Intended for healthcare professionals

Letters Positive effects of covid-19

Positive effects of covid-19 and social determinants of health: all in it together?

BMJ 2020; 370 doi: (Published 03 July 2020) Cite this as: BMJ 2020;370:m2633
  1. Sarah E Hill, senior lecturer1,
  2. Sharon Friel, professor of health equity and director2,
  3. Jeff Collin, professor of global health policy1
  1. 1Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK
  2. 2Menzies Centre for Health Governance, School of Regulation and Global Governance (RegNet), Australian National University, Canberra, ACT 2601, Australia
  1. s.e.hill{at}

We welcome Nelson’s analysis of the potentially positive effects of covid-19,1 particularly in providing an opportunity to reassess priorities. Nelson points out the unanticipated benefits of recent behaviour changes. We think that the real revolution is a re-discovery of the health potential of state intervention.2

Although we applaud governments’ efforts, we note that these have been partial and extremely uneven. Already the virus is disproportionately affecting less privileged groups,34 and containment measures have precipitated an economic recession that will be hardest on poor people.5

These inequities are unsurprising to those familiar with6 the WHO Commission on the Social Determinants of Health, which reported that population health is driven by the conditions in which people are born, grow, live, work, and age, and that social injustice is the biggest killer of all.7

There are three important implications. First, governments must ameliorate inequalities in the negative effects of covid-19. Measures taken to support businesses and wage earners2 have thus far been largely blind to class, gender, and race.3489101112 We have yet to see the extent to which the pandemic and associated policy responses will exacerbate underlying economic and social inequities.91213 Second, governments should consider how plans for lifting lockdown can be tailored to minimise harm to already disadvantaged groups and to ensure equal enjoyment of the associated benefits.14

Finally, covid-19 will produce a truly positive effect only if it catalyses a sustained commitment to reducing social, economic, and environmental inequalities. If as a society we are serious about using this crisis to reassess our priorities, we need to recognise the need for change beyond individual responsibility for “risky behaviour.” The genuinely positive and sustained effects of covid-19 will come only when we acknowledge and act on systemic factors of wealth redistribution, public provision, and social protection to a resilient, healthy, and fair society.15


This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.


View Abstract