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Academics from the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) have called for urgent additional support for the NHS in parts of the country most likely to be adversely impacted by a ‘twindemic’ of COVID-19 and flu this winter.

It comes as new evidence published in Lancet Public Health has found that COVID-19 mortality rates were consistently higher in areas of socioeconomic disadvantage, both in the UK and globally.

This latest research was undertaken by Professor Clare Bambra, Inequalities lead for the NIHR ARC North East and North Cumbria (NENC), and Dr Vic McGowan from Newcastle University and a member of the ARC NENC’s Inequalities theme.

The findings add to a growing body of evidence of an unequal pandemic resulting from inequalities that are caused by the social factors that influence health – including housing conditions, employment and access to good-quality health care.

Globally, COVID-19 has exacerbated existing inequalities among the most socially disadvantaged and reducing these inequalities requires long-term action.

The COVID-19 pandemic took place against a backdrop of social and economic inequalities.

Previous research focussed on England had already identified significant regional inequalities with high rates of COVID-19 deaths in the most deprived northern regions.

However, there has been no assessment of whether there was a similar association in other countries. 

This new work sought to explore what is known about geographical inequalities in COVID-19 deaths globally. 

Lead author on the study, Dr Vic McGowan, said: “Our review provides clear evidence that those living in the most deprived communities shouldered the greatest burden from COVID-19. The Levelling Up agenda in the UK has the potential to reduce inequalities between areas of high and low deprivation, this would go some way to preventing inequalities arising in future pandemics.” 

Co-author Clare Bambra, Inequalities Lead for the NIHR Applied Research Collaboration (ARC) North East and North Cumbria added: “Our research shows that COVID-19 is an unequal pandemic. People in more deprived communities, globally and in the UK, have been most impacted with higher deaths.

“As we face a possible twindemic of flu and COVID-19 this winter in England, additional support for the NHS in those parts of the country most likely to be adversely impacted should be considered as a matter of urgency. Health inequalities between the rich and the poor exist globally. Tackling this requires collaborative cross-government action, for example working with people who have lived experience of living in deprivation to develop effective solutions.”

More about the study

Researchers reviewed 95 studies from across the globe and found extensive evidence of inequalities in COVID-19 deaths among those living in the most deprived areas.

A large majority of these studies (86 out of 95) showed that during the first two years of the pandemic, there were inequalities at every level of geography – neighbourhood, town, city, region – people living in poverty had higher rates of COVID-19 deaths than their more affluent neighbours across the globe.  

There was evidence of an association between COVID-19 deaths and area-level deprivation in four out of six global regions. Findings are in-line with data on area-level inequalities from other recent pandemics, for example H1N1 influenza, Ebola and Zika.  

Understanding the relationship between COVID-19 mortality rates and deprivation is complex.

Deprivation is affected by wider social determinants of health such as housing, working conditions, unemployment, healthcare access etc. This can cause higher exposure to the virus, for example people in low-income jobs are less amenable to remote working so employees were less able to benefit from local lockdown restrictions and working from home. Self-isolation is also harder in overcrowded housing and densely populated areas.  

Read the full research paper – published in Lancet Public Health, 2 November 2022

Further information

This research was carried out as part of the NIHR School for Public Health Research Health Inequalities theme Equal England research project led by Fuse.  

Fuse, the Centre for Translational Research in Public Health, is a partnership of public health researchers across the five universities in North East England. The Centre works with policy makers, practice partners and the public to improve health and wellbeing and tackle inequalities. Fuse is a founding member of the NIHR School for Public Health Research (SPHR). Find out more here: www.fuse.ac.uk 

A version of this news release was first published by the NIHR School for Public Health Research (SPHR) on 3 November 2022