The Health Foundation’s COVID-19 impact inquiry began in October 2020, exploring the pandemic's implications for health and health inequalities in the UK. Since then, the inquiry team has been gathering evidence from a wide range of sources. The resulting report, due to publish next week, will provide a comprehensive review of the factors that affected people’s experiences of the pandemic and led to the UK’s devastating COVID-19 death toll. It also sets out what is needed to improve the nation’s health and shines a light on the immediate issue of recovery.
We spoke to two members of the inquiry team, Mehrunisha Suleman and David Finch, about the work that’s gone on behind the scenes to gather and analyse a wealth of important evidence and build a detailed picture of the pandemic’s impact on our country.
What did the inquiry set out to achieve?
Mehrunisha: We wanted to build a picture of society prior to the pandemic so that we could understand what people’s health, social and economic assets were going into the pandemic, and how this then affected what happened during the pandemic.
In the UK, improvements in life expectancy and healthy life expectancy have sadly declined over the last decade, and those burdens have been felt unequally, clearly following a social gradient. What we have seen in the pandemic is a clear tracking of these issues, with those already affected by pre-existing inequalities feeling the impact of COVID-19 more severely.
We also wanted to document what happened as a result of the actions taken as a country in response to the pandemic. Lockdowns and restrictions have been crucial for suppressing the virus and saving lives, but have also really impacted people’s jobs and their financial security. For example, our evidence shows that families who went into the pandemic on lower incomes have been more likely to spend their savings or go into debt to make ends meet. Whereas those on higher salaries have been more likely to save extra money during the pandemic.
Dave: The inquiry has reviewed a huge range of existing evidence and also carried out in-house analysis to better understand the impact of the pandemic so far. We wanted to create a go-to resource for people to understand the effects on different groups of people, and also to inform policy responses and developments into the future.
What methods has the inquiry used to gather the evidence?
Dave: We’ve used a wide range of methods. It’s been a really consultative process, guided by our expert advisory panel (chaired by Dame Clare Moriarty), and with input from many different stakeholders. That input has been crucial in helping us frame some of the key issues.
Mehrunisha: Yes, our consultative process with stakeholders from across the four UK nations has been vital. Early on we picked out key themes to focus on, such as digital exclusion and disability, and wanted to incorporate expert perspectives. We did that by consulting with people with lived experience of disability, and we ran a collaborative workshop with the Good Things Foundation on the impact of digital exclusion.
We commissioned a review of existing qualitative evidence and built on that through our own in-house review and a call for evidence. That helped us reach organisations whose work we wouldn’t otherwise have had access to. Over 75 organisations submitted 100 different pieces of evidence, which gave us rich detail when looking at groups disproportionately impacted by the pandemic.
And lastly we’ve looked at quantitative evidence, including data coming out of the Office for National Statistics. Our in-house analysis has also helped to understand the impacts on different groups or regions in more detail.
What areas were most challenging when it came to accessing the evidence you needed?
Mehrunisha: It’s a lot harder to find data about some groups, particularly homeless communities, refugees, and Roma traveller communities. Also the data isn’t always that joined up, so it can be hard to link up health care data with some of the wider determinants of health. Lastly there is a lack of data on ethnic minority communities. We knew that already, but it really showed itself during the inquiry and we had to try and fill in those gaps.
Dave: We’ve had to constantly adapt to a changing context. When we began the inquiry, we thought by the time we were reporting, we’d be close to the end of the pandemic. But that’s clearly not the case. And that’s just meant that there’s always more evidence to collect.
What are you most proud of in terms of what the inquiry has achieved?
Mehrunisha: I’ve been involved since the start, and I’m incredibly proud of our commitment throughout to reach out to as many people as possible to really learn and listen. That consultative element has been really valuable. I hope that shows in the report. We’ve captured voices and experiences that you wouldn’t hear otherwise – marginalised groups such as homeless people, and those facing domestic violence or sexual exploitation.
Dave: For me the most successful element of the inquiry has been the thing that was hardest, the potential scope of the work. While trying not to make it unmanageable, we’ve covered a wide range of areas in detail to clearly understand the different impacts of the pandemic.
How will the report support wider work by the government to help the UK recover from the pandemic?
Dave: The inquiry report will present the evidence we’ve uncovered and set out what we think are the key risks and opportunities for health both in the short and long term. That includes things like the economic fallout of the pandemic, and how the shape and scale of that might affect different groups, potentially further widening health inequalities.
Mehrunisha: If we don’t take these facts into account when thinking about recovery, we risk further erosions to the health of people who’ve faced the most impact from the pandemic – due to the impacts on their education, their housing, and their jobs.
At the same time there are opportunities. For example, the shift towards flexible home working has opened up new opportunities for women who otherwise couldn’t work due to caring responsibilities.
We hope the inquiry evidence can inform the government’s efforts to level up and ensure that everyone has the opportunity for good health going forward.
Dave: Realistically the pandemic isn’t going away entirely for a while. But while we’re going to need to learn to live with COVID-19, we don’t have to live with such inequalities. We’ll need to continue to adapt services into the future, and the report also provides important evidence to help shape that response and to prevent issues arising which further disadvantage some people.
What comes next for the inquiry?
Dave: Some elements of the inquiry work will continue once the report is published. We’ll be publishing our evidence library online later in the year, providing more detail for those who need to drill down further. Sign up for updates to be notified when this launches.
We’re also building on the evidence to inform the policy changes we’d like to see in the future. This will certainly feed into the Health Foundation’s work to inform the development of a cross-government health inequality strategy.
Find out more
Watch out for the launch of the inquiry report next week and sign up now for our webinar on 6 July, summarising the key findings on what needs to be done in recovery to create a healthier, fairer society.
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.