This is a guest article by two of the UK’s leading public health researchers, Nisreen A Alwan, Associate Professor in Public Health and Nida Ziauddeen, Senior Research Assistant in Public Health, both of the University of Southampton
Protecting the economy versus protecting health is a false dichotomy. However in the context of ending the lockdown, they are presented by politicians as warring factions. While the economy during the coronavirus pandemic appears to be at the mercy of public health, the latter has always been a consequence of the former.
Being poor and being from an ethnic minority carry more risk of dying from COVID-19 in England. In the United States, a similar picture is emerging with income inequality being recognised as an influential factor in covid-19 spread. ‘Hot spots’ for coronavirus include low-income neighbourhoods with predominant ethnic minority residents and unemployment, and working-class neighbourhoods with a high proportion of ‘essential workers’ less able to practise social distancing. People residing in poor or immigrant neighbourhoods in major urban areas such as New York City are less likely to get tested, but more likely to test positive for COVID-19.
The picture is becoming clear; the burden of covid-19 is falling heavily on poor and marginalised groups, similar to what we have seen with HIV.
It is not only about the direct effect of the virus. Lockdowns impact the socially and economically disadvantaged the most. These same groups of people are suffering the most from the social distancing measures imposed to control pandemic spread. Lockdown is likely to directly affect non-COVID19 health determinants including mental illness and domestic abuse. Take the case of school closures for example. These affect children unequally with some suffering the most, not only from an educational viewpoint but also from lack of economic support such as free school meals and the provision of social and safeguarding services. Food poverty is a real and serious problem for many children in the absence of meal provision by schools. Those children who continue to learn digitally tend to be from well-resourced families attending high-achieving schools.
The socioeconomic disparities in health we are seeing during this pandemic are not new. The economy determined health before covid-19. The same economic factors influencing covid-19-related outcomes have always had a substantial impact on health outcomes before the pandemic, including chronic diseases such as diabetes, heart disease and cancer, as well as their determinants like smoking, obesity, alcohol intake and lack of exercise.
For example, life expectancy in England clearly follows a socioeconomic gradient, with the gap between the rich and poor recently increasing. The more deprived the area where people live, the shorter their life expectancy. Among women in the most deprived areas, life expectancy actually fell compared to 10 years ago. Worldwide, life expectancy is strongly linked to gross domestic product (GDP) per capita. Countries with the highest GDP like Japan and Switzerland have the longest life expectancy.
Investing resources in closing the health inequalities gap will boost the economy. The return on investment for prevention initiatives such as improving immunisation coverage is enormous. On the other hand, following old and familiar ways of ignoring health inequalities will not pay off in a post-pandemic world.
The economy will have to pour massive resources and remain in a constant reactive mode to keep its shores safe from the waves of disease. Neither the economy nor public health will win unless they work as a joint force not as warring opponents. Therefore, any lockdown exit strategy, including testing and vaccination programmes, must be equitable in terms of who benefits from it and who it protects.
The pandemic is spelling it out for us; the economy will only be as healthy as the most vulnerable member of society.
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