The North of England’s economy has been hit harder than the rest of the country during the COVID-19 pandemic with inequalities between the North and the rest of the country exacerbated according to a new report.

The Northern Health Science Alliance, NIHR Applied Research Collaborations (North East and North Cumbria, Greater Manchester, North West Coast, Yorkshire and Humber), and the NIHR School of Public Health Research report COVID-19 and the Northern Powerhouse: Tackling Health Inequalities for UK Health and Productivity looks at the impact of COVID-19 on the health and economic inequalities between the Northern Powerhouse and the rest of England.

It has found the pandemic hit the North harder and more deeply and that mitigating measures must be put in place to stop inequalities rising further and faster.

The report conservatively estimates the economic cost of the increased mortality in the North during the pandemic at £6.86bn and the reductions in mental health in the region due to the pandemic at around £5bn a year.

The increased mortality rates in the Northern Powerhouse remains significant even after accounting for deprivation, ethnicity and the age-structure of the population. Figures show austerity simultaneously put the region in a more vulnerable position by reducing health and wellbeing, and cost the UK around £2bn a year in lost productivity, with over £16bn lost since 2011.

The report led by scientists from Newcastle University, the University of Manchester, University of York and University of Liverpool found:

• An extra 57.7 more people per 100,000 died in the Northern Powerhouse than the rest of England between March and July and this could cost the UK economy an additional £6.86bn in reduced productivity
• Mental and financial wellbeing was hardest hit in the Northern Powerhouse, as was loneliness
• Reductions in mental wellbeing in the Northern Powerhouse could cost the UK economy up to £5 billion in reduced productivity
• Austerity disproportionately affected the Northern Powerhouse, particularly areas of high deprivation which led to reduced productivity
• Reductions in the core spending power of local authorities in the Northern Powerhouse by £1 per-head cost £3.17 per-head in lost productivity, equivalent to around a £2bn loss in GDP per-year, or £16bn between 2011 and 2018
• Pre-pandemic child health, a key predictor of life-long health and economic productivity, was poor and deteriorating in the Northern Powerhouse. Since the pandemic, adverse trends in poverty, education, employment and mental health for children and young people have been exacerbated
• Economic outcomes, particularly unemployment rates, were hardest hit in the Northern Powerhouse.

Across the board these estimates are likely to be conservative as the North of England has been hardest hit during the second wave of the pandemic and these modelling exercises were concerned around outcomes from the first wave.

Professor Clare Bambra, Professor of Public Health, Newcastle University, said: “Our report highlights that we are not all in the pandemic together with the Northern regions being hardest hit. Health and wealth in the Northern Powerhouse lagged behind the rest of the country even before the COVID pandemic, and over the last year our significant regional inequalities have been exacerbated.

“We need to significantly ‘level up’ the country by providing immediate additional support to local authorities and devolved administrations in the North – and by investing further in public health prevention in the Northern Powerhouse. In this way, we can reduce the inequalities that the pandemic has highlighted and ensure that our regions are better equipped for building back better.”

Dr Luke Munford, Lecturer in Health Economics, University of Manchester, said: “The findings in this report reaffirm the results of our earlier analyses that showed the inextricable link between health and wealth. The Northern Powerhouse, on average, has been hit harder by COVID-19 than the rest of England in terms of both health and wealth outcomes.
“We cannot get away from their interconnectedness. The fact that these regional inequalities persist even after we account for deprivation and other known determinants means that there are other factors at play. These regional inequalities need to be addressed fast, or we risk letting the Northern Powerhouse fall further behind. A sensible place to start would be improving the health of people living in the Northern Powerhouse.”

Professor David Taylor-Robinson, Professor of Public Health and Policy at the University of Liverpool, and Professor of Child Public Health at the University of Copenhagen, said: “The poor child health of children in the North of England is unacceptable, and a major driver of the stark inequalities in later adult health and productivity documented in this report.
“The pandemic has made things worse, and the dramatic rise in child poverty predicted will have negative impacts for generations to come unless we take concerted action. To have any chance of ‘levelling-up’ it is essential that families with children are prioritised in the pandemic response and that immediate action is taken to reduce child poverty.”

