Coronavirus: Has Covid-19 exposed UK's underlying ill health?

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By Dominic Hughes
Health correspondent, BBC News

Covid-19 has taken a disproportionate toll on those with underlying health conditions.

Some experts say the crisis has shone a light on the poor state of our health as a nation. But in many communities it has also highlighted the link between ill health and poverty.

So what lessons has coronavirus taught us - and will ministers and health leaders act upon them?

'Meeting my demons'

Those with type 2 diabetes, often associated with being overweight or obese, have been particularly vulnerable to falling seriously ill with Covid-19.

About a fifth of all those who have died after contracting coronavirus had diabetes.

Roxana Falfara knows that she falls into that dangerous category.

Ever since she was a child, Roxana has had a difficult relationship with food.

She understands that her eating is tied up with her mental health, but says that doesn't make it any easier to manage.

Roxanna Falfara: "I had this anxiety of going out, especially with knowing I have type 2 diabetes"

"Every time you sit at a table you meet your demons. So you meet the addiction every time you have to eat."

As an adult, Roxana became very overweight and developed type 2 diabetes.

Now she's trying to eat more healthily and lose weight ahead of a second bout of surgery.

But, with her heightened vulnerability to Covid-19, the past few months have been tough for her.

"I had this anxiety of going out, especially with knowing I have type 2 diabetes," she says. "I'm at a high level of danger so I tried to avoid going out as much as I could."

In her home town of Sheffield, about 60% of the adult population is overweight or obese.

And like Roxana, that group was among those at greatest risk of falling seriously ill during the pandemic.

The story of Sheffield

The coronavirus has exposed the deep inequalities in our health.

What happened in Sheffield at the height of the coronavirus pandemic reflects what happened in many towns and cities across the UK.

The more affluent areas of Sheffield escaped pretty much unscathed. But in the poorer parts of the city, they saw some of the highest mortality rates in the entire country.

For the director of public health in Sheffield, Greg Fell, that raises some really difficult questions about the underlying state of our public health.

He describes it as a complex, multi-layered picture.

"It's the environments in which we live. It's the poverty, it's the poor housing, it's the lack of educational opportunities, it's the job opportunities," he says.

"Economic policy, housing policy, all of those things make a difference to health, far more so than the treatment the NHS can provide."

Inequalities 'amplified'

So what has this coronavirus pandemic told us about the underlying state of our health - and more broadly, our society?

Earlier this year an influential report warned that life expectancy - particularly among the poor - had stalled.

Now the author of that report, Sir Michael Marmot, says coronavirus has reinforced the connection between poverty and ill health.

"Health and health equity, the fair distribution of health, tell us a great deal about how well society is doing," he says.

"And the fact that health stopped improving, life expectancy has stalled, and inequality in life expectancy is increasing - that told us that over the last decade, society had stopped improving and inequalities in society had been increasing.

"So when the pandemic came, it just exaggerated, it exposed and amplified those inequalities."

For many public health experts, the coronavirus crisis is the inevitable consequence of decades-long failure to address our unhealthy habits.

Prof John Wass has spent much of his professional life studying a pandemic that has been growing steadily for decades - obesity.

"The fact that we have one of the highest death rates in the world is something which really does need to be understood," he says.

"We are not a healthy nation with regard to, for example, the statistics for obesity, the statistics for diabetes, and so on.

"This is not a simple thing. It's not just selling fewer McDonalds on the high street.

"We need a situation where health is linked to education, it's linked to healthy eating and agriculture, it's linked to business.

"So we need a joined-up approach between all the government departments.

"It's complicated - but this is a complicated thing that needs a solution."

Coronavirus: An opportunity?

Governments set the direction of policy, but the job of creating real change on the ground falls to people like Sheffield's director of public health.

And despite the challenges posed by coronavirus, Greg Fell is still optimistic that the situation we find ourselves in might present an opportunity.

"We know that we have neglected the health of the public for many, many years," he says. "Now is a perfect time to start to put some of that right.

"We know that health is unequally distributed. We know that people who are from black and minority ethnic backgrounds live shorter lives and in poorer health than those of us who are white British.

"We know that those who are disabled live shorter lives in poorer health. We know those who live in the poorest parts of our towns have shorter lives and poorer health.

"So now's a perfect time to put that right, there's never been a better time to put that right."

As communities across the UK reflect on their experience of coronavirus, the challenge for political leaders is how to apply the lessons of the pandemic.

It's hard to draw any conclusion other than a real transformation of our nation's health will need fundamental changes in society.

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