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Declining mental health, long COVID and preventable deaths – new book outlines how the COVID-19 pandemic hit the North harder

Around 2,500 deaths could have been prevented if ‘Levelling Up’ of the North had occurred pre-pandemic, according to a new book by researchers linked to Applied Research Collaborations (ARCs) in the North of England.

Northern Exposure, written by Professor Clare Bambra and Dr Natalie Bennett of Newcastle University and Dr Luke Munford and Sam Khavandi of the University of Manchester, builds on reports the authors produced with the Northern Health Science Alliance (NHSA) over the course of the pandemic. These showed the devastating impact of regional inequalities and how severely COVID-19 hit the North of England.

It reveals how:

• Around 2,500 deaths could have been prevented if ‘Levelling Up’ of the North had occurred pre-pandemic.
• The average COVID-19 mortality rate during the first 13 months of the pandemic was 17% higher in the North – an additional 29.4 more deaths per 100,000 people.
• Rates of long COVID are 30% higher in the North than in the rest of the country.
• Hospital pressure was 10% greater in the North, and experienced larger reductions in elective, inpatient, emergency inpatient and outpatient procedures.
• People from minority ethnic backgrounds, women and younger people experienced greater declines in mental health during the pandemic. People in these groups in the North had worse mental health scores than those in the rest of England

The book also details how, in addition to the severe health impacts, the pandemic also took a toll on economic outcomes. On average, those living in the North experienced:

• A 20% higher rise of levels in unemployment compared to the rest of England
• An additional 6 weeks in the harshest levels of lockdown
• A drop in wages during the pandemic compared to elsewhere in the country

Professor Bambra, lead for Inequalities and Marginalised Communities at the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria, has been instructed as an independent expert witness to module 1 (which examines the UK’s pandemic preparedness and resilience) of the COVID-19 Independent Public Inquiry, chaired by Baroness Heather Hallett. She will do this alongside Professor Michael Marmot, from the Institute of Health Equity.

She said: “Emerging from the COVID-19 pandemic and entering further challenging times, our book highlights the urgent need for policies that support the building of a stronger, healthier, and more equal country – for everyone.”

Co-author Luke Munford, deputy lead for Economic Sustainability at NIHR ARC Greater Manchester, said: “Before the COVID-19 pandemic, England was a deeply unequal country. Individual circumstances, including where you live, led to different outcomes in key domains of people’s lives, including their health and wealth. We found that more deprived areas in the North experienced greater COVID-19 mortality than equally deprived areas in the rest of the country. In particular, the effects of deprivation on health are made worse when an area is in a region which already has higher deprivation levels.”

Hannah Davies, health inequalities lead for the NHSA, wrote the foreword for the book. She said: “Understanding where the North of England fits into the rejuvenation of the country is vital. The economic arguments for improving the health of the most deprived communities in the UK are clearly and dramatically shown. The North’s relatively poor physical and mental health meant it suffered under the pandemic for longer and it hit harder. Nowhere has it been illustrated more clearly that health is wealth – and that is a lesson we must take into the future.

“Unless action is taken to rectify this, there is likely to be a long-term health legacy from the COVID-19 crisis – with health inequalities increasing into the future. To avoid a long shadow of COVID-19 hanging over the future of the North, we need to act to reduce the North-South divide.”

Northern Exposure is published by Policy Press, an imprint of Bristol University Press and is available to view at https://library.oapen.org/handle/20.500.12657/61395

EDITORS NOTES

Clare Bambra is professor of public health, Population Health Sciences Institute, Newcastle University and and lead for Inequalities and Marginalised Communities at the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria. She is an interdisciplinary social scientist working at the interface of public health, health politics and policy, health geography and social epidemiology. Twitter @ProfBambra

Dr Natalie Bennett is a research associate in the Population Health Sciences Institute at Newcastle University and the NIHR ARC North East North Cumbria, working on health inequalities. She is a Social Epidemiologist with a background in Human Geography and interests in the social determinants of health. Twitter @DrNCBennett

Sam Khavandi is a research associate in Health Economics at the University of Manchester and the NIHR ARC Greater Manchester. He is an applied health economist with a background in public health focusing on the wider determinants of health and consequences of health inequalities. Twitter @HOPE_UoM

Luke Munford is senior lecturer in health economics at the University of Manchester and deputy lead for Economic Sustainability at NIHR ARC Greater Manchester. He is an applied economist who uses large data to understand the causes and consequences of health inequalities. Twitter @dukester24

The NHSA ltd is a partnership established by the leading Universities and NHS Hospital Trusts in the North of England to improve the health and wealth of the region by creating an internationally recognised life science and healthcare system. It links ten universities and ten research-intensive NHS Teaching Trusts with four Academic Health Science Networks (AHSNs covering a population of over 16 million).

The NHSA’s members include: Newcastle University, Durham University, University of York, University of Liverpool, University of Manchester, Lancaster University, University of Central Lancashire, University of Sheffield, Sheffield Hallam University, University of Leeds, The Newcastle Upon Tyne Hospitals NHS Trust, South Tees Hospitals NHS Trust, Leeds Teaching Hospitals, Sheffield Teaching Hospitals, Rotherham, Doncaster and South Humber NHS Foundation Trust, Manchester University NHS Foundation Trust, Liverpool University Hospitals NHS Foundation Trust, Hull and East Yorkshire Hospitals, Lancashire Teaching Hospitals, Tees, Esk and Wear Valleys Foundation NHS Trust, Innovation Agency, Yorkshire and Humber AHSN, AHSN North East North Cumbria, Health Innovation Manchester.

For more information on the NHSA visit www.theNHSA.co.uk

The NHSA, in partnership with MedCity, received funding from Research England for a three-year project to improve the visibility of UK life sciences expertise on the international stage, which began in early 2020.

Funding is being provided from the Research England Development (RED) Fund which supports strategic projects aiming to implement innovations in research and knowledge exchange.

Research England shapes healthy, dynamic research and knowledge exchange in English universities. It distributes over £2.2bn to universities in England every year; works to understand their strategies, capabilities and capacity; and supports and challenges universities to create new knowledge, strengthen the economy, and enrich society. Research England is part of UK Research and Innovation alongside the seven Research Councils and Innovate UK. www.ukri.org/re, @ResEngland

Bristol University Press, and its imprint Policy Press, is committed to publishing the highest-quality scholarship in the social sciences and aligned disciplines. It seeks to make a positive contribution to society from the advancement of ideas through to practical implementation. As a not-for-profit publisher, it puts integrity before profit and research before sensationalism to ensure that it provides an internationally respected platform for the global scholarly community to disseminate work that matters.

BristolUniversityPress.co.uk

@BrisUniPress