PUBLIC HEALTH
an urgent priority. We need ambitious and binding national goals to drive progress, a cross-government strategy to reduce health inequalities and increased investment in prevention and public health.”
A watershed moment?
The trends in inequality highlighted by the pandemic prompted the publication of a report by the Health Foundation which examined the question: ‘Will COVID-19 be a watershed moment for health inequalities?’ It warned that “without consideration of the long-term health implications of the lockdown and likely economic shock, which stem from necessary measures to protect lives in the short term, the toll on the nation’s health risks going well beyond the number of people who will die with COVID-19. This toll will fall unevenly across our society.”
The Health Foundation stated that mitigating its effects will require a thorough analysis of how health inequalities are intertwined with the course of the virus, as well as with the necessary government and societal response to halt its spread. The report points out that existing health inequalities are linked to a greater severity of symptoms – and likelihood of death – for those contracting COVID-19.
Deep-rooted discrimination in British society creates systemic barriers to the conditions needed to live a healthy life, which contributes to poorer health outcomes among some within the black, Asian and minority ethnic communities in the UK
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. Sally Warren, director of policy at The King’s Fund.
(when compared to the outcomes of white British people). Given that the risk of dying with COVID-19 is strongly associated with experiencing existing poor health, this makes the virus potentially more dangerous for these groups. Also, while there is evidently variation in the lives of those from minority ethnic backgrounds, overall, workers who form part of the black, Asian and minority ethnic community are more likely to live in densely populated urban areas and are disproportionally represented in high-risk key worker jobs. This is particularly true in London, which has seen the largest number of COVID-19-related deaths of any region. As well as those with the poorest health being more likely to experience worse outcomes from COVID-19, the Government measures to curb the spread of the virus are leaving many of these same people exposed to greater risks to their physical and mental health. These risks stem from increased exposure to the virus and from increased economic and social hardship during the lockdown. Those on lower incomes are more likely to have continued travelling into
work. Less than one in ten of the lower half of earners say they have the option to work from home during the lockdown, compared with half of the highest earners. Many low earners have also been classified as key workers, particularly in retail and food, and though their continuing to work has been for the wider social good, they have at times been given inadequate protection. It is not just the virus that presents an increased health risk in the current circumstances. The Government response, while saving lives in the short term, is already having economic consequences for those at the sharp end of inequalities. Where they are not in key worker roles, many millions of families, who were already struggling to get by, are facing reduced or non-existent incomes.
Those on low wages are seven times as likely as high earners to have worked in a sector that has been shut down. This insecurity can be expected to have an immediate impact on the mental health of those affected. The response is also contributing to an increase in food insecurity. Rising prices and reduced access to fresh food exacerbates the difficulties some families already face in putting a healthy meal on the table – preliminary research indicated that the number of adults who were food insecure in Britain had quadrupled after the lockdown. Children are perhaps even more acutely affected. The Trussell Trust reported a 122% rise in emergency food parcels given to children from food banks in their network during the second half of March 2020, compared to the same period in 2019.
Beyond the immediate harm caused by COVID-19 itself and the accompanying lockdown, the Health Foundation warns that there will be longer term implications of the measures taken to control the spread of the virus. As the NHS diverts resources to the crisis, there are consequences for people with existing health needs. The paring back of routine care means that preventative services have been put on hold, such as cancer screening in Scotland. Management of some existing long-term conditions is also on hold, as GP surgeries pause non- urgent and non-essential routine care in England, and English hospitals pause routine operations. Initial data is also showing that there have been lower presentations for
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