COVID-19 and Inequality in London
My Fair London supporter, Tom McDonough, outlines some of the inequalities that the coronavirus has revealed.
One of the biggest myths to emerge during the COVID-19 pandemic is that the coronavirus is a great leveller: a sickness that strikes all communities with equal venom, irrespective of social standing or ethnic group. However, that is not the case.
This myth has been pedalled by politicians eager to acquire the common touch and welcomed by those keen to see harmony prevail in a nation long divided along class lines and scarred by three years of wrangling over Brexit. This myth has been helped along by the presence of high profile COVID-19 survivors: Idris Elba, Prince Charles, Tom Hanks, footballing legend Kenny Dalglish, Health Secretary Matt Hancock and, of course, Boris ‘man of the people’ Johnson.
Whilst politicians are happy to spout social distancing measures with an air of ease and simplicity to the nation, Marmot is challenging this narrative of egalitarianism suggesting instead that lockdown has in fact “exposed the fault lines in society...those who could work from home and those who could not; those who could retreat to holiday homes and those in crowded flats; those with income reserves and those who could not afford to buy food; those in a position to offer home education to their children and those not so fortunate or well equipped."
This messaging of faux equality from our leaders and a lack of acknowledgement of their own privilege, renders them out of touch with the realities of lockdown for many individuals, ignoring the fissure of inequality throughout the UK that this disease has amplified.
While it’s undoubtedly true that COVID-19 presents us with a common cause around which many of us can rally, it certainly isn’t the case that we are all equally affected by it. Soon after the outbreak we understood that the virus posed more of a risk to older people than the rest of us; it soon emerged that men and BAME people were more likely to be felled by it. These early insights were supported by a report published by the Intensive Care National Audit Research Centre, which showed the median age of patients critically ill with COVID-19 to be 60, that 72% of these patients were men and 34% were from from BAME communities (ICNARC, May 1st 2020).
What has been less well publicised, however, is that COVID-19 is also affecting lower income earners far more than other groups. The bottom two fifths of the population are 50% more likely to fall critically ill with COVID-19 than higher earners (ICNARC, 2020). The rate of deaths involving COVID-19 is more than twice as high in the most deprived areas than the least deprived ones (ONS, May 2020).
London was affected early and has been hard hit, currently registering over 300 cases per 100,000 of the population, and just under 6,000 deaths recorded by 1st June. In the first phase (up to 17 April) Newham topped the list in the capital with 144 deaths per 100,000 population, while Brent has seen 142, Hackney 127, Tower Hamlets 123 and Lambeth 104. The inequalities that prevail in the nation can be mapped within the city with poorer, more crowded boroughs being harder hit than the affluent areas.
As is the case under normal circumstances, low income Britons are paying for their relative poverty and low social status with their lives. COVID-19 aside, the number of deaths from all causes in any given period in Britain increases with each step along the scale from the most to least privileged decile of the population. In 2017, for example, the worst off tenth had 518 deaths per 100,000 while the most privileged tenth had 152 (ONS, 2019). COVID-19 follows this pattern but in an even more aggressive way. Comparing the two poorest with the two most privileged deciles of the population gives us even starker figures, with former notching up over 120 deaths per 100,000 people and the latter recording between zero and 10 deaths per 100,000 (ONS, May 2020).
A key cause of health inequality in Britain is economic inequality. In extremely economically unequal countries, people feel anxious about their status, stressed (including in early life), atomised and - for those at the bottom - disempowered. All of these factors affect our mental state and our mental wellbeing in turn impacts our physical wellbeing (Wilkinson and Pickett, 2009). Everyone’s health is worsened by inequality but people at the lower end of our social pecking order pay the highest price of all, suffering the greatest levels of stress and the worst health.
