‘Levelling up’ just got much harder Launch of the Health Foundation’s COVID-19 impact inquiry

Without doubt the coronavirus (COVID-19) pandemic is the biggest crisis to hit the UK in living memory. The growing toll of COVID deaths and cases is evidence that this is a genuine health emergency. But the impact on job losses, business failures and rising domestic violence are a reminder this is also an economic and social crisis that will have its own impact on the nation’s health.

Our new analysis suggests that the combined effect of the virus and the restrictions imposed by government have compounded existing health inequalities. It suggests that those living in the nation’s poorest areas – who already had lower life expectancy than those in better off areas – are now facing worsened long-term health outcomes linked to intense financial hardship.

The pandemic is also taking its toll on people who previously had the job and housing security that underpins good health. Our research reveals that some less socioeconomically deprived areas are experiencing above average increases in Universal Credit receipt – a strong indicator of economic hardship.

Understanding how COVID-19 will affect health inequalities and health outcomes is crucial if government is to manage the pandemic response and the recovery in ways that help people lead healthier lives in future. It is also essential if the government is to deliver on its commitment to levelling up the poorest parts of the country. 

The COVID-19 impact inquiry

This is why the Health Foundation is today launching its COVID-19 impact inquiry, a UK-wide inquiry exploring the pandemic's implications for health and health inequalities. The inquiry, which will report in the summer of 2021, is being guided by a panel of leading figures in epidemiology, economics and the breadth of influences on people’s ability to lead a long and healthy life.

Drawing on evidence from numerous data sources, the inquiry will examine the impact of the virus, of lockdowns and the other measures used to control it, on key areas of life including health, the health care system, employment and education. It will consider how deprivation, age, gender, ethnicity, mental health and disability have affected people’s experiences of the pandemic.

The COVID-19 impact inquiry builds on the work of our previous research exposing how, before the pandemic hit, the UK was already falling behind comparable countries on life expectancy. Our report Mortality and life expectancy trends in the UK showed that the UK has a lower life expectancy and slower improvements in life expectancy than comparable high-income countries. The Marmot Review 10 Years On highlighted large and growing gaps in health between different communities.

The challenge of trying to protect people from the virus while ensuring that these pre-existing inequalities are not exacerbated is perhaps one of the greatest public policy challenges facing the country. We hope the COVID-19 impact inquiry will help to inform those efforts.

Before COVID-19 there was a gap of nearly 10 years between life expectancy in the most and least deprived communities. COVID-19 deaths have followed a similar pattern with mortality rates twice as high in the most deprived 10% of areas compared with the least deprived areas. It is also clear that ethnicity, occupation, gender, age, and local area all contribute to some people being at much higher risk than others, with multiple characteristics heightening their risk. Disabled people have been hit particularly hard with death rates two to three times higher than non-disabled people (ONS).

Our new analysis shows that the UK’s most deprived local authorities have borne the brunt of the impact of COVID-19 and the response to the pandemic:

• 5 of the 10 local authorities with the highest excess mortality rates during the first wave of the pandemic were from the 30% poorest areas, only two were from the most affluent 30% of local areas.
• The share of the population receiving Universal Credit – an indicator of economic hardship – increased on average by 8.0 percentage points in the poorest 20% of local authorities, compared to 5.1 percentage points in the most affluent 30%.
• Before the pandemic, those same areas already had poorer health, with female life expectancy at birth in 2017–19 2.4 years lower than the 30% of people living in the least deprived areas.

This new analysis suggests that those living in the nation’s most deprived areas, who already had poorer health, are now at risk of worsened long-term health outcomes and intense financial hardship as a result of the pandemic.

However, the impact of COVID-19 and the response to the virus has been felt across the UK. No community has been spared with high excess mortality across all regions of the UK. The economic shock has been broad, with some of the greatest percentage increases in the receipt of Universal Credit occurring in the least deprived areas.

The COVID-19 impact inquiry will be guided and informed by an expert advisory panel, who will offer independent scrutiny of the inquiry’s findings and reach into wider networks of insight and influence. Panel members confirmed so far:

Clare Moriarty (Chair), Victor Adebowale CBE, James Banks, Yvonne Coghill, Sarah Davidson, Fozia Irfan, Polly Mackenzie, Professor Sir Michael Marmot, Robin McAlpine, Auriol Miller, James Nazroo, Vanessa Pinfold, George Davey Smith and Matthew Whittaker.

Heather Wilson is Programme and Policy Officer at the Health Foundation.

David Finch (@davidfinchthf) is a Senior Fellow at the Health Foundation.

Tim Elwell-Sutton (@tim_esPH) was Assistant Director of Strategic Partnerships in the Healthy Lives team at the Health Foundation. 

Mehrunisha Suleman (@MehrunishaS) is a Senior Research Fellow at the Health Foundation.