The UK’s National Health Service is under unprecedented strain due to coronavirus, but is this just the beginning of a wider healthcare crisis?
The current restrictions brought about by coronavirus (COVID-19), coupled with the direct effects of the virus on workers and firms, are having a huge impact on economies in the UK and around the world.
We know the resulting economic downturn will have significant consequences on people’s physical and mental health, both in the short and long term – and a debate has started over whether the adverse health effects of a recession may in fact be greater than the increased morbidity and mortality within the pandemic itself.
A recession will lead to a large rise in the prevalence of chronic illness
Recent research for the UK has indicated that a recession will lead to a large rise in the prevalence of chronic illness. As a benchmark, during the most intense part of the 2008 financial crisis in the UK, there was around a five per cent fall in the employment rate. If there were a similar drop in the employment rate over the coming year, our analysis predicts that the prevalence of chronic conditions in the working-age population will rise by somewhere between seven and 10 per cent.
This increase translates into around 900,000 more people of working age who will suffer from at least one chronic condition, such as asthma, depression and heart problems. Unfortunately, the shock to employment from the coronavirus pandemic is likely to be much larger than this.
Our results predict a particularly large rise in mental illness, including depression and generalised anxiety. This prediction is particularly worrying as levels of mental ill-health already increased after the financial crisis of 2008 and have not dropped in the 10 years since.
More generally, health effects of the situation will differ across generations, regions and socioeconomic groups.
Evidence is already emerging that the economic repercussions of the crisis are falling disproportionately on young workers, low income families and women. Groups of particular concern are families with young children or where mothers are pregnant - economic shocks and downturns have been shown to be important during pregnancy and early childhood - and low income or low socioeconomic status individuals of all ages where health vulnerabilities and mental health problems are already prevalent.
Repercussions of the crisis are falling disproportionately on young workers, low income families and women
Those with pre-existing poor mental health will also be particularly vulnerable. The adverse impact of recessions on mental health and mortality from suicide is clearly documented across a number of studies. To add to this, social distancing in itself is likely to have complex and nuanced effects on mental health.
There will also be considerable differences between local areas in the impact of an economic shock. In our research on recessions and chronic ill health we found more pronounced responses to changes in employment in areas that are already less resilient to economic shocks such as Eastern Scotland, the Tees Valley, Derbyshire, East Wales, Cumbria and East Yorkshire. These are areas with a higher proportion of employment in “blue collar” industries, areas which have older populations and areas with populations who are already in poorer long-term health.
In facing this economic downturn, government intervention will play a key role in determining the eventual health effects of the resulting recession, with the UK government needing to make the tough call of where to prioritise resources.
Importantly, in recent years the UK welfare system has evolved to protect incomes through the extensive use of in-work benefits. Whilst this proved to be a positive during the 2008 financial crisis when incomes and wages fell but employment held up, continued erosion of the value of out-of-work benefits relative to average wages leaves the system far less able to deal with mass unemployment shocks than it was.
Rebuilding lost human capital may well be much more complex than replacing physical or financial capital
The Coronavirus Job Retention Scheme (JRS) has a specific purpose of preserving jobs as well as incomes and is desirable in this respect. Obviously, within the lockdown period most of those who do lose their jobs will find it very difficult to find new work, but the JRS should help to ensure that once the social distancing measures are lifted, more have retained their jobs and can return to work.
Rebuilding lost human capital may well be much more complex than replacing the physical or financial capital that has been wiped out in the large recessions experienced recently. The government response to the virus will need not just to protect income and employment in the short run, as the current measures in the UK are intended to do, but will also have to address ways of stemming the increasing cost to the NHS and individuals of rising levels of chronic ill-health.
The current arguments about the trade-offs between isolation and return-to-work are more nuanced than simple “lives” versus “money”: instead they are more to do with “lives” versus “healthy lives”.