Emerging evidence on health inequalities and COVID-19: June 2020

In early May, a Health Foundation long read asked whether the coronavirus (COVID-19) pandemic could be a watershed moment for health inequalities. Since then, we have been rounding up the emerging evidence about the unequal impact of the virus and the wider governmental and societal response.

As the period of lockdown continued through June we learned more about these unequal impacts. Here, we give an overview of some of this emerging evidence. While the progressive lifting of lockdown measures began during June, much of the evidence presented reflects the period of full lockdown and the early stages of restrictions being eased.

The unequal risk of becoming seriously ill with COVID-19

It has been clear since the early stages of the pandemic that the health impacts are likely to be unequal, and to exacerbate pre-existing health inequalities. The risk of becoming seriously ill or dying with COVID-19 is greater among people living in more socioeconomically deprived areas, and for black and minority ethnic groups. Recent reports have deepened our understanding of why this is.

Geography

The Institute for Fiscal Studies’ Deaton Review has reported on the geography of the COVID-19 crisis in England, looking at vulnerability to the direct health impacts of the virus together with the economic and social impacts. The report shows how vulnerability in health, jobs and families relate to each other, and identifies nine local authorities that are more vulnerable than average on health, economic and social lines. These local authorities are spread across the country and include both urban and rural areas. The vulnerabilities differ across the country though, with coastal towns being vulnerable in terms of jobs and health, the northern spine of England due to the age profile of the population and deprivation, and London – despite a relatively young and healthy population – due to its reliance on tourism and hospitality, and poor children missing out on schooling. 

More on this topic:

• Analysis of ONS data by Inside Housing looks at COVID-19 deaths in relation to levels of overcrowding, social housing and homelessness in local authorities. We will focus in more depth on housing in a future blog.
• The Resolution Foundation reports on local differences in the economic impact of COVID-19.
• The IPPR looks at the impacts of austerity in the north of England in the decade prior to the pandemic.

Ethnicity

Public Health England has published findings of a literature review and stakeholder engagement activity, aimed at understanding why black and minority ethnic communities are disproportionately affected by COVID-19. Beyond the data discusses the role of factors associated with ethnicity including occupation, population density, use of public transport, household composition and housing conditions including overcrowding in COVID-19 transmission, and of inequalities in pre-existing health conditions in morbidity and mortality. Critically, the report highlights that many of those consulted highlighted the role that racism, discrimination, stigma, fear and trust have played in the unequal impact of COVID-19 on minority ethnic communities. 

More on this topic:

• A report in the BMJ highlights how fear of accessing health care is a potential route for widening of health inequalities in black and minority ethnic groups. 
• A report from the Race Equality Foundation highlights a lack of translated materials on shielding for the Chinese community in Manchester.

The unequal impact of COVID-19 on children and young people

In our previous round up we focused on some of the ways in which COVID-19 has been unequally impacting children and young people through school closure and economic impacts. The ONS reports in June that a fifth (21%) of adults with school-aged children had been asked to send their children back to school, and two-thirds (67%) said their children were now attending school some or all of the time. As previously reported, there are likely to be inequalities in which children return, and vulnerable children will have been at particular risk during school closure.

The Early Intervention Foundation has reported on the pandemic’s impact on services that support vulnerable children. They have identified some benefits in the form of virtual and cross-agency working, but also serious concerns about difficulties of protecting vulnerable children when home visits were severely restricted. And many vulnerable children were not in school or early years provision, meaning less opportunity for teachers to identify and monitor safeguarding concerns. The report also highlights fears that the full extent of the hardships faced by families have not yet become apparent, and that services will be overwhelmed by demand in the coming months as lockdown eases. 

More on this topic:

• The NPC and the Centre for Youth Impact report on how youth services can create safe online spaces for children. 
• Not specifically in the context of COVID-19, but particularly important due to the potential impact of this, the What Works Centre for Wellbeing report on measuring wellbeing in schools and colleges.

The unequal economic impact of COVID-19

A comment piece in the Lancet explores the unequal impacts by gender. Women are more likely to work in health and social care roles, are more likely to be doing unpaid care work for children and elders, and are more likely to experience job loss. Calls for actions to address this include governmental and organisational policies that increase the opportunities for both women and men to combine paid employment and unpaid caring, provision of high-quality child and elder care, and means of quantifying unpaid care to allow financial support and pension systems that account for this.

More on this topic:

• The Institute for Fiscal Studies draws together evidence in a comprehensive report on inequalities during the pandemic, focusing on economic inequalities.
• The ONS released statistics on personal and economic wellbeing showing further signs of increasing economic inequality.
• The Resolution Foundation reports on the role of Britain’s wealth inequality on the wider economic impact.
• The Resolution Foundation reports on family incomes and spending

The unequal impact on mental health

We previously focussed on the impact of the pandemic on mental health and the importance of this for long-term health inequalities. Since then, a report from the UCL study on mental health impacts of the pandemic found that people with lower household incomes, a mental health diagnosis, younger adults, those living alone and those in urban areas are less likely to go outdoors for at least 15 minutes a day, and are most at risk of loneliness, depression and anxiety.

More on this topic:

• The ONS reports on changes in anxiety in the population between April and May.
• Health Foundation analysis explores how changes in people’s economic circumstances relate to their mental health during the early lockdown period.

Conclusion

Growing understanding about some of the mechanisms by which COVID-19 may be exacerbating health inequalities – and producing new ones – points to important areas for mitigating action. The gradual opening up of the economy during July brings many new challenges that it will be important to monitor and understand, but also opportunities for action on health inequalities. An upcoming Health Foundation long read will explore these further.

The health of the whole nation is one of its key assets, and it is vitally important that the reduction of health inequalities plays a central role in the unlocking and recovery of the economy. We will continue to round up emerging evidence as this gradual emergence from lockdown progresses over the coming months.