ADD2449 Rapid Evidence Review: Inequalities in relation to COVID-19

The COVID-19 pandemic is the most significant public health crisis in living memory. The economic, health and social challenges arising from both the virus itself, and from the lockdown are far-reaching. Recovery will take many months, if not years. Having data about Londoners will be crucial to informing the recovery effort. Data will be collated from a wide range of sources to provide a holistic overview of the socio-economic state of London, which will support public policy decision-making.

There has already been significant reporting of the disproportionate impact of COVID-19, particularly in relation to deaths and severe cases, among Black, Asian and Minority Ethnic (BAME) groups in the UK. Recent modelling work from the Institute for Fiscal Studies (IFS), Office for National Statistics (ONS) and Oxford University has confirmed the extent of the disparities which cannot be explained by available measures of health and social inequalities. Further analysis is required to understand issues such as occupational exposure to COVID-19 and how these intersect with other characteristics such as housing and household characteristics. Public Health England (PHE) is now conducting a national review of COVID-19 and its impact on BAME communities.

The Mayor of London and GLA will work with PHE as far as possible on this review but are keen to understand the unique situation in London and the likely further impact of an economic downturn on existing inequalities to develop its own response.

In 2018 the Mayor published Inclusive London, his equality, diversity and inclusion strategy for London. His vision was for everyone in London to “be able to share in its prosperity, culture and community life regardless of their age, social class, disability, race, religion, gender, gender identity, sexual orientation, marital status, or whether they are pregnant or on maternity leave.”

In the same year he also published his Health Inequalities Strategy. The strategy highlighted how London remains deeply divided, with too many Londoners suffering ill health because of social and economic exclusion. One of the key messages was that health is part of a wider picture: a fairer economy, a stronger and more integrated society and an environment that helps people stay fit and healthy contributes to wellbeing, health outcomes and prosperity. By making sure that health is considered in all of the Mayor’s strategies – from food, to housing, to economic development, to transport – he aims to create a city where no one's health suffers because of who they are, or where they live or work.

This sets the scene for this new piece of work. COVID-19 has already begun to highlight stark social, economic and environmental impacts that will contribute to health inequalities. These impacts are not experienced equally, and we already have evidence of the disproportionate burden on men, older people, and some BAME communities. The Mayor and the GLA would like to understand this in more detail, as well as the impact the pandemic is having on Londoners of other characteristics and with multiple characteristics that may make them more at risk of infection, hospitalisation or poor prognosis including death.

London is demographically different from the rest of the country. For example, Londoners are younger on average, but with a growing older population. A larger proportion of Londoners are migrants, people in London are most likely to identify as LGBT+, and Londoners are twice as likely to identify as being of a Black, Asian or Minority Ethnic (BAME) background compared with the rest of England and Wales.

London also stands alone as the largest urban area in the country, with a population size much greater than the next big city region (Birmingham). Its population growth has been driven strongly by migration, with significant inflows and outflows reflecting a high level of transience. London’s size brings its own unique challenges in relation to Londoners’ travel patterns and living conditions. Air quality is poorer, Londoners have less access to a private or shared garden and overcrowding is more prevalent. London's higher housing costs lead to a much higher rate of poverty than the rest of the country once these are taken into account.

This work will complement national work being led by PHE’s project to better understand how different characteristics could impact on how people’s health outcomes are affected by COVID-19 across the clinical pathway. The London review will include a wider range of protected characteristics rather than gender and ethnicity, as well as social and economic inequalities, and will focus on the specific London context as a major city. This work will help shape and deliver London’s recovery and renewal from the pandemic by highlighting social and economic inequalities that have driven differences in the impact of coronavirus across London’s communities and the inequalities created as a result of this crisis,

The requested £25,000 will be used to commission an organisation to conduct a rapid evidence review around the impact of COVID-19 on different groups of Londoners.

To understand and document the impact of COVID-19 on the full range of protected groups, as well as socio-economic characteristics, with particular regard to its effect in London. As well as the initial impact of experience of COVID-19 as a disease the review will look at likely further impacts of the resulting economic downturn which may exacerbate existing inequalities in terms of the labour market, education, health, access to food etc.

Under Section 149 of the Equality Act 2010, as a public authority, the GLA must have ‘due regard’ of the Public Sector Equality Duty (PSED), that is the need to:

• eliminate unlawful discrimination, harassment and victimisation;
• advance equality of opportunity; and
• foster good relations between people who have a protected characteristic and those who do not.

Equality, diversity and inclusion are the drivers behind this research. The work to understand the impacts of the COVID-19 pandemic on the full range of protected groups and socio-economic inequality expands upon the national government’s work which has a primary focus on ethnic background.

Understanding the experiences of more groups of Londoners will help the GLA shape the development of policy going forward to increase fairness and ensure that equality impacts are considered as critical decisions are made.

Key risks and issues

There are no conflicts of interest to note for any of those involved in drafting or clearance of the note.

Links to Mayoral strategies and priorities

This work ties in with the Mayor’s Equality, Diversity and Inclusion strategy and Health Inequalities Strategy. Both of these strategies themselves tie in with many, if not all, of the Mayor’s other statutory and non-statutory strategies.

Consultations and impact assessments

This decision request builds on feedback from policy colleagues, the Mayor’s Office and external stakeholders to carry out analytical work to explore the issue of disproportional impacts of COVID-19, which should be considered in conjunction with a parallel workstream to develop policy responses to these impacts.

Approval is being sought for expenditure of £25,000 towards commissioning an organisation to conduct a rapid evidence review around the impact of COVID-19 on different groups of Londoners.

This expenditure will be funded by the 2020/21 Social Evidence Base Budget, within the Communities and Social Policy Unit.