1 year on since lockdown began – our lives have changed but what lessons have we learned?

This time last year we headed into our first lockdown. No one could have foreseen the journey ahead of us. The effects of COVID-19 have touched every aspect of our way of life. But what have our collective experiences over the past 12 months taught us about the impact of COVID-19 on the nation’s health?

One of the most immediate and apparent lessons has been the value of robust crisis planning to ensure the continuation of health services. As the country shut down, so did routine appointments and other health checks. From cancer referrals to reproductive health appointments, NHS referrals and waiting times have reached a record high. People have themselves felt understandably anxious around visiting hospitals and GP clinics in the early days of the pandemic, with 76% of people uncomfortable visiting a hospital and 63% with visiting their GP due to fears of being exposed to coronavirus. While services were able to be more maintained during the second lockdown, there can be no question that we are yet to fully realise the wider impact of the pandemic on people’s health.

Not least because while the NHS backlog and growing waiting times are some of the more immediate health consequences of coronavirus, a slower burning fuse has also been lit – the impact of the economy on people’s livelihoods and long-term health.

Loudly and clearly, the pandemic has shown the role of the wider determinants of health. From employment and income, to education and housing, the pandemic has brought all these areas into sharp focus – with millions of school children having to shift to learning online, 1.9 million people spending the last 6 months unemployed or on furlough and nearly 70% of adults in the UK feeling worried about the impact of COVID-19 on their life. Some groups have felt this more than others, with young people and those from minority ethnic communities more likely to have experienced job loss, furloughing or reduced pay during the pandemic.

While many of us went into lockdown expecting the pandemic to be over by the summer, a year on, the duration of the economic and social consequences of the pandemic is a cause for concern. For example, the persistently low paid have been more than twice as likely to report very low life satisfaction, very low happiness and feelings of worthlessness during the pandemic, compared to those with no loss of pay. Furthermore, one in three households in England had at least one major housing issue prior to the pandemic, therefore spending more time in overcrowded, unaffordable and poor-quality homes as a result of lockdown measures.

As we recover from the pandemic, the challenge for decision makers is whether we extinguish the burning fuse and use the social upheaval to – in the words of Michael Marmot – build back fairer, or whether inequalities and their consequences for people’s health and society as a whole become further entrenched.

The Health Foundation’s COVID-19 impact inquiry is assessing the impact of the pandemic on health and health inequalities across the UK and will bring forward the evidence needed to rebuild a fairer society. An important part of this evidence is the perspectives of a range of diverse organisations and individuals who have shared how the pandemic has impacted them. By taking stock of these experiences, we will use our findings to provide a robust analysis for the government to build its COVID-19 recovery plans.

Ultimately, the pandemic has taught us that a healthy population is one of our nation’s most important assets. Good health is key to economic growth and should be at the heart of the levelling up agenda. Creating a healthy society requires more than a first-class health care system. From education, to housing, to good quality work and a decent safety net – all need to be part of the recovery. Health care professionals have long enjoyed high public trust – perhaps now more than ever. Which is why the collective voice of the health sector can be instrumental in advocating for a recovery that addresses the root causes of poor health and leads to a stronger, healthier society.

Jo Bibby (@JoBibbyTHF) is Director of Health at the Health Foundation.

This blog was originally published by the BMJ on 23 March 2021.