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Covid-19: Poverty

Volume 812: debated on Thursday 27 May 2021


Asked by

To ask Her Majesty’s Government what assessment they have made as to whether there is a correlation between areas with high COVID-19 infection rates and high levels of poverty; and if there is such a correlation, what steps they intend to take to address this as part of their levelling up agenda.

My Lords, the facts are heartbreaking. Covid, like many diseases, has hit hardest those who are most vulnerable: the poorest, the most disabled and those who work in some of the most difficult jobs. The vaccine rollout and community testing programmes have shown what the country can do, but there is much more to be done. That is why we are publishing a levelling-up White Paper, and health inequalities will be central to that.

My Lords, I am grateful to the Minister for his reply and the work that he and colleagues are doing in a fast-changing scene. We know that it is not easy. Does he agree that care for the poorest, most disadvantaged and most vulnerable in the community is one of the signs of a healthy society? Can he be more specific about how equality of opportunity in the levelling-up agenda will be rolled out?

My Lords, I can certainly speak for the inequalities we have in health. The right reverend Prelate is entirely right—Covid has been a real reminder of the impact of deprivation and inequality on the population. Those who are disabled are two-and-a-half times more likely to have had some form of life issue with Covid. In terms of deprivation, mortality in the most-deprived neighbourhoods was more than double the rate than in less-deprived neighbourhoods. Those facts are chilling. They are a wake-up call, and we will be working through our levelling-up agenda.

My Lords, as the latest Marmot review made clear, damaging and heartbreaking levels of inequality and poverty, especially child and family poverty, weakened our resilience in the face of Covid. Apart from getting people into paid work, which increasingly is failing to protect from poverty, what is the Government’s anti-poverty strategy?

My Lords, I can speak for the health dimension. I should emphasise the work of the office for health promotion. Under the Chief Medical Officer, the OHP will deliver proactive, predictive and personalised preventive strategies. We believe that there is a huge opportunity off the back of Covid to really change the health inequalities of the country, and that is what the OHP will be devoted to doing.

My Lords, levelling up is a UK-wide ambition and priority; health and public health are devolved responsibilities. Will the Minister undertake to take a good look at how the various parts of the United Kingdom have dealt with problems that they have faced? For example, Wales appears at the moment to be far more successful in rolling out vaccination than England, Scotland and Northern Ireland. We should not be too proud to learn from each other in order to overcome some of the deep inequalities that have developed over the past years.

My Lords, the vaccine race is being contested right across the country, and I take my hats off to all those who are delivering the programme so effectively. We are not too proud to learn from each other. In fact, I pay tribute to, for instance, those in Scotland who have programmes around alcohol and drug use, which are pioneering on a worldwide level. We have to work on this all together, and we will absolutely use the best case studies to apply the best programmes on a countrywide basis.

My Lords, I draw attention to my position as a fellow of the Royal Statistical Society. There is an old adage that correlation does not necessarily indicate causation. While it is easy to talk about levels of poverty, there are other factors such as lifestyle and ethnicity, and there will be a need for some multiple regression when studying the consequences. When the committees are inevitably set up to look at the causes and how to deal with those matters, will the Minister make it a priority that a good, well-qualified statistician is included among the members of any committee that is set up?

My Lords, I hear my noble friend’s warning very clearly and he is absolutely right. We must not be confused between statistical correlation and causation. However, one thing that has become clear is that in Covid personal health status, particularly obesity, has been a driver of severe illness and mortality. The environments in which people live and work have been a driver of infection. Those two are probably inescapable conclusions and will be central to our levelling-up agenda.

The pandemic has brutally exposed the health inequalities that ran deep in our society even before Covid-19, and it is certainly welcome that the White Paper acknowledges that. However, even the best efforts of an integrated care system can only go so far in preventing ill health. Forthcoming legislation needs to be underpinned by national policy measures and funding to tackle overarching determinants of health. With that in mind, will the Minister comment on why the Queen’s Speech did not contain improved funding for public health, given the Government’s professed commitment to levelling up and building back better?

My Lords, the noble Baroness is entirely right that it cannot be for either the law or the Department of Health to solve a national challenge. That is why the Prime Minister has committed to appointing a cross-ministerial board. It needs the co-ordination and focus of many different departments that handle health, social welfare and the culture of the country to tackle these tricky, long-standing and difficult challenges.

Could the Minister add the levelling-up agenda to the arguments for not delaying opening up on 21 June? Overcaution at this stage would be particularly devastating for ordinary working people. Even if the cost-benefit analysis is post hoc, I ask the Minister to start looking now at the health impacts of lockdown, not Covid as such, on the less well off. The health impacts of being confined in overcrowded houses, no gardens for kids and worries about job security are likely to have taken their toll, and we need to learn from what has happened.

My Lords, it is a difficult fact that males working in low-skilled elementary occupations, such as security guards, had rates of death more than three times higher than the general population. That illustrates that often those in the most difficult jobs face the greatest threat of infection. The best thing we can do for the economy is to get rid of this virus, for which we need vaccination and testing, and that is the Government’s focus.

My Lords, following the effects of Covid-19, restoring the nation to good health will require a new social compact, backed by a national cross-departmental health inequality strategy. I am pleased to hear the Minister say that the reduction of health inequality will be in the health Bill, but could he confirm that the legislation will include commitments from other departments and the Government?

My Lords, we have provisions for tackling obesity in the health and social care Bill, as the noble Lord knows, but the focus of the cross-ministerial board on health will be to bring together government efforts on not just obesity, but health inequality in the round. The board’s remit has not yet been published, nor has its membership or chairmanship, but I reassure noble Lords that that is coming reasonably soon.

So we have to wait for a cross-ministerial board; that will really make a difference. Overall, the Government’s record has been appalling. Improvements in life expectancy, which had been rising steadily since the 1950s, stalled in 2010 when the Conservatives were elected and throughout the subsequent decade. What is more, according to the King’s Fund, real government spending on public health has fallen by 15% in the last six years. That is not new, so why do we have to wait for the so-called levelling-up White Paper and this cross-ministerial thingy? Why can the noble Lord’s department not get on with boosting public health locally, rather than reshuffling the deckchairs nationally by abolishing Public Health England and diluting that focus?

I feel inspired by the noble Lord’s passion for the subject, but it is not fair or reasonable to suggest that death rates in the country are driven by the electoral cycle. Far from it—this Government have been extremely committed to the obesity strategy, not least because of the personal story of the Prime Minister. We have not abolished Public Health England; we have redefined it as two organisations, UKHSA and the OHP. The impact of those will be profound.

Is the Minister aware of the social mobility pledge, which is trying to remove impediments to people applying for highly skilled jobs so that they do not follow the route that their families may have followed into underpaid jobs, where they remain in poverty for ever? I would very much like him to look at this. I support the pledge and many hundreds of businesses are following that example and removing these impediments.

The noble Lord speaks movingly about this important issue and social mobility is itself a massive issue for the country. It does not fall directly within the remit of the Department of Health, but the NHS itself can be an enlightened employer in this respect. Many families have seen great advances in their personal development there, and I hope that it has a spirit of meritocracy and opportunity. I would be glad to write to the noble Lord to share with him the kinds of initiatives designed to increase social mobility that there are within the NHS.

Sitting suspended.