Chapter 1: Covid inequalities and the wider determinants of health
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.