A failure to tackle health inequalities made worse by the Covid-19 pandemic risks “condemning” the next generation of children to “less flourishing” lives than their parents, a health expert has warned.
Professor Sir Michael Marmot urged ministers to do “whatever it takes” to put improving health and wellbeing at the “heart” of all Government policy, as he published a report highlighting the scale of the impact of the coronavirus crisis on people in England.
The report, Build Back Fairer: The Covid-19 Marmot Review, found that the Covid-19 outbreak had damaged everyone’s prospects of improved long-term health, particularly children who are at risk of shorter lives post-pandemic.
Prof Marmot said the impact of the virus and the Government’s response to the crisis was “entirely predictable” based on analyses of the previous decade of worsening health inequalities as a result of austerity.
His report, published on Tuesday, highlighted that England’s excess death rate linked to Covid-19 was higher than anywhere else in Europe.
He said the “social gradient” of lower mortality being associated with less deprivation pre-pandemic was “remarkably similar” to that seen during the pandemic.
“The fact that the attempts to control the pandemic, lockdown, would make poor people poorer, and not make rich people poorer on the whole, maybe even make them richer, that was, unfortunately, entirely predictable,” he told journalists in a briefing ahead of the report’s release.
He added that “the inequalities in Covid-19 and the inequalities in health are not different phenomena. They’re almost the same phenomenon.”
Prof Marmot cited contributing factors as “poor governance”, social and economic inequalities, reductions in spending on public services and being an “unhealthy” nation going into the pandemic.
A previous report produced by Prof Marmot in February, Health Equity In England: The Marmot Review 10 Years On, found that “flatlining” life expectancy and worsening health inequalities over the past 10 years had led to a “lost” decade in England.
Prof Marmot, who is professor of epidemiology at University College London (UCL) and director of the UCL Institute of Health Equity, said the pandemic had affected “every stage of the life course”.
He said policymakers were previously “not putting health and wellbeing as a priority” and should have seen the growing “crisis” in health inequalities.
His new report found that the pandemic had adversely affected young people’s social and emotional development, widened the education gap, reduced family incomes and increased poverty and unemployment.
Underlying health, deprivation, occupation, ethnicity and Covid-19 accelerated regional inequalities, particularly in the North West and North East of England, the report found.
It said these were “undermined by pre-pandemic regressive cuts” and “made worse by differing pandemic containment measures”.
Covid-19 deaths among ethnic minority communities were “shockingly high”, with Prof Marmot emphasising the need to tackle the “structural racism” that leads to systemic disadvantages such as poorer living conditions and exposure to the virus at work.
An increase in alcohol consumption, smoking, obesity inequalities and declines in mental health during the pandemic was leading to a “new health crisis”, the report said.
Outlining a raft of recommendations for Government, Prof Marmot warned that unless it takes action, it risks England becoming “increasingly an unhealthy country with large inequalities” with the danger that it could “fall behind other European countries in a way that is unnecessary”.
“I think if you don’t follow the kind of recommendations we make, we are condemning the next generation to a less flourishing life than their parents had,” he said.
He highlighted countries in Asia, such as Korea, as examples of nations that had controlled the pandemic “well” with less economic and social impact.
Short-term recommendations in the report include catch-up tuition for students in deprived areas, removing the “two child” benefit cap, extending furlough support, funding additional training for young people, increasing local government Covid-19 grants, and raising public health funding from 0.15% to 0.5% of GDP.
More long term, the report calls for efforts to reduce child poverty, make increased Universal Credit payments permanent, focus on reducing inequalities in early years development, cut pollution levels in deprived areas and build affordable, carbon-neutral homes.
“We can’t afford not to do this,” Prof Marmot said, arguing that government debt is “no excuse”.
“We’ve got some incorrect notion about the necessity of austerity,” he said.
Prof Marmot said it would be a “tragic mistake” if the country went back to the “status quo” that existed before the pandemic.
Dr Jennifer Dixon, chief executive of the Health Foundation, which commissioned the report, said: “Mitigating the damage caused by the pandemic to education, employment and income must be at the heart of the Government’s plans for recovery and levelling up.
“For young people, this means practical help to find employment and training to access better- quality jobs. As we rebuild, these measures are vital to ensure that the generation of young people who have lived through the pandemic don’t continue to feel its impact on their health throughout the rest of their lives.”
Professor Dame Parveen Kumar, chairwoman of the British Medical Association (BMA) board of science, said: “With England’s Covid-19 excess death rate being the highest in Europe, our inability to withstand the pandemic as well as other comparable rich counties is an important lesson in the value of good public health.”
She urged action on addressing the link between deprivation and structural racism, and added: “It is absolutely unacceptable that in a country of such means there is such a strong divide between the richest and poorest in society.
“This report should serve as an important call to action for the Government to invest in the health of this nation in the long term as, in these challenging uncertain times, closing the gap has never been more important.”
A Department of Health and Social Care spokesman said the Government has worked “tirelessly” to protect the NHS and save lives during the “unprecedented” pandemic.
“We are absolutely committed to supporting the mental wellbeing of children and young people – NHS mental health services have remained open and we’ve launched a new tailored Every Mind Matters campaign with tips and advice to promote mental wellbeing.
“We’ve had the highest levels of life expectancy in recent years – Covid-19 will impact these figures – and it has shone a light on the differences in health outcomes between communities, and we remain committed to levelling up health outcomes so everyone can enjoy a long, healthy life.”
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