Ambulance outside of Guys hospital

Urban health COVID-19

Why Sajid Javid needs to think beyond healthcare to tackle post-COVID health inequality

2 July 2021
5 min read

Policy and Influencing Director, Anna Garrod, talks about the role the new Health Secretary can play in tackling health inequity in cities and beyond.

Congratulations to the new Secretary of State for Health and Social Care, Rt Hon Sajid Javid MP. The new Minister spent his first day in the job on Monday visiting St Thomas’ Hospital, a short walk from the Houses of Parliament across Westminster Bridge.

The setting could not be a more fitting reminder of the monumental battle to tame this pandemic. On one side of the river, the most extensive Government policy response since the Second World War is taking place. On the other, the NHS is delivering round-the-clock, capacity-busting care.

Much has been written about the scale of the task ahead for the incoming Secretary of State: from COVID-19 vaccines to track and trace, the backlog of non-urgent NHS appointments, and the long-awaited reform of social care. That’s not to mention the Government’s ambitious manifesto commitments of 50,000 new nurses, 40 new hospitals, and the small matter of a major piece of health and care legislation to steer through Parliament. The to-do list is not inconsiderable and rightly requires Mr Javid to turn his mind to futureproofing our health and care system.


Not just a matter for Sajid Javid, or the Department of Health and Social Care

The greatest health crisis in living memory has demonstrated in no uncertain terms that our new Minister for Health and Social Care needs to focus his efforts far beyond his own department. The factors behind COVID-19 mortality rates lie beyond the reach of tackling waiting lists and addressing the workforce crisis in the NHS, as important as these endeavours are.

The facts remain that you are far more likely to test positive for, become seriously ill or die from COVID-19 if you live in crowded housing, have a precarious inflexible job, or experience financial insecurity. Likewise, the higher mortality rates for people from Black and other minority ethnic backgrounds are increasingly shown to be related to structural racism. The result of which means they are more likely to be dealing with financial insecurity and its knock-on effects. Our recent report on health and money found that people from Black communities are now more than twice as likely to anticipate difficulties paying their usual bills and expenses (34% of Black respondents vs. 14% national average).

Even clinical risk factors for COVID-19, such as obesity and living with long-term conditions, are associated with living in poverty. Our Easing Pressures report, published earlier this year with King’s College London, found that in our local boroughs of Lambeth and Southwark more than one in five people (23%) in the most deprived areas live with multiple long-term conditions, compared to only one in ten (11%) in the least deprived neighbourhoods.

Health inequality starts long before treatment

In this way, for Sajid Javid all roads lead to one conclusion: this pandemic has shown that the greatest gains to our health will come from focusing change on where we live and work throughout our lives. This is something that our evidence at Impact on Urban Health tells us again and again.

COVID-19 has devastatingly demonstrated that health inequity is a matter of life and death, and a matter of fairness too: some groups in society have borne the greater health, social and financial burdens of this pandemic and there is overwhelming agreement that fixing this injustice can no longer be pushed aside.

However, despite the daunting scale of these issues, we know from our work that the solutions are often remarkably simple and practical. What has made them elusive so far is our insistence to still think in silos, whether in Government, local decision-making, or within the NHS. Another of our recent reports with the London School of Economics illustrates the power cross-sector policymakers have to build back more equitably over the next decade (and the huge risks if they do not).

The pandemic has demonstrated what’s possible when science, community and businesses come together to prioritise health. It is clearer now than ever that the systems and infrastructures we live in are designed and can be redesigned – that inequality is not an inevitable part of modern life.

With this in mind, Sajid Javid cannot ‘go it alone’ if he truly wants to improve the health of our nation. With the recommendations and evidence below, we encourage Sajid Javid to venture out and visit these key colleagues in Whitehall:

  • Secretary of State for Business, Energy and Industrial Strategy: at Impact on Urban Health, we know from our partnerships with industry that simple action from businesses can have a positive impact on health. And from supermarkets to major construction companies, businesses repeatedly tell us that they want to do more. Simple changes to supermarket layouts can improve the healthiness of shopping baskets, with no impact on profit. Likewise, we are exploring whether smarter planning of haulage to construction sites can increase efficiency and improve air quality. The Secretary of State returns to his old stomping ground, the Department of Business, Energy and Industrial Strategy, with an encouraging win-win message: such initiatives to promote health are increasingly economically sound as investors require businesses to ramp up their ESG efforts.
  • Secretary of State for Education: School closures during COVID-19 lockdowns have shone a light on the importance of school food, particularly for children from families on low incomes For children eligible for Free School Meals, a hot, healthy lunch at school is a lifeline, and particularly pertinent given the importance of a nutritious diet in preventing life-long health issues and major risk factors for COVID-19 such as obesity. However, we know that there is too much variability in the quality of the food being served in our schools. As schools return to normality, now is the time for a review of school food, with a view to ensuring all children have access to healthy, nutritious meals.
  • Secretary of State for Work and Pensions: The relationship between the economy and health has never been clearer, as the Government has grappled with the unenviable task of balancing economic damage with protecting lives. This relationship between finances and health plays out distressingly at an individual level too. We know that poor health often means it is more difficult to remain in employment, which in turn can lead to housing insecurity and financial precarity. And the converse is also true – poverty and poor housing are linked to worsening health. To take a truly preventative approach, the new Secretary of State needs to take a trip to the Department of Work and Pensions to explore how we can join up services that support people at these important junctures. Our Financial Shield project is a form of social prescribing that brings together GP services, debt advice and housing associations, to proactively offer financial advice and debt management services to people at risk of financial insecurity.

The pandemic has demonstrated what’s possible when science, community and businesses come together to prioritise health. It is clearer now than ever that the systems and infrastructures we live in are designed and can be redesigned – that inequality is not an inevitable part of modern life. We’re here to support Sajid Javid to ensure we build back better, putting health equity at the heart of decision-making in the crucial months ahead.

To find out more about how we can support policymakers with data, case studies and briefings contact our Policy and Influencing Director Anna Garrod.