This book by public health academic Dr Jatinder Hayre describes how the COVID pandemic exposed long standing fault lines of inequality, how these inequalities were worsened by the pandemic and how they have the potential to have long term consequences across society. It’s divided into seven chapters; the first three of which focus on the social determinants of health; education, food exclusivity and insecurity, and homelessness. Chapter four covers the impact of the COVID-19 on children’s mental health. Chapter five considers inequity experienced by particular demographic groups, and chapter six explores the potential societal consequences of worsening childhood inequity. At the end of the book Hayre presents his ‘manifesto’.

The chapters on education, food exclusivity, and homelessness set out the importance of the determinants to child health and the pre-pandemic context, before discussing the impact of COVID-19. Hayre considers the impact both with regards to short term outcomes and takes an interesting life course perspective postulating on longer term consequences for individuals and society. These chapters include a helpful discussion of relevant policy before considering opportunities for post pandemic reform.

In the fourth chapter Hayre covers the impact of COVID-19 on children’s mental health, discussing the impact of social determinants such as isolation, remote learning, family stress, and highlighting the different experience of children from more affluent and less affluent backgrounds. He also highlights the difficulties experienced by some of the most vulnerable- carers, children with SEN and ethnic minorities, illustrating the intersectionality experienced by some with layering of disadvantage.

It is in this chapter that the style of writing seems to change from a factual and academic tone to a more figurative, opinion-based style which could be perceived in some places as tending towards hyperbole. For example, writing about children’s experiences of being out of school during the pandemic, the author writes ‘Academic setbacks soon bled into emotional despair’ and ‘the mental anguish of being left out- of both education and social life- was sharp’ (p.50). Such emotive language makes for a compelling read. However, additional references may have guided readers to any evidence base behind these statements and how generalisable this might be.

The antepenultimate chapter on child sub demographics considers inequity experienced by particular demographic groups, including, ethnic minority children, LGBTQ+, children with disabilities and young carers and refugees. This is an important chapter highlighting some of the specific issues faced by these groups which are often overlooked, thereby deserving this focussed attention.

Chapter six addresses the societal consequences of child health inequity, outlining consequences including: workplace disruption and loss of productivity, effect on reduced capacity to care for our elderly, and a ‘collapse of community ties.’ In this chapter Hayre stretches beyond the existing evidence base to consider potential negative consequences for children and society. For example, an important link is made between chronic childhood illness and the impact on parents’ engagement in the workplace. However, this seems to then be extended to postulating on a wider potential impact suggesting ‘the damage is not limited to families: entire industries can falter, undermining Britain’s reputation as an economic power house’ (p.72). In my view, such statements may also need further evidencing to fully convince the reader.

At the end of the book Hayre presents his ‘Manifesto’ the ‘Hayre Doctrine of Hayre’s weighted universalism’. To me, this doctrine describes proportionate universalism as described by Marmot in Fair Society Healthy Lives in 2010 (1) but focused specifically for the context of children. He proposes five core pillars to frame interventions and policy.

In presenting this book Hayre shows his clear passion for an extremely important topic.  Voices like his are important to draw attention to health and social injustices that persist. The book offers an interesting critical analysis on consequences of the COVID pandemic for children, and the effect on the already widening Health Inequalities gap which preceded the pandemic.

Many readers may agree with much of what is written in this book. However, it prompted a reflection for me on the importance of a consistent and robust evidence base to guide our thinking when considering future consequences of these issues so we can be persuasive to policy makers in our calls for urgent action in this arena. That said, it is not an easy task to generate an evidence base that creates a link from a relatively narrow lens of childhood health inequity to the broader and far more complex social issues of economic stability and community cohesion, which the postulations in the book seem to attempt to do. Whilst it does offer some steps to guide our thinking, my overall sense is that we all, perhaps as an academic community and society at large, have a lot more work to do.

References:

1. Marmot M. Fair society, healthy lives. London. Institute of Health Equity. 2010. [Cited 5th September 2025] Available from:: https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf

Book reviewer:

Alice Deasy is a GP working in an area of Sheffield with a rich cultural heritage which faces many challenges related to deprivation. She also works as a Senior Clinical Teacher at the University of Sheffield, and is involved in embedding health inequity teaching into the Undergraduate Curriculum. Her longstanding interest in Health Inequity has led her to many different activities including; a leadership fellowship in Health Inequity, establishing the FairHealth charity with Dom Patterson, working as a Health Inequalities lead in a Primary Care Network, and, through the Sheffield Deepend Network, establishing a wellbeing programme supporting professionals working in Primary Care.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

 

 

 

 

 

 

 

 

 

Alice Deasy is a GP working in an area of Sheffield with a rich cultural heritage which faces many challenges related to deprivation. She also works as a Senior Clinical Teacher at the University of Sheffield, and is involved in embedding health inequity teaching into the Undergraduate Curriculum. Her longstanding interest in Health Inequity has led her to many different activities including; a leadership fellowship in Health Inequity, establishing the FairHealth charity with Dom Patterson, working as a Health Inequalities lead in a Primary Care Network, and, through the Sheffield Deepend Network, establishing a wellbeing programme supporting professionals working in Primary Care.