Professor Kate Pickett from the Department of Health Sciences at the University of York said: “Covid-19 has brought into sharp focus the unacceptable inequalities in health and life chances suffered by children in the North. We need policies now that support our families and children during and following the pandemic.”

Hannah Davies, Health Inequalities lead for the Northern Health Science Alliance, said: “Health inequalities between the North and the rest of England have been growing for over a decade. This report demonstrates the impact that has had on the productivity of the region and how it has led COVID-19 to take a devastating grip on the North.
“We call on the Government to follow the recommendations of the report to put mitigating measures in place, to support public health measures, reduce child poverty, tackle mental health to support North through the pandemic and allow its ambition of levelling up to become an achievable reality.”

The report authors make a series of recommendations to stop further deteriorations in the level of inequalities:
1. Place additional resource into the Test and Trace system in the Northern Powerhouse and deliver through local primary care, public health, NHS labs and local authority services to ensure full population coverage.
2. Target clinically vulnerable and deprived communities in the Northern Powerhouse in the first phase of the roll out of the COVID-19 vaccine.
3. Increase NHS and local authority resources and service provision for mental health in the Northern Powerhouse. Invest in research into mental health interventions in the North.
4. Reduce child poverty – increase child benefit, increase the child element of Universal Credit by £20 per week, extend provision of free childcare, remove the benefit cap and the two-child limit; and extend provision of free school meals. Invest in children’s services by increasing government grants to local authorities in the Northern Powerhouse.
5. Maintain and increase the additional £1,000 extra funding of Universal Credit.
6. Provide additional resource to local authorities and the NHS in the Northern Powerhouse by increasing the existing NHS health inequalities weighting within the NHS funding formula in its reset and restore plans.
7. Deliver a £1 billion fund ring-fenced to tackle health inequalities at a regional level and increase local authority public health funding to address the higher levels of deprivation and public health need in the North.
8. Create northern ‘Health for Life’ centres o¬ffering a life-long programme of health and wellbeing advice and support services from pre-natal to healthy ageing programmes. Targeted to the most deprived areas in the North, they will take a preventative approach to health directly into the communities which need it most.
9. Deliver health and mental health promotion interventions together with industry and employers, targeted at employee mental and physical health.
10. Level up investment in health R&D in the North of England to create high value jobs and support local health and drive the economy.
11. Recommit to ending child poverty.
12. Develop a national strategy for action on the social determinants of health with the aim of reducing inequalities in health, with a key focus on children.

Henri Murison, director of the Northern Powerhouse Partnership, said: “We cannot ignore evidence that COVID-19 has had a vastly disproportionate effect and so it’s essential we prioritise the clinically vulnerable and deprived communities when it comes to the roll-out of the vaccine.

“We fully endorse the recommendations for a locally-led track and trace system. As we go into the second national lockdown, now is the time to get a handle on improving the overly centralised system which has so far under-utilised local government knowledge and expertise.

“Even areas that have Metro Mayors, such as Dan Jarvis in Sheffield City Region, were not given backing for local models, despite their existing powers and significant public mandate. Nevertheless, places such as Bradford and Cumbria have had huge success in running their own locally funded systems.

“There is a clear link between health inequalities and productivity, which has been well demonstrated by Northern researchers prior to the pandemic. We, alongside 77 other business leaders across the North, wrote to the Prime Minister last week to make the case for a Northern Economic Recovery, including levelling up Research and Development spending, including in health, to the North.”

Sarah Longlands Director of IPPR North said: “This report powerfully highlights the impact of poor health on the North’s economy and presents a powerful argument for a health stimulus as part of our longer term recovery.
“Covid-19 has illustrated the scale of health inequalities in the North and we have seen many areas disproportionately affected by the pandemic, not only as a result of existing health conditions, but by the wider determinants of good health including housing, income and access to local services. As we contemplate a future recovery, we must recognise the vital role of investing in a healthier future for the people who drive the Northern Powerhouse. “

Full report here.