Chapter 1: Covid inequalities and the 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