PUBLIC HEALTH
COVID-19: the impact of health inequalities
The coronavirus pandemic has exposed the stark inequalities that exist in society. Black and Asian ethnic groups, people from deprived areas and the elderly have been disproportionately affected by the virus, with a higher risk of mortality. As COVID-19 highlights health inequalities as a major public health issue, could this be a watershed moment?
At the start of this year, the Institute for Health Equity published The Marmot review 10 years on.1
It examined trends in health
inequalities in England over the last decade and found that regional and socioeconomic differences in health are large and growing. The report showed that life expectancy improvements were stalling and there was a decline in the number of years some people could expect to live a healthy life. Since the publication of the review, in
February, the landscape of the UK has changed irrevocably. Many thousands of families have lost loved ones and many millions of families face uncertainty and hardship, with a toll on their long-term health and wellbeing. The coronavirus pandemic has brought to the fore the harsh realities of health inequalities and there has been a major public focus on the impacts of deprivation, ethnicity and age on outcomes and mortality. A report from Public Health England confirmed that the impact of COVID-19 has replicated existing health inequalities and, in some cases, increased them.2
PHE found
that the mortality rates from COVID-19 in the most deprived areas were more than double the least deprived areas, for both males and females. This is greater than the inequality seen in mortality rates in previous years, indicating greater inequality in death rates from COVID-19. People from Black ethnic groups were most likely to be diagnosed and death rates from COVID-19 were highest among people of Black and Asian ethnic groups. This is the opposite of what is seen in previous years, when the mortality rates were lower in Asian and Black ethnic groups than White ethnic groups. Therefore, the disparity in COVID-19 mortality between ethnic groups is the opposite of that seen in previous years. An analysis of survival among confirmed
OCTOBER 2020
COVID-19 cases and using more detailed ethnic groups, shows that after accounting for the effect of sex, age, deprivation and region, people of Bangladeshi ethnicity had around twice the risk of death than people of White British ethnicity. People of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity had between 10% and 50% higher risk of death when compared to White British. Commenting on the report, Sally Warren, director of policy at The King’s Fund, said: “The coronavirus pandemic has exposed the stark inequalities that exist throughout our society. People who have been worst affected by the virus are generally those who had worse health outcomes before the pandemic, including people working in lower-paid professions, those from ethnic
minority backgrounds and people living in poorer areas. “We’ve known for many years that these groups typically have worse health outcomes, but there has been disappointingly little effort over the past decade to address inequalities and improve people’s health. The scandal is not that the virus has disproportionately affected certain groups, but that it has taken a global pandemic to shine a light on deeply entrenched health inequalities. “Public health is about much more than infection control, and healthier populations will be more resilient to new threats. Preventable conditions including obesity and Type 2 diabetes are major risk factors for COVID-19. This should be a wake-up call for the Government to make population health
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