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Mitigating the wider health effects of covid-19 pandemic response

BMJ 2020; 369 doi: (Published 27 April 2020) Cite this as: BMJ 2020;369:m1557

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  1. Margaret Douglas, MPH programme co-director1 2,
  2. Srinivasa Vittal Katikireddi, clinical senior research fellow2 3,
  3. Martin Taulbut, information manager2,
  4. Martin McKee, professor of European public health4,
  5. Gerry McCartney, consultant in public health2
  1. 1Usher Institute, University of Edinburgh, Edinburgh, UK
  2. 2Public Health Scotland, Glasgow, UK
  3. 3MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  4. 4London School of Hygiene and Tropical Medicine, London, UK
  5. Correspondence to: M Douglas
  1. Health inequalities are likely to widen without action to support those most vulnerable to the economic and other effects of social distancing measures, argue Margaret Douglas and colleagues

Countries worldwide have implemented strict controls on movement in response to the covid-19 pandemic. The aim is to cut transmission by reducing close contact (box 1), but the measures have profound consequences. Several sectors are seeing steep reductions in business, and there has been panic buying in shops. Social, economic, and health consequences are inevitable.

Box 1

Social distancing measures

  • Advising the whole population to self-isolate at home if they or their family have symptoms

  • Bans on social gatherings (including mass gatherings)

  • Stopping flights and public transport

  • Closure of “non-essential” workplaces (beyond the health and social care sector, utilities, and the food chain) with continued working from home for those that can

  • Closure of schools, colleges, and universities

  • Prohibition of all “non-essential” population movement

  • Limiting contact for special populations (eg, care homes, prisons)


The health benefits of social distancing measures are obvious, with a slower spread of infection reducing the risk that health services will be overwhelmed. But they may also prolong the pandemic and the restrictions adopted to mitigate it.1 Policy makers need to balance these considerations while paying attention to broader effects on health and health equity.

Who is most at risk?

Several groups may be particularly vulnerable to the effects of both the pandemic and the social distancing measures (box 2). Table 1 summarises several mechanisms through which the pandemic response is likely to affect health: economic effects, social isolation, family relationships, health related behaviours, disruption to essential services, disrupted education, transport and green space, social disorder, and psychosocial effects. Figure 1 shows the complexity of the pathways through which these effects may arise. Below we expand on the first three mechanisms, using Scotland as an example. The appendix on provides further details of mechanisms, effects, and mitigation measures.

Box 2

Groups at particular risk from responses to covid-19

  • Older people—highest direct risk of severe covid-19, more likely to live alone, less likely to use …

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