Introduction from David Somekh EHFF Network Director:
For this edition, we again have four diverse contributions.1. Louise Marshall from the UK Health Foundation has kindly agreed for us to re-publish her article about emerging evidence of the relation between health inequalities and COVID. Her message relates to what ought to happen during the ‘recovery phase’ to deal with these issues.
2. Similarly, Lars Munter has shared an article he co-wrote, published elsewhere, about implications for hygiene, post-COVID.
3. Sean Conlan has pointed us to a post-COVID piece, this time about the concept of the circular economy and the value of investing in the environment, published by the European Forest Institute.
4. Finally, a short opinion piece from me, stressing how important testing is in this particular phase of the pandemic in Europe given the very real uncertainty we’re faced with as we all stumble away from ‘lock-down’, to some kind of ‘new normal’ that will differ, depending on where we live (and which can be seen on different levels and timescales, whether we’re thinking about our daily lives, our economy or our international relationships).
What COVID-19 is teaching us about inequality and the sustainability of our health systems
Louise Marshall, Senior Public Health Fellow at The Health Foundation
Emerging evidence on health inequalities and COVID-19: May 2020
Round-up blog by Louise Marshall, Senior Public Health Fellow at the Health Foundation
A recent Health Foundation long read suggests that the coronavirus (COVID-19) pandemic could be a watershed moment in creating the social and political will to build a society that values everyone’s health – now and in the long term.
The global pandemic, and the wider governmental and societal response, is certainly bringing health inequalities into sharp focus. And it has been apparent from the early stages of the pandemic that some groups are at much higher risk of catching and dying from the virus than others. Factors such as age, gender, ethnicity and socioeconomic deprivation are all known to be important. Critically, these factors combine in complex ways to put some people at much greater risk.
In addition, the measures taken to control the spread of the virus are having unequal socioeconomic impacts, which are likely to deepen health inequalities in the long term. Over the coming months, the Health Foundation will continue to round up key evidence on COVID-19 and inequalities. Here, we give an overview of some key themes emerging from recent work on the unequal impact of COVID-19, focusing on how children and young people are being affected, and the economic effects of the pandemic.
The unequal risk of becoming seriously ill from COVID-19
Public Health England’s COVID-19: review of disparities in risks and outcomes has added to previous evidence that shows the impact of the virus has replicated existing health inequalities, in some cases increasing these. The greatest risk factor for dying with COVID-19 was found to be age, but the risk was also higher among those living in more socioeconomically deprived areas, among black, Asian and minority ethnic groups, and in certain occupational groups. The report, however, did not examine how many of the underlying, upstream factors driving health inequalities across different population groups have contributed to these COVID-19-related inequalities.
The unequal impact of COVID-19 on children and young people
Education and skills
While children and young people are at much lower risk of becoming seriously ill with COVID-19, various strands of emerging evidence suggest that they may be hit hardest by the measures introduced to control the pandemic.
One concern is that the closure of schools may widen existing educational inequalities. This is important for long-term health inequalities as by the age of 30, those with the highest levels of education are expected to live 4 years more than those with the lowest levels of education. The Sutton Trust has been monitoring the impact of school closures and found wide disparities in the ability of pupils to learn at home. Pupils from middle class homes are twice as likely as those from working class homes to take part in online lessons (30% versus 16%). Over half of primary (51%) and secondary (57%) pupils at private schools have accessed online lessons daily, which is more than twice as likely as those at state schools.
Similarly, the Institute for Fiscal Studies has found that children in higher income families were spending 30% more time on home learning that those from lower income families – and that higher income families were more willing for their children to go back to school when they reopen. This may lead to a situation where those struggling the most with home learning remain at home, while those who have spent the most time learning at home return to school, risking significant increases in educational inequalities.
- A Sutton Trust report on university access and student finance.
- A Sutton Trust report on the impact on apprenticeships.
Employment prospects for young people
There are also concerns that young people who have completed their education may be bearing the brunt of the economic impact of COVID-19. The Resolution Foundation’s coronavirus survey found that the youngest and oldest earners have been hit hardest by job losses and pay reductions. One third of those aged 18–24 have lost jobs or been furloughed – twice the proportion of those aged 35–49.
