A new report by the Health Foundation has analysed the factors that fuelled the UK’s Covid-19 death toll, revealing the stark health inequalities across the four nations.

Drawing on a broad range of evidence, the report asks two questions. Firstly, how were people’s experiences of the pandemic influenced by their pre-existing health and health inequalities? And secondly, what is the likely impact of actions taken in response to the pandemic on the nation’s health and health inequalities – now and in the future?

Some groups were disproportionately affected by poor Covid-19 outcomes

The report acknowledges that the restrictions put in place by the government supressed the spread of the virus and saved lives. However, despite these efforts, during the first year of the pandemic the UK experienced some of the worst outcomes internationally.

For example, the UK had the fourth highest excess deaths of OECD countries in 2020 and excess deaths for people younger than 65 were the second highest in Europe after Bulgaria. By March 2021, a year on from the first lockdown announcement, there had been in excess of 119,000 deaths.

Behind these figures lie the “unequal burdens” experienced by different population groups and regions. The inquiry’s findings highlight the groups which were disproportionately affected by severe illness and death. For example:

  • During the first wave, 40% of all UK deaths were among care home residents.
  • 60% of people who died with Covid-19 between January and November 2020 were disabled.
  • Black African men were 3.7 times more likely to die with Covid-19 than their white counterparts during the first wave.
  • Bangladeshi men were five times more likely to die than their white counterparts during the second wave.

Certain socioeconomic factors were also associated with an increased risk of transmission. In England, Covid-19 mortality rates were more than twice as high for people from the most deprived 10% of local areas compared with people from the least deprived, and almost four times as high for people younger than 65.

Pre-existing differences in health were also associated with worse outcomes from Covid-19, with those aged 50–69 in the most deprived areas twice as likely as those in the least deprived areas to have at least two long-term health conditions.

Type of occupation and access to financial support also influenced the risk of developing poor outcomes from the virus. People working in elementary, caring, leisure and other service occupations had higher mortality rates, and these were higher still for men.

Death rates are thought to be higher in these roles partly due to poor existing health conditions but also because they remained open during lockdowns. For lower income workers, the inadequate level of support for sick pay was a key factor in not self-isolating.

Immediate and future risks to health

The findings revealed by the inquiry reveal the stark differences in health across the population. The report highlights various immediate and future risks to health, which are particularly prominent among these at-risk groups.

In order to tackle this issue, the report highlights some core issues that need attention from the government and policymakers as they take the recovery forward. These include:

  • Tackling the backlog of 6 million “missing patients” with unmet healthcare needs
  • Providing support for those with long Covid, particularly women and those from deprived backgrounds who are more at risk
  • Addressing the mental health crisis caused by pandemic restrictions
  • Encouraging those in-need to access social care services
  • Getting child safeguarding referrals back to normal levels
  • Increasing vaccine uptake among deprived groups.

The report also warns that as the government ends the various financial support measures currently in place, such as the furlough scheme and the boost to Universal Credit, unemployment levels will rise and millions of families will experience a drop in income. With this will come poorer physical and mental health, as well as an increase in poverty, widening the gap in future health outcomes.

The loss of education during the pandemic also risks widening the gap in future health outcomes, as millions of children missed periods of education after schools were forced to shut. However, the loss of education did not fall evenly, with children from more disadvantaged backgrounds expected to have worse educational outcomes.

Recovering from the pandemic

Considering the findings, the report concludes that the government’s recovery plan must prioritise creating opportunities for good health which will in-turn boost the UK’s economic recovery.

“Immediate action is needed to address the harm caused by the pandemic – tackling the healthcare backlog, protecting family finances and ‘catching up’ on education. There needs to be greater protections for low-paid workers as well as schemes and targeted support for people whose mental health has deteriorated to get back into work,” the report states.

In the long-term the report suggests that the government should invest in areas with historically low employment and those that were hardest hit by the pandemic in order to reduce existing health inequalities. It states that the Covid-19 pandemic has highlighted the need for adequate safety nets that can support people thorough income and health shocks and has shown that our public services need re-designing to put prevention first.

Ultimately, this report highlights the importance of the nation’s health in sustaining the economy and preserving a good quality of life for all its members. The government must therefore address the root causes of poor health and invest in people and their communities to ensure the creation of a healthier, more resilient society.