Earlier today (1 May 2020) the Office for National Statistics (ONS) launched a report on Deaths involving COVID-19 by local area and socioeconomic deprivation: deaths occurring between 1 March and 17 April 2020. The statistican for this report noted that “People living in more deprived areas have experienced COVID-19 mortality rates more than double those living in less deprived areas. General mortality rates are normally higher in more deprived areas, but so far COVID-19 appears to be taking them higher still.”
The Director of the Bristol Poverty Institute, Professor David Gordon, has been approached by the media to offer expert opinion on why this may be the case. His response is as follows:
“There are a range of reasons why the death rates in the 30% of the most deprived areas are more than twice as high as in the richest areas. Firstly, people in poorer areas are more likely to get a Covid-19 infection. They are more likely to be key workers (for example, care assistants, shop assistants, building workers, bus drivers, delivery drivers, etc.) so they are more likely to come into contact with infected people than their peers in richer areas who may be able to work from their homes. Many key worker jobs are low paid and therefore these key workers often live in deprived areas. People in deprived areas are more likely to have to rely on public transport than people in richer areas and thus come into contact with infectious people. They are also more likely to have worse internet connections and not be able to afford the premium on grocery home delivery services so will need to go out to shop for food more often than people in richer areas. Deprived areas tend to have higher population densities than richer areas; therefore people in these areas are more likely to have contact with an infected person when they leave their homes for exercise, medical care, food shopping, etc. The higher the population density the more difficult maintaining social distancing is likely to be.
“Secondly, people in poor areas who have a Covid-19 infection are more likely to die. There is a higher risk of severe disease and death from a Covid-19 infection if you have underlying health condition such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer. People in deprived areas are more likely to suffer from these particular underlying health conditions than people in richer areas for a range of reasons, such as greater pollution levels, greater stress levels, greater inflammation levels, greater risk of H. Piori infections in childhood, etc. The Inverse Care Law unfortunately still affects the NHS in the UK – the quality of health care is inversely related to health need, i.e. deprived areas on average have worse health care than richer areas.
“It is very disappointing but not surprising that more people are dying of Covid-19 infections in deprived areas, given the reasons listed above. However, what is a surprise is that the inequality in death rates between richer and poorer areas from Covid-19 are so much greater than deaths from other causes. In the most deprived 30% of areas people are more than twice as likely to die from Covid-19 infections compared with people in the richest 10% of areas in both England and in Wales – so this is not just a ‘London effect’. So far the Public Health response to the pandemic has not targeted or tried to shelter people living in deprived areas – this is clearly needed given these new ONS statistics.
“These data tell us about death rates from Covid-19 by area deprivation level but they do not tell us who is dying in these ‘poor’ and ‘rich’ areas. The assumption is that poor people are more likely to die of Covid-19 than rich people but these data do not prove this. They of course also do not tell us why there are much higher death rates in poorer areas but we can make an educated guess as to the causes.”
The full ONS report can be accessed here: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19bylocalareasanddeprivation/deathsoccurringbetween1marchand17april