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

In early May, a Health Foundation long read asked whether coronavirus (COVID-19) could be a watershed moment for health inequalities. Since then, we have been rounding up emerging evidence about the unequal impacts of the virus and the wider governmental and societal response.

Lockdown measures continued to ease across the UK during July, with some localised tightening in response to local increases in infections, but the pandemic continues to have an unequal impact on society. Much of the evidence emerging over the past month still reflects the period of full lockdown, but some evidence is starting to capture the early stages of restrictions being lifted. Here, we give an overview of some of the evidence emerging from July.

The unequal impact of COVID-19 in different parts of the country

From the outset of the pandemic, local areas have been affected differently and have needed to respond in different ways to the crisis, with Directors of Public Health leading local responses. As our recent long read Learning from lockdown highlights, local leadership and innovation, such as Barnsley’s new vulnerability index, has helped to mitigate some of the worst impacts of the crisis on the most vulnerable people in society. 

Polling by the Local Government Association reveals that trust in councils has increased during the pandemic: in June 2020, 71% of residents reported trusting their council, an increase of 12 points from February. In contrast, research from the University of Oxford presents a substantial decline in trust in the UK government: from 67% in April to 48% by the end of May.

The all-party parliamentary group for ‘left-behind’ neighbourhoods has published analysis of the impact of COVID-19 on these areas, bringing together a range of socioeconomic data. Residents of these so-called ‘left-behind’ areas are unequally impacted by both clinical and financial risk as a result of the pandemic. There is also less evidence of a strong response from the voluntary and community sector in these areas. The report states this may not be surprising, as these areas are in part defined by having a relative lack of community assets, social infrastructure and a less well-developed civil society sector. However, this finding highlights the ways in which such communities are vulnerable to the impacts of the pandemic and lack protective measures to mitigate these.

More on this topic:

• The New Local Government Network has published a report on the role of mutual aid in the COVID-19 response.
• The innovation foundation Nesta has called for more equal spending on research and innovation across the UK as part of recovery plans, following analysis showing research spending is concentrated in the south-east of England.
• Research from the Institute for Fiscal Studies highlights different ways and extents to which local authorities are exposed to financial risk as a result of the pandemic.

The unequal impact of COVID-19 on employment

In previous round up blogs, we have highlighted inequalities in who has been most impacted by reduced employment and/or income during the pandemic. This includes those in low-paid jobs, young people and female parents. Further evidence has emerged about the unequal impacts on these groups.

Resolution Foundation analysis of a YouGov survey commissioned by the Health Foundation found that the hospitality and retail sectors have suffered some of the worst blows of the economic crisis, in part explaining the disproportionate impact on 18 to 24-year-olds. The report recommends measures such as increasing spending on social care by £5bn to create 180,000 jobs, recognising prospects in the hospitality and retail sectors are unlikely to improve soon.

The government’s Summer Economic Update focused on reducing the impact of the COVID-19 crisis on the job market, including the creation of short-term jobs for people aged 16–24 at risk of long-term unemployment. Analysis from the Resolution Foundation highlights a huge challenge ahead to deliver these ambitions.

Research from King’s College London and Ipsos Mori found gendered differences in work and childcare during the crisis. In May, female parents reported spending 7 hours on childcare in an average weekday, compared with 5 hours for male parents.

More on this topic:

• The Institute for Employment Studies found that employment fell significantly between February and April for those in low-paid jobs, with no statistically significant change in the likelihood of being in work for those in higher paying jobs. 
• The IPPR published a new report on preventing youth unemployment after COVID-19, highlighting that without further government action there could be an additional 620,000 young people unemployed by the year.
• An article published in the British Medical Journal highlights that workers based in slaughterhouses and meat packing plants are at greater risk of COVID-19 infection.

The unequal impact of COVID-19 on finances

The Health Foundation has published new analysis exploring the relationship between income and health outcomes, and how the pandemic is exacerbating long-term inequalities in income and health. The analysis found that people in the bottom 40% for income were almost twice as likely to report poor health than those in the top 20%. The economic consequences of COVID-19, and its disproportionate impact on people with low incomes, risks fuelling greater health inequalities in the future.

The pandemic has had a huge impact on people’s incomes. Polling from the Citizens Advice Bureau found 38% of households reported lost income because of the crisis, with nearly 1 in 10 households reporting loss of 80% or more.

There is also mounting evidence that people who were already on low incomes have been hardest hit. The IFS reports that the poorest fifth of households have been hardest hit in terms of earnings, with a fall in median household earnings of around 15%. All other quintiles saw a fall of 4–5%. Total income for the poorest group has not fallen further behind the average reflecting temporary increases in benefits.

The Money Advice Trust published findings from their survey of National Debtline callers. Worryingly, this found that 90% of people calling reported having no savings to protect them against the impact of a drop in income. 25% of respondents with savings had already used these up during the pandemic.

More on this topic:

• The IFS has examined changing living standards and found that despite temporary changes, the benefits system provides less support to out-of-work households than in 2011.

The unequal impact of COVID-19 on mental health

New analysis of the UK Household Longitudinal Study, published in the Lancet, found that mental health in the UK had deteriorated by late April 2020, compared with pre-COVID-19 trends. This was particularly apparent in women, young people, and those with young children.

Pre-existing mental health conditions are also a risk factor for declining mental health during lockdown. A survey by Mind found that 65% of adults and 75% of young people surveyed reported that their mental health had worsened from early April to mid-May. Women, people with disabilities and those living in social housing were most likely to report declines.

Across the wider population, the ONS found that while average anxiety levels had been falling since a peak in March, this trend reversed during the first 2 weeks of July, when lockdown measures began to be eased.

The People and Nature Survey for England found that 36% of adults are reporting spending more time outside since COVID-19 restrictions began, with 85% agreeing that ‘being in nature makes me very happy’.

More on this topic:

• The ONS has also published analysis on people who are clinically extremely vulnerable. 60% reported in June that their mental health had stayed the same since being advised to shield, while 29% reported their mental health worsening. A further 7% reported it had got much worse.
• A Young Minds survey of people aged 13–25 found 80% of respondents reported worsening mental health, often related to feelings of anxiety, isolation, loss of coping mechanisms or loss of motivation.

Conclusion

While the further lifting of lockdown has meant a return to many aspects of pre-pandemic life for many people across the UK, local lockdowns and increased caution nationally at the end of July serve as a reminder that the pandemic is far from over, and some areas and groups are being affected more than others.

The impacts of COVID-19 will be long lasting – for some groups more than others. As we’ve highlighted throughout the crisis, health inequalities could widen without concerted government efforts to address their causes. Restarting the economy is now the government’s priority. An inclusive recovery is needed that provides everyone with the opportunity of a healthy future.

Cara Leavey (@caraleavey) is Policy and Programme Officer at the Health Foundation.

Isabel Abbs is Policy Support Officer at the Health Foundation.

Louise Marshall (@louisemarsha11) is Senior Public Health Fellow at the Health Foundation.