In December 2019, the COVID-19 pandemic quickly spread around the world. In 2020, the NIHR SPHR funded Health Inequalities research team responded to the NIHR’s call to respond to the pandemic by adapting the focus of the planned research to focus on the new pandemic. Along with our colleagues at the Northern Health Sciences Alliance and the NIHR ARCs in North East and North Cumbria, East of England, Greater Manchester, Yorkshire and Humber, and North West Coast, we began a programme of research investigating inequalities in COVID-19.
Our research and why it is useful
COVID-19 is a global pandemic, affecting all parts of the world and all parts of society and significantly affecting the way we live and interact with each other. It has caused unprecedented costs to the NHS, public health, social care and the national economy. Everyone, from all walks of life, has been affected by the pandemic. But, as our NIHR School of Public Health Research has shown, some people have been – and will be – far more affected than others: COVID-19 is an unequal pandemic.
Our research has shown that COVID-19 infection rates are higher in more deprived regions, amongst people with low incomes, and in urban compared to rural areas. COVID-19 deaths are twice as high in the most deprived neighbourhoods of England compared to those in the most wealthy areas. There are even more stark inequalities by ethnicity and race, with minority ethnic groups experiencing death rates that are up to three times as high as their white majority counterparts. Emergency measures taken to contain the virus, including lockdowns, have also impacted people unequally, and the growing economic crisis created by the pandemic is already being experienced unequally.
In summary, disadvantaged communities such as minority ethnic groups and people living in poverty face higher exposure to COVID-19. When infected, they are more likely to suffer severe health consequences than more advantaged groups. Factors such as housing and working conditions, access to healthcare, and risk of gender-based violence make lockdowns have an unequal effect on physical and mental health as well.
Our research highlighted these inequalities and the extent of them to practitioners, policymakers, the media and the public, examining how and why COVID-19 is an unequal pandemic. It also identified the causes of these inequalities and potential ways we can try to reduce the impact of them.
Our researchers raised awareness of inequalities in COVID-19 to policymakers, practitioners, the media and members of the public. Their work demonstrates the flexibility that the team was able to achieve in order to meet this emerging national and global emergency.
- The research published in the Journal of Epidemiology and Public Health summarised the emerging national and international data on inequalities in COVID-19 in terms of the fact that in wave 1, the COVID-19 death rate was twice as high in deprived areas when compared to affluent areas, and up to three times as high in minority ethnic groups. We compared inequalities in COVID-19 to the historical data relating to the Spanish Flu Pandemic of 1918.
- Their research examined the pathways leading to inequalities in COVID-19 by developing the concept of a ‘syndemic pandemic’. This is the concept that the severity of the COVID-19 pandemic is magnified by existing inequalities in chronic diseases and the social determinants of health. Therefore, the impact of COVID-19 is felt more strongly by groups who are already disadvantaged.
The team produced this visualisation -‘The syndemic of COVID-19, non-communicable diseases (NCDs) and the social determinants of health’. It has been used in several policy reports on the pandemic including the Chief Medical Officer for Wales in his 2021 Special Report on COVID and was used by the EU policy think-tank Eurohealthnet in their factsheet on research on the COVID-19 pandemic and health inequalities. This was circulated to their 10,000 members in policy and practice across the EU.
- As a result of this work, the team were commissioned by Independent SAGE to lead their report on inequalities. This was presented to over 8,000 practitioners, policymakers and members of the public via the Independent SAGE Friday online briefing in November 2020. The discussion panel included the Shadow Secretary for State for Health.
- The research was presented to Public Health Wales, the Norwegian Agency for Development Cooperation, the French Institute of Public Health, EU Commission Science Committee on Crisis Resilience, Response and Preparedness, UNESCO, the All Party Parliamentary Group for Left Behind Areas, the German Public Health Association, and the Integrated Care System Prevention Board North East and North Cumbria (NENC) and the Deep End GP network NENC.
- The work on examining the regional inequalities in mortality from the 1918 pandemic in England and Wales received widespread social and print media coverage including the Daily Telegraph, Daily Mail and regional newspapers.
- We also published work on the gender-based health inequalities arising from the COVID-19 pandemic in terms of health and the economy. Decades of international research shows that, across Europe, men have shorter life expectancies and higher mortality rates than women, and yet, women report higher morbidity. These gender-based health inequalities also appear to be evident within the COVID-19 pandemic and its aftermath. It was presented to the EU Commission and featured extensively in a DG Justice and Consumers report on Gender and Health.
- The team examined the disproportionate impact of COVID-19 on the North of England in terms of health and the economy. They found that there were an additional 12.4 deaths per 100,000 in the North compared to the rest of England in the first wave of COVID-19, that unemployment rates during the pandemic are higher in the Northern regions, and that reductions in mental well-being in the Northern Powerhouse during the pandemic could cost the UK economy up to £5 billion in reduced productivity. When published in November 2020, it received widespread national social and mass media coverage including BBC One News, ITV News, Sky News, Guardian, Times, Independent as well as coverage in regional newspapers including the Yorkshire Post. It was sent to all MPs in the Northern regions with follow up conversations by our report partner the Northern Health Sciences Alliance. It was cited in Public Health England’s 2021 guidance on health inequalities, Inclusive and Sustainable Economies: Leaving no one behind.
- Equal England also hosted three joint webinars with the NIHR ARCs in October and December 2020 and April 2021 on COVID-19 and inequalities which attracted over 200 participants per event from across the SPHR Equal England: Health Inequalities Knowledge Exchange Network.