Inquiry finds working age adults in poorest areas almost four times more likely to die from COVID-19 The Health Foundation calls on Government to learn the lessons from the financial crisis and invest in health, to rebuild the economy and prevent long-term scarring

6 July 2021

The Health Foundation calls on Government to learn the lessons from the financial crisis and invest in health, to rebuild the economy and prevent long- term scarring

The results of a new inquiry published today reveal working age adults in England’s poorest areas were almost four times more likely to die from COVID-19 than those in the wealthiest areas.

The findings are disclosed in a landmark report by the Health Foundation, one of the most comprehensive studies into the factors that fuelled the UK’s devastating COVID- 19 death toll.

The nine-month investigation found that the COVID-19 mortality rate was 3.7 times higher for those younger than 65* living in the poorest 10% of neighbourhoods than in the wealthiest in England. Poorer underlying health left them at greater risk, a pattern which reflects pre-pandemic mortality trends. People in their 50s and 60s living in the poorest areas are twice as likely to have at least two pre-existing long-term health conditions such as lung disease or diabetes.**

The inquiry concludes that the recovery needs to prioritise creating opportunities for good health – a vital asset needed to level up and rebuild the UK economy. Around 8 in 10 adults surveyed*** agree it is important the government addresses differences in health outcomes between those living in richer and poorer areas during the recovery – the same number agreed they were worried about the impact of the pandemic on the UK economy.

The report describes how following the 2008 financial crisis, public services were eroded, and the underlying economy and social fabric were frayed. This damaged health leading to stalling life expectancy, especially for people living in the poorest areas of the country. In turn this reduced resilience to the pandemic and significantly reduced the UK’s ability to manage the pandemic effectively.

Research report

Unequal pandemic, fairer recovery

July 2021
Research report

A comprehensive review of the factors that affected the UK’s devastating COVID-19 death toll.

The charity is calling for immediate action to prevent further erosion of health from the pandemic and ensure a recovery that improves health, avoiding mistakes of the past. It argues the government needs to close the education gap, address the health care backlog, support those in greatest poverty and provide targeted mental health support. However, the authors highlight that longer-term repair means investment: creating good jobs and improving working conditions of the lowest paid, and boosting public services to build resilience in the health of the nation for the future.

The inquiry amassed extensive evidence that existing poor health, reflecting wider inequalities in people’s circumstances, put people at higher risk of death once exposed to the virus. Factors including type and quality of work, housing conditions, and access to financial support to self-isolate all contributed to increased exposure to the virus among working age adults. Key findings include:

  • Among workers, men in roles such as security guards, care workers and taxi drivers were more likely to die from COVID-19 – with those working in sectors which remained open not only at highest risk of exposure, but also at higher risk of death due to existing poor health.
  • Low rates and coverage of statutory sick pay and difficulty in accessing isolation payments reduced people’s ability to self-isolate, increasing exposure and spread.

The inquiry also explored the disproportionate impact of the pandemic across certain groups in society. People from ethnic minority communities, young people, those suffering from mental health conditions and disabled people in particular experienced worsening and compounding inequalities, increasing their exposure to COVID-19 and threatening their future health.

It warns that the full impact of the pandemic on household finances is still to come. A build-up of debt and the discontinuation of both the Coronavirus Job Retention Scheme and the Universal Credit uplift later this year risk a crippling blow to people’s finances, particularly in the poorest areas.

Jo Bibby, Director of Health at the Health Foundation comments:

‘We may have to learn to live with COVID-19, but we don’t have to live with its unequal impact. The shortcomings of the response to the 2008 financial crisis left a legacy
of deep-rooted issues – poor health, increased financial insecurity and strained public services – which left the UK more vulnerable to the pandemic’s health and economic impacts.

‘We cannot afford to make the same mistake twice. Government must address the root causes of poor health and invest in jobs, housing, education and communities. This is the only way to create a healthier society that can meet the challenge ahead and better withstand future crises.

‘Ministers across government should work together to put health at the heart of the forthcoming levelling up strategy, with clear targets and a regular, independent assessment of the nation’s health laid before parliament.’

Dame Clare Moriarty, Chair of the COVID-19 impact inquiry and (now) Chief Executive of Citizens Advice adds:

‘The legacy of the pandemic is all around us in terms of unmet health need, mental health problems, gaps in educational attainment, loss of employment and financial insecurity. If we are to avoid these issues leaving long term scarring on our communities, it’s time to make a choice about how we move forward and where we invest.
‘This is our chance to close the chapter on the remnants of the financial crisis response and build back better and fairer. We need to aim for a recovery that builds economic and social resilience, with ‘levelling up’ not limited to geographical areas of disadvantage but that addresses the needs of groups who have experienced the most damaging impacts of the pandemic.’

Further information

*The data used for this analysis includes all people aged under 65 where deaths are due to COVID-19. The vast majority of these are adults, with ONS data showing that 0.2% of deaths involving COVID-19, or 37 deaths by end of May 2021, were among people aged 0-19. Recent ONS data shows that the ratio of excess deaths for under 65s relative to over 65s in the UK were the second highest in Europe. Within England, the difference in the COVID-19 mortality rate between richest and poorest was almost twice as high for under 65s (3.7 times) than for over 65s (2 times).

**We have used a 500,000 patient sample from the primary care data set, the Clinical Practice Research Datalink (CPRD). The data is provided by patients and collected by the NHS as part of their care and support. The analysis uses CPRD protocol number 20 143.

***About the survey – This public opinion research was conducted by Kantar Public for the Health Foundation. The survey data and details on the methodological approach can be found here. A total of 2,556 interviews were conducted online among adults aged 16+ living in the UK between 10 and 14 June 2021. All interviews were conducted online using the Kantar Research Express. The Kantar online access panel was the main sample source.

About the COVID-19 impact inquiry

Initiated in October 2020, the Health Foundation’s COVID-19 impact inquiry set out to understand how the UK’s experience of the pandemic could inform the decisions of a government committed to improving the nation’s health, shining a light on the key issue of recovery.

The final report lays bare the unequal impact of the pandemic and how the same crisis has fallen unevenly. It provides a panoramic view of the pandemic to highlight lessons for recovery and the action needed from government to create a fairer, healthier and more prosperous society.

The inquiry was informed by an expert advisory panel with a diverse range of knowledge and experience across the areas of inequalities, economics and the wider determinants of health. A diverse set of voices across the UK informed the report’s robust analysis of how different groups have been affected – from young people to people from ethnic minority communities, to those suffering from mental health

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