Emerging evidence on health inequalities and COVID-19: March 2021

People’s experiences of the pandemic have been shaped by their health and existing inequalities. The Health Foundation’s COVID-19 impact inquiry has been gathering evidence from a range of sources to better understand this.

Measures to control the virus have fallen unevenly across society – including the impact on women and key workers, as well as the wider implications for people’s mental health.

The impact on women

The Institute of Fiscal Studies has reported that school closures, job losses and furloughing have all had a significant impact on parents, especially mothers. The survey revealed that in April–May 2020 fathers were caring for their children for twice as many hours as they had been in 2014–15. Despite this, mothers were still more likely to have left paid work, reduced their working hours or spent their working hours simultaneously caring for their children.  

There is some emerging evidence that this has worsened over the course of the pandemic. The ONS reported that during the current lockdown, 63% of mothers have taken on responsibility for homeschooling compared with the first lockdown when parents reported splitting homeschooling more equally.

The University of Essex identified that women are more likely to experience a negative impact on their mental wellbeing due to increased family responsibilities, financial worries and loneliness. This burden is even greater for single parents as highlighted during the first lockdown:

‘We so far seem to be pretty stuck on the basics. Worrying about finding food and whether we will run out. Taking three children round a supermarket when they touch everything, run around, put their fingers up their noses, it’s very stressful!’

Violence and abuse

The pandemic has also had a worrying impact on gender-based violence and abuse. During the first wave of the pandemic, Women’s Aid reported that 61.3% of the domestic abuse survivors they support said abuse had worsened since the beginning of the pandemic, with perpetrators using the lockdown measures to increase their control over their partner’s lives. Over half, 53.3%, said that the pandemic had triggered memories of abuse and affected their mental health, with one woman saying:

‘Living with my ex felt like being imprisoned in my home. This lockdown has bought back feelings of fear, loneliness, isolation.’

Our evidence review found that the pandemic's impact has been felt even more acutely by women experiencing other inequalities such as disabled women, women from ethnic minority communities and women from working-class backgrounds.

More on this topic:

• Early findings from the University of Nottingham, the University of Warwick’s Institute of Employment Research and the UK Women’s Budget Group on the impact of COVID-19 on working-class women
• City University report on impact of COVID-19 on domestic abuse reported to the police
• LSE blog on the impact of the pandemic on women
• University of East Anglia paper on pregnant women’s experiences of health care during the pandemic

The effects on people’s mental health

The UCL COVID-19 Social Study shows that happiness and life satisfaction levels in January 2021 were at the lowest since the study began in March 2020. Encouragingly, both have been increasing in the past few weeks and are now similar to levels seen in June/July 2020. However, this is not yet seen in depression and anxiety levels, which have been worsening since the end of the summer until the data collection at the end of January.

Drivers of worsening mental health

Research by the University of Liverpool reported that a main driver for worsening mental health was social isolation, with those who feel more connected to their community having better wellbeing and quality of life. The UCL study also found that loneliness levels are at their highest since the first lockdown and have been increasing since the start of the January lockdown.

Some groups are affected more than others

Certain groups have experienced disproportionate effects on their mental health as a result of the pandemic. The mental health charity Rethink found that over three-quarters of people with pre-existing mental illnesses reported their mental health had got worse. People with an eating disorder, obsessive-compulsive disorder or a personality disorder were among those most likely to be affected.

Young people have been unequally impacted with higher levels of stress, anxiety, depression, loneliness and sleep loss. And those living alone have also been adversely affected across different outcomes.

In addition to experiencing one of the greatest increases in loneliness and higher levels of anxiety and depression symptoms, individuals from ethnic minority communities have also reported more thoughts of death or self-harm. The levels are the highest since the start of the first lockdown and were still rising by the end of January 2021.

Access to mental health services

Findings published in the Lancet show that adverse effects on people’s mental health during the pandemic coincided with a reduction in referrals to mental health services, diagnoses of depression and anxiety, and anti-depressant prescribing across the UK. Although these reductions returned to expected levels in England by September 2020, they remained a third lower than expected across the other nations.