The Resolution Foundation estimates that an additional 640,000 18–24-year-olds could find themselves unemployed over the coming year, with evidence from previous recessions indicating the most severe effects on unemployment are among young people recently leaving education and those with fewer qualifications. This could impact these young people for many years to come, through long-term scarring of their employment and pay prospects and this, in turn, is also likely to widen health inequalities.
The unequal economic impact of COVID-19
The economic impact of lockdown was immediate. Government figures published in mid-May show that on 9 April 2020 – just a couple of weeks into lockdown – there were 4.2 million people on Universal Credit. This represented an increase of 1.2 million people (40%) in one month. Most claimants during the pandemic are ‘searching for work’ (those not working or on very low earnings who are required to be taking action to secure work as a condition of receiving benefits). This increased by two-thirds from 1.1 million to 1.8 million people between 13 March and 9 April.
Those being hit hardest by the economic impacts of COVID-19 tend to be those who were already economically vulnerable. The Resolution Foundation found a clear gradient in loss of jobs and of hours, as well as furloughing, across the earnings distribution, with 30% of the lowest earning fifth of employees having been furloughed or lost jobs, compared to 8% of the highest earning fifth. The Understanding Society survey of UK households has also found that the lowest earners have been worst hit by loss of earnings, with the most severe losses for single parents. In the highest income bracket, average earnings have fallen by £46 a week from an average of £832, while in the lowest bracket they have fallen by £43 a week from £297. On average, single parents’ earnings have fallen by more than double the amount in households that have children and more than one adult.
There is also evidence that the economic shock of COVID-19 has had an almost immediate effect on people’s mental health. Both the Mental Health Foundation and ONS have reported far higher levels of anxiety and feelings of not coping well with stress among those financially impacted by the pandemic. One fifth of people surveyed by the Mental Health Foundation, who identified as unemployed, reported suicidal thoughts in the previous fortnight. This compared with 9% of those in employment. Given the socioeconomic gradient in loss of income and jobs, this mental health burden and the long-term health impacts of job losses will also be unequally distributed across society.
The closure of schools and childcare facilities has posed a significant challenge to parents and affected their ability to continue working. There is evidence that this impact may affect women more than men. The Institute of Fiscal Studies looked at how families have balanced work and family life during lockdown, finding mothers have taken on more childcare, home education and housework than fathers since schools closed. Mothers are also more likely to have lost work or been furloughed, which could widen gender disparities in pay and work over the longer term.
- The Food Foundation reported on borrowing money or going into debt and food insecurity as a result of COVID-19.
- The Child Poverty Action Group highlighted the impact of the benefit cap on households during the pandemic.
- A Resolution Foundation report on the economic impacts on different groups of workers.
Conclusion
Originally published on the Health Foundation website, 5 June 2020
https://www.health.org.uk/news-and-comment/blogs/emerging-evidence-on-health-inequalities-and-covid-19-may-2020
Further reading from the Health Foundation
By Jo Bibby, Grace Everest and Isabel Abbs
Published 7 May 2020
https://www.health.org.uk/publications/long-reads/will-covid-19-be-a-watershed-moment-for-health-inequalities
Emerging findings on the impact of COVID-19 on black and minority ethnic people
By Tim-Elwell Sutton, Sarah Deeny and Mai Stafford
Published 20 May 2020
https://www.health.org.uk/news-and-comment/charts-and-infographics/emerging-findings-on-the-impact-of-covid-19-on-black-and-min
Guest Blog: Finally Ready for Hygiene 2.0?
Lars Münter and Professor Lisa Ackerley explore how hygiene practices could be revolutionised as a result of the Covid-19 crisis.
Professor Lisa Ackerley
“Covid-19 exposes many challenges from health care to infectious disease control. But it also highlights the need for a hygiene strategy and design revolution of the public sphere that can slow or stop future calamities at home, in workplaces and transport.
We would argue that many of these fail to identify the elementary reason why Coronavirus has been able to spread too easily, which is simply because we have a society that makes life easy for infectious diseases.
