22 November 2021

COVID-19 health inequalities: Keeping our focus now and beyond the pandemic

The COVID-19 pandemic has impacted all of us. Millions across the country have acquired or been diagnosed with the infection, with thousands suffering its debilitating medium and long-term effects. Far too many of us have lost loved ones, family members, neighbours or colleagues to this disease, and all of us have had to change how we live and plan our lives in the face of its continued presence. We will undoubtedly be dealing with the direct and indirect impacts of this pandemic, at home and abroad, for years to come.

Despite its universal impact, there is no doubt that this has been felt more acutely in some communities than others. In June 2020, Public Health England (PHE) published the first report to take a systematic look at the disparities in risks and outcomes from COVID-19, following the first wave of the pandemic. This confirmed COVID’s disproportionate impact across a range of characteristics including age, sex, geographic area of residence, socio-economic status and race/ethnicity.  The accompanying Beyond the Data report integrated findings from a review of the existing published literature with extensive stakeholder interviews, and highlighted the social, cultural, economic and societal factors underpinning these disparities. Factors including occupation, household size and composition, access and delayed presentation to health services, low levels of trust and engagement were identified by community representatives, and confirmed in subsequent studies, as powerful drivers of disproportionality throughout the course of the pandemic.

As we have experienced successive waves of the pandemic, it has become increasingly clear that the exacerbation of health inequalities remains one of its most defining characteristics. Over time, we have seen how the behavioural, clinical, socio-economic, cultural, and structural determinants of COVID inequalities have intersected with growing scepticism, pandemic fatigue and misinformation.

Taken together, all of these factors will continue to shape the epidemic’s trajectory and how different communities will experience and be able to respond to the pandemic. This includes changing patterns of risk, engagement and participation in COVID preventive measures (e.g. face mask wearing, testing, contact tracing and vaccination programmes), and ultimately the risk of hospitalisation and death.

However, armed with a deeper understanding of the direct and indirect impacts of COVID, new clinical interventions and therapeutic agents, expanding vaccination coverage and growing experience with managing community transmission, we are now better placed to manage and reduce the impact of this disease. This is further strengthened when combined with the new community centred insights, partnerships and ways of working acquired throughout the pandemic response. Indeed, we are now better placed to identify and reduce COVID’s disproportionality with the potential to apply these insights, capacities and capabilities to other areas.

As we approach the winter season and a new phase, our priorities will rightly and necessarily shift from acute pandemic response to social and economic recovery, and here a continued focus on tackling inequalities becomes even more critical. We must be honest and clear about the lessons arising from the pandemic and how these will help us to do things differently, work more effectively, using stronger partnership working, to achieve better outcomes. We must continue to harness robust and comprehensive local data, evidence, and insights in order to better characterise the nature of the inequalities faced by our communities, prioritise and deliver more effective and cost-effective interventions, and evaluate our efforts to mitigate them.

We must continue to build upon the positive relationships and collaborative leadership behaviours acquired during these challenging times, whether greater innovation, devolved decision making, collaborative problem-solving, responsiveness and agility, co-production, and integration. These were powerful assets in our clinical and community pandemic responses and allow us to tackle the emerging challenges with renewed purpose, confidence, and clarity. Our renewed relationships with local communities provide a firmer foundation for utilising more of our community assets, developing better community-centred and culturally competent solutions to intractable problems. The current and planned reconfigurations of our public health, NHS and social care systems should seek to build upon these new opportunities, reinforcing that we cannot drive improvements in health in isolation, and that everyone, especially our local communities, will be needed as partners on the road to recovery.

Health inequalities are neither new nor unique to our lived experiences in England; in contrast, they are longstanding, deep-rooted, and pervasive. However, they are not immutable. COVID has shown us, in communities across the nation, that health and care providers, local government, stakeholders from multiple sectors working alongside local communities, with appropriate national support, can find new and impactful ways to respond to a major health crisis and reduce its devastating impact. Now is the time to create the legacy we want to see emerging from this experience, building upon the foundations we have created, the relationships we have made, and continuing the difficult but honest conversations that we have begun. Let’s grasp these opportunities and build a better, healthier and fairer future for all.

Professor Kevin Fenton, Board Member, NHS Race and Health Observatory

Regional Director London, Office of Health Improvement & Disparities

Regional Director Public Health, NHS London

Statutory Health Advisor to the Mayor of London, GLA and London Assembly