Covid death risk ‘almost four times higher’ for poorest in England

The chances of dying from Covid-19 were nearly four times higher for adults of working age in England’s poorest areas than for those in the wealthiest places, an inquiry into of the health impacts of the pandemic has found.

The nine-month inquiry by the Health Foundation charity said a decade of widening health inequalities and cuts to public services had “frayed the nation’s health” and contributed to the UK’s disproportionately high Covid death toll compared with similar countries.

It called for urgent action to reduce health differences and urged significant public investment in the NHS, jobs, housing, education, communities and social security. There must be no reboot of the austerity policies of the past decade as the UK prepared to move out of the pandemic, it warned.

“We may have to learn to live with Covid-19, but we don’t have to live with its unequal impact,” said Jo Bibby, the foundation’s director of health, adding: “We cannot afford to make the same mistake twice.”

The report echoes many of the findings of the public health expert Sir Michael Marmot’s report into Covid health inequalities in Greater Manchester, published last week, and reflects increasing concerns over the scale and focus of the government’s plans for the UK’s long-term recovery from the pandemic.

The chair of the inquiry, Dame Clare Moriarty, said: “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.”

In her introduction to the report, Moriarty wrote: “The legacy of the pandemic is all around us in unmet health need, mental health problems, gaps in educational attainment, loss of employment and financial insecurity. If we are to avoid these becoming long-term scars, it’s time to confront our choices about how we value people.”

There have been more than 150,000 excess deaths in the UK during the pandemic. The single biggest factor in the spread of Covid in the UK was the timing of lockdowns and the stringency of restrictions, the inquiry said. “Once the virus had spread the extent to which different groups were affected … reflected variations in underlying health and socioeconomic factors that increased risk of exposure and worse outcomes.”

High Covid death rates in the poorest areas were driven in part by poor pre-existing health problems, the inquiry found. People aged 50 to 69 in the 10% most deprived neighbourhoods were more than twice as likely to have long-term conditions that put them at higher risk, such as diabetes and chronic lung conditions.

Jobs and occupations including caring, manufacturing and leisure also increased the risk exposure to the virus, as did poor housing conditions. Going into the pandemic, overcrowding in private and social rented housing in England was at its highest recorded level.

As well as being highest in deprived areas, Covid mortality rates were higher for certain groups, such as care home residents, disabled people and ethnic minority communities. Young people suffered disproportionately high levels of mental ill health.

This was a landmark opportunity to rebuild public services and reduce widening health inequalities and declining life expectancy across the UK, the inquiry said. “A recovery that puts increasing – and fair – opportunities for good health as a priority will need action to deal with the conditions that lead to poor health in the first place.”

Adequate income, good-quality jobs and housing were necessary ingredients for good health, the inquiry said. “The decline in improvement in health life expectancy partly reflects the erosion of these social conditions in the UK in the decade preceding the pandemic – affecting certain groups to a greater extent.”

The pandemic had “laid bare” the weaknesses of policy decisions made after the 2008 financial crash to drastically reduce public spending, the inquiry said. This meant when Covid struck, public services were in a weakened state and the health and financial resilience of many poorer households had been drastically weakened.

The widening of health inequalities in the UK over the past decade had “exposed the UK to a high death toll and reduced people’s ability to deal with the subsequent economic shock,” it said.