Who Counts and Who Gets Counted? Health Equity in Infectious Disease Surveillance

[...]if health equity is not at the core of our surveillance activities, inequities will inevitably arise, persist, and widen over time. [...]our current surveillance activities have focused almost exclusively on the direct effects of the pandemic on population health, measured in terms of SARS-CoV-2 infections or deaths that can be directly attributed to COVID-19. ACKNOWLEDGING SOCIAL AND HISTORICAL CONTEXT The methodological choices we make when analyzing data can profoundly affect the conclusions we draw about the existence, direction, and magnitude of health inequities. [...]choices are not purely objective and value-free;rather, they reflect one's view of the world and judgments about what sources of variation in health status are permissible. [...]statistical adjustment for covariates such as age and geography when comparing disease risk across racial/ethnic groups reflects the belief that different distributions of age or geography are not important components of racial disparities in disease risk.7 By contrast, an analytic approach that seeks to understand how racial health inequities are produced might stratify on age and place to assess the roles of age and geography-population characteristics that are themselves shaped by structural racism-in determiningthe distribution of disease across population groups. Because the analysis and interpretation of surveillance data have real consequences for the subsequent implementation of public health interventions, it is critical that analyses be grounded in an antiracist approach that acknowledges the role of social and historical forces in shaping the distribution of disease.