Some groups disproportionately affected by the pandemic


Care home residents: Care home residents accounted for 40% of all COVID-19 deaths during the first wave. This was due to increased exposure to the virus, a high prevalence of underlying health conditions among this group and was compounded by a lack of access to PPE and a high turnover of social care staff due to insecure terms and conditions.

Disabled people: 6 out of 10 people who died with COVID-19 between January and November 2020 were disabled. Those with a learning disability were at even greater risk of dying than those with a physical disability. Many disabled people also experienced a decline in health due to cancellations of treatment, reduced access to health care, or a worsening of conditions from a drop in physical activity and were six times more likely to report feeling depressed than the general public (in June 2020).

Ethnic minority communities: People from ethnic minority communities are at higher risk of mortality due to COVID-19. During the first wave, black African men were 3.7 times more likely to die than white British men. During the second wave, Bangladeshi men were five times more likely than white men to die from COVID-19. People from ethnic minority communities also provided more hours of unpaid care, experienced higher levels of income loss and were twice as likely to have experienced food insecurity throughout the pandemic.

Young people: In April 2020, 2 million children experienced food insecurity. For many, school closures meant missed learning as well as the loss of important sources of emotional support. Levels of psychological distress among 18–24 year olds had almost doubled in April 2020 compared with 2017/18. Loss of employment was significantly higher among young people. Between March 2020 and February 2021, employment levels for those aged 16–24 had fallen by 9% compared with 0.4% for those aged 25–64. Young people from a black background were more likely to have reduced employment than their white peers.

Disproportionately affected groups summary

People’s experiences of the COVID-19 pandemic have varied widely. Some have faced disproportionate hardship and poorer health outcomes than others.

This section looks at how the pandemic has affected the lives of four groups whose experiences have been compounded by multiple factors:

  • care home residents
  • disabled people
  • ethnic minority communities
  • young people.

The section also covers the less documented experience of marginalised groups such as homeless communities, those facing sexual exploitation and people in prison.

Care home residents

COVID-19 impacts

Figure 11: Excess mortality in care homes, England and Wales, January 2020 to May 2021

Source: Weekly provisional figures of care home resident deaths registered in England and Wales.

Care home residents accounted for 40% of all UK deaths attributed to COVID-19 during the first wave. The age and higher prevalence of underlying conditions among this group puts them at risk of worse outcomes once exposed to the virus: 90.4% of COVID-19-related deaths among care home residents in England and Wales had at least one pre-existing condition.

The same disproportionate impact was not seen during the second wave (as shown by Figure 11). This suggests that the biggest risk factor for this group was the initial exposure that resulted from the spread of the virus due to the timing of lockdown, discharge from hospital without tests, and the lack of protections such as availability and access to PPE.

Another factor that may have contributed is the difficulty of achieving effective infection control and isolation in this setting, where some residents require high levels of physical support for day-to-day activities. Infection control measures were introduced too slowly within social care, which led to further viral exposure and spread. Social care provision is highly fragmented, with many social care workers employed on insecure contracts with poorer financial support for those needing to self-isolate such as sick pay and access to isolation payments. This may have contributed to increased exposure, with more people coming into care homes due to a higher turnover of agency staff.

Health Foundation analysis in May 2020 found that care homes in different regions across England were affected differently. After accounting for care home beds in each region, care homes in northern England and London had more deaths relative to the number of care home beds than other areas. Another study shows that outbreaks in care homes had no relationship with deprivation. However, mortality in care homes did have a relationship with deprivation. This means that deprivation did not affect exposure but did affect severity of outcomes. This difference may be due to poorer underlying health among care home residents in more deprived areas.,

Wider health impacts

Access to health care

Between March and May 2020, emergency hospital admissions from care homes for conditions other than COVID-19 (including stroke and heart attack) decreased by 36%. Routine elective admissions for care home residents (including care such as cataract surgery, some cancer treatment and hip replacements) fell by 63%. Compared with the 56% reduction in routine admissions for the general population, this suggests that people living in care homes – who often have complex health needs and require high levels of hospital care – were particularly hard hit by reduced services with implications for their quality of life.


To protect the health of older people, given their vulnerability, the UK government placed strict visiting restrictions on care homes. For an extended period, from March 2020 to March 2021, care home residents were generally not allowed to receive visitors leading to them feeling isolated and desperately missing their families.,  Some relatives were able to stay in touch with residents using the phone and digital technology. But for some less able to use technology effectively – particularly those with dementia – this was not always possible. For this reason, many care homes found innovative uses of technology to facilitate feelings of contact, such as using big screens, or recording and replaying the sound of relatives.

