Not an equal opportunity disease: Covid-19 and health inequalities

Posted by Clare Bambra, Professor of Public Health, Newcastle University and Ryan Riordan, 5th Year Medical Student, University of Cambridge

Spanish Flu of 1918 was experienced unequally, with higher rates
  of infection and mortality among the most disadvantaged

As Covid-19 began to spread rapidly across the UK in early March, politicians and the media were keen to tell us that we were ‘all in it together’ and that the virus ‘does not discriminate’. As time passed, it became apparent that this wasn’t the case.

We now know that Covid-19 is far from a socially neutral disease, with clear clusters of more severe impact amongst our most deprived and marginalised communities.

We now know that people living in more socio-economically disadvantaged neighbourhoods and minority ethnic groups have suffered more with higher infections and death rates.

Historically, this has also been the case - evidence has shown that previous pandemics including the Spanish Flu of 1918 and the H1N1 pandemic of 2009 have also been experienced unequally, with higher rates of infection and mortality among the most disadvantaged parts of the country – both in the UK and internationally. 

Emerging evidence from a variety of countries suggests that these inequalities are being mirrored today in the Covid-19 pandemic. Both then and now, these inequalities have emerged through the syndemic nature of Covid-19, as it interacts with and exacerbates existing social inequalities in chronic disease and the social determinants of health.

The syndemic of COVID-19, non-communicable diseases (NCDs)
 and the social determinants of health

This is down to a number of factors – not least unequal exposures to the social determinants of health (the conditions in which we are born, grow, live, work and age) leading to higher rates of almost all of the known underlying clinical risk factors that increase the severity and mortality of Covid-19 (e.g. high blood pressure, diabetes, cardiovascular disease).

We may have been living under the same regulations, but across the country, our experiences of ‘lockdown’ were widely different. We knew this. We weren’t ‘all in the same boat’ - we were in the same ocean in the middle of the same storm - but some were on luxury liners and others on rapidly-deflating dinghies.

We saw lower-paid care workers, shop workers, transport workers, factory workers continuing to work face-to-face with the public, while others worked from home on full pay or were furloughed with some semblance of job security.

There were families trying to stay sane in small flats without outdoor space and with empty cupboards, whilst others in more fortunate circumstances trebled their flower delivery order to ensure their homes looked good during Zoom meetings.

 

The divide in our society is stark on many levels, and as we go forward, who will pay the price of the multi-billion pound interventions that the government has put in place to see us through this period, and bear the brunt of the post-Covid-19 global economic slump? 

Covid-19 has laid bare our longstanding social, economic and political inequalities. Even before the pandemic, life expectancy amongst the poorest groups was already declining in the UK and the USA and health inequalities in some European countries have been increasing over the last decade.

I know that this all makes for grim reading for researchers, practitioners and policymakers concerned with health inequalities. So what can we do?

It is vital that this time, the right public policy responses, such as expanding social protection and public services and pursuing green inclusive growth strategies, are undertaken so that the Covid-19 pandemic does not increase health inequalities for future generations. Public health must ‘win the peace’ as well as the ‘war’. It is our job to make that case.

As we start to shape our ‘new normal’ and as the government unveils its post-Covid-19 recovery plans for the UK, public health policy must be a priority.

We need to act now if we want to avoid deepening the health inequality divide even further for generations to come.

Read the full essay: The Covid-19 pandemic and health inequalities

With thanks to the NIHR Applied Research Collaboration North East & North Cumbria 

Image attribution:

1. Otis Historical Archives, National Museum of Health and Medicine / Public domain. https://commons.wikimedia.org/wiki/File:Emergency_hospital_during_Influenza_epidemic,_Camp_Funston,_Kansas_-_NCP_1603.jpg
2. The syndemic of COVID-19, non-communicable diseases (NCDs) and the social determinants of health (adapted from Singer and Dahlgren and Whitehead). With acknowledgement to Chris Orton from the Cartographic Unit, Department of Geography, Durham University, for his assistance with the graphics. https://jech.bmj.com/content/early/2020/06/13/jech-2020-214401.full?ijkey=haFkUOyJurtabHz&keytype=ref#F1
3. Screenshot taken from the Financial Times website: https://www.ft.com/content/8ea1c992-89f8-11ea-a109-483c62d17528 09/07/2020