COVID-19 and the north–south health divide

What is the north–south health divide?

Over the past few decades the deep-rooted regional inequalities in health across England have continued to grow alarmingly. The COVID-19 pandemic has made this alarm deafening; the inequality in England’s health took centre stage as the virus hit harder and lingered longer in the areas of poorest health, and the north was especially affected.

People in the north of England are consistently less healthy than those in the south. This is true across all social groups and among both men and women. There is a 2-year life expectancy gap between the northern regions and the rest of England, and premature death rates are 20% higher across all age groups.

Over the past 50 years, this is equivalent to over 1.5 million northerners dying earlier than if they had experienced the same lifetime health chances as those in the rest of England.

The images above clearly show the regional health divides within England, particularly between the north east and south east regions, which have the lowest and highest life expectancies respectively.

These regional health inequalities have important implications in the context of COVID-19, as we explored in our NHSA and NIHR ARC report: COVID-19 and the Northern Powerhouse.

How has COVID-19 affected the north?

Our report shows the unequal health and economic impacts of COVID-19 on the region defined as the Northern Powerhouse due to underlying health inequalities. We found mortality rates during the first wave (March–July 2020) were substantially higher in the Northern Powerhouse than the rest of England. In this time, an extra 12.4 more people per 100,000 died in the north than the rest of England due to COVID-19, and an extra 57.7 more people per 100,000 died in the region due to all causes.

Adverse trends in poverty, education, employment and mental health for children and young people have clearly been exacerbated over the pandemic, particularly in the north. Looking at some of the factors that may have contributed to this inequity, we found austerity measures had disproportionately affected the north – particularly in its areas of high deprivation. A brutal truth emerged: economic and health inequalities between the north of England and the rest of the country are, without significant intervention, likely to worsen for subsequent generations.

What needs to happen to reduce regional health inequalities?

To reduce regional health inequalities as an essential part of any levelling up strategy, we think policymakers now need to:

• place additional resource into the Test and Trace system in the north, and deliver this through local primary care, public health, NHS labs and local authority services
• support clinically vulnerable, deprived and minority ethnic communities in the north to receive COVID-19 vaccines
• increase NHS and local authority resources and service provision and invest more in research into mental health interventions in the north of England in order to tackle the mental health crisis.

In the longer term, we are calling for:

• a recommitment to ending child poverty in the UK by increasing child benefit and the child element of Universal Credit by £20 per week; removing the benefit cap and the two-child limit; providing free childcare and extending the provision of free school meals
• an increase to the existing NHS health inequalities weighting within the NHS funding formula, along with a £1 billion fund ring-fenced to tackle health inequalities at a regional level
• an increase in local authority public health funding to address the higher levels of deprivation and public health need in the north
• community interventions, such as creating northern ‘Health for Life’ centres offering a lifelong programme of health and wellbeing advice and support services
• levelling up of investment in health R&D in the north of England to create high value jobs and support local health
• a national strategy for action to reduce inequalities in health, with a key focus on children,

What can RCP members do?

There is a clear role for RCP members in supporting reducing regional health inequalities through encouraging and supporting people from deprived, Black, Asian and minority ethnic and other under-served communities to receive the COVID-19 vaccine. They can also help to identify and support communities with the highest health needs, for example through the Deep End approach to primary care.

Members can also advocate for wider scale changes (such as increasing NHS and local authority funding) to take action on the social determinants of health. This could include supporting the RCP-led Inequalities in Health Alliance.

Clare Bambra is professor of public health at the Institute of Population Health Sciences at Newcastle University, and health inequalities lead for NIHR ARCs. Hannah Davies is head of external and public affairs at the Northern Health Science Alliance. Dr Luke Munford is lecturer in health economics at the Division of Population Health, Health Services Research & Primary Care at Manchester University