Urban health • COVID-19

Emerging lessons from the COVID-19 pandemic

21 April 2021

Five pathways for cross-sector action on urban health equity

In brief

The COVID-19 pandemic brought into sharp focus the health disparities that have long existed worldwide. Moreover, the pandemic exposed their roots in systems of exclusion and power. Throughout the world, we have seen drastically different local and national responses to the health crisis, and the accompanying economic downturn. Furthermore, these varied in levels of risk and vulnerability and emergent supports.

Working with Urban Institute, a US urban health think tank, we convened international experts. We wanted to explore their experiences of handling the pandemic across their cities as it unfolded in real-time. As a result, we have begun consolidating our learning. Importantly, we started to identify the crucial questions that need addressing to achieve urban health equity as we begin to build back from the pandemic.

Executive summary

We brought together experts in health, urban development, and social change. Discussions centred on whether the pandemic offers an opportunity to address the systems that embed the disparities which are especially apparent in our cities.

The three-part dialogue series, held in November and December 2020, brought together leaders from academia, philanthropy, and private health practice. Accordingly, these leaders brought scholarly and practical insights into the pandemic’s impacts on urban health equity. In addition, the links between local actions and system-level solutions, and the potential for innovative approaches to address the challenge, were also discussed.

Overall, a central message emerged from these conversations. Achieving urban health equity requires leadership and collaboration among different actors in society.

Conclusion

The COVID-19 pandemic has laid bare the links between structural drivers—particularly structural racism—and the social determinants of health that have manifested in disproportionate mortality and morbidity for minoritised groups.

The dialogue series was a unique opportunity amid the pandemic for experts to exchange insights and explore emerging lessons and pathways for action. Urban Institute’s report is a synthesis of the three conversations and the issues that were highlighted, with some reference to the emerging evidence of the pandemic’s impacts on urban health equity.

It also highlights the links between local actions and system-level solutions and the potential for innovative approaches to address challenges. However, there is much to learn. As part of these conversations, we identified several unanswered questions for consideration as we recover from the pandemic with health equity at the core. This ranged from how to address structural factors that impact health to the practical tools and resources required to empower local leaders to apply global insights locally.

The overlap between neighbourhood disparities, inequality, and structural racism has been further illuminated by the pandemic’s disparate outcomes: areas populated by people with low incomes have experienced greater exposure to COVID-19 than wealthier communities.

Marmot et al. 2020

Our commitment

The health inequalities highlighted by COVID-19 are not new. However, the increased visibility of the social determinants of health has created a moment. Without a doubt, more people are focused on addressing the challenges of health equity. Therefore we plan to use this moment in time to create change. In addition, we want to work with people and organisations that are willing to do the same -in our place in south London, nationally and across the world.