This month, Wales reached the tragic milestone of 5,000 official deaths attributed to COVID-19, almost doubling the rate of deaths from the virus in just a couple of months. What this figure doesn’t reveal is that, proportionally, Wales has recorded some of the highest death rates in the UK. Of the six localities in the UK reporting the highest death rates per capita, five are located in Wales, with the highly deprived areas of Merthyr Tydfil and Rhondda Cynon Taf taking the top two spots. 

Wales may count fewer citizens than the rest of the UK, but its smaller population size masks the fact that its population are among those who have carried COVID-19’s greatest burden. To better understand the impact of COVID-19 on Wales, I recently participated in a roundtable where we gathered evidence and perspectives from different communities to inform the Health Foundation’s COVID-19 impact inquiry – an initiative exploring the pandemic's implications for health and health inequalities. We discussed the areas where the country has been most impacted during the pandemic, and opportunities for these issues to be addressed. 

We agreed that, to an extent, Wales has had certain advantages over the rest of the UK when responding to the threat of COVID-19. Unlike in England, NHS organisations are integrated in Wales, covering all aspects of care – from primary care to mental health. The system is also smaller and more contained than in England, facilitating strong partnerships both internally and with external stakeholders. Since the outbreak of COVID-19, this has enabled the Welsh health system to ensure consistency across services, supporting the effective allocation of PPE and improving access to digital health care across the country, while still benefiting from close collaboration with NHS England and policymakers.

Yet, if our health response has been so co-ordinated, why are Welsh death rates so high? The simple answer is that health care is not the only contributor to overall health outcomes – or whether people catch and survive COVID-19, or don’t. Many other factors come into play, across both the short and long term.  

Perhaps the most crucial element concerning governments during the pandemic has been the impact on employment. Wales was already experiencing the long-term effects of endangered manufacturing industries, and a greater reliance on public sector jobs which had been hit by austerity and cuts even before the pandemic. Wales also has the highest rate of people claiming furlough and Universal Credit, with research from Wales TUC highlighting that one in three workers in Wales think that their financial situation is only going to worsen in the next 6 months.

Unlike health care services, however, the economic response to the pandemic – and programmes such as furlough and Universal Credit – are managed by the UK government. These programmes are designed to be a one-size-fits-all approach, and therefore do not always accurately reflect the differing needs of our population.

Wales has a markedly different demographic make-up to the wider UK population, and was experiencing heightened inequalities even before the pandemic. This has put people in Wales at greater risk from COVID-19 and being negatively impacted by the measures designed to mitigate the spread of the virus. As an example, a quarter (25%) of the population in Wales are disabled (compared to 21% in England). This undoubtedly has contributed to the even greater disparity in COVID-19 related deaths among this group; in July, the Office for National Statistics reported 68% of Wales’ COVID-19 deaths were attributed to disabled people, compared to 59% in England. 

These differences have not only impacted people in Wales in the here and now, but also put the population at a high risk of longer-term health impacts from the pandemic. According to Citizens Advice Cymru, 93% of people who have lost a job since the pandemic have begun to feel the coronavirus outbreak has had a negative effect on their wellbeing. 

Closer collaboration between governments is crucial to ensure the way the pandemic has impacted differently on Wales is reflected in the way UK interventions are designed and allocated. Policies for health and economic opportunity must work in tandem, and be agreed quickly, to tackle increasing inequalities.

We know that health provision is only a small part of the response to, and the overall impact of, the pandemic on Welsh lives. We must now consider the social and economic impact of lockdowns and restrictions, as a result of both the Welsh and UK governments’ response measures. As we embark on our recovery, it is crucial we understand how inequalities in Wales have contributed to the COVID-19 death toll, and how the wider impacts of the pandemic could affect life expectancy for people in Wales in the longer term. Only then can we hope to address longer term impacts to people’s physical and mental health resulting from their income, housing and access to education having been affected by this crisis.

To what extent have people in Wales been at a disadvantage during the pandemic? That is the question we hope to address in the coming months, to ensure that in the future everyone can enjoy the same opportunities for good health and wellbeing, wherever they live.

Auriol Miller is Director of the Institute of Welsh Affairs (IWA) and member of the Health Foundation’s COVID-19 impact inquiry expert advisory panel.

Sign up to receive updates about the COVID-19 impact inquiry. 

This blog was originally published in Western Mail print edition.

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