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

A recent Health Foundation long read suggests that the coronavirus (COVID-19) pandemic could be a watershed moment in creating the social and political will to build a society that values everyone’s health – now and in the long term.

The global pandemic, and the wider governmental and societal response, is certainly bringing health inequalities into sharp focus. And it has been apparent from the early stages of the pandemic that some groups are at much higher risk of catching and dying from the virus than others. Factors such as age, gender, ethnicity and socioeconomic deprivation are all known to be important. Critically, these factors combine in complex ways to put some people at much greater risk.

In addition, the measures taken to control the spread of the virus are having unequal socioeconomic impacts, which are likely to deepen health inequalities in the long term. Over the coming months, the Health Foundation will continue to round up key evidence on COVID-19 and inequalities. Here, we give an overview of some key themes emerging from recent work on the unequal impact of COVID-19, focusing on how children and young people are being affected, and the economic effects of the pandemic.

The unequal risk of becoming seriously ill from COVID-19

Public Health England’s COVID-19: review of disparities in risks and outcomes has added to previous evidence that shows the impact of the virus has replicated existing health inequalities, in some cases increasing these. The greatest risk factor for dying with COVID-19 was found to be age, but the risk was also higher among those living in more socioeconomically deprived areas, among black, Asian and minority ethnic groups, and in certain occupational groups. The report, however, did not examine how many of the underlying, upstream factors driving health inequalities across different population groups have contributed to these COVID-19-related inequalities.

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

Education and skills

While children and young people are at much lower risk of becoming seriously ill with COVID-19, various strands of emerging evidence suggest that they may be hit hardest by the measures introduced to control the pandemic.

One concern is that the closure of schools may widen existing educational inequalities. This is important for long-term health inequalities as by the age of 30, those with the highest levels of education are expected to live 4 years more than those with the lowest levels of education. The Sutton Trust has been monitoring the impact of school closures and found wide disparities in the ability of pupils to learn at home. Pupils from middle class homes are twice as likely as those from working class homes to take part in online lessons (30% versus 16%). Over half of primary (51%) and secondary (57%) pupils at private schools have accessed online lessons daily, which is more than twice as likely as those at state schools.

Similarly, the Institute for Fiscal Studies has found that children in higher income families were spending 30% more time on home learning that those from lower income families – and that higher income families were more willing for their children to go back to school when they reopen. This may lead to a situation where those struggling the most with home learning remain at home, while those who have spent the most time learning at home return to school, risking significant increases in educational inequalities.  

More on this topic:

• A Sutton Trust report on university access and student finance.
• A Sutton Trust report on the impact on apprenticeships.

Employment prospects for young people

There are also concerns that young people who have completed their education may be bearing the brunt of the economic impact of COVID-19. The Resolution Foundation’s coronavirus survey found that the youngest and oldest earners have been hit hardest by job losses and pay reductions. One third of those aged 18–24 have lost jobs or been furloughed – twice the proportion of those aged 35–49.

The Resolution Foundation estimates that an additional 640,000 18–24-year-olds could find themselves unemployed over the coming year, with evidence from previous recessions indicating the most severe effects on unemployment are among young people recently leaving education and those with fewer qualifications. This could impact these young people for many years to come, through long-term scarring of their employment and pay prospects and this, in turn, is also likely to widen health inequalities. 

The unequal economic impact of COVID-19

The economic impact of lockdown was immediate. Government figures published in mid-May show that on 9 April 2020 – just a couple of weeks into lockdown – there were 4.2 million people on Universal Credit. This represented an increase of 1.2 million people (40%) in one month. Most claimants during the pandemic are ‘searching for work’ (those not working or on very low earnings who are required to be taking action to secure work as a condition of receiving benefits). This increased by two-thirds from 1.1 million to 1.8 million people between 13 March and 9 April.

Those being hit hardest by the economic impacts of COVID-19 tend to be those who were already economically vulnerable. The Resolution Foundation found a clear gradient in loss of jobs and of hours, as well as furloughing, across the earnings distribution, with 30% of the lowest earning fifth of employees having been furloughed or lost jobs, compared to 8% of the highest earning fifth. The Understanding Society survey of UK households has also found that the lowest earners have been worst hit by loss of earnings, with the most severe losses for single parents. In the highest income bracket, average earnings have fallen by £46 a week from an average of £832, while in the lowest bracket they have fallen by £43 a week from £297. On average, single parents’ earnings have fallen by more than double the amount in households that have children and more than one adult.

There is also evidence that the economic shock of COVID-19 has had an almost immediate effect on people’s mental health. Both the Mental Health Foundation and ONS have reported far higher levels of anxiety and feelings of not coping well with stress among those financially impacted by the pandemic. One fifth of people surveyed by the Mental Health Foundation, who identified as unemployed, reported suicidal thoughts in the previous fortnight. This compared with 9% of those in employment. Given the socioeconomic gradient in loss of income and jobs, this mental health burden and the long-term health impacts of job losses will also be unequally distributed across society.

The closure of schools and childcare facilities has posed a significant challenge to parents and affected their ability to continue working. There is evidence that this impact may affect women more than men. The Institute of Fiscal Studies looked at how families have balanced work and family life during lockdown, finding mothers have taken on more childcare, home education and housework than fathers since schools closed. Mothers are also more likely to have lost work or been furloughed, which could widen gender disparities in pay and work over the longer term.

More on this topic:

• The Food Foundation reported on borrowing money or going into debt and food insecurity as a result of COVID-19.
• The Child Poverty Action Group highlighted the impact of the benefit cap on households during the pandemic.
• A Resolution Foundation report on the economic impacts on different groups of workers.

Conclusion

There is a real danger that COVID-19 will increase inequalities. The government response to this crisis must be designed to mitigate this by taking account of the ways in which some people bear the brunt of multiple impacts. Those hardest hit by the pandemic tend to be those already most disadvantaged. In the recovery phase, policy must also take a long-term view and consider the potentially life-long impacts of the pandemic on children and young adults.