Research for a report exploring which groups of people and places in London were most vulnerable to Covid-19 began in June as the pandemic was receding and the challenge was thought to be how to “build back better”. Now, with the results in, what can we learn from that report when the immediate challenge is how to avoid being overwhelmed by a second wave?
Packed with data exploring numerous consequences of Covid-19 – on population health, but also employment, income and housing impacts – the report is evidence of the sheer scale of the social upheaval now being experienced. As such, the general message in the face of a second wave is that responses to it must not get stuck on just a few big ideas, either about what the problem is or about what should be done, and that policy makers should focus on those most vulnerable to its impacts.
In particular, instead of succumbing to the very British habit of wanting to blame bad things on bad behaviour, policy makers should focus on those people who are unable to avoid risk, either because of the work they have to do or because of their living arrangements at home.
Several research findings provide substance for this argument. Using an official categorisation of occupations at high risk of infection, the report shows that some of the high-risk occupations are filled disproportionately by Londoners in both black and Bangladeshi ethnic groups whose overall death rates were among the highest in the first wave. This is not evidence of cause and effect, but does point towards some of the deeper economic factors behind the now well-known inequalities in Covid-19 outcomes. Not ruling other causes out, this is evidence of where to look and what to pay attention to.
The report also underlines the potential significance of both overcrowding and those people over the age of 70 sharing a home with people of working age. While again not definitive, statistical connections and a scientific understanding of how transmission takes place – the leaked SAGE guidance to government three weeks ago noting that “household transmission remains the most widely recorded setting of transmission” – point to this being a factor that must be taken into consideration. Instructions to self-isolate must be practicable. If someone’s living conditions at home – no spare bedroom, sharing a bathroom and kitchen – are such as to make self-isolation impossible, there needs to be another solution.
In response, the report recommends that two groups of people should now routinely be regarded as vulnerable, with the risks they face being investigated accordingly. The first group of people is those working in occupations at high risk of contracting the virus. While the highest-risk occupations are mainly in health or care, the ten largest high-risk occupations also include teaching, waiting staff, and cab-driving.
The second group is people of all ages living in overcrowded homes. As the report points out, the extent of overcrowding that many Londoners contend with marks the capital out from the rest of the country.
In contrast to these questions, which in the face of a second wave are urgent, those about how to “build back better” are important and of short and longer-term population health significance. Who is most at risk from the withdrawal of the furlough scheme? How does unemployment impact a London workforce whose housing is less secure and less eligible for support from social security than during the last big recession a dozen years ago? Which parts of London could expect to be hit hardest? Are there any common patterns? And what about the situation of long-standing vulnerable groups, such as children with special needs or adults with learning disabilities, following months when attention and resources had been focused on the virus itself?
Combining data on employment, furlough support, housing tenure and claims for Universal Credit, the report can be seen as painting a picture of where London’s younger working class (say those under 40) is now concentrated: in half a dozen boroughs to the outer east and north-east, stretching from Enfield to Barking & Dagenham; in Brent, Ealing and Hounslow to the west; and in Croydon to the south, which if viewed separately from Greater London, would be England’s eighth largest city.
In response, to these new threats, the report recommends that two further groups should now be identified as vulnerable as a result of the economic shock of the recession. They are, first, people working in occupations and sectors at high risk of substantial job loss and second, people renting their home from a private landlord or buying with a mortgage who have made a new claim for Universal Credit since the start of the lockdown. These two groups overlap and the second will certainly be visible to public authorities through the claims they make for support.
Financial strain impacts relationships and mental health. Report data also draws attention to the sharp rise in the incidence of self-reported mental health problems among younger adults and those who are key workers, noting again a pattern with the younger working-age adults who are most exposed to the economic threat. Although the survey on mental health is nationwide, there is no reason to suppose that London is an exception. Data also highlights the needs of long-standing groups of both children and adults of all ages with particular vulnerabilities, for example children living in areas of deprivation, adults with learning disabilities and people seeking asylum.
Vulnerability can be understood as a way to describe population groups with less control to mitigate infection risk and the economic and social impacts of Covid-19. Taken together, the clear implication is that the threat posed by the pandemic is not confined mainly to those over 60 or even those over 50. Public health, understood in the round, is under threat across the board. As we face a second wave, policy makers should focus on a wider definition of vulnerability and protect people who are unable to avoid risk because of the work they do or their living arrangements at home.
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