People living in care homes were also profoundly affected by the number of friends and other residents dying from COVID-19 around them. Infection control measures in care homes limited people’s ability to grieve effectively.

Disabled people

COVID-19 impacts

Disabled people have been among those most at risk of dying from COVID-19. In England between 24 January and 20 November 2020, 6 out of every 10 people who died with COVID-19 were disabled., The risk of death involving COVID-19 was 3.1 times greater for ‘more-disabled’ men compared with non-disabled men and 3.5 times greater for ‘more-disabled’ women than non-disabled women. This risk was even higher for people with a learning disability, who were 3.7 times more likely to die from COVID-19 than someone without a learning disability.

Figure 12: Age-standardised mortality rates for deaths related to COVID-19 among 30 to 100 year olds by self-rated disability status, England, January 2020 to November 2020

Source: ONS, Updated estimates of coronavirus (COVID-19) related deaths by disability status, England.

Many disabled people live in communal settings, placing them at increased risk of COVID-19 transmission and an increased risk of death. This risk was particularly stark for those with learning disabilities. One-third of those who died due to COVID-19 between 2 March and 9 June 2020 had been living in residential care.

Place of residence, socioeconomic and geographical circumstances, as well as pre-existing health conditions, all play a part in the increased risk experienced by disabled people. After adjusting for these, the risk reduced to 1.1 and 1.4 for more-disabled men and women respectively, and 1.7 for men and women with a learning disability. This unexplained difference in mortality risk is likely due to factors that affected exposure such as reliance on health and social care services placing disabled people at higher risk of exposure.

“In September 2020, 50% of disabled people reported experiencing reduced or no treatment, compared with 27% of non-disabled people.”

Access to PPE was an issue too. A survey of disabled people conducted in April 2020 found that many who needed PPE struggled to access it. This was particularly an issue for those who directly employ personal assistants and were responsible for providing protection for them.

Wider health impacts

Access to health care

Before the pandemic, studies had shown people living with severe disability were reporting worse access to health care, with the main barriers being transport, cost and long waiting lists. These prevailing inequalities in access persisted through the pandemic, increasing disabled people’s risk of worsening health outcomes.

Disabled people were more likely to experience reduced access to routine services. In September 2020, 50% of disabled people reported experiencing reduced or no treatment, compared with 27% of non-disabled people. By February 2021 there was a slight improvement, to 40% of disabled people versus 19% of non-disabled, but the disparity still remained.

Many of those whose planned treatments were cancelled struggled with pain management and people were often unable to access their usual physiotherapy or exercise activities.


In February 2021, more disabled people than non-disabled people reported that the pandemic had adversely affected their health (35% compared with 12% for non-disabled people) and wellbeing (65% compared with 50%).

Many found it difficult to carry on with their usual activities and maintain physical activity during lockdown. Nearly a third (29%) of respondents to one survey said they were struggling to stay physically active. One-third of people with Parkinson’s reported that their health deteriorated and they experienced increased symptoms during lockdown, while one-third of people with multiple sclerosis felt that their symptoms worsened.

Mental health

In June 2020, disabled people were six times more likely to report moderate to severe depression. These unequal mental health impacts persisted through to March 2021. Families of children with disabilities reported that the pandemic had negatively affected their child’s health and wellbeing (93%), behaviour and emotions (87%), and mental health (82%).

Some disabled people reported that they felt pressured into agreeing to do not resuscitate (DNR) notices with little or no consultation.,

Figure 13: Wellbeing and effect of social restrictions by disability status, Great Britain, February 2021

Source: ONS, Coronavirus and the social impacts on disabled people in Great Britain: February 2021.

Health and day-to-day living

Many disabled people reported difficulty obtaining essential items:, over 60% of respondents to one survey struggled to access food, medicine and necessities.

Disabled people were also more likely to experience food insecurity. In April 2020 over one-third (38%) of disabled mothers (compared with 17% of non-disabled mothers) said they were struggling to feed their children.

Lack of adjustments for disabled people’s needs and negative attitudes faced by those with sensory and invisible impairments added to difficulties leaving the house and shopping.

Longer term impacts

Access to government information and advice

Many disabled people felt that government information and guidance about COVID-19 restrictions was not specific enough and was not always disseminated in formats or languages that were accessible to all groups., More than three-quarters (78%) of deaf people found information shared by the government to be partly or completely inaccessible.

