One of the consequences of the COVID-19 pandemic has been to illuminate far-reaching health and socioeconomic inequalities in many countries. The pandemic's impact has fallen disproportionately on the most vulnerable individuals and along racial, ethnic, occupational, and socioecomic lines. Inequalities in people's protection from and ability to cope with this pandemic and its tremendous societal costs stress the importance and urgency of the societal changes needed to protect population health and wellbeing in the future.
Build Back Fairer: The COVID-19 Marmot Review,published Dec 12, 2020, argues that a decade of growing inequality in England partially explains why it has had one of the worst COVID-19 infection and mortality rates in Europe and risks emerging from the pandemic as an even more socially and economically divided nation. Before the pandemic, life expectancy increases had stalled in England, gaps in healthy life expectancy were growing between wealthy and poor regions and individuals, and a decade of government austerity measures had enhanced regional inequalities in employment, poverty, and educational outcomes, as well as health. England's inequalities are reflected in the COVID-19 pandemic. In March to July, 2020, COVID-19 mortality rates in the most deprived local areas were double those in the least deprived areas and the highest excess mortality rates outside of London during the pandemic have been in poorer regions, like the West Midlands, and North-West and North-East England. Age-standardised COVID-19 mortality rates are substantially higher in frontline and lower-waged occupations than in office-based occupations. Higher transmission risk is linked to overcrowded housing and inability to self-isolate. Mortality rates among racial and ethnic minority groups have been up to three times higher than those of the White population; even after accounting for demographic, socioeconomic, and underlying health factors. The risks of both contracting COVID-19 and of severe illness and mortality reflect overlapping structural determinants of health that are bred by inequality and transmitted across generations.
For children and young people, the pandemic threatens their education and future, and that of more disadvantaged youths especially. Students from poorer households have been less able to access online learning or private tutoring and a majority of teachers from the most deprived English schools reported that their pupils are 3 months or more behind in their learning. Unemployment could rise as high as 7·5% by the middle of 2021 and a survey of leading economists predicts that the UK will take longer than other high-income countries to recover economically from the pandemic. An unmitigated recession risks higher rates of childhood poverty over the coming years and high unemployment among young people entering the labour market.
The Build Back Fairer report warns not to repeat the mistakes of the austerity years and thereby allow the COVID-19 crisis to deepen and perpetuate inequalities. Instead, the report urges the government to close the COVID-19 education gap by providing funding for laptops and catch-up tuition, ensure fair school examination arrangements and prioritise young peoples' mental health and development, and, in the longer term, invest in early years services in deprived areas (including improved pay and training for the childcare workforce), support parents with free childcare, reduce child poverty, ensure that all young people are engaged in education, employment, or training, and raise the minimum wage for apprentices. The recent statement from the Institute for Fiscal Studies Deaton Review on Inequality stressed that the opportunity cost of the pandemic for young people is potentially huge, but also that it is a “once-in-a-generation opportunity to tackle the disadvantages faced by many that this pandemic has so devastatingly exposed”.
The pandemic provides harsh lessons about the societal vulnerabilities that arise from inequality. There is a clear need for financial recommitment to public health capacity, but also this should accompany a substantial commitment to tackling the social determinants of poor health and wellbeing. Investing in young people and support in long-deprived regions and sectors of society is arguably one of the most powerful ways to break the chain of inequality transmitted from generation to generation. Adopting a broadened, equity-focused approach to population health should be an essential part of building a more resilient society that is better prepared to weather future pandemics.
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