Life after Covid – Building Back Fairer in the South

This is a guest blog by Councillor Dave Shields who is currently Southampton City Councillor for the Freemantle Ward. Dave was born, raised and educated in Southampton. Leaving full time school education at 17 he held a number of jobs – including a zoo-keeper, accounts clerk with a local shipping company and clerical officer at the Census Office – before moving to London to study for a degree. Dave was previously chair of the Southampton’s Health & Wellbeing Board (2013-2020) and member of the Safe City Partnership (2017-2021). At a national level Dave has served as a committee member of Healthwatch England (part of the Care Quality Commission) and more recently as a member of the Local Government Association’s Community Wellbeing Board.

The content of this post is solely the opinion of the author and does not necessarily reflect the opinions and beliefs of the Southern Policy Centre.

Life after Covid – Building Back Fairer in the South

As we start to emerge from 18 months of the covid pandemic, thoughts turn to how best to rebuild our local economy and public service support systems. Can there be a return to the old normal or did we need to look at things differently in light of experience? Here I look at our experience in Southampton and explore what lessons we can draw from other areas and from leading public health academics.

Local Context

In the week ending 9 September, 2021 (the time of writing) Southampton recorded 753 cases of covid – a City total since the beginning of the pandemic to 25,037. Sadly, there have been 399 covid deaths with 262 occurring in hospitals and 137 in the community most (103) in care homes.

Southampton’s infection rate of 298.2 cases per 100,000 population is similar to the national and regional picture. However, this is expected to rise as the impact of the lifting of restrictions, return to school and university and attendance at large scale leisure and sporting events start to be felt.

Many people have been blighted by the illness and long-term effects of infection. This needs to be seen in the context of the impact of lockdown on the economy and on daily lives, with long term consequences for mental health, employment, criminal justice, education and welfare support.

We are currently experiencing a third wave of the pandemic. We need to understand the differential impact experienced across the population with variations by age-group, gender, ethnicity, deprivation, occupation and geography.

Indirect effects of the pandemic include delays in healthcare access for non-covid related conditions, physical and mental health deterioration caused by prolonged restrictions, and changes to people’s financial situation due to loss of employment, self-isolation or ill health. Significant loss of educational experience due to lockdowns or self-isolation will also have negative impacts for children and young people, once again with segments of the population impacted differentially.

Pre-existing ill health is also a risk factor for long covid. Nationally 962,000 people were estimated to be experiencing self-reported long COVID at the beginning of July with 18.5% reporting severe limitations in undertaking everyday activities.

Rising to the Challenge in Southampton

One of the positives to emerge has been the extent of community resilience; the valuing of key workers, volunteering with local mutual aid groups or simple good neighbourliness.

Following the initial lockdown in March 2020 many local citizens experienced isolation and needed support for daily essentials like groceries or access to medication. To ensure no one was left behind the City Council set up – together with its NHS and voluntary sector partners – a Community Support Hub based at the Guildhall.

In September 2020, the Council set up a Community Champions scheme to further harness this community spirit. A network of over 400 local covid community champions (from all walks of life) has been playing their part to keep communities safe by sharing important information and advice whilst providing the Council’s Public Health and Stronger Communities teams with regular feedback. This has been invaluable in helping to dispel myths and overcome barriers created by fake news and sinister conspiracy theories.

In November 2020, a modest grant from the Home Office enabled the Council to recruit a team of covid Marshalls whose role was to engage, explain and encourage members of the public to follow national guidelines. This enabled thousands of online and face-to-face interactions with the public and responses to hundreds of reports from concerned residents and business owners. Outcomes were overwhelmingly positive and played a key role in the reopening of the local economy by supporting businesses to manage queues and one-way systems, helping to prevent mixing between groups in public spaces and providing advice on how to wear face coverings.

The Council funded several community-led covid innovation projects, recognising that community, voluntary and faith sector organisations have crucial links with communities able to creatively support key public health messaging including:

  • promoting covid messages in different languages by trusted members of the community
  • social media videos by young people working alongside the University of Southampton LifeLab and Southampton Children’s Hospital Youth Ambassador Group
  • a range of community training and online engagement events

Taking Stock

Sadly – despite vaccination take-up covid has not disappeared. Though we can be positive about the situation in Southampton as cases continue to fall, we know that this can and will change quickly. So current partnership priorities Include: supporting the roll out of vaccines, supporting communities with lower take up rates; testing – both symptomatic and symptom-free – as a vital tool to keep outbreaks under control and break the chains of transmission; ensuring that key settings (e.g. workplaces, schools, care homes) are prepared for further outbreaks; monitoring prevalence and impact on the City’s communities through analysis of available data to inform decision making; communicating transparently and unambiguously with residents, visitors and businesses on key public safety messages.