Income and employment

During the pandemic, the employment gap between disabled and non-disabled people persisted across the UK. By June 2020, 67% of disabled women and 65% of disabled men had their employment negatively affected by COVID-19, compared with 50% of women and 43% of men living without disability. This could have longer term implications for disabled people’s income and employment prospects, threatening financial resilience and the ability to live independently.

Ethnic minority communities

COVID-19 impacts

Ethnic minority communities have been among those most at risk of being exposed to and dying from COVID-19. During the first wave of the pandemic, age-standardised mortality rates for COVID-19-related deaths were more than three times higher for black African and Bangladeshi men and more than two times higher for black African and Bangladeshi women than their white counterparts (see Figure 14).

During the second wave (from 12 September 2020 onwards), the differences in COVID-19 mortality compared with the white British population increased for Bangladeshi and Pakistani people. Those from Bangladeshi ethnic backgrounds had the highest rates, 5 times and 4.1 times greater than for white British men and women respectively. Although the risk among people of black Caribbean and black African ethnicity still remained elevated in the second wave, the risk compared with white British people reduced compared with that in the first wave. ONS analysis shows that a large proportion of the difference in mortality observed between different ethnic groups is due to factors such as deprivation, occupation, living circumstances and pre-existing health.

Changes in the difference in mortality reported by ethnicity during the first and second waves require further examination. The improved outcomes for people from black backgrounds in the second wave suggests that the risk factors were modifiable – more likely to be the result of environmental rather than genetic factors for example – and can be addressed. Although a single factor cannot be identified to explain this improvement, it is a likely combined consequence of better access to public health messaging, the ability to self-isolate, better access to PPE and accessing health care services earlier. The increased mortality among those of Bangladeshi and Pakistani backgrounds needs careful further investigation to understand and ameliorate these inequalities.

Figure 14a: Risk of death involving COVID-19 relative to those of white ethnicity (men), England, 24 January 2020 to 31 March 2021

Source: ONS, Updating ethnic contrasts in deaths involving the coronavirus (COVID-19), England: 24 January 2020 to 31 March 2021.

One UK-based study showed that although obesity is an established risk factor for COVID-19 outcomes (such as increased hospitalisations and deaths) among all ethnic groups, the strength of association is strongest in those of black ethnicity. This means that people from black ethnic groups with obesity are at greater risk of being admitted to critical care, of being mechanically ventilated and of dying in hospital.

Wider evidence shows that the disproportionate number of COVID-19 hospitalisations and deaths among ethnic minority communities cannot be explained entirely by underlying health or comorbidities using existing data. Even after accounting for regional differences, residence type, socioeconomic factors and health measures such as pre-existing conditions, men of black African ethnicity had a 2.2 times higher risk of death from COVID-19 than those of white ethnicity in the first wave and 1.7 times higher in the second. Similarly, the risk for black African women 1.5 was times higher than for white women in the first wave and 1.2 times higher in the second.

Figure 14b: Risk of death involving COVID-19 relative to those of white ethnicity (women), England, 24 January 2020 to 31 March 2021

Source: ONS, Updating ethnic contrasts in deaths involving the coronavirus (COVID-19), England: 24 January 2020 to 31 March 2021.

Public Health England has reported some of these differences are due to racial discrimination, and that the associated stress has a negative effect on people’s long-term mental and physical health, as well as affecting COVID-19 exposure risk and outcomes.

A range of evidence details how people from ethnic minority communities have been more exposed to COVID-19, due to living and working conditions. Among minority ethnic communities, numbers were above the UK average for people:

  • living in poor living environments (25% versus 8.6%)
  • living in overcrowded housing (Bangladeshi 24%, Pakistani 18%, black African 16%, Arab 15%, mixed white and black African 14% and black Caribbean 8% versus 2% white British)
  • unable to work from home in June 2020 (33% versus 27%)
  • likely to be classed as key workers in June 2020 (28% versus 23%)
  • likely to use public transport at least once a week in June 2020 (26% versus 10%)
  • working in elementary occupations (black 16% versus 10% for all) and process, plant and machine operatives (Pakistani/Bangladeshi 15% versus 6%).

Survey data from June 2020 also reveals that discrimination may have reduced people’s ability to protect themselves from infection – for example, through having little choice but to do jobs with greater risk of exposure to COVID-19 or by not having fair access to PPE. A greater proportion of ethnic minority key workers (32%) said they were not given adequate PPE compared with white counterparts (20%). An even higher prevalence of inadequate PPE was reported within the following ethnic minority communities: Bangladeshi (50%), Pakistani (42%) and black African (41%).

