NA NA
leave of hours people incidence decreased
were not at home by 7.7 log points
by a 0.38 h or 22.9-
min and the propor-
tion of individuals
away from home
for more than eight
hours per day
declined by 1.8%
point
Barr 2021 [43] USA Survey Food assistance NA NA The community- NA NA
based free meal
distribution program
led to healthier eating
and reduced stress
among participants
Page 11 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Batra 2023 [44] USA Quasi-experimental Expanded child tax NA NA Program resulted NA Adults of Black,
credit in fewer depressive Hispanic, and other
and anxiety symp- racial and ethnic
toms among low- backgrounds dem-
Ogunbameru et al. BMC Public Health
income adults. (13.3 onstrated greater
percent reduction reductions in anxiety
from baseline anxiety symptoms compared
levels (25.5 percent) to non-Hispanic White
adults with children
Jacobson 2022 [45] USA Randomized con- Incentive for vac- Increases vaccination NA NA NA Financial incentives (2024) 24:2106
trolled trial cination rates between 1.0% reduced vaccination
and 1.6% points rates in both older
individuals (ages 40
and over) and those
who indicated they
supported Trump
in the 2020 presiden-
tial election
Jun’d 2022[60] Australia Survey Incentive for vac- Program participants NA NA NA NA
cination were 2.27 (95%
CI 1.73 to 2.99)
times more likely
to be vaccinated
Kim 2021 [46] USA Survey Food assistance NA NA Implementing NA NA
SNAP subsidy
after unemployment
insurance expira-
tion was predicted
to lead to a threefold
higher risk of anxiety
and depressive symp-
toms among those
experiencing consid-
erable financial hard-
ship versus no hard-
ship (P < .001),
Page 12 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Liu 2023 [48] USA Survey Cash transfer NA NA There was a nega- NA African American
tive association households were
between the amount less likely to increase
of stimulus received spending, Hispanic
Ogunbameru et al. BMC Public Health
and financial households were
hardship (a proxy more likely to increase
for mental well- savings
being) experienced
by respondents
during the COVID-19 (2024) 24:2106
pandemic
Pollack 2023 [52] USA Longitudinal obser- Expanded paid sick States with pre-exist- NA NA NA NA
vational leave ing paid sick leave
policies exhibited
a greater drop
in mobility (P < 001)
Shmueli 2022 [66] Israel Survey Incentive for vac- Program did NA Incentives such NA NA
cination not increase as monetary rewards
the probability or the green pass
of getting vaccina- did not
tion immediately increase the probabil-
ity of getting vaccina-
tion immediately
Dudley 2021 [36] USA Survey Incentive for vac- the odds of report- NA NA NA NA
cination ing receiving
influenza vac-
cine compared
to the control group
was 0.22 (95%CI:
0.09– 0.51)
Page 13 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Yue 2020 [65] Singapore Randomized con- Incentive for vac- increased participa- NA NA NA The effect of increas-
trolled trial cination tion in vaccination ing incentives on influ-
from 4.5% to 7.5% enza vaccination
(P = 0.001) rates was significant
Ogunbameru et al. BMC Public Health
in nonworking elderly
group than those who
worked(P = < 0.001)
and
differed by eth-
nicity (P = 0.001), (2024) 24:2106
socio-economic
status(P = < 0.0001),
household size
(0.009), and a measure
of social resilience
(P < 0.001)
Zhai 2018 [37] USA Survey Expanded paid sick Compared to work- NA Paid sick leave NA NA
leave ers with no paid sick was independently
leave, influenza vac- associated with seek-
cination coverage ing treatment
estimates for workers for influenza illness
with paid sick leave (adjusted prevalence
was approximately ratio (95%CI) 1.21
10–15% higher (1.01, 1.44)
Asfaw 2017 [38] USA Survey Expanded paid sick workers with paid Assuming 10% NA Paid sick leave could NA
leave sick leave spent to 12% of days save employers
an average of 1.10 absent due to illness, $0.63 to $1.88 billion
more days away 0.026% transmission in reduced illness-
from work per year rate, and an average related absenteeism
due to illness daily contact of three costs per year
or injury (95% CI: to five coworkers,
0.90 to 1.30)] a worker at work
due to lack of paid
sick leave could
infect on the aver-
age 0.0405 to 0.0810
coworkers per year
Page 14 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Wilson 2014 [39] USA Survey Expanded paid sick Adjusted odds Decreased the num- Universal paid leave Universal paid White non-Hispanics
leave of having a vac- ber of influenza is predicted to result leave averted 63.8 had higher odds
cination increased cases by 57 thou- in 18.2 thousand thousand workdays of receiving flu vac-
with paid leave sand fewer healthcare vis- lost to influenza cination than another
Ogunbameru et al. BMC Public Health
vs. without paid its, for the flu annually each year, race/ethnicity
leave (OR = 1.42, CI:
1.31–1.53)
Marinescu 2021 [22] USA Survey Unemployment NA NA NA 10% increase NA
assistance in unemployment
benefits resulted (2024) 24:2106
in 3.6% decline
