Urban health • COVID-19

Unprecedented times, familiar inequalities

17 March 2021

5 min read

A year on from the first lockdown, Kieron Boyle shares what we've learned over the past year and what’s next in the fight against health inequality.

Kieron Boyle

Former Chief Executive

It has been an entire year since COVID-19 was declared a pandemic and the country first went into lockdown.

The commentary at the time was that the pandemic was a leveller. We now know that wasn’t true. What COVID-19 has shown us is how our society operates and who it fails.

The pandemic has disproportionally impacted sections of society, most notably women, Black and Asian and minority ethnic communities, and people who are poor. But this is not new. The pattern tracks exactly those experiencing other health inequalities – particularly in urban areas – from obesity to the harmful effects of air pollution.

If we weren’t clear before, we must be now: these issues are systemic and need to engage a wide set of actors, well beyond healthcare, to make real change. Cities are uniquely placed to make this collaboration possible. Their ever-changing nature means they are the perfect testbed for new ideas and approaches to health.

But in order for them to be so, we need to be clear-eyed on what may lie ahead. Rather than coming out of COVID-19 we are heading into a new phase.

The commentary at the time was that the pandemic was a leveller. We now know that wasn’t true. What COVID-19 has shown us is how our society operates and who it fails.

Kieron Boyle Former Chief Executive

The pandemic is changing, not ending

We may come to see these past 12 months, defined both by the awful effects of the virus and the heroic efforts of scientists and healthcare workers, as the first wave of this disease.

We are only now starting to see the second wave. These are the long-term impacts of COVID-19. Ahead of us is the true extent of the backlog of other health issues, including those related to long-COVID, and the numbers of people needing support for their mental health, not least NHS and other frontline workers.

Even longer term, though, is a third wave. These are the health effects of a huge shock to our economic system. Precarious employment, housing insecurity and financial stresses all contribute to poor health and none will be experienced equally.

Our work has been across all three — from providing emergency support to local communities, to understanding the effects of local air pollution, to working with private rented sector landlords to help tenants at risk of eviction from spiralling into poor health.

We embarked on a six-month project to understand how the rapid changes forced by lockdown restrictions affected air quality with Global Action Plan.

With School Food Matters, we deliver 1 million breakfasts to families at risk of food insecurity during school closures.

The critical issue of race

Critically in a global city like ours, the past year has also led to a more urgent awareness of the link between race and health outcomes. There has been well publicised data on the higher death rates of Black and Asian people throughout the pandemic. This mirrors other health inequalities. We know for example that in Lambeth the proportion of people living with two or more long-term conditions is almost twice as high among Black communities as white ones.

Of course, race isn’t the issue — racism is. We need to take this from an abstract issue to one of pressing, actionable need, and agree as a society that it is neither acceptable nor unavoidable.

Over the past year, we’ve been working with community researchers to understand the impact the pandemic was having on local residents. This research showed us that many people, predominantly Black, Asian and other miniority ethnic residents, had unanswered questions about the vaccines – their effectiveness, development and side effects – which meant they were undecided about whether or not to take it. This uncertainty was driven by rational concerns that are underpinned by a fundamental issue: a lack of trust. This includes access to trusted and evidence-based information, as well as trust of the health systems due to previous experiences of systemic racism.

That’s why, at the beginning of this year we launched a portfolio aimed at improving access to knowledge about the COVID-19 vaccines. Working with local partners, we want to ensure that there is consistent and equitable information available to everyone to help them make an informed decision.

For change to happen, people have to see the need for change, have a desire to change, and know what to change.

Kieron Boyle Former Chief Executive

All to play for

For change to happen, people have to see the need for change, have a desire to change, and know what to change. Certainly there is a need and a growing consensus for doing things differently. For us that’s more people seeing how health is a collective outcome and that for cities to be resilient they need to be fairer.

The challenge is to use this momentum to articulate precisely what a healthier urban future looks like. Alongside the Urban Institute and LSE Cities, we’ve been asking this question of others across the UK and internationally, and In the next few weeks we have several reports coming out sharing their insights. You can be notified about them here.

The key theme across them is just how much agency we have as a society to shape the futures ahead of us. Cities are designed, which means they can be redesigned. Increasing health inequalities do not need to be inevitable.

If the experience of the past year for many of us has been all those things we can’t do, let’s make sure this next year is about all those things we can, and should, start changing.

Unprecedented times, familiar inequalities

The pandemic is changing, not ending

The critical issue of race

All to play for

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