Wider health impacts

Mental health

The gap in mental wellbeing between men from ethnic minority communities and white British men increased in April 2020. In particular, Bangladeshi, Pakistani and Indian men reported significantly greater increases in mental distress compared with men from other ethnic minority communities and those from white British backgrounds. Although women reported higher levels of and a higher increase in distress than men across ethnicities, the increase did not differ by ethnicity. The difference in mental wellbeing between men and women only increased among white British individuals.

“Employment worries negatively affected the mental health of 61% of people from ethnic minority communities, compared with 51% of white people.”

Existing inequalities, heightened in the context of the pandemic, contributed to deterioration in mental health. Almost one in three people from ethnic minority communities said problems with housing made their mental health worse. People from ethnic minority backgrounds were less likely to have good access to green spaces, with only 39% of adults saying that they lived close to green space, compared with 58% of those from white British backgrounds.

Employment worries also negatively affected the mental health of 61% of people from ethnic minority communities, compared with 51% of white people. Teachers reported that parental concerns over safety were highest in schools with higher proportions of pupils from ethnic minority communities.

Longer term impacts

Unpaid care

Ethnic minority communities are providing more hours of unpaid care, with 47% of those from black African backgrounds reporting providing unpaid care in winter 2020 compared with 32% across the population. A greater proportion of Indian, Pakistani, Bangladeshi and Caribbean ethnic groups reported providing more than 20 hours of care a week compared with white British and Irish groups.


Pakistani and Bangladeshi children were overrepresented among those not receiving any distance teaching (12.1% versus 9.3% of those from white backgrounds) and among those who attended school during lockdown as children of key workers (7% versus 3%).

Income and financial support

Members of ethnic minority communities had greater levels of income loss, ranging from 29% to 43% compared with 22% among white British people (apart from black Caribbean people, where only 21% reported an income loss).

Just over two-thirds (69%) of people from ethnic minority communities had heard of the furlough scheme, dropping to 61% of people of Bangladeshi origin, compared with 88% of white people. Over half of ethnic minority women said that they were unsure where to turn for help as a result of the pandemic, compared with 18.7% of white respondents. Fewer than half of ethnic minority people were aware of the measure enabling people out of work due to the crisis to claim Universal Credit (44%, versus 62% of white people). In one survey, significantly more ethnic minority women and men reported that they had lost government financial support (43% and 48%) compared with white women and men (13% and 21%).

Food insecurity

People from ethnic minority communities were twice as likely to experience food insecurity throughout the pandemic (18.3% versus 9.6% from white backgrounds from March to August 2020, and 19.7% versus 8.8% from August to January 2021).

Young people

Young people are generally at least risk of poor health outcomes from COVID-19. But they have faced significant changes in education, employment and social support, impacting young people’s mental health and health behaviours. The pandemic will also have a bearing on their future health prospects.

Mental health and health risk behaviours

Mental health: The UKHLS found that the prevalence of psychological distress among 18–24 year olds increased from around 23% in 2017–19 to 44% in April 2020, compared with 19.4% in 2017–19 and 30.6% in April 2020 for all adults.

Drugs and alcohol: There were accounts of increases in health risk behaviours among young people, including increased use of drugs or alcohol. Nearly a third of young people were using alcohol or illegal drugs, with highest levels among 18–24 year olds. 2020 also saw the first increase in a decade in young adults aged 18 –24 starting to smoke for the first time.

Food security: There was great concern during the pandemic around food provision for those children and young people who would usually receive free school meals. Widespread media reports challenged the adequacy and nutritional value of the food parcels provided in their place. A month into lockdown, 2 million children had experienced food insecurity and one-third of children eligible for free school meals were still not receiving any substitute provision.

Exercise: Sport England found that in the 2019–20 summer term, less than half of boys and girls in years 9–11 engaged in 60 minutes of physical exercise each day, with almost 7% fewer boys engaging compared to the previous year, although there was an increase of 2.5% among girls. About 45% of those aged 18–29 were doing less exercise during the January 2021 lockdown than in the March 2020 lockdown, while only 15% were doing more.

Experiences with implications for future health

The Young people’s future health inquiry identified the following four ‘assets’ as important for the 12–24 age group in securing the foundations of future health:

  • skills and qualifications
  • emotional support
  • personal connections
  • financial and practical support.

