The COVID-19 Pandemic and Health Inequalities

Overview

Journal J Epidemiol Community Health

Specialty Health Services

Date 2020 Jun 15

PMID 32535550

Citations 729

Authors

Clare Bambra

Ryan Riordan

John Ford

Fiona Matthews

Affiliations

Soon will be listed here.

Abstract

This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics-drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.

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References

Murray C, Lopez A, Chin B, Feehan D, Hill K . Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis. Lancet. 2006; 368(9554):2211-8. DOI: 10.1016/S0140-6736(06)69895-4. View

Robinson T, Brown H, Norman P, Fraser L, Barr B, Bambra C . The impact of New Labour's English health inequalities strategy on geographical inequalities in infant mortality: a time-trend analysis. J Epidemiol Community Health. 2019; 73(6):564-568. DOI: 10.1136/jech-2018-211679. View

Biondi M, Zannino L . Psychological stress, neuroimmunomodulation, and susceptibility to infectious diseases in animals and man: a review. Psychother Psychosom. 1997; 66(1):3-26. DOI: 10.1159/000289101. View

Guo L, Wei D, Zhang X, Wu Y, Li Q, Zhou M . Clinical Features Predicting Mortality Risk in Patients With Viral Pneumonia: The MuLBSTA Score. Front Microbiol. 2019; 10:2752. PMC: 6901688. DOI: 10.3389/fmicb.2019.02752. View

Akhter N, Bambra C, Mattheys K, Warren J, Kasim A . Inequalities in mental health and well-being in a time of austerity: Follow-up findings from the Stockton-on-Tees cohort study. SSM Popul Health. 2018; 6:75-84. PMC: 6138882. DOI: 10.1016/j.ssmph.2018.08.004. View

Bambra C . Work, worklessness and the political economy of health inequalities. J Epidemiol Community Health. 2011; 65(9):746-50. DOI: 10.1136/jech.2009.102103. View

Chen J, Krieger N . Revealing the Unequal Burden of COVID-19 by Income, Race/Ethnicity, and Household Crowding: US County Versus Zip Code Analyses. J Public Health Manag Pract. 2020; :S43-S56. DOI: 10.1097/PHH.0000000000001263. View

Whitehead M, Pennington A, Orton L, Nayak S, Petticrew M, Sowden A . How could differences in 'control over destiny' lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment. Health Place. 2016; 39:51-61. DOI: 10.1016/j.healthplace.2016.02.002. View

Chowell G, Bettencourt L, Johnson N, Alonso W, Viboud C . The 1918-1919 influenza pandemic in England and Wales: spatial patterns in transmissibility and mortality impact. Proc Biol Sci. 2007; 275(1634):501-9. PMC: 2596813. DOI: 10.1098/rspb.2007.1477. View

10.

Segerstrom S, Miller G . Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004; 130(4):601-30. PMC: 1361287. DOI: 10.1037/0033-2909.130.4.601. View

11.

Summers J, Stanley J, Baker M, Wilson N . Risk factors for death from pandemic influenza in 1918-1919: a case-control study. Influenza Other Respir Viruses. 2014; 8(3):329-38. PMC: 4181481. DOI: 10.1111/irv.12228. View

12.

Grantz K, Rane M, Salje H, Glass G, Schachterle S, Cummings D . Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918. Proc Natl Acad Sci U S A. 2016; 113(48):13839-13844. PMC: 5137773. DOI: 10.1073/pnas.1612838113. View

13.

Crighton E, Elliott S, Moineddin R, Kanaroglou P, Upshur R . A spatial analysis of the determinants of pneumonia and influenza hospitalizations in Ontario (1992-2001). Soc Sci Med. 2007; 64(8):1636-50. DOI: 10.1016/j.socscimed.2006.12.001. View

14.

Krieger N, Rehkopf D, Chen J, Waterman P, Marcelli E, Kennedy M . The fall and rise of US inequities in premature mortality: 1960-2002. PLoS Med. 2008; 5(2):e46. PMC: 2253609. DOI: 10.1371/journal.pmed.0050046. View

15.

Lowcock E, Rosella L, Foisy J, McGeer A, Crowcroft N . The social determinants of health and pandemic H1N1 2009 influenza severity. Am J Public Health. 2012; 102(8):e51-8. PMC: 3464856. DOI: 10.2105/AJPH.2012.300814. View

16.

Barr B, Kinderman P, Whitehead M . Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013. Soc Sci Med. 2015; 147:324-31. DOI: 10.1016/j.socscimed.2015.11.009. View

17.

Gibson M, Petticrew M, Bambra C, Sowden A, Wright K, Whitehead M . Housing and health inequalities: a synthesis of systematic reviews of interventions aimed at different pathways linking housing and health. Health Place. 2010; 17(1):175-84. PMC: 3098470. DOI: 10.1016/j.healthplace.2010.09.011. View

18.

Todd A, Copeland A, Husband A, Kasim A, Bambra C . Access all areas? An area-level analysis of accessibility to general practice and community pharmacy services in England by urbanity and social deprivation. BMJ Open. 2015; 5(5):e007328. PMC: 4431167. DOI: 10.1136/bmjopen-2014-007328. View

19.

Beckfield J, Bambra C . Shorter lives in stingier states: Social policy shortcomings help explain the US mortality disadvantage. Soc Sci Med. 2016; 171:30-38. DOI: 10.1016/j.socscimed.2016.10.017. View

20.

Rutter P, Mytton O, Mak M, Donaldson L . Socio-economic disparities in mortality due to pandemic influenza in England. Int J Public Health. 2012; 57(4):745-50. DOI: 10.1007/s00038-012-0337-1. View