in job applications
Kim 2021 [57] South Korea Survey Cash transfer NA NA NA Cash voucher NA
scheme increased
consumption spend-
ing among 36%
of the households
Bienvenido-Huertas Spain Simulation Mixed NA NA NA Unemployment aids NA
2021 [63] could contribute
to alleviating energy
poverty, especially
if the unemployed
individual worked
in a poorly paying
job or for just a few
hours
Han 2020 [23] USA Simulation Cash transfer NA NA NA Government cash NA
program resulted
in a decline
in poverty dur-
ing the COVID-19
pandemic
Karger 2020 [70] USA Simulation Cash transfer NA NA NA $1,200 stimulus NA
payment disbursed
increased consumer
spending by $546
Page 15 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Fan 2020 [25, 35] USA Simulation Unemployment NA NA NA The CARES Unem- NA
assistance ployment Insurance
policies reduced
cumulative deaths
Ogunbameru et al. BMC Public Health
by 4.9%
Evangelist 2022 [26] USA Survey Unemployment NA NA NA the unemployment NA
assistance insurance declined
health care services
spending declined
by 1% (2024) 24:2106
Stiemele 2021 [68] USA Survey Food assistance NA NA NA Food insecurity NA
decreased most
among those who
received the local
food assistance
program
Raifman 2021 [29] USA Retrospective obser- Unemployment NA NA NA unemployment NA
vational assistance insurance was asso-
ciated with a 4.3%
decrease in food
insecurity and a 5.7%
decrease in eating
less due to financial
constraints
Kubota 2021 [55] Japan Survey Cash transfer NA NA NA Cash payments NA
increased was asso-
ciated with a jump
in spending rate
Fang 2020 [25] USA Survey Food assistance NA NA NA The alternative NA
school meals
improved with food
security for lower-
income families
Martin 2020 [30] USA Simulation Mixed NA NA NA Social protection NA
programs reduced
the increase in pov-
erty rates
Page 16 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Clay 2021 [31] USA Survey Food assistance NA NA NA Food assistance NA
programs were asso-
ciated with a higher
likelihood of expe-
Ogunbameru et al. BMC Public Health
riencing food
insecurity (OR: 2.59
(1.62,4.16)
Raifman 2020 [33] USA Survey Unemployment NA NA NA unemployment NA
assistance insurance was asso-
ciated with a 4.4% (2024) 24:2106
decline in food
insecurity, and 6.1%
decline in eating
less due to financial
constraints
Bhutta, 2020 [34] USA Survey Mixed NA NA NA The CARES Act NA
improved house-
holds’ financial
security
Men 2022 [62] Canada Survey Mixed NA NA NA The applicants NA
of Canada Economic
Response Benefit,
regular Employment
Insurance benefits,
and other Employ-
ment Insurance
benefits had 2.53,
1.80, and 3.01
times higher
adjusted odds
of food insecu-
rity, respectively,
than non-applicants
Page 17 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
measure impact
Madeira 2021 [64] Chile Survey Mixed NA NA NA Income NA
and expenses
support program
represented 13.6%
Ogunbameru et al. BMC Public Health
of the average
households’ perma-
nent income of poor
families in April 2020
Breunig 2023 [59] Australia Retrospective obser- Cash transfer NA NA NA Program recipi- NA
vational ent had 46% (2024) 24:2106
of their weekly
pre‐COVID‐19
wages replaced
by the transfers
Choi 2022 [71] South Korea Survey Cash transfer NA NA NA The stimulus pay- NA
ments increased
local consumption
in establishments
accepting the Gyeo-
nggi local currency
relative to other
establishments
Li 2022 [47] USA Survey Food assistance NA NA NA SNAP significantly NA
reduced food
insecurity by 24.5%
among households
who were already
food insufficient
before the pan-
demic and by 11.9%
for households
with children
Page 18 of 22
Table 1 (continued)
Author, year Country Study Design Economic relief Public health Population General well-being Non-health Equity impact
program type measure impact health outcomes outcomes
associated with
public health
Ogunbameru et al. BMC Public Health
measure impact
Lowery 2022 [49] USA Survey Food assistance NA NA NA Healthy Helping NA
program was associ-
ated with a $26.95
increase in monthly (2024) 24:2106
spending on fruit,
vegetables, nuts,
and legumes
and other shifts
in the composition
of food purchases
Park 2023 [50] USA Survey Unemployment NA NA NA Unemployment NA
assistance insurance reduced
mortgage debt pay-
ments
Pilkauskas 2023 [51] USA Randomized con- Cash transfer NA NA The cash transfer pro- The cash transfer NA
trolled trial gram had no impact program had
on mental health no impact on mate-
rial hardship, parent-
ing, child behavior,
partner relationships,
hardship avoid-
ance, consump-
tion, employment,
and benefit use
Wahdat 2022 [53] USA Survey Cash transfer NA NA NA Economic Impact NA
Payment was asso-
ciated with 9.2%
decrease in food
insufficiency
Page 19 of 22
Ogunbameru et al. BMC Public Health (2024) 24:2106 Page 20 of 22
we were only able to focus on selected infectious diseases. Supplementary Material 3. A comprehensive dataset of the outcomes
This limitation makes our findings disease-specific, requir- extracted from the 50 eligible studies.
