The Covid-19 Pandemic Exaggerated Health Inequalities in England

The Pandemic has increased health inequalities in England, according to a recent report by the Institute of Health Inequalities – Build Back Fairer – The Covid-19 Marmot Review: The Pandemic, Social and Health Inequalities in England.

Prior to the Pandemic, from 2010 to 2020, health inequalities between the least and most deprived were increasing in England.

Pre-pandemic, increases in life expectancy had stalled, but life expectancy for the most deprived 10% of the population actually decreasing in some regions (such as parts of the North East and London) during some years in that 10 year period.

Covid-19 increased health inequalities

The charts below show the mortality rates per one thousand between March and July 2020.

As you can see, there are drastic differences already between the least and most deprived deciles – 600/ 100 000 for the poorest decile, compared to 400/ 100 000 for the wealthiest decile.

But the difference is greater when we look at the covid related mortality rate – this is 200/100 000 for the poorest, compared to nearly 100/ 100 000 for the wealthiest.

So health inequalities increased from a difference of 1.5.1 to nearly 2:1 as a result of the Pandemic.

Some of this difference is explained by the different levels of exposure due to occupation – as a general rule, professional workers are more able to work from home and stay isolated, while manual workers and care workers need to actually go to work in person, and this is reflected in the different mortality rates by occupation (‘social class’) for the same period as above:

Explaining health inequalities… it’s not ALL about the Pandemic

Professor Marmot is at pains to point out that these health inequalities were in existence BEFORE the pandemic, and that government health policies between 2010 to 2020 explain WHY poor people have died in such huge numbers from covid-19 and why England has the highest covid related mortality figures in Western Europe.

In particular Marmot points to the following government policies:

  1. A political culture that undermined social inclusivity and cohesiveness and failed to promote the common good
  2. Widespread inequality, which is bad for socio-economic outcomes in general, with the most deprived ‘steered’ towards poor living conditions and unhealthy lifestyles.
  3. Government austerity policies – an underfunded health and social care sector.

In terms of what to do, the report makes a number of suggestions, mainly to do with introducing policies to improve health outcomes of the most deprived, and this will take a broader/ deeper approach to social change rather than just being about health!

Relevance to A-level Sociology

This is a VERY sociological report – putting the covid mortality rate in longer term context.

The point is that we can’t just blame the Pandemic for killing people – certain types of people (the poor) died in larger numbers proportionality to the rich – which means there was a social cause to the high covid death toll in England.

And that cause was, according to this report, already high levels of existing inequality.

This is a rare example of some long-term quantitative analysis, it sounds almost like Functionalism/ Positivism in its approach.

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Why is the UK’s Child Mortality Rate so High?

The United Kingdom has the highest child mortality rate in Western Europe except for Malta. The UK’s child mortality rate currently stands t 6.5 per thousand live births.

This has been the case for many years now and a recent research study into the causes has found that deprivation is the key factor which correlates with higher infant mortality rate.

Dr Karen Luyt from the University of Bristol lead the study which found that every extra 10% increase in deprivation, there is a corresponding increase in the child mortality rate.

To put it bluntly* the poorer a child is the more likely they are to die before they reach 18 years of age. (*and maybe crudely as poverty isn’t exactly the same thing as deprivation).

It’s not that being born into deprivation itself directly causes a child to be more likely to die compared to a child born into wealth, it’s the societal and lifestyle factors associated with being born into deprivation.

And the primary factor which causes higher child mortality rates is exposure to smoking.

The programme above features one interview with someone from a deprived background which illustrate how this works – she describes how she started smoking at 14, along with all her friends, and this wasn’t discouraged as her entire family smoked too.

She describes how her friends would pool their lunch money to buy cigarettes and do without lunch and sometimes use the school emergency fund not for lunch but again for cigarettes.

And then when these teenagers become adults they carry on smoking, and when some of them eventually get pregnant, around 6% of them continue smoking into pregnancy, and it’s that which increases the likelihood of child mortality.

(The link between smoking during pregnancy and damaging the foetus is well established).

There have been government intervention programmes to try and help people quit smoking but they are less successful in poorer areas where more people smoke as it’s simply harder to quit when more people around you in your daily life are smoking.

And not to mention cuts to government pubic health funding recently which mean many of these quit smoking programmes have been cut back.

This issue was the investigation of a recent News Night study which you can view on YouTube:

NB – the first half of the video is about the issue of smoking, the second half mainly consists of politicians lying about their commitments to improving public health funding.

Relevance to A-level sociology

This provides yet more evidence of the consequences of inequality in society, and the harmful effects of deprivation in particular, and it’s a useful update to topic of death rates, which have long been declining in rich countries, but this reminds us that even in rich countries like Britain the death rate can be relatively high in deprived areas.

If we look at the agenda of the report it’s also interesting that ‘deprivation’ is the main cause of high child death rates and yet the whole video is about the lifestyle issue of smoking – this might be an example of agenda setting from a Marxist point of view – shifting the emphasis away from the broader issue of inequality to the ‘lifestyle’ factor of smoking.

Finally, it’s a good example of quantitative data analysis – with a research team talking data from the public health database and correlating this with other factors such as the deprivation index. This is is research broadly in line with Positivist tradition.

Is alcohol really that bad for your health?

The new ‘safe’ level of alcohol consumption should be none, at least according to a recent study into the health risks of alcohol published by the The Lancet.

This contradicts the current official government guidelines on the ‘safe’ level of drinking: currently around 14 units per week for women, and 21 for men.

The findings of this research study were widely reported in the mainstream media:

  • The Daily Mail reported that ‘just one glass of wine a day increases your risk of various cancers’.
  • Even The Independent reported that ‘the idea that one or two drinks a day is good for you is a myth’.

alcohol health statistics.png

But what are the actual statistical risks of different levels of alcohol consumption?

The actual risk of developing a drink related alcohol problem for different levels of drinking are as follows:

  • No drinks a day = 914/ 100 000 people
  • One drink a day = 918/ 100 000 people
  • Two drinks a day = 977/ 100 000 people

I took the liberty of putting this into graph form to illustrate the relative risks: blue shows the proportion of people who will develop alcohol related problems!

alcohol health risks

This means that statistically, there is only a 0.5 % greater risk of developing an alcohol related illness if you have one drink a day compared to no drinks, which hardly sounds significant!

Meanwhile, there is a greater increase in risk if you have two compared to 1 drink a day, which suggests the government guidelines have got this about right!

(NB, despite the headlines, The BBC and Sky did a reasonable job of reporting the actual stats!)

So why did some news papers report these findings in a limited way?

This could be a classic example of News Values determining how an event gets reported: it’s much more shocking to report that the government has got its advice wrong and that really there is no safe level of drinking!

Or it could be that these newspapers feel as though they’ve got a social policy duty to the general public… even if there is only a slight increased risk from alcohol consumption, maybe they feel duty bound to report it in such a way to nudge behaviour in a more healthy direction.

In terms of why some newspapers did a better job of reporting the actual findings: it could be that these are the papers who rely on advertising revenue from drinks companies? Maybe the Mail and the Independent don’t get paid by drinks companies, whereas Sky does>?

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