Lessons from the pandemic

It is still a little early to assess the full impact of the Covid-19 pandemic on our health, but enough evidence is now in to draw some tentative conclusions.

Health think tank The Health Foundation has published its latest report which should supplement the public inquiry which finally got underway this week.

One of the most important implications of the ending of the pandemic is the effect it has on death rates.

These were distorted during the pandemic but are now reverting back to the levels we saw in 2019. This in turn means that we can bring renewed focus to a disturbing trend they uncovered: since 2011 improvements in life expectancy in the UK had stalled and gone in reverse for some groups of people.

In order to tackle this we need to know why it is happening in order to work out what to do to get the trend back on track.

This is incredibly complicated: how long you live depends on many factors that come into play throughout your life: the conditions in which you are born, grow, live and age.

Figures show that since 2011 life expectancy for those from more deprived areas has stalled, and in the case of women has actually decreased. For the affluent life expectancy has increased but by a lower rate than in the past.

Identifying and dealing with the causes is critical: this is a matter of human rights that cannot be left unaddressed.

We do know two things, however. The first is that the strongest influences on people’s health are the social, economic, environmental and commercial conditions of people’s lives – the ‘wider determinants’ of health. The second is that mortality rates between the rich and the poor and the poor are widening as is the greater prevalence of indicators of poor health such as childhood obesity in deprived areas. 

And whilst the slowdown is widespread among comparable high-income countries, it has been more rapid and sizeable in the UK than elsewhere. Similarly whilst younger adults are generally continuing to see improvements in comparable European countries, in the UK this is not the case.

More research on this problem is fundamental and will require a whole of government approach. In Northern Ireland that will require a fully functioning Executive and Assembly.

In itself Covid has focused attention on health inequalities so whilst the number of Covid deaths has reduced, the higher risk of death for those from deprived areas remains.

In any given month across the UK mortality rates have generally been three to four times higher in the most deprived areas than in the least. People from ethnic minorities are also especially vulnerable.

When vaccination was underway much was made of the speed of the UK’s rollout. Now we are able to say that take-up has been about the same, or slightly below other western European countries.

Once again both deprivation and ethnicity were factors. The take-up of three or more vaccinations was 20 percentage points higher in the least deprived areas than in the most deprived areas. Those whose first language is not English were also less likely to have been vaccinated or have received a booster.

It would seem one of the key lessons of the 1840s Great Famine in Ireland has still not been learned. Then much of the Irish-speaking population were unable to read English so did not understand the information released by the government. 

One of the enduring mysteries of the pandemic is the impact of long Covid.

In March 2021, the ONS survey suggested around 930,000 people in England had long COVID. By June 2022, this number was 1.6 million. As there were respectively an estimated 13 million infections by March 2021 and 62 million by the later date this suggests the first 13 million infections led to 930,000 cases (around 1 in 14), while the next 49 million infections led to around 700,000 instances of long COVID (around 1 in 70).

 There’s not an explanation for the discrepancy yet but some trends are clear: people with health conditions, living in more deprived areas and older people are more likely to have long Covid.

Most of the focus in health is on the growth of waiting lists by June of this year it stood at 6.5 million with 323,000 waiting over a year.

But this alarming state of affairs cannot be purely down to what happened during the pandemic: there are other factors at play. Bed capacity has been limited due to infection prevention control measures and staff absence rates increased with the wave of Covid infections in late 2021.

Other pressures, including a backlog in primary care and difficulty discharging patients into social care settings, have added to disruption. But the biggest problem of all is workforce shortages which in turn has impacted staff wellbeing and absence, a vicious spiral.

One positive is that mental health has improved since the start of the pandemic, with levels down to what they were in 2019. The main concerns today are anxiety among women, which remains higher than before the start of the pandemic. Then this the impact of the cost of living crisis and the question of whether the experience of the pandemic may have reduced resilience to further crises, with some people less able to cope.

 This should be balanced against a rise in drug and alcohol-related deaths and reductions in physical activity with a corresponding increase in obesity levels. All these have widened health inequalities with deprived areas most affected.

Going forward there are other areas of concern as well:

 – the repercussions of the lost learning for youngsters during pandemic and inadequate funding to allow children to catch up, coupled with an increase in absenteeism from school;

Increases in the number of those who are no longer economically active whether through sickness or choice;

The long term effects of the virus and long Covid which will emerge over time.

Two things, however are clear: the pandemic shows how well-directed policy has the power to address social ills. The second is that the failure to address historical inequalities was exacerbated by pandemic.

The tragedy is that the Westminster government is currently poised to make those problems a whole lot worse.