Health Foundation analysis estimates a potential 11% more referrals a year for services in the next 3 years due to the pandemic. Furthermore, Mind found that more than a quarter of adults and young people did not access support because felt they did not deserve support and a quarter of those who tried to access support were not able to do so.

More on this topic:

• The Samaritans report on the impact of the pandemic on young people and self-harm
• Royal College of Psychiatrists find an increase in patients needing urgent and emergency care
• University of Glasgow research on mental health and health behaviours before and during the initial lockdown

Key workers and inequalities

Financial insecurity

Measures such as the Job Retention Scheme – which saw 4.5 million workers furloughed in January – and the temporary uplift of £20 a week to Universal Credit have provided important financial support during the pandemic. However, many key workers have continued to work what hours they can while at greater risk of infection.

YouGov reported that in some sectors designated key workers were ​not on secure contracts​ and suffered from lost earnings from having to self-isolate. Among essential workers, in sectors such as delivery, transport and food, nearly half felt that they would take a financial hit if they had to self-isolate, including 8% who would not get paid at all.

A parent, who has been working reduced hours as a school cook, reported:

‘Our kids have always been able to go to the fridge and get what they want but during the last couple of weeks we’ve had to tell them to slow down. It’s a sign that things are getting harder for us financially and so it’s essential we keep working.’

Negative impacts on mental health

Gender equality and women’s rights charity the Fawcett Society found that half of critical workers had experienced anxiety as a result of their work, with YouGov finding almost half of essential workers had experienced stress (49%) or anxiety (47%).

The mental health of doctors has been affected in a variety of ways – from worry about COVID-19 risk to dealing with death and feelings of exhaustion, as found in regular surveys by the BMA:

‘I feel like I am more concerned for my family members and even though they support me fully, it feels like I am opening them to risk unwillingly.’

‘One of the most “exhausting” and worrying parts of working life under the COVID-19 crisis has been dealing with death in such great quantity.’

An evidence submission from the Nursing and Midwifery Council also highlighted the impact of the pandemic on the mental health of nurses, which has induced severe anxiety, depression and stress, with emerging signs of post-traumatic stress disorder. Further studies have found that the worst affected key workers are those who are young and those with a clinical risk, and that mental health concerns were most linked to inadequate PPE, shielding and self-isolating.

Workplace support

Some key workers have felt unsupported by their employers to stay safe during the pandemic. Runnymede has highlighted the disproportionate inequalities facing key workers from minority ethnic groups in the workplace. This included being assigned tasks that left some key workers  feeling more exposed to the virus and less able to access PPE (not just in health care or care roles).

The BAME Communities Advisory Group for the Department of Health and Social Care found that 35% of social workers from ethnic minority groups criticised the support offered by their employer, local authority or workforce support measures.

The pandemic has magnified the workplace inequalities facing key workers who have stayed in work throughout the crisis. These inequalities have implications for everything from personal finances to mental health and wellbeing. Policy responses during and in the COVID-19 recovery must ensure that key workers are protected at work.

More on this topic:

• Study on London Bus Drivers by the UCL Institute of Health Equity
• A blog by Nuffield Foundation on the social and emotional struggles faced by key workers
• Queens Nursing Institute report on the effect of the COVID-19 pandemic on the UK’s nursing and residential homes

Conclusion

A healthy population is one of the nation’s most important assets. But the pandemic – and the wider governmental and societal responses – have exposed longstanding inequities in society with long-term implications for health and health inequalities.

As set out here, some in society have been particularly affected over the past year, not only in terms of health but the social and economic effects too. Reducing these inequalities should be central to recovery. It is vital that we learn from the pandemic and people’s experiences to ensure that in rebuilding we create a fairer society for all.

We will be exploring more on these topics through the COVID-19 impact inquiry. This blog series will continue to highlight the pandemic’s unequal impact on different groups in society. Sign up to receive updates from the inquiry.