Covid has shone a light on existing health inequalities in Southampton where people living in more deprived areas on average have a significantly lower life expectancy and suffer from worse health outcomes. We will continue to ensure taking steps to tackle this inequality is at the heart of our work, and move towards adopting a health in all policies approach across the Council

Looking Ahead

On 6 October, the City’s Health & Wellbeing Board will receive a proposal for undertaking a Southampton covid Health Impact Assessment to explore and better understand how the many issues have affected Southampton residents. It will utilise all available data sources that can allow for the assessment of both the direct and indirect effects of the pandemic and where the latest data available is relevant to the period of the pandemic.

Acknowledging that the impact of covid is experienced differentially across the population, the assessment seeks to identify where the city might be able to focus collective effort to reduce underlying structural health inequalities as we build back both better and fairer.

What can we learn from others?

Southampton’s suggested forward approach is very much in line with Prof. Sir Michael Marmot’s recommendations contained in a report commissioned last year by the independent think tank the Health Foundation. This painted a pretty bleak national picture of stalling life expectancy, rising health inequalities between socioeconomic groups and regions, and life expectancy declining for people in the most deprived areas.

In his foreword, Marmot commented on England’s “comparatively poor management of the pandemic” which he associates with the nation’s health improvement falling behind that of other rich countries since 2010. A number of possible explanations were given for this: poor governance and a political culture which does not afford priority to the conditions for good health; continuing increases in social and economic inequality, including poverty among families with children; austerity and accompanying cuts to funding of many vital public services; and the poor state of the nation’s health increasing the lethality of covid.

Marmot argues that commitment is needed by Government at two levels in order to build back fairer:

  1. to social justice and putting equity of health and wellbeing at the heart of all policy-making, nationally, regionally and locally.
  1. to specific actions that create healthier lives for all where society needs to deal both with inequalities and with the climate crisis

In addition, focused targeted action is needed at the local level in the following areas of policy:

  • communities and places
  • housing, transport, and the environment
  • early years, children and young people
  • income, poverty and debt
  • work and unemployment
  • public health

In the summer, the Institute of Health Equity published a report commissioned in 2019 by the Mayor of Greater Manchester to inform and support action on health inequalities. Health in Greater Manchester, along with much of the north, suffers more than areas in southern England due to a decade of austerity and regressive funding allocations. Covid has made things worse: exposing the underlying inequalities in society and amplifying them.

Covid mortality was 25% higher in Greater Manchester than in England as a whole, and the social gradient in mortality was steeper. The effect of the pandemic has been dramatic; in 2020, life expectancy fell by 1.2 years in women in the North West and 1.6 years in men compared to lower falls in England of 0.9 and 1.3 years.

In a blog piece for the BMJ the report authors, Prof. Sir Michael Marmot and Prof. Jessica Allen propose a framework for building back fairer in Greater Manchester based on six key themes:

  1. future generations – improving equity in the prospects for young people
  2. resources – compensating for cuts to public services of the last decade
  3. standards – improving living and working conditions important for health
  4. institutions – where businesses and public sector develop as ‘anchor’ institutions with a positive community impact
  5. monitoring and accountability – working with partners to develop a set of key health inequality indicators
  6. greater local power and control – implementation of further meaningful devolution capable of addressing underlying determinants of poor health

Conclusion

In building back fairer in Southampton and the wider south I contend that we need an approach similar to that being proposed for Greater Manchester. Although levels of deprivation are more concentrated in large parts of the North, the Midlands and Greater London there are significant and entrenched pockets in many of our southern urban and coastal communities; pre-existing health inequalities in the south show very wide variations between different geographies and we should ensure that our citizens here are not left behind as we start to recover from the pandemic.

References

1.    Build Back Fairer: The COVID-19 Marmot Review (December 2020): Build Back Fairer: The COVID-19 Marmot Review – The Health Foundation

2. Marmot and Allen: Building back fairer in Greater Manchester (June 30, 2021): Michael Marmot and Jessica Allen: Building back fairer in Greater Manchester – The BMJ

3. Robin Poole, SCC Consultant in Public Health: Covid-19 Update and Impact – forthcoming report to Southampton Health & Wellbeing Board (6 October 2021) link: SUBJECT: (southampton.gov.uk)

Useful Links

Covid-19 Updates – Southampton Data Observatory link: COVID-19 updates (southampton.gov.uk)

Southampton’s Covid-19 Community Champions Network link: Become a COVID-19 Community Champion (southampton.gov.uk)

Dave Shields

September 2021