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Analysis

Using socioeconomics to counter health disparities arising from the covid-19 pandemic

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2149 (Published 08 June 2020) Cite this as: BMJ 2020;369:m2149

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Rapid Response:

Rising to the Triple Challenge - Covid-19, Brexit and Climate Change

Dear Editor,

In their article, Anderson et al (1) highlight the need to mitigate the longer-term effects of the Covid-19 pandemic in an equitable way. We would like to highlight that for the United Kingdom (UK) specifically, plans need to address the triple public health challenge it faces from not only Covid-19, but from climate change and the UK Brexit as well.

Covid-19 has dramatically changed the lives of the world’s populations and economies. Lockdowns and other restrictions to control its transmission are revealing the complex, interwoven relationships between health, well-being, inequalities, the economy, the environment and society as a whole. Evidence must be drawn from this calamity not just to aid recovery but to inform a ‘new normal’ that addresses inequities and fragilities that Covid-19 has exposed. For the UK, our responses must also consider other existential threats already facing the four nations in the union. Our exit strategy and recovery plans need to mesh seamlessly with our plans to exit the European Union and must develop resilience and provide support to many vulnerable industries and communities. The twin challenges from Covid-19 and Brexit must also work with the climate change agenda. Solutions to the well-being and economic challenges posed by Brexit and Covid-19 cannot sacrifice the health of future generations; burning resources now and expecting our children and grandchildren to cope with the aftermath. Health and well-being in the UK faces an unprecedented triple challenge that must be tackled in a coordinated fashion that considers the coming days and decades.

In 2019 Public Health Wales published a Health Impact Assessment (HIA) on the public health implications of Brexit (2) . Using a similar multi-focal lens that covers immediate, medium- and long-term perspectives the HIA approach is now being used to examine climate change and aspects of the Covid-19 pandemic. Our work to date already demonstrates many commonalities and synergies in their impact across health inequalities, relationships and wider determinants of health. Poverty and inequalities increase vulnerability to the health impacts of Covid-19, climate change and Brexit. Poor mental well-being, inter-generational / social conflict and division and the need for community resilience are constant themes across each.

Rather than seek to return to our inequitable and unsustainable systems, new balances must be found across health protection, improvement and health care services; between health eroding businesses and new sustainable economies with high standards in employment and industry; between global commerce and travel and the need for disease control and planetary health. Critically, our efforts must include a public health perspective to protect the most economically, physically and mentally vulnerable who are so often disenfranchised.

Outside of war time, Covid-19, Brexit and climate change may represent the biggest combined challenge to health and well-being that the UK has ever faced. However, they also provide an opportunity for it to set a new direction using equity and sustainability as its compass. New policies cannot be obsessed only with politically driven short-term cycles, measured by GDP and indifferent to their impact on future generations. In Wales, the Well-being of Future Generations (Wales) Act provides a key driver to do this; compelling government and public sectors to consider inequalities and sustainability. However, Brexit, Covid-19 and climate change have shown that the biggest challenges we face move seamlessly across the borders of the UK nations. Consequently, when any nation leaves communities vulnerable it is only a matter of time before everyone experiences the consequences.

Liz Green, Programme Director for HIA, Wales Health Impact Assessment Support Unit / WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales

Sara Wood, Public Health Researcher, WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales.

Mark A. Bellis, Director, WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales. Professor of Public Health, College of Health Sciences, Bangor University

(1) Anderson G, Frank JW, Naylor CD, Wodchis W, Feng P. Using socioeconomics to counter health disparities arising from the covid-19 pandemic. BMJ 2020;369:m2149

(2) Public Health Wales. The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach. Public Health Wales: Cardiff 2019

Competing interests: No competing interests

11 June 2020
Liz Green
Programme Director for HIA
Sara Wood, Mark A. Bellis
Wales Health Impact Assessment Support Unit / WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales
Creosnewydd Hall, Wrexham, LL13 7YP