As the success of the vaccination programme sets the UK on the course towards recovery, it is essential to learn the lessons from the past 18 months. The UK experienced some of the poorest outcomes from the pandemic when compared with similar and neighbouring countries, along with some of the worst economic impacts. The timing of pandemic restrictions and the UK’s regional and international connectedness were leading factors in determining the extent to which the virus spread. But the way COVID-19 has affected different parts of the UK and various populations has seared public consciousness and is a result of pre-existing health and socioeconomic conditions.

It was necessary to impose far-reaching restrictions during the pandemic to suppress the spread of the virus in advance of the population being fully vaccinated. Without these measures, deaths from COVID-19 would have been of an even greater magnitude. The government also took unprecedented action to help mitigate the economic consequences of the restrictions.

Other parts of society also stepped in to support the most vulnerable, from mutual aid groups to food suppliers. However, many services – from education, health and social care to child protection services – were put on hold, or became harder to access. This has meant many people went without the help they urgently needed and are at risk of facing erosions to their immediate and longer term health.

The conclusions of the inquiry points to the need for action in two areas. First, the need for immediate action to address the harm caused by the pandemic. And second, supporting longer term change to prevent future deterioration of health. Ensuring progress will require robust mechanisms for an ongoing assessment of the state of the nation’s health by an independent body and implementation of a cross-government health inequalities strategy.

A legacy of the last crisis

The shape of the UK’s society and economy before the pandemic hit was a consequence of past events and policy choices of successive governments. Decades of reform have led to the benefit system acting as a last resort form of financial support. Growth in productivity, pay and incomes were weak by historical standards even before the financial crisis and there has been growth in forms of insecure work – all of which have reduced the financial resilience of households.

The previous decade of disinvestment in public services meant that their levels of resilience were already low. The shift in provision towards tackling acute need rather than dealing with root causes meant that many of the inequalities highlighted during the aftermath of the financial crisis had not been addressed. These have come to the fore again during the pandemic and further compromised people’s health.

A new approach

Another fragile recovery from the current crisis is avoidable. The pandemic has shown the leading role that government will play in the face of an emergency. A recovery that puts increasing – and fair – opportunities for good health as a priority will need action to deal with the conditions that lead to poor health in the first place. The scale and pace of intervention has continued a shift in public expectations that began towards the end of the last decade. Today, there is a far greater sense that increased government action will be crucial to the recovery and greater public support for increased spend on public services.

Recent public polling has shown that over half (55%) of the UK public were concerned that the COVID-19 pandemic has worsened inequalities, with 8 in 10 people in the UK agreeing that government must address these unequal health outcomes between those living in richer and poorer areas.

“The UK government’s levelling up agenda provides the basis for action to address the differences in outcome and opportunity between places and people.”

The recovery from the pandemic presents a landmark opportunity for a new settlement between the state, individuals, the third sector and business. Putting the goal of improving health and reducing inequalities at the heart of the economic recovery can help remove barriers to future prosperity and create a more secure future. This inquiry did not set out to formulate specific policy recommendations. However, the review of the evidence points to the need for action within two areas:

  • Immediate action to address the harm caused by the pandemic and prevent longer term scarring effects. This includes tackling the health care backlog, increasing mental health support to help people back into work, protecting family finances, creating jobs, and ‘catching up’ education and training.
  • Building resilience for the longer term. This includes putting in place an adequate safety net to cope with future income and health shocks, providing greater protections for low-paid workers, designing better quality jobs, creating stronger communities and investing in higher quality public services to put prevention first through the government’s levelling up agenda.

Supporting change

The UK government’s levelling up agenda and the associated Build Back Better plan for growth provide the basis for action to address the differences in outcome and opportunity between places and people. Many existed before the pandemic and some have worsened or are at risk of worsening.

When the pandemic hit, the government was already facing difficult fiscal decisions, with growing pressure from an ageing society, the uncertainty of Brexit, a prolonged period of weak growth and an intention to ‘turn the page on austerity’.

Providing quality public services and ensuring a sustainable recovery in the aftermath of the pandemic will require significant investment. Reducing the national debt too quickly will risk undermining the recovery and leave the country vulnerable in another crisis. In the medium term spending to sustain resilient public services will need to be matched by additional revenue – a national conversation is needed about doing so in a way that is fair by income and between young and old.

But change is not purely about additional spend. Government can place a greater focus on using resources wisely, joining up initiatives across government and taking a ‘prevention first’ approach to enable better spending through local government.

Mechanisms are needed to support coordinated, long-term strategic action at national and local level. A cross-government health inequalities strategy with explicit targets for improvement can ensure a sustained focus on the range of government activity that influences health in the short and longer term. In doing so, government will need to look beyond capital investment projects, which have tended to dominate the levelling up agenda, to incorporate investments in human and health capital. In making decisions about allocating spend, greater weight needs to be placed on longer term, preventative measures and health and wellbeing gains.

A comprehensive set of metrics – such as the ONS Health Index – can be used to set goals and assess wider progress than simply the deliverables from specific initiatives. The index provides a framework for action on factors that have both short and long-term effects on people’s health and can incentivise action that will lead to improvements now as well as building resilience for the future. Ensuring improvements are made in the nation’s health, and avoiding further decline, will require an independent body to give parliament a robust assessment of progress.

Building a more resilient society

For years, tension has been growing between maintaining public services and the political desire to keep taxes low and reduce national debt. The resulting strategy has focused on tackling acute need without preventing issues arising in the first place. The experience of the pandemic has laid bare the weaknesses of this approach. There is now more evidence than ever of the crucial role that a healthy population plays in the success of the economy and prosperity of a nation.

In many ways the pandemic has acted as an accelerant to the long-term consequences of policy decisions made over the past decade. The present moment represents an opportunity to make sure this recovery is managed better than the last one: investing in, rather than eroding, the conditions needed for sustaining a healthy population and, with it, a healthy economy.

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