Covid-19: what austerity means for our health

We hear a lot at the moment about how a decade of austerity has meant that the NHS and the social care system is not equipped to deal with the fallout from coronavirus. Rightly so – it is a scandal. Underfunding and neglect has made it difficult for the health and care system to weather the winter, let alone a pandemic. But austerity has also made those most at risk of contracting coronavirus more vulnerable to its health consequences.

We all know by now that older people and those with underlying health conditions face greater consequences if they contract the virus, but what we hear less about is the social gradient in the prevalence of health conditions. The poorer you are, the more likely you are to have a disability or life-limiting health condition. This is because health is determined, more than anything else, by the social, economic and environmental conditions that we find ourselves in – be it the quality of our housing and employment, the adequacy of our income, our access to quality health and care services or our connections with others.

This social gradient of health in the UK has got worse over recent years. In some parts of the country, life expectancy is in decline and some people can expect to live a greater proportion of their shorter lives in ill health than they would have 10 years ago. For all people, the years that they will spend in poor health have increased since 2010: by 0.4 years for men and 0.8 years for women. On average, healthy life expectancy at birth differs by 12 years between the most and least deprived local authorities.

Last month, the Health Foundation published an updated version of the Marmot Review – a landmark review into health inequalities from 2010 – setting out the reasons behind the widening gap. It found that the primary cause is the 10 years of austerity imposed on the UK.

Rolling back spending and support at a time of growing need has resulted in increasing social, economic and regional inequalities that reproduce inequalities in health outcomes. The report says:

“From rising child poverty and the closure of children’s centres, to declines in education funding, an increase in precarious work and zero hours contracts, to a housing affordability crisis and a rise in homelessness, to people with insufficient money to lead a healthy life and resorting to food banks in large numbers, to ignored communities with poor conditions and little reason for hope … Austerity will cast a long shadow over the lives of the children born and growing up under its effects.”

Cruelly, many of those people who have had their healthy life expectancy shortened by austerity, and therefore with a heightened vulnerability to the virus, will also be those least able to avoid contracting it. Just as the consequences of coronavirus are unevenly distributed, so is exposure. Social distancing, for instance, is a lot easier with the means to do so. As Frances Ryan comments: ​“there is a privilege to being able to cut yourself off from work – be it being able to afford the cost of extra heating during the day, having enough disposable income to stockpile food and medicine, or having a job you can do at home (or indeed one that provides sick pay if you’re not there)”.

In the New York Times, Max Fisher and Emma Bubola note that ​“research suggests that those in lower economic strata are likelier to catch the disease. They are also more likely to die from it”. They conclude that ​“as coronavirus spreads across the globe, it appears to be setting off a devasatating feedback loop with another of the gravest forces of our time: economic inequality”.

Austerity, as a response to our last big national crisis (the financial crisis), failed to account for its effects on inequality and health and coronavirus is exposing the consequences of this. To face up to the coronavirus crisis, we need to learn from our mistakes and place inequality at the front and centre of our response. Unless decisive action is taken, coronavirus and the economic impact to follow will further widen inequalities and worsen the health of the nation. This is both unfair and unwise — a resilient economy cannot be built on the foundations of inequality and poor health. The government must act now to ensure that resources are fairly distributed and that everyone is able to get through the crisis and beyond.