COVID-19: UK must ’Build Back Fairer’ warns new Marmot Review

A generation of children and young people risk worsening health and having shorter lives post the COVID-19 pandemic, warns Professor Sir Michael Marmot, Director of UCL’s Institute of Health Equity, in his new landmark report published today.

Build Back Fairer: The COVID-19 Marmot Review notes that in England the excess death rate linked to COVID-19 is higher than anywhere else in Europe. Pandemic containment measures (lockdowns, tier systems, social isolation) have harmed children and young people’s well-being and has damaged everyone’s prospect for improved long-term health.

The new review builds on the UCL Institute of Health Equity’s Health Equity in England: The Marmot Review 10 Years On, published in February this year. England entered the pandemic already in a poor state of health; improvement in life expectancy was slower than in almost every other rich country, and the numbers of people in poor health was risking; inequalities in health between socioeconomic groups and regions were rising; and life expectancy for people living in the most deprived areas was actually going down. Child poverty had increased and public services had been cut, in an unfair way: steeper cuts in poorer areas. A decade of austerity had damaged the nation’s health.

The COVID-19 Marmot Review highlights the UK’s lack of social cohesion - everyone working together for the common good - as an additional reason for the country’s current poor state of health. And it implores government not to choose between our health and the economy. Countries that had more effectively managed the pandemic had less of an economic hit and, as a result, less likelihood of containment measures causing long-term harm to health and health inequalities (see Editor’s Notes for more details).

The mantra of Build Back Better must become Build Back Fairer Sir Michael urges to reduce widening social, economic, environmental and health inequalities, level up differences in health between Regions, and mitigate against increasing regional inequalities and a new generation of children and young people’s mental and physical health declining further, risking shortening their lives.

Sir Michael said: "The COVID-19 pandemic has shown us how highly valued our health is, and how closely it is linked to the functioning of society and it would be a tragic mistake to attempt to re-establish the status quo that existed before the pandemic - a status quo that saw the UK as the worst in Europe, marked by stagnation of health improvement and widening health inequalities.

"There is an urgent need to do things differently, to build a society that functions to meet the needs of its members; to build a well-being economy that puts achievement of health and well-being at the heart of government strategy, rather than narrow economic goals; to build a society that responds to the climate crisis at the same time as achieving greater health equity."

Key findings - why we need to Build Back Fairer:

  • England’s excess death rate linked to COVID-19 highest in Europe because of failures to control the pandemic alongside the UK’s ’lost decade’ in health pre-pandemic
  • The pandemic has had an adverse impact on young people’s social and emotional development; the closing of early years settings is likely to make early child development worse; and closure of schools has contributed to an already wide educational gap
  • Containment measures and resulting social/economic impacts e.g., reduced family income, reduced employment/training and increases in poverty, harming young people’s physical & mental health as well as training/employment prospects, widening inequalities long term
  • The more deprived the local authority, the higher the COVID-19 death rate, with North of England worst hit, mirroring the pre-pandemic widening health and social determinants inequalities between Regions
  • Overcrowded living conditions and poor quality housing are associated with high COVID-19 deaths (housing conditions had deteriorated for many in the previous decade), which are shockingly high for ethnic minority communities
  • Systemic disadvantages among ethnic minority communities, including living conditions and exposure to the virus at work and at home, result from structural racism
  • Being a key worker, unable to work from home and being in close proximity to others all higher risk, with managers living in deprived areas higher risk than elementary workers living in least deprived areas
  • Close association between underlying health, deprivation, occupation, ethnicity & COVID-19 accelerating regional inequalities, particularly NW and NE England, which were underminded by pre-pandemic regressive cuts, made worse by differing pandemic containment measures
  • New health crisis created by pandemic-associated behaviour changes including increasing alcohol consumption, smoking & obesity inequalities & declines in mental health, all made worse by pre-pandemic deterioration of working & living conditions

Short-term key recommendations to reduce inequalities exposed and amplified by the pandemic:

  • Early Years: Increase early years funding to prevent closures & improve access to parenting programmes
  • Education: Provide laptops & urgently roll out catch-up tuition in full for students in more deprived areas
  • Children & Young People: Remove ’two child’ benefit cap & fund additional training for young people
  • Working & Living: Enforce minimum wages; increase furlough to 100%; end five-week wait for UC
  • Sustainability: Increase local government COVID-19 grants & housing allowance; remove council tax cap
  • Prevention: Public health core to tackling new health crisis; Increase funding to 0.5% of GDP from current 0.15% level (2.5% of NHS budget)

Medium-term key recommendations to overcome deterioration in socioeconomic conditions caused by the pandemic and associated societal response (lockdown & decreased economic activity):

  • Early Years: Improve availability & quality of early years services; increase spending to OECD average
  • Education: Restore school per-pupil funding to 2010 levels; address deteriorating mental ill health
  • Children & Young People: Reduce child poverty to 10%; increase apprenticeships & in-work training
  • Working & Living: Ensure living wage for healthy living; make UC £1000/year increase permanent
  • Sustainability: Reduce road traffic air pollution in deprived areas; build sustainable affordable homes
  • Prevention: Health interventions to improve health behaviours must focus living and working conditions

Long-term key recommendations to create a cohesive society prioritising a well-being economy through a national inequalities strategy, led by the Prime Minister, to tackle inequality and climate crisis:

  • Early Years: Government should prioritise reducing inequalities in early years development
  • Education: Attainment to match best in Europe & put equity at heart of education policy & funding
  • Children & Young People: Reverse mental health declines; all u21s in education, employment or training
  • Working & Living: Health equity & wellbeing heart of economic planning; consider four-day week
  • Sustainability: Ensure 100% of housing is carbon neutral & aim for net zero GHG emissions by 2030
  • Prevention: Public health system prioritising deteriorating living & working conditions to improve health

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