Major challenges lie ahead to protect vulnerable communities

You may have heard it said that coronavirus does not discriminate — that celebrity, royalty, or the car you have in the driveway cannot protect you from infection.

However, the virus is a disease and is being shown to behave like other diseases, in that it disproportionately affects the people in society living in most severe poverty.

Poverty is not good for anyone’s health.

Wealthier individuals are consistently shown to live longer and have better quality of life throughout those years, while deprivation is a risk factor for cancer, diabetes, heart disease, stroke and mental ill-health.

The Department of Health’s first report on the differing levels of impact of Covid-19 suggests that people living in the most deprived areas of Northern Ireland have been substantially more likely to be infected.

We can infer from this that these communities will remain at greater risk for as long as the virus is in circulation.

But the most striking numbers in the report describe the relative levels of hospitalisation in deprived versus affluent areas.

Here the differential is much greater than the gap in likelihood of infection.

Having to go to hospital is a reasonable indication that your coronavirus symptoms have been severe, or that you’ve had complications and are at risk.

So, in addition to the greater likelihood of exposure, coronavirus is exacting an additional toll on those in the most deprived areas, due to the already higher prevalence of underlying conditions in those same communities.

To paraphrase Donald Rumsfeld, you face into a pandemic with the population you have.

What we are seeing before our eyes is that, if some of the population are already disproportionally carrying the burden of ill-health, then the nature of a pandemic is to exacerbate those health inequalities.

The report also notes disproportionate risk of infection among women.

This is likely due in part to women bearing the majority of our society’s caring burden, both professional and unpaid, informal and familial care, as well as being in more regular contact on average with schools and children’s peers.

Another well-known pattern in health research is that while certain health promotion programmes and treatments can improve overall population health, they can also widen health inequalities at the same time.

This is often because of lower uptake and access to information and services among those most economically deprived.

Therefore, a major challenge lies ahead to prepare vulnerable communities to take advantage of treatments and vaccination as it becomes available, so as to avoid further pain and tragedy in those communities.