Lars Munter
Investing in nature to transform the post COVID-19 economy
This article has been much copied already. We can’t share the original from the Solutions Journal but this extract
https://www.efi.int/news/investing-nature-transform-post-covid-19-economy-2020-06-10)
allows you access to the paper on the 10 point action plan for the circular economy as a pdf.
An article published in Solutions Journal sets out a 10-point Action Plan to create a circular bio-economy devoted to sustainable well being.
The COVID-19 crisis and future recovery presents a unique opportunity to transition towards a sustainable wellbeing economy centered around people and nature. The Action Plan is a call for global, holistic and transformative action to put the world on a sustainable path, and features the latest scientific insights and breakthrough technologies from a number of disciplines and sectors.
Coordinated by EFI (European Forest Institute) Director Marc Palahí, the Action Plan sets out the importance of moving towards a circular bioeconomy to holistically transform and manage our land, food, health and industrial systems with the goal of achieving sustainable wellbeing in harmony with nature.
“The Action Plan is our response to HRH The Prince of Wales’ recent call to invest in nature as the true engine for our economy”, said Marc Palahí. “It is divided up into six transformative action points, and four enabling action points, which mutually reinforce each other and should be implemented in an integrated manner. (the link to the plan is below)
The 10 action points include:
1. Aim at sustainable wellbeing
2. Invest in nature and biodiversity
3. Ensure an equitable distribution of prosperity
4. Rethink holistically land, food and health systems
5. Transform industrial sectors
6. Reimagine cities through ecological lenses
7. Create an enabling regulatory framework
8. Bring purposeful innovation to the investment and political agenda
9. Ensure access to finance and enhance risk-taking capacity
10. Intensify and broaden research and education
Da
Test, Test and Test
by David Somekh.
With most European countries now opting for some degree of relaxation of their ‘lockdown’, inevitably there have been some localised outbreaks of fresh infections. To liken these to a ‘second wave’ (which in 1918 killed more people than the first wave) is dubious because a) testing in many places has been variable, so infection rates now are difficult to compare with previous and b) potential changes in the virus’s behaviour as it has spread also make the situation difficult to judge. So currently, we just don’t now. Other than what is already evident, which is that there will be so-called spikes of new infections if people are in difficult circumstances (e.g. working in meat-packing factories) or are being over-enthusiastic about the apparent easing of ‘lock-down’ and start behaving as if the problem is over. We have learnt a lot more about the virus than we knew at the beginning of this year, but one principle remains as important as it was when the WHO first made its statement, that in order to contain the virus, every nation must heed the mantra ‘test, test and test.’
The real and pressing question is: where countries claim to have put in place such programmes (some much later than others for complex reasons), do they have the capacity to deliver testing at the level that is required? If they are in reality under-resourced and cannot deliver the number of tests needed, then their programmes are both a poor use of public money but of greater concern because their existence would lead the public at large to have confidence in public health measures that are not in practice, protecting them as they were designed to do.
This is a time of very great uncertainty. Take people’s jobs and their country’s economy over the next six or twelve months. How much worse off are we likely to be? Travel around Europe is starting to open up again. Will people really go back to using air travel for example at the level they did before the crisis? Could the surviving airlines handle this? When will borders be as permeable as they were pre-crisis? Most of all, the health of our communities. The most pessimistic of the experts warn us that the threat from the virus needs to be finally assessed only after the coming winter, for what seem to be plausible reasons. Meanwhile there is a serious backlog of health treatments and assessments which also has to be dealt with.
People want there to be light at the end of the tunnel, of course they do. Equally governments are very anxious to re-start their economies and willing to take some risks regarding the health of their societies, which they hope their voters will understand. What can support these concerns, in the light of this great uncertainty, some European sources are now saying, is solidarity: a willingness for countries to work together, to learn from each other’s attempts to deal with the attendant problems. EHFF agrees. We believe that at this stage, isolationism or like positions must be seen as counter-productive and ultimately dangerous to societies’ futures wellbeing.
And don’t forget…..
EHFF has a Twitter feed where you can find up-to-date links to partners’ activities and relevant articles and thoughts from us.