ing careful interpretation if attempting to extrapolate find-
ings to other infectious diseases (e.g., HIV). Further, we did Acknowledgements
not search the grey literature and only included publications The following authors are supported by Canada Research Chairs (CRC): SM
in English. Our findings may therefore be biased towards (Tier 2 CRC in Mathematical Modelling and Program Science, CRC-950-
232643); BS (Tier 1 CRC in Economics of Infectious Diseases, CRC-2022-00362).
English-speaking high-income settings.
Our review’s strength lies in our use of a rigorous scop- Authors’ contributions
ing review methodology. Screening and data extraction AO and BS conceptualized the study. AF acquired the data. AO, GBG, AP and
MH screened and analyzed the data. AO, KL, SM, BS interpreted the data. AO
forms were pretested by all reviewers and revised as drafted the manuscript. AF, SM, KL and BS revised the manuscript. All authors
needed to ensure they are adequately sensitive to capture read and approved the final manuscript.
outcomes in eligible studies. We searched multiple rel-
Funding
evant electronic scientific databases to ensure our results The preparation of the manuscript was supported by Emerging and Pandemic
were comprehensive and accurate. Lastly, our eligibility Infections Consortium, University of Toronto.
criteria had no restriction on study design.
Availability of data and materials
All data generated or analysed during this study are included in this published
Policy implications article and its supplementary information files.
Our findings provide compelling evidence that shows
that individual-level economic relief programs are valu- Declarations
able, and their importance transcends health in pandem-
Ethics approval and consent to participate
ics. Although individual-level economic relief programs Not applicable.
are capital-intensive, their broad and positive impact on
public health measures, population health, general well- Consent for publication
Not applicable.
being, equity, and social determinants of health (e.g., eco-
nomic stability) may make investing in them worthwhile. Competing interests
As countries prepare for future pandemics, our findings The authors declare no competing interests.
provide evidence to stakeholders to recognize health equity as Author details
a fundamental public health goal when designing pandemic 1
Institute of Health Policy, Management and Evaluation, University of Toronto,
preparedness policies. Further, expansion of well-designed, Toronto, ON, Canada. 2 Toronto Health Economics and Technology Assess-
ment (THETA) Collaborative, University Health Network, Toronto, ON, Canada.
robust, social safety net programs (such as individual level 3
School of Global Health, York University – Keele Campus, Toronto, ON,
economic relief programs) for equity-deserving populations Canada. 4 Library & Information Services, University Health Network, Toronto,
should be considered since evidence show that these pro- ON, Canada. 5 Dalla Lana School of Public Health, University of Toronto,
Toronto, ON, Canada. 6 Department of Medicine, Division of Infectious Disease,
grams not only improve health equity and social needs, but University of Toronto, Toronto, ON, Canada. 7 Centre of Urban Health Solutions,
they may also address social determinants of heath. St, Michael’s Hospital, Toronto, ON, Canada. 8 Public Health Ontario, Toronto,
ON, Canada. 9 ICES, Toronto, ON, Canada.
Conclusion Received: 3 October 2023 Accepted: 15 July 2024
Individual-level economic relief programs implemented
during epidemics/pandemics significantly impacted pub-
lic health measures, outbreak-related population health
outcomes and health equity. Our study findings can help References
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