We have heard the soundbites throughout the pandemic: “we’re all in this together”; “the virus does not discriminate”. These are strong words, but such simplistic notions could not be further from reality. It is now well documented that there have been huge disparities across population groups in both the likelihood of becoming infected with Covid and also in the severity of the impact of lockdown restrictions on travel, work and education.
Boris Johnson’s announcement on Monday night was expected and necessary, given that hospital admission rates are now 40% higher than ever before, but, like many others, I felt demoralised by it. Once again, there is a sinking feeling, with no clear end date for lockdown, and the only certainty being that we will see increasing numbers of deaths from Covid in the coming weeks. However, my work with colleagues on how policy decisions shape future health inequalities makes me acutely aware that I will not be among the worst affected.
The Institute for Fiscal Studies (IFS) Deaton Review of Inequalities – begun some 18 months ago – confirmed this week what many have feared and suspected: coronavirus has both exposed and further deepened inequality in health, wealth and education.
In the months that follow, many peoplewill experience layers of disadvantage that will magnify the impacts of the pandemic. For instance, low-income migrant or temporary workers typically have jobs that cannot be done from home, placing them at greater risk of contracting Covid-19. The loss of income they face from quarantining is substantial if they become infected, and insecure employment often means that they might not have a job to return to. Without savings or a network to rely on for financial support, even a temporary halt in income can have huge mental health and social consequences.
A recent Citizens Advice report found that more than half a million people in England are behind on their rent. The majority weren’t in arrears before the pandemic and are experiencing stress about possible eviction.
The latest school closures in England are among the most contentious measures. Schools are essential not only for learning but also for pastoral care and, for the most disadvantaged children, adequate nutrition. The IFS review found that children from poorer homes have fallen furthest behind, and that pupils in private schools are twice as likely as state-educated children to be having online lessons during lockdown.
Think of how different the impact of additional disruptions in schooling will be for children in varied socioeconomic circumstances. A child who has a private room, laptop and well-educated parents with sufficient time to support home schooling will have a very different learning experience to one who shares a room with siblings, has no internet access and whose parents are busy working, or who do not speak English well enough to help them learn at home. The latter child is also less likely to have access to a garden. Hence rules that limit access to schools and time outside the house could have a spiralling impact on educational attainment, hunger and mental and physical health.
The fact that the new restrictions apply to us all makes it easy to forget that the effects are not, in reality, equal – they will be much more pronounced and complex for the most vulnerable. The government must not neglect interventions that mitigate the unequal impact of its new coronavirus control policies. Months of restrictions during 2020 have tested and frustrated most of us, but the lessons we have learned should be our greatest asset now. We were late to recognise and address the structural determinants driving inequalities in risk of infection and access to quality healthcare in the initial health crisis caused by coronavirus.
This time, policymakers must recognise and proactively address the often unequal impacts of the measures they are introducing to bring infections down. This will require targeted interventions, such as ensuring that children of lower-income parents have access to suitable computers and internet access that are essential for home learning.
Rishi Sunak’s budget announcement, scheduled for 3 March, should also have equity as a key consideration. It is imperative that economic support packages for firms and workers affected by the Covid crisis also adequately cover people in informal employment, and those who have had to stop working because of care responsibilities or health issues that required shielding. The latter are exactly the type of already disadvantaged groupsthat policies must immediately target, not simply ignore until public protests force the government into action.
It is also important to remember that inequalities do not only manifest during periods of severe lockdown. They will also appear as we start to resume social mixing and roll out the vaccine.
We are at a crossroads for deciding whether policies will protect or simply neglect vulnerable groups. With many people experiencing disadvantages simultaneously – such as job insecurity, precarious housing, language barriers and underlying health conditions – the effects of these decisions should not be underestimated. While this pandemic is unprecedented in many ways, policymakers would do well to reflect on lessons from the 2008 financial crisis, when countries with stronger welfare systems often had faster economic recoveries and avoided worsening the health of already disadvantaged groups.
With the vaccine rollout, a functioning testing and tracing system, and testing at borders, we may have the means to eventually put Covid behind us. But if we apply one-size-fits-all, universal policies, we will widen existing health, economic and social inequalities, and these will haunt us all, long after the pandemic has ended.
Dr Mishal Khan is a social epidemiologist and consultant with the Global Health Programme at Chatham House and an associate professor in the Faculty of Public Health and Policy at the London School of Hygiene & Tropical Medicine
