Five key findings from our COVID-19 impact inquiry

1. Health and socioeconomic inequalities left parts of the UK vulnerable to the virus and defined the contours of its devastating impact.

By mid-March 2021 the pandemic had led to 119,000 excess deaths in the UK. Yet underneath this headline figure, the pandemic has highlighted stark differences in the health of the UK’s population and the unequal pattern of COVID-19 deaths mirrors existing inequalities in our society. In England, COVID-19 mortality rates were more than twice as high for people from the poorest 10% of local areas compared with people from the wealthiest, and almost four times as high for the working age population.

We show how some groups in society have been disproportionately affected: during the first wave of the pandemic, 40% of all UK deaths were among care home residents and 6 out of 10 people who died with COVID-19 between January and November 2020 were disabled. People from ethnic minority communities had significantly higher risk of mortality – 3.7 times greater for black African men than their white counterparts during the first wave, and Bangladeshi men were more than five times more likely to die during the second wave.

2. Job type and insufficient access to financial support contributed to increased exposure to the virus among working age adults.

Poor working and living conditions, and lack of access to financial support saw some people more exposed to COVID-19. For lower income workers, low rates and coverage of statutory sick pay, and difficulty in accessing isolation payments, reduced people’s ability to self-isolate, thereby increasing their likelihood of catching the virus.

Men in roles such as security guards, care workers and taxi drivers were more likely to die from COVID-19. Death rates were highest for women working in caring, leisure and other service jobs. This partly reflects the poorer existing health of people working in those occupations, but also the higher risk of exposure in sectors which remained open during lockdowns.

3. The risks to people’s health go beyond the direct harm caused by the virus.

As well as the direct impact of COVID-19 on health, measures to control the virus have had wide-reaching consequences, affecting people’s lives and livelihoods differently – with both immediate and longer-term consequences for their health and wellbeing.

The reprioritisation of health care services to manage demand created by COVID-19 has led to increased unmet need for care. Health Foundation analysis shows that 6 million ‘missing patients’ did not seek treatment in 2020, which could mean many living with poor health for longer. In cases of acute need, such as cancer care, delayed treatments are likely to lead to reductions in survival rates.

Pandemic restrictions also affected people’s mental health through reduced social interaction, changing work conditions and loss of work and income. By September 2020, a fifth of the population had experienced a sustained deterioration in their mental health. Women, younger people, the unemployed and those facing financial hardship have fared the worst.

There’s also the future risk to health to consider, including the long-term impact of gaps in educational attainment, loss of employment, and financial insecurity – that could take a toll on people’s health for years to come.

As the government’s temporary financial support measures – the £20 Universal Credit uplift and coronavirus job retention scheme – come to an end, the pandemic risks further eroding people’s health through a decline in living standards, an increase in poverty and higher unemployment. This follows an extended period of people experiencing financial pressures with 28% of adults having experienced a deterioration in their family finances by September 2020 and almost 2 million being fully furloughed or unemployed for 6 months by February 2021.

4. The legacy of the 2008 financial crisis has had a direct bearing on our experience of the pandemic.

The nation’s health has suffered over the past decade. Following the 2008 financial crisis, public services had been eroded and the underlying economy and social fabric frayed. This led to increased financial insecurity and strained public services having to focus on acute need rather than preserving long-term health.

These deep-rooted issues – poor health, increased financial insecurity and strained public services – left the UK more vulnerable to COVID-19’s health and economic impacts. Without action to address these issues our resilience to future shocks and our long-term recovery are at risk.

The government needs to act immediately to address the harm caused by the pandemic and prevent longer term scarring. This includes tackling the NHS backlog, protecting family finances, and ‘catching up’ on education. Greater protection is needed for low-paid workers, as well as schemes and targeted support to help people whose mental health has deteriorated to get back into work.

5. A fair recovery from COVID-19 must address the root causes of poor health

The unequal impact of the pandemic was not inevitable. Government must address the root causes of poor health and invest in jobs, housing, education and communities. Building future resilience by investing in the conditions that keep people healthy and prosperous is the only way to create a healthier society that can meet the challenge ahead and better withstand future crises.

There are also opportunities to build on some of the positive changes seen during the pandemic, including remote working and access to services, increased awareness of health inequalities, and strengthening of local communities. All of these can be harnessed to improve health and reduce inequalities.

Building the foundations for long-term recovery – one that improves health as well as the economy – will require significant action and investment from government. A cross-government health inequalities strategy is needed to ensure ministers across government work together to level up health. We need to see clear targets for improving health and a regular, independent assessment of the nation’s health that is laid before parliament. This approach will pay dividends for the nation’s health and prosperity in the longer term.