A REPORT released today shows northerners were more likely to die from COVID-19, spent nearly a month and-a-half more in lockdowns, suffered worse mental health and were made poorer than the rest of England during the first year of the pandemic.

Around half of the increased COVID-19 mortality and two-thirds of the increased all-cause mortality were explained by preventable higher deprivation and worse pre-pandemic health in the North.

The report from the Northern Health Science Alliance, Policy@Manchester and northern National Institute for Health Research Applied Research Collaborations (NIHR ARCs), has laid clear the devastating impact of the pandemic on people across the North of England.

The report found:

• People living in the North had a 17% higher mortality rate due to COVID-19 than those in the rest of England. Their mortality rate due to all causes was 14% higher.
• About half of the increased COVID-19 mortality in the North and two-thirds of the increased all-cause mortality were explained by potentially preventable higher deprivation and worse pre-pandemic health.
• The North’s care home COVID-19 mortality was 26% higher than the rest of England.
• In the North 10% more hospital beds were occupied by COVID patients than in the rest of England.
• Increased mortality in the North of England could cost the national economy up to £7.3bn in lost productivity. This will likely to be a conservative underestimate given the North’s economy has also been hardest hit.
• On average people living in the North had 41 more days of the harshest restrictions than people in the rest of the country.
• The North experienced a larger drop in mental wellbeing, more loneliness, and higher rates of antidepressant prescriptions: there was a 55% increase in the presence of minor psychiatric disorders, such as anxiety and depression, in the North compared to a 50% increase in the rest of England.
• Wages in the North were lower than the rest of England before the pandemic and these fell further during the COVID-19 pandemic (from £543.90 to £541.30 per week) whereas wages increased in the rest of the country (from £600.80 to £604.00 per week).
• The unemployment rate in the North was 19% higher than the rest of England.

The COVID-19 pandemic has hit the country unevenly with a disproportionate effect on the North of England – increasing regional health and economic divides. The Northern Health Science Alliance commissioned the report to understand the impact of the first year of the COVID-19 pandemic on health and productivity in the North and identify the opportunities for levelling up regional health and productivity.

The report shows the unequal health and economic impacts of COVID-19 on the North with higher rates of COVID-19 related mortality and unemployment.

Report authors make a series of recommendations to Government including:
• Place-focused vaccination programmes targeted at vulnerable populations in the North of England.
• Increase NHS and local authority resources and service provision for mental health in the North. Invest in research into mental health interventions in the North.
• Invest in increasing capacity in northern hospitals to help them catch-up on non-COVID-19 health care.
• Make health a key part of an integrated levelling up strategy.
• Recommit to ending child poverty. Increase child benefit, increase the child element of universal credit by £20 per week, extend provision of free childcares, 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 North.
• Maintain and increase the additional £1,000 extra funding of universal credit.
• Provide additional resource to local authorities and the NHS in the North by increasing the existing NHS health inequalities weighting within the NHS funding formula in its reset and restore plans.
• Deliver a £1bn 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.
• Create northern ‘Health for Life’ centres offering a life-long programme of health and wellbeing advice and support services from pre-natal to healthy ageing programmes.
• Deliver health and mental health promotion interventions together with industry and employer, targeted at employee mental and physical health.
• 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. Invest in North’s testing and diagnostics infrastructure.
• Build resilience in the North’s population through developing 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.

Dr Luke Munford of University of Manchester said: “The pandemic has hit us all hard in different ways, but our report shows that people living in the North were much more likely to be hardest hit, both in terms of health and wealth. The fact that over half of the increased COVID-19 mortality and two-thirds of all-cause mortality was potentially preventable should be a real wake-up call. We need to invest in the health of people living in the North to ensure they are able to recover from the devastating impacts of the pandemic.”

Professor Clare Bambra of Newcastle University said: “Our report shows how regional health inequalities before COVID have resulted in an unequal pandemic – with higher rates of ill health, death and despair in the North. The economic impact of the lockdown is also looking likely to exacerbate the regional economic divide. The government’s levelling up agenda needs to seriously address health inequalities in the North – for all generations.”

Health Inequalities lead for the Northern Health Science Alliance, Hannah Davies, said: “As we approach autumn with uncertainty around an expected increase in COVID-19 cases and with increasing questions about what ‘Levelling Up’ will mean for the North of England it is clear significant action must be taken in tackling health inequalities.

“The Government has made clear its commitment to level up and to tackle health inequalities, this report shows the importance of making that a reality with significant funding to tackle ill health through significant investment into public health and the NHS in the North of England.”

Professor David Taylor-Robinson of Liverpool University said: “Even before the pandemic we were seeing extremely concerning trends in rising health inequalities with life expectancy going backwards, particularly for women in the most disadvantaged areas in the North of England – the same areas affected by rising poverty and cuts to services that support health.

“The pandemic arrived in the middle of this worrying scene and amplified existing inequalities. As outlined in this new report, poor populations in the North have been hit the hardest in terms of COVID related mortality, and our analysis shows that much of this is due to pre-existing deprivation and poor health. Building back fairer will require long term investment to address the root causes of poor health in the North.”

For more information on the NHSA visit www.theNHSA.co.uk

The Applied Research Collaborations (ARCs) in the North East & North Cumbria, North West Coast, Yorkshire and Humber and Greater Manchester are regional applied health research collaborations funded by National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social