How did norms shape decision-making about essential public spaces during the COVID-19 pandemic? Insights from four Canadian provinces

Background: Non-pharmaceutical interventions regulating access to public space to prevent the transmission of COVID-19 were implemented worldwide with considerable sub-national and national variation. Despite the prominent influence of norms in health governance, existing research has not explored their role in shaping decisions about which services and activities in public spaces were essential to keep open (or not) during the pandemic. We sought to identify these norms and understand how decision-makers drew on them to define whether services were essential and policies for accessing them. Methods: This study draws on 103 interviews and government and non-government agency documents to examine how decision-makers in the four Canadian provinces of British Columbia, Ontario, Québec, and Nova Scotia navigated the complexity of defining and keeping open essential services and activities during the pandemic. Results: We identify a pandemic response ‘norm cluster’ outlining a range of norms active in decision-making to regulate public space, which influenced the stakeholders engaged in policymaking and the stringency and timing of non-pharmaceutical interventions. Many services and activities shifted between essential and non-essential depending on how decision-makers balanced these norms. This process was complex and politicized as decision-makers sought to address multiple problems and values, advocated by different stakeholders, and which sometimes required conflicting policy responses. Conclusions: Norms shape how decision-makers balance disease containment alongside other social needs during pandemic response. Future research should examine norm dynamics in other jurisdictions during pandemic response and health emergencies. Policymakers may consider outlining the norms that should guide decision-making in pandemic response plans.