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State of the Region 2020 Full Report

Impact on our Health

Beyond the economic impact: COVID 19 and health inequalities

The conditions in which we are born, grow, live, work and age have important implications for our physical and mental health, as individuals and across wider society. The West Midlands Combined Authority (WMCA) sets out a vision for building a healthier, happier, better connected and more prosperous West Midlands, recognising the inextricable link between health and wealth. COVID-19 has the potential to create and widen health inequalities, both through the direct impacts of the virus, and the indirect impacts of the control measures imposed. While underlying health conditions increase the risk of serious consequences from infection, the economic and social response to COVID-19 has the potential to exacerbate inequalities in physical and mental health.

Many of the frontline key workers who are most at risk of contracting the virus are in low paid, insecure employment.  Where someone’s home is not a place of safety, or when they do not have ready access to essentials such as food and medicine, being more isolated may place them at greater risk of harm. Social distancing and isolation can have a detrimental impact on mental health and wellbeing, including through harmful health behaviours and reducing access to services and support.

Crucially, the pandemic has highlighted existing socioeconomic inequalities that have underpinned poorer outcomes in already disadvantaged groups. A recent review by Public Health England (PHE) confirmed that the that the impact of COVID-19 has replicated existing health inequalities and, in some cases, has increased them.

Nationally, the largest disparity found was by age. Among people already diagnosed with COVID19, people who were 80 or older were seventy times more likely to die than those under 40. Risk of dying among those diagnosed with COVID-19 was also higher in males than females;  those living in the more deprived areas than those living in the least deprived; and those in Black, Asian and Minority Ethnic (BAME) groups than in White ethnic groups.

It is important to note that these analyses did not take into account underlying health conditions or differences in occupational groups. However, a further review focusing specifically on BAME groups found that BAME individuals are more likely to work in occupations with a higher risk of COVID-19 exposure. In addition, the risks associated with COVID-19 transmission, morbidity, and mortality can be exacerbated by the housing challenges faced by some members of BAME groups. 

Consultation with stakeholders also highlighted historic negative experiences of healthcare or at work may mean that individuals inBAME groups are less likely to seek care when needed or as NHS staff less likely to speak up when they have concerns about PPE or testing. 

Socioeconomic inequalities have consistently been highlighted as key. BAME groups tend to have poorer socioeconomic circumstances which lead to poorer health outcomes; ONS data and PHE analysis confirmed the strong association between economic disadvantage and COVID-19 diagnoses, incidence and severe disease. Economic disadvantage is also strongly associated with the prevalence of smoking, obesity, diabetes, hypertension and their cardio-metabolic complications, which all increase the risk of disease severity. 

While unpacking the relative contributions made by different social and economic factors is challenging as they often intersect and do not all act independently, it is clear that action is needed across the whole system to improve the wider determinants of health and actively reduce inequalities. This in line with the inclusive growth principles promoted by the WMCA, and reinforces the importance of building an inclusive economy where all citizens can benefit.