The pandemic has adversely affected all four areas with implications for young people’s future health and prosperity.

Skills and qualifications

Engagement with and access to home education was extremely variable during periods of school closure and much harder for vulnerable groups to manage. In general, most children and young people spent fewer hours learning at home than they would have at school.

Although there was increased engagement in the second period of school closure from January 2021, the gap remained. This is because children from poor backgrounds received fewer active resources from schools, had less access to study space and were more likely to be less supported by their parents than those from wealthier households. Teachers reported some groups were less – sometimes significantly less – engaged in remote learning than their classmates. This included:

  • pupils with limited access to IT or study space (81%)
  • vulnerable pupils (62%)
  • pupils with special educational needs and disabilities (58%)
  • pupils eligible for Pupil Premium funding (52%), and
  • young carers (48%).

Young people have expressed concern about the disruption to their education. The lockdown was particularly hard for those who missed exams and/or were transitioning to another phase of education. Only 17% of young people felt happy that exams had been cancelled and were more likely to feel uncertain (51%) or worried (18%).

Young people on vocational training were affected by the disruption on a practical level, but there has been less research on their transitions into work. In April 2020, only 39% of apprenticeships continued as normal, with 36% furloughed and 8% made redundant. Just under one-fifth (17%) of apprentices had their off-the-job learning suspended.

Emotional support

The experience of lockdown and spending more time at home was mixed for many young people. The majority (92%) in a YMCA survey from July 2020 said they enjoyed seeing more of their family. The majority (90%) also used digital communication to connect with people online.

However, lockdown and educational disruption took its toll. In April 2020, young people were three times more likely to report not enjoying day-to-day activities than they were in 2017–18. Young people reported decreased ability to concentrate, worse sleep, and loss of confidence. Young women (58%) reported lower moods than men (43%).

The situation was especially severe for young carers, with two-thirds (69%) reporting feeling less connected to others than they had before the pandemic. Many young people with mental health needs also reported feeling overwhelmed with heavy workloads when restarting school in September.

Financial and practical support

The Young people’s future health inquiry found a distinct difference between the outcomes of young people who had a safety net of financial and practical support and those who did not. This support was often from families but could come from the state or other sources.

Government action to mitigate some of the economic impacts of the pandemic has undoubtably helped a large proportion of young people. Many have also been able to fall back on the safety net provided by their families. However, different groups of young people have been affected in different ways.

Loss of employment: Between March 2020 and February 2021, employment levels for those aged 16–24 had fallen by 9% compared with 0.4% for those aged 25–64. While employment rates have reduced (to 51.9% at the end of 2020), unemployment (14.4%) and economic inactivity (6.2%) have increased alongside a decline in vacancies.

There have been stark differences in changes to employment among different ethnicities, widening inequalities that existed before the pandemic. The unemployment rate for young people aged 16–24 from black ethnic backgrounds rose 9% from 25% to 34% between March 2020 and January 2021 but only 3% for those from white backgrounds from 10% to 13%.

The Sutton Trust found that 79% of undergraduate students from working-class backgrounds and 76% of students from middle-class backgrounds were worried about gaining the skills and experience required for employment in February 2021. A Prince’s Trust survey found that one in five young people (21%) felt scared that their skills and training are no longer useful. Nearly a quarter (23%) said that retraining seemed pointless because ‘there are no jobs anyway’.

Coronavirus Job Retention Scheme: Young people are more likely to work in shutdown sectors such as hospitality and retail. This is reflected in the fact that 9% of young workers were furloughed, in comparison to 6% of all workers.,

“Between March 2020 and February 2021, employment levels for those aged 16–24 had fallen by 9% compared with 0.4% for those aged 25–64.”

The income security and broader certainty provided by furlough appears to have provided some mental health protection. More than a quarter (28%) of those furloughed reported poor mental health – comparable to those with no change in employment – in contrast to the 36% reporting poor mental health who had lost their job.

Housing: Young renters were no more likely to default on their rent than people in older age groups. However, 18–29 year olds were by far the most likely to have moved during the crisis. By May 2020, over 7% had moved compared with less than 2% across older age groups. This figure is partly explained by students moving from university (3% of the age group), leaving 4% moving for other reasons. This may be a result of some young people using the practical safety net provided by their families and moving back home.

There is likely to be a substantial number of young people in the private rental system who do not have this safety net and who are struggling to meet rent payments with reduced income. Private and social renters are now more than twice as likely as people with mortgages to have lost their jobs (8% of private renters and 7% of social renters, compared with 3% of homeowners).

