Misguided economic policies are missed opportunities to undo the damage of a health vs wealth legacy, say authors 

He flexes his jaw to try and slide his oxygen mask half an inch up his face, his arms exhausted, his mouth dry and coarse like sandpaper. In the fleeting moments between his mask fogging up, from across the emergency room you can see sheer disbelief in his eyes. Simon* is only in his 20s and has been admitted to the emergency department, unable to catch his breath. He continued to work despite symptoms of covid-19, for fear of losing income. 

Hundreds of miles away in her local surgery, Maya*, in her 60s, sobs behind the door of a consultation room, feeling she’s wasting her GP’s time for a trivial problem. She grieves for the loss of her husband to covid-19 in the Autumn, and is now unable to afford her prescriptions for anxiety medication. She isn’t coping.

Encounters like these form part of a recurring pattern witnessed among our colleagues in hospitals and clinics throughout the country. They are stark reminders that the economic conditions of our daily lives shape our health in indelible ways.

The disease burden of covid-19, as with most other health burdens, has fallen hardest on the poorest. Simultaneously, the pandemic has pushed the economically insecure closer to the edge of financial catastrophe. If the last year has illustrated one thing, it’s that the nation’s health and economic wellbeing aren’t inexorably in tension with one another, as this government has assumed. They are two sides of the same life-changing coin. Socio-economic inequality compounds inequalities in health, obstructing millions from living dignified, healthy lives. 

We’ve been here before. The fallout from the 2008 global financial crash, and the “lost decade” of regressive cuts that followed, fortified evidence of the link between people’s social circumstances and their risk of ill-health. In February 2020, just before the pandemic took hold in the UK, Health Equity in England: The Marmot Review 10 Years On captured the impacts of this pre-existing public health crisis in painful detail. It showed that life expectancy in the UK had stopped improving for the first time in 100 years and even began receding for the UK’s poorest women. A year on from Marmot’s report, covid-19 and the government’s responses to it, continue to exacerbate this deep injustice.

As healthcare workers, we treat the symptoms of harmful economic policies every day. Our patients’ lived realities confront the “health versus wealth” approach that underpins the government’s pandemic response, exposing it as a dangerous false dichotomy. It would be easy to blame someone who continues to work, despite having symptoms of covid-19, but what if like Simon they are one of almost 3 million who were unable to benefit from the chancellor’s Job Retention Scheme, and who remain neglected after the Spring budget? Without adequate financial and practical support for self-isolation, not everyone can afford to do this. Wealth as it turns out, is the best shielding strategy from the virus.

Many others like Maya in similarly precarious positions have turned to Universal Credit. She is one of more than a million people who have applied since March 2020, with applications at a rate five times higher than the equivalent peak following the 2008 recession. Some have waited months for payments to cover basic necessities at the point when they are most unshielded. The government continues to resist calls to make the crucial £20 weekly uplift permanent, fuelling anxiety for millions of families. 

Our recent co-authored Medact report Health Versus Wealth? starts from the premise that our economy should prioritise the nation’s health and health equity as inherently valuable social assets. It charts how, during the pandemic, our government has failed on both health and the economy: the UK has one of the highest covid-19 mortality rates in the world, hand-in-hand with one of the biggest economic recessions among G7 nations. We argue that this happened because the government failed to understand that health and economic wellbeing are inexorably intertwined.

These misguided priorities are impeccably encapsulated by the £849 million “Eat Out to Help Out” scheme. Research suggests between 8% to 17% of new cases in the second wave could be attributed to the scheme, championed in the name of “re-starting the economy.” Yesterday’s announcement to extend stamp duty will do little to salvage the financial prospects of those confronted with the undignified choice of a heated house or hot meal.

Recent surveys show a majority of the public believe that health and wellbeing should be prioritised above economic growth and believe that wealth differences are unfairly large. The UK has one of the weakest safety nets in its own post-war history, and far weaker than the majority of neighbouring economies. Yet public support for stronger welfare is the highest in twenty years.

Similarly, leading figures in the health community have called for greater social protection, to create the preconditions which enable people to live healthy and dignified lives. With a faint glimmer of light at the end of the tunnel for many, “building back better” must start with more ambitious action to financially support those needing to self-isolate, plug gaping holes in the social safety net, and implement Marmot’s recommendations. Sadly, this is a reality that so many, including our patients like Simon, Maya and colleagues, are yet to experience.

Monica Sharman is a Foundation Doctor working in the Yorkshire & Humber Deanery and member of Medact’s Economic Justice & Health Research Group. Twitter: @monica_sharman

Hannah Talwar is a Foundation Doctor working in the West Scotland Deanery and a member of Medact’s Economic Justice & Health Research Group.

Amaran Uthayakumar-Cumarasamy is a Foundation Doctor working in the Yorkshire & Humber Deanery and member of Medact’s Economic Justice & Health Research Group.

*Not real names 

Competing interests: none declared.