Health inequalities and the recovery from COVID-19

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The impact of the COVID-19 pandemic has not been felt evenly across Scotland. Some people have been much more likely to get ill or die from COVID-19, and others have been disproportionately affected by the measures taken to control the virus. This blog looks briefly at health inequality in Scotland before the pandemic, how the virus has had an uneven impact, and what could be done during the recovery to address these differences in health across the nation. For a more detailed look at the effects of COVID-19 on health inequality, check out the SPICe research briefing Health Inequality and COVID-19 in Scotland.

What are health inequalities?

Health inequalities are “avoidable and unjust differences in people’s health across the population and between specific population groups”. Many people think they are unjust and avoidable as they are caused by societal and economic factors known as the ‘social determinants of health’.

Which groups are affected by these inequalities?

People living in deprived areas, people with physical and learning disabilities, people belonging to ethnic minority groups and unemployed people are just some groups who are more likely to have worse health than the rest of the population. This list is not exhaustive, and where people fit into more than one of these groups, the effects can be compounded. This is known as intersectionality – a word used to describe the “interconnected nature of social categorisations such as race, class, and gender, creating interdependent systems of discrimination or disadvantage”.

What’s health inequality like in Scotland?

Before the COVID-19 pandemic, health inequalities were very marked for some groups in Scotland.

In 2019, healthy life expectancy, the length of time someone can expect to live in good health, was 26 years shorter for men and 22 years shorter for women living in the most deprived parts of Scotland compared to those in the least deprived.  

In the most deprived areas, the premature death rate was over four times greater than in the least deprived areas.

People living in more deprived areas have lower levels of wellbeing than those living in less deprived areas. The hospital admission rate for heart attack is also higher for those living in deprived areas, more than twice that of those living in the least deprived areas. Cancer incidence is also more common in the most deprived areas of Scotland. Public Health Scotland found mortality rates for all cancers combined are 74% higher in the most deprived compared with the least deprived areas.

How uneven has the impact of COVID-19 been?

Early in the pandemic, some politicians and commentators referred to COVID-19 as “a great leveller” which would affect everyone equally. It has become clear that this is not the case. A few examples are outlined below, but many more groups have been affected particularly badly.

Research during the first wave of COVID-19 infection found that people with learning disabilities were twice as likely to test positive for COVID-19, twice as likely to be hospitalised, and three times as likely to die from COVID-19 than the general population.

Those living in the most deprived areas were more than twice as likely to be admitted to hospital, and twice as likely to die from COVID-19.

People from ethnic minority backgrounds have also been disproportionately affected. National Records of Scotland analysed deaths from COVID-19 in the first wave of infection in 2020, and found that people of South Asian background were twice as likely to die compared to white people. When Public Health Scotland analysed data looking at the second wave of infection, they found that people of South Asian background were three times more likely to die or be hospitalised than white people.

The figure below shows how the impact of COVID-19 has varied by area of deprivation.

Here we’ve only looked at direct health harms. Indirect harms, such as longer waiting times for treatment, cancer screening programmes being paused, and worsening mental health, resulting from the restrictions to control the virus, rather than the virus itself, have also disproportionately affected some groups more than others. You can find out more about the indirect health harms in the SPICe research briefing Health Inequality and COVID-19 in Scotland.

How could we address health inequality as we recover from the pandemic?

So we’ve seen that some groups mentioned above (and many others) were more likely to experience poor health before COVID-19, and have suffered more than the general population during COVID-19. How will we ensure that these groups are not left behind as we recover from COVID-19?

The Institute of Health Equity published ‘Build Back Fairer: the COVID-19 Marmot Review’ in December 2020. This report makes recommendations for England, but many of them are relevant in Scotland too, looking at factors like employment, housing, previous health conditions and ethnicity.

Looking specifically at Scotland, the Scottish Government set up the Social Renewal Advisory Board to make proposals for how to renew Scotland after the pandemic. Its report “If not now, when?” looks at how income could be distributed more fairly and how everyone should have access to basic rights and services.

The Mental Health Foundation, has looked at how the COVID-19 recovery can address worsening mental health in Scotland. Its manifesto outlines building a ‘wellbeing society’, where the causes of poor mental health are addressed highlighting the importance of prevention.

Most organisations who have looked at the COVID-19 recovery’s impact on health inequality agree that it needs to focus on addressing the fundamental causes of differences in people’s health across the population, rather than just dealing with the symptoms.

To find out more check out the SPICe research briefing Health Inequality and COVID-19 in Scotland.

Alex Priestly, Researcher and Lizzy Burgess, Senior Researcher, Health and Social Care