Personal connections

The Young people’s future health inquiry described personal connections as whether young people had confidence in themselves, along with access to social networks or mentors able to offer them appropriate advice on navigating the adult world. These informal contacts and networks are more difficult to build in an online environment, with many of the usual routes to developing this social capital being less readily available during the pandemic.

Even when options were available for face-to-face contact between lockdowns, there was a reduction in uptake due to social distancing and concern about the virus. For example, in universities, participation in student societies fell from 54% in autumn 2019 to 39% in autumn 2020 and to 30% in January 2021.

Box 5: Experiences of homelessness, prison and sexual exploitation during the pandemic

The pandemic has made life harder for many people across the UK, including those in the criminal justice system, people experiencing homelessness and sexual exploitation prior to the pandemic.

Homeless people

In response to COVID-19, government and local authorities cooperated to move people experiencing homelessness into hotel or B&B accommodation (via the ‘Everyone In’ scheme). While this move was welcomed by many and presented opportunities to support people into permanent accommodation or employment, living in close proximity and sharing facilities made social distancing and isolating difficult. Groundswell, a homelessness charity, reported that 38% of London hostels had suspected COVID-19 cases, with 41% of unwell residents sharing bathrooms and 35% of affected hostels using communal dining rooms. The charity estimated the death rate for people living in London hostels to be 25% higher than among the general population.

For many migrants experiencing homelessness, COVID-19 brought the unprecedented experience of statutory support. In suspending all immigration-based eligibility criteria attached to welfare, the UK government provided – for the first time – a response to the crisis of migrant homelessness. Regardless of immigration status, people experiencing homelessness were given access to a private room, washing facilities, three meals a day, and – crucially for those previously ineligible for statutory support – engagement with a homelessness response service. However, despite the call to accommodate all homeless people, rough sleeping continued in London between April and June 2020 and 49% of those identified were non-UK nationals.,

People in prison and their families

At the beginning of the pandemic, there were widespread fears that prison populations would be impacted significantly by the virus. Prisons tend to be overcrowded, with many shared facilities, and prisoners are exposed to a large number of staff. Data up to early 2021 showed that people in prison experienced three times the death rate from COVID-19 than people of the same age and sex in the general population.

For prisoners, visits from friends and family are considered a lifeline: a protective factor for mental health and suicide and key to rehabilitation. However, for many people in prison during the pandemic these visits were not allowed. Restrictions on visits also impacted the right to family life of up to 17,000 children with mothers in prison. This prolonged separation is likely to have influenced these parent-child relationships and caused some degree of trauma for children and the families who support them.,

Prison restrictions also led to education, support visits, therapies and rehabilitation programmes being withdrawn. Research indicates that the loss of offender behaviour programmes caused significant stress for prisoners, in some cases disrupting sentence plans and hampering prospects of release.

Sexual exploitation

The pandemic has worsened health and wellbeing among people experiencing complex challenges – not least by reducing already limited incomes, leaving people without basic supplies including food and clothing. For many vulnerable women, this has led to an increased risk of sexual exploitation.

Reports suggest an increase in the number of women using sex work to survive during the pandemic. Between March 2020 and July 2020, the national charity Changing Lives saw an 83% increase in women accessing its specialist support for people selling sex – driven by the need for food and rent, and to provide for children. It also saw a 62% rise in women saying they had experienced sexual violence during the same period.

With social distancing measures in place, much sex work moved away from the street and into private homes. This is more dangerous as the women are out of sight of services, harder to access and often alone. People new to sex work are often unaware of the risks they face or the support available.

Disability was defined based on self-reported answers to the 2011 census question: ‘Are your day-to-day activities limited because of a health problem or disability which has lasted, or expected to last, at least 12 months?’ More-disabled people are those who responded ‘Yes, limited a lot’, whereas less-disabled people are those who responded ‘Yes, limited a little’.

This is based on the living environment deprivation domain of the Index of Multiple Deprivation (IMD). This includes houses without central heating; houses that fail to meet the Decent Homes standard; poor air quality; road traffic accidents involving injury to pedestrians and cyclists.

§ This information was provided by the University of Portsmouth (Principal Investigator: Dr Simon Stewart) which is part of a larger study funded by the ESRC and UKRI.

This information was provided by Chantal Edge as part of an evidence review commissioned by the Health Foundation.

** This information was provided by Nadine Smith who conducted interviews with workers at Changing Lives charity as part of research commissioned by the Health Foundation.

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