Chapter 1: Covid inequalities and the wider determinants of health
Wider determinants of health
Our health is rooted in the social, environmental, and economic circumstances into which we are born and grow - these are known as the wider determinants of health. The diagram below shows how inequalities are driven by interactions between:
- these wider determinants of health
- the psychosocial impact of those experiences
- health harming behaviours that are adopted in an attempt to alleviate the psychosocial impact of a person's experiences
- the physiological impact of those interactions resulting in ill-health.
Wider determinants of health
- Access to goods and service
- Income and debt
- Employment / quality of work
- Education and skills
- Housing
- Power and discrimination
- Natural and built environment
- Health behaviours - smoking, diet, alcohol
- Psycho-social factors - isolation, social support, social networks, self-esteem and self-worth, perceived level of control, meaning / purpose of life
- Physiological impacts - high blood pressure, high cholesterol, anxiety / depression
The aspects of life that create the conditions where inequality thrives, including the type of housing that people live in, what job they do, and their level of income, are many of the same things which prevented people from being able to protect their families and their community from Covid. These are also things that made it harder for people to cope with the measures brought in to stop the spread of Covid, such as lockdowns and social distancing.
If we look at our diagram through a Covid-19 lens, we can see examples of the impact of the pandemic on each of the wider determinants of health and their related factors:
- More services going online increases digital exclusion
- Low income households have been particularly vulnerable to the economic impacts of the pandemic
- Unemployment rates hardest hit in the north
- School closures increases educational inequalities
- More time spent in poor quality and over crowded housing impacts health and wellbeing
- Some groups experienced disproportionate levels of exposure and death from virus
- Access to outdoors and green space important in lockdown
Health behaviours
Covid containment measures have resulted in changes in health behaviours
Psycho-social factors
Widespread feelings of loneliness and isolation as a result of lockdown and social distancing behaviours
Physiological impacts
Surge in demand for mental health services and support
Covid-19 inequality
Evidence has identified potential pathways that link deprivation to higher Covid-19 infection rates, cases, case severity and deaths. (Bambra, C., Munford, L., et al (2020) COVID-19 and the Northern Powerhouse, Northern Health Science Alliance (opens new window), Newcastle.)
Exposure - as a result of inequalities in working conditions.
Lower paid workers, particularly in the service sector, were much more likely to be key workers and thereby required to work during lockdown, and also more likely to rely on public transport. There was a clear social gradient in the ability to work from home.
Transmission - inequalities in housing conditions are also likely to have contributed to inequalities in Covid-19.
Deprived neighbourhoods are more likely to contain houses of multiple occupation, lack outdoor space, and experience high population densities which may have increased transmission rates, as well as making isolation more difficult.
Vulnerability - due to a higher burden of pre-existing health conditions that increase the severity and mortality risk of Covid-19.
We know that these co-morbidities arise as a result of inequalities in the wider determinants of health.
Susceptibility - due to immune systems being weakened by long term exposure to adverse living and environmental conditions.
The wider determinants of health also work to make people from deprived communities more vulnerable to infection from Covid-19 even when they have no underlying health conditions. Our Gateshead stories show this relentless interaction between Covid-19 and established and emerging inequalities.