Last week, the UK marked a year since its first national lockdown began in response to the devastating global pandemic that has so far resulted in more than 126,000 UK deaths (Worldometers 2021). While we continue to do all we can to prevent the spread of the virus, manage infected patients, and roll out vaccines, the disruption to our social, economic and health systems also goes on.
However, in the government’s roadmap out of lockdown urgent action is needed to ensure we don’t solve one crisis and exacerbate multiple others.
A year on from when the pandemic first forced us all adapt to a ‘new normal’, many researchers are investigating the inadvertent health consequences of the outbreak.
This includes the impact lockdown has had on our mental health and alcohol intake (Niedzwiedz et al 2021) and how it has increased inactivity and unhealthy eating behaviours (Robinson et al 2021).
One issue which quite rightly has had significant attention during the pandemic is the disproportionate impact the virus has had on lower socio-economic groups and minorities (Van Dorn, Cooney and Sabin 2020).
However, when it comes to the health of the nation, researchers in public health have known for a long time that there are stark differences in life expectancy across certain population groups (Marmot et al 2010).
This is because the conditions in which you are born, grow, live, work, and age can determine your health outcomes. For example, income and wealth, or lack of it, can determine the prospects of the area in which where you live, the type of green spaces available in your area and the quality of foods you can afford to buy.
This, in turn, has consequences, by limiting the chances of adopting a healthy diet and having access to places for exercise.
In 2008, the World Health Organization gathered evidence which recommended what countries can do to promote equity in health.
These recommendations included implementing policies which improve daily living conditions and tackle the unequal distribution of power, money, and resources. An understanding of these determinants and recommendations should be enabling action to reduce health inequalities.
What we have seen is the pandemic exacerbating the problem further (Bambra et al 2020, Burström and Tao 2020) and an economic recession triggering increased poverty (Asare and Barfi 2021). This is why the issues creating inequalities in health need urgent action to protect those at greatest risk.
Increasing physical inactivity
Physical inactivity negatively impacts both physical and mental health and is among the top 10 greatest causes of ill health nationally (Sport England 2017). An increase in physical activity can also positively impact health, social and economic status, meaning it can have a positive correlation between outcomes and structural inequalities (Smith, B., et al., 2018).
Therefore, creating opportunities for decreasing inactivity and enabling physical activity for everybody is essential.
However, previous research has also highlighted that interventions which aimed to increase physical activity have, in fact, exacerbated inequalities for communities with certain protected characteristics, which can include age, ethnic or national origin, religious belief, sexual orientation, gender reassignment, sex, being pregnant, married, in a civil partnership or has a disability (Cavill and Rutter 2017).
Researchers in public health are crucial for measuring and understanding this problem and assessing the impact of action. Their research should be able to provide practical guidance for those implementing key policies and programmes and, as a public health research nurse, I have a responsibility to translate my findings into actionable and accessible recommendations.
This is why Dr Clare Roscoe, Dr Niamh Mourton and myself have worked with Public Health England to produce an evidence-based guidance for commissioners of a variety of sectors to understand and address inequalities in physical activity.
The guidance analysed the Sport England (2021) Active Lives Survey 2015-19, existing research and conducted qualitative study with practitioners delivering physical interventions to communities with protected characteristics. The guidance should, if applied, proactively work towards equal opportunities for all individuals in health and wellbeing.
What can we do?
In order to begin to tackle the true extent of the impact of COVID-19 on the nation’s health empowering the communities with those at greatest risk is key. You might think that you are powerless to act because, ultimately, it is government legislation and policy which is needed to make real change to inequalities.
However, individuals can play a role in raising awareness of these issues. We can all call out individual blame on health behaviours such as obesity or alcoholism and educate others on the wider systemic issues, such as the cost of living a healthy lifestyle. Ultimately, we can all do more to meet practical, environmental, social, and psychological needs of communities we know are at greater risk of inequalities of health.
Asare, P. and Barfi, R., 2021. The Impact of Covid-19 Pandemic on the Global Economy: Emphasis on Poverty Alleviation and Economic Growth. Economics, 8(1), pp.32-43
Bambra, C., Riordan, R., Ford, J. and Matthews, F., 2020. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health, 74(11), pp.964-968
Burström, B. and Tao, W., 2020. Social determinants of health and inequalities in COVID-19. European Journal of Public Health, Volume 30, Issue 4, August 2020, Pages 617-618, https://doi.org/10.1093/eurpub/ckaa095
Cavill, N. and H. Rutter, (2017) The impact of interventions and policies on socio-economic status differentials in physical activity: Evidence review for the Health Equity Pilot Project (HEPP).
Commission on Social Determinants of Health, 2008. Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. World Health Organization.
Van Dorn, A., Cooney, R.E. and Sabin, M.L., 2020. COVID-19 exacerbating inequalities in the US. Lancet (London, England), 395(10232), p.1243.
Marmot, M., Allen, J., Goldblatt, P., Boyce, T., McNeish, D. and Grady, M., (2011). Fair society, healthy lives. Strategic review of health inequalities in England post-2010
Niedzwiedz, C.L., Green, M.J., Benzeval, M., Campbell, D., Craig, P., Demou, E., Leyland, A., Pearce, A., Thomson, R., Whitley, E. and Katikireddi, S.V., 2021. Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study. J Epidemiol Community Health, 75(3), pp.224-231.
Robinson, E., Boyland, E., Chisholm, A., Harrold, J., Maloney, N.G., Marty, L., Mead, B.R., Noonan, R. and Hardman, C.A., 2021. Obesity, eating behavior and physical activity during COVID-19 lockdown: A study of UK adults. Appetite, 156, p.104853.
Sport England (2017) Review of evidence on the outcomes of sport and physical activity. Report for Sport England
Sport England (2021) Active Lives. Available at: Active Lives | Sport England 15th March 2021
Smith, B., et al., (2018) Physical activity for general health benefits in disabled adults: summary of a rapid evidence review for the UK Chief Medical Officers' update of the physical activity guidelines. London: Public Health England.
Worldometer (2021) COVID-19 Coronavirus pandemic. Available at: Coronavirus Update (Live): 118,243,352 Cases and 2,624,068 Deaths from COVID-19 Virus Pandemic - Worldometer (worldometers.info) 15th March 2021