“No data, no problem”? A critical reflection of health monitoring systems and equity during COVID-19 in Finland

Background: Lessons drawn from the COVID-19 pandemic have highlighted that health monitoring systems in various countries did not adequately capture how the pandemic affected individuals and groups in vulnerable situations. Disaggregated data on different population groups were often not available nor utilized to target responses. Much less attention, however, has been paid on why this was the case and what implications this may have had for health equity in both COVID-19 responses and future health system preparedness. We draw on health systems and policy research as well as social epidemiology to focus on data governance, i.e. the decisions, reasons, and factors affecting how data are collected, utilized, analyzed and presented in health systems. Methods: The article is written as a critical reflection in which we approach the Finnish response(s) to COVID-19 as a case study. We first describe the Finnish health monitoring system infrastructure prior to COVID-19, then present how data were utilized during the pandemic, and finally, demonstrate how data shaped responses, equity, as well as public perception of the crisis. Results: This critical reflection demonstrates how health monitoring systems, and particularly health system data, became both structural enablers and gatekeepers to equity during COVID-19 in Finland. A critical focus on data shows that the response in Finland during COVID-19 largely relied upon a homogenous perception of its population, reflected by the most commonly utilized data and indicators in national data dashboards. Disaggregated data for more tailored responses were eventually utilized, but only after the allocation of short-term additional resources. Conclusions: Based on our reflections regarding the COVID-19 pandemic in Finland, we argue that data have a critical role in framing health issues, garnering public attention for certain types of responses, and rendering certain population health issues visible or invisible. We discuss the implications of health monitoring and data practices in a single country context during COVID-19 for health system preparedness more generally. We conclude that equity-centered data and health monitoring practices should be viewed as a critical health system capacity.