Health inequalities in the UK have been getting steadily worse since the Tory’s austerity regime began in 2010. For the first time in 100 years, life expectancy is actually decreasing for poorest people in the country. Meanwhile, the amount of time we spend in poor health has been increasing for all of us (Marmot, 2020). Given that lower income Britons were in comparatively poor health before the pandemic struck, their high COVID-19 mortality rate was to be expected.
However, this is not just a tale of health. Poorer people’s social and economic circumstances have left them exposed to elevated levels of hardship and increased financial and health risks during the COVID confinement. They are more likely to live in crowded homes with no gardens and to have jobs that bring them into contact with the public (delivery jobs, supermarket workers, rubbish collectors etc) and they are less likely to be able to work from home, or have savings to fall back on. Those working in jobs at the lower end of the income scale, such as zero hour contract roles, will also feel they lack autonomy and control over their lives.
Another group that been especially hard hit by the virus and lockdown is disabled people. Being among the poorest people, they are experiencing all the problems associated with relative poverty in addition to challenges related – directly and indirectly - to living with their disabilities under confinement conditions.
Access to food is one major issue as many seriously ill disabled people have been left off the Government’s ‘extremely vulnerable’ list, which entitles people to free food deliveries. Being too frail to risk shopping expeditions, they are either going hungry or relying on drop offs from friends, family, neighbours and volunteers if they’re lucky enough to have a support network.
Moreover, loneliness has greatly intensified for many disabled people as day centres, clubs, groups, shops and work places have closed down and visitors have stopped coming. 35% of disabled people have said that spending too much time alone is impacting on their wellbeing compared to 20% of non-disabled people (ONS, April 2020). Mental distress is also being more keenly felt among disabled people than others, with data showing that 45% are ‘very worried’ about the impact of the virus and 65% are experiencing reduced wellbeing, compared to 30% and 56%, respectively, for non-disabled people (ONS, April 2020).
Finally, the Coronavirus Act has removed safeguards from the Mental Health Act and effectively suspended the Care Act 2014 duties on local authorities in England to assess and arrange services to meet the needs of adults with disabilities and their carers. Amounting to a peeling back of disabled people’s rights, these changes will have a huge impact on people’s quality of life, especially those with mental health problems, learning disabilities and dementia.
COVID-19, then, is certainly not a great leveller. Instead of democratising our suffering, the pandemic has further exposed the fault lines of our fractured society. Granted, there has been some increase in our levels of co-operation in the face of our common foe, but our alleged newfound sense of national camaraderie has been overstated. Unfortunately one of the consequences of living in a highly unequal society is that people tend to be more individualistic, competitive, atomised and less interested in the common good (Wilkinson and Pickett, 2018). We may bang pots and pans to thank the NHS but the grim reality is that more than a third of people surveyed by ONS last April were not confident that a local community member would help them out in a crisis during the COVID-19 pandemic. And let us never forget how people behaved in the early days of the crisis, with panic buyers emptying our supermarket shelves as they stockpiled food. Some people even posted videos of their bounty on Facebook, their footage showing rooms stacked from floor to ceiling with food. It was less ‘spirit of the blitz’ and more ‘spirit of loads-a-money!!!’. As the lock-down continued, violations of the social distancing rules seemed to increase: people were partying, holding picnics, meeting friends and sunbathing in parks. Some have blamed this behaviour on a lack of clarity over the rules, but until May 10th the rules on going out were crystal clear. While the Government’s startling hypocrisy in its defence of Dominic Cummings must have contributed recently we should not be surprised that some people have been behaving in this way due to the culture of individuality and self-value above community.
However, there are also some reasons for hope. The pandemic has revealed the importance of low paid workers and public services (and how underfunded they are). It has shown that the Government can act to support ordinary people if it wants to. It has also further reinforced the nation’s love affair with our free-at-the-point-of-use, universal, tax-payer funded healthcare system and it has reminded us how unequal we are. Across the world it does look like the countries most committed to neoliberal economic dogma have seen the largest numbers of their citizens die. Perhaps these lessons will nudge us towards the realisation that it’s time to become a fairer society.