By Chris Phillipson and Dr. Tine Buffel

Despite the lifting of legal restrictions to control the pandemic, uncertainty remains about the direction of travel in terms of infections, hospital admissions and deaths. Increases in cases may be lower than predicted but contrasts remain across the UK, with the possibility of further rises in the months ahead. But the debate about how to manage the pandemic remains stuck between reliance upon conflicting Government and scientific advice, and the shift to ‘individual responsibility’. Yet this division ignores the crucial role of local communities both in highlighting inequalities but also their potential for supporting vulnerable groups.

The first two waves of the pandemic highlighted social inequalities, especially those affecting low-income neighbourhoods and Black, Asian and minority ethnic communities. COVID-19 hit areas weakened by cuts to both economic (e.g. loss of jobs) and social (e.g. closure of community centres) infrastructure. Reflecting this, Build Back Fairer: The COVID-19 Marmot Review highlighted how COVID-19 mortality rates were higher than would have been the case if conditions in deprived neighbourhoods had improved rather than deteriorated in the period to 2020.

But there is another side to the community dimension which deserves emphasis. The two waves of the pandemic saw an upsurge of mutual aid groups, these complemented by use of digital technology, including neighbourhood-based WhatsApp and Facebook groups and local online forums. Existing community-based organisations also played a vital role, expanding traditional as well as new activities, including meal deliveries, IT assistance, telephone befriending schemes, and bereavement counselling. Communities have illustrated inequalities associated with COVID-19 but also ways of mobilising assistance to those most affected. Strengthening community-based approaches will be crucial in controlling any surge in cases: they can assist in the dissemination of advice and messaging about protection from the virus; encourage individuals hesitant about having initial and/or booster vaccines; and reach out to isolated individuals within neighbourhoods.

Given the need for longer-term planning, the key question becomes: how can organisations and groups be helped to continue the work started at the beginning of the pandemic? Four areas of activity will be essential:

First, local authorities should undertake an assessment of the resources likely to be needed by voluntary groups to respond to an increase in demand for services: many are likely to be running out of funds and/ or experiencing staff shortages, limiting their capacity to provide effective support. This is especially the case in areas of multiple deprivation where COVID-19 has had the most damaging impact. The focus now should be on restoring support networks ahead of any rise in the incidence of COVID over the autumn, driven by factors such as the return of schools, hesitancy over booster vaccines, and reduced vaccine efficacy.

Second, mobilising community participation will be vital in the next phase of the pandemic, in particular: supporting collective forms of organisation within neighbourhoods; encouraging those working on a voluntary basis within communities; supporting new and existing mutual aid groups; and ensuring accessible meeting places – the closure of pubs, libraries and communities centres depleting for many localities the social networks which maintain community life.

Third, given lengthening waiting lists for hospital treatment and social care, ‘community advocates’ will be needed for those requiring services but unable to represent themselves and who lack anyone who can speak on their behalf. This may be especially important for older adults who recent research suggests are most likely to have delayed or cancelled medical appointments as compared with other age groups.

Fourth, ensuring more diverse forms of communication about the effects of COVID-19 is vital. One of the weaknesses of current approaches is over-reliance on access to the internet as a medium for transmitting public health messages. Yet this ignores the extent of digital exclusion amongst particular groups. To take one example, in Greater Manchester, 57% of people 75 and over, and 23% of those 65-74 are non-users of the internet (the figures are higher in more deprived neighbourhoods). Given this context, non-digital communication about the pandemic needs to be increased, e.g. leaflets through doors, advertising in shops and local newspapers, work through faith-based and other organisations.

The impact of COVID-19 can be measured in a variety of ways – quality of life, mortality, and long-term illness. Reflecting these, we know that the pandemic has already accelerated the decline in life expectancy which had started to affect poorer areas in England and Wales over the period 2010-2020. In consequence, developing a new public health policy will be necessary to address the deep-seated inequalities which COVID-19 has exposed. Supporting this task must be the knowledge gained working within and getting support from those communities and groups for whom the effects of the pandemic are likely to stretch over many years to come.

Further information about the issues discussed in this blog can be found in: Phillipson, C. Lang, L., Yarker, S., Doran, P Goff., M & Buffel, T. COVID-19 and Social Exclusion: Experiences of Older People Living in Areas of Multiple Deprivation, 2021. Available at: https://documents.manchester.ac.uk/display.aspx?DocID=56003

ILC are launching two reports on immunisation in September 2021. The first will explore how to improve uptake of routine vaccines throughout the UK, including among ethnic minority and lower socioeconomic status communities. The second will focus on improving uptake among people from at-risk groups.

Find out more and register here.