The biggest tragedy of Covid lies in inequality

By - Integrated Care Journal

As Lottie Moore, Policy & Publishing Executive at Public Policy Projects writes, Covid-19 is not a pandemic that affects everyone equally. Rather, it is a syndemic: bringing together the concurrent pandemics of coronavirus, discrimination and disadvantage.

For some time, UK health disparity has been an embarrassing stain on a nation that has one of the best healthcare systems in the world. Data published by the Office for National Statistics (ONS) in 2018 revealed that life expectancy in the UK has stalled for the first time in over a century (for women in the most deprived areas, it is actually decreasing). UK health inequality prior to Covid-19 was a problem, but thanks to pandemic, the situation is now desperate.

During that now infamous spring of 2020, Chief Medical Officer Professor Chris Witty repeatedly affirmed that Covid-19 kills both directly and indirectly. The respiratory disease has directly killed nearly 100,000 people in the UK, but resulting lockdowns, designed to protect the public, have also claimed lives and have placed untold strain upon our society.

Covid-19 has caused the biggest disruption to education since the Second World War. In June 2020, the Education Endowment Foundation (EEF) predicted that only three months of school closures had reversed the attainment gap by a decade. Since March of last year, there has been a 60 percent increase in foodbank usage: six food parcels are now handed out every minute in the UK. The Institute for Fiscal Studies (IFS) revealed the median household income for the poorest fifth of society fell by 15 percent between March and June 2020. Covid-19 is not just killing people – its collateral damage is decimating the life aspirations of those at the bottom of the social ladder.

The pandemic has shone an uncomfortable light on existing health UK inequalities: deprivation-related inequalities in mortality rates from Covid-19 follow a similar trajectory to inequalities in mortality generally. ONS statistics show that between March and July of 2020, a male living in the most deprived area of England was twice as likely to die from Covid-19 than his equivalent in the least deprived area. Among other reasons, this is because those at the bottom of the social scale are more likely to live in overcrowded housing, work in the service industry and have pre-existing health conditions. The highly anticipated Government Fenton Review, which analysed factors impacting health outcomes from Covid-19, revealed there to be consistently higher rates of mortality from Covid-19 among BAME groups. Despite speculation otherwise, as yet there is no evidence these deaths are due to biological factors, but entirely avoidable inequalities in health.

Understanding health inequality requires an intersectional approach. The World Health Organization’s (WHO) research ascertains that “the social conditions in which people are born, live, and work are the single most important determinant of good health or ill health, of a long and productive life, or a short and miserable one. ” Nowhere is this truer than in the UK where, currently, one person dies prematurely from poor social conditions every 10 minutes.

Social determinants of health include location, socioeconomic status (SES), education and employment. The intersecting nature of these determinants means that no one social determinant can be understood in isolation from another. Social conditions (or determinants) of Inequalities in health are thus expensive to the public purse not just in terms of health, but education, the justice system and employment.

Sir Michael Marmot, the UK’s leading expert on health inequality, released Build Back Fairer: the Covid-19 Marmot Review in December 2020. The report produced short, medium and long-term recommendations on what needs to be done to tackle health inequality as the UK recovers from the pandemic. A large section of the report focuses on early years; under the central recommendation “Give every child the best start in life” – Marmot makes it clear that Covid-19 has had a significant effect on the personal, social and physical wellbeing of children. The classroom was downloaded onto to the iPad and left thousands of children behind in the process. Disadvantaged children have been disproportionately affected by loss of learning time, access to online learning and systemic inequality in the exam grading system. Much public attention has been drawn to the loss of access to social and financial support schools offer. For the 17.3 percent of children who qualify for free school meals (FSM) in the UK, access to nutrition has been a heavily politicised issue.

While it is impossible to predict the extent to which health inequalities will impact future generations, most recent NHS practise regarding health inequalities was released In August 2020. In the third phase response to the Covid-19 pandemic, eight urgent actions were outlined. These include protecting the most vulnerable from Covid-19, restoring core NHS services inclusively, developing digital care pathways and accelerating preventative programmes for those most at risk of poor health outcomes. Better collaboration between local and national authorities on this issue was also emphasised as a key priority.

The warning signs of health inequality have been evident for some time and successive reports highlighting this have thus far failed to generate meaningful action. Covid-19 should be a wakeup call to UK policymakers, our society cannot continue to function while our citizens are not equally protected.

Public Policy Projects is exploring health inequality in more depth in its State of the Nation report Addressing the National Syndemic: Closing the Gap in UK Health Inequality. For more information, please contact

References available upon request.

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