Barbara Reichwein, Programme Director, Guy's and St Thomas' Charity
May 06, 2020
At the heart of our multiple long-term conditions programme is a focus on the relationship between livelihoods and ill-health. The current crisis makes the importance of this painfully clear: when our health suffers, so do our social and economic lives, and vice versa. This is true in Lambeth and Southwark, nationwide and globally.
Evidence from the Office of National Statistics shows that the impact of Coronavirus on those living within inner-cities is disproportionately high. People in diverse, densely populated areas with high levels of socio-economic deprivation are hardest hit. In our place in inner-city London, an estimated 16 - 17% of people are at clinical risk of severe illness from COVