A perfect storm - health inequalities and the impact of COVID-19

Health inequalities are largely due to the unfair and unjust inequalities in society in which people are born, live, work and age.

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The unequal distribution of the social determinants of health, such as education, housing and employment, drives inequalities in physical and mental health, reduces an individual’s ability to prevent sickness, or to take action and access treatment when ill health occurs. These inequalities are complex and embedded in society but they are also preventable. The dimensions of inequality are complex and overlapping as represented in the overlapping dimensions of health inequalities.

Health inequalities such as deprivation, low income and poor housing have always meant poorer health, reduced quality of life and early death for many people. The COVID-19 pandemic has starkly exposed how these existing inequalities - and the interconnections between them such as race, gender or geography, are associated with an increased risk of becoming ill with a disease such as COVID-19 (Coronavirus (COVID-19) Related Deaths by Ethnic Group, England and Wales: 2 March 2020 to 15 May 2020Disparities in the risk and outcomes of COVID-19).

Importantly, as a result of the pandemic, we are all more aware of what is meant by health inequalities and the ways in which they impact on people’s lives. Therefore, it is vital to act now and drive forward work programmes that reduce inequalities, prevent poor health and improve people’s opportunities for better health. It is vital too that the structural inequalities in our society – unemployment, overcrowded housing, and a lack of green space, as a few examples, are tackled because it is changes at the root cause that will reduce health inequalities in the long term.

One of the positive outcomes of COVID-19 has been the explosion of access to services online. In the main this has been received positively by residents. They have attended consultations online via phone or zoom calls, with GPs, nurses and sexual health clinics. It has enabled people to obtain contraception, medicines and advice. However, the downside of this for say young people living at home, is the potential lack of privacy (medicines arriving via the post or consultations being overheard), while for those who are not equipped with access to the internet, are excluded altogether from this new type of access.

Local government, aware of the circumstances of so many of their residents, is focussing on reducing these inequalities, working with the wider health system to enable recovery from the pandemic and to build sustainable and healthier futures.

This overarching briefing will describe the national literature on COVID-19 risk factors and the evidence to date on inequalities, drawing out key themes. It will examine both the impact of COVID-19 on inequalities and the impact of the pandemic restrictions on inequality. It will explore what steps councils are taking to reduce those inequalities.

Each of the supplementary briefings will examine these key themes in greater detail, introducing case studies from local authorities around the country that offer ideas and opportunities for supporting residents and reducing some of those inequalities.

What local government is doing

There is wide recognition that a system wide approach is required to have an impact on the severity of health inequalities people face. Joint working between the civil, service and community sectors as illustrated below can enable system wide impact. Health inequalities are now on the agenda of every integrated care system as they bring together partners from health, social care, the voluntary sector and public health.

View the components of the population intervention triangle in Place based approaches for reducing health inequalities.

References
  1. Office for National Statistics, Coronavirus (COVID-19) Related Deaths by Ethnic Group, England and Wales: 2 March 2020 to 15 May 2020
  2. Public Health England, Disparities in the risk and outcomes of COVID-19 GOV.UK, 2020
  3. Bambra C, et al. J Epidemiol Community Health 2020, The COVID-19 pandemic and health inequalities
  4. Marmot, Health Foundation, Build Back Fairer: The COVID-10 Marmot Review 
  5. Centre for Economic Performance, COVID-19 and the self-employed: Six months into the crisis 2020
  6. Johnson P, Joyce, R, Platt, L, (2021) IFS Deaton Review of Inequalities: A New Year’s message; Institute for Fiscal Studies, Nuffield Foundation
  7. Office for National Statistics, Why Have Black and South Asian People Been Hit Hardest by COVID-19? 
  8. Carers UK (2020) Caring behind closed doors: six months on
  9. WHO (2020) Gender and COVID-19 Advocacy Brief 
  10. Global Health 5050, (International Center for Research on Women (ICRW), African Population and Health Research Center (APHRC) The Sex, Gender and COVID-19 project
  11. Griffith DM, Sharma G, Holliday CS, Enyia OK, Valliere M, Semlow AR, et al. Men and COVID-19: A Biopsychosocial Approach to Understanding Sex Differences in Mortality and Recommendations for Practice and Policy Interventions
  12. PHE (2019) Place based approaches for reducing health inequalities
  13. Office for National Statistics, Coronavirus (COVID-19) Related Deaths by Occupation, England and Wales - Office for National Statistics
  14. Office of National Statistics “Coronavirus (COVID-19) Related Deaths by Ethnic Group, England and Wales: 2 March 2020 to 15 May 2020
  15. Runneymede Trust Overexposed and under-protected the devastating impact of COVID-19 on BME communities
  16. PHE (2020) COVID-19 deaths of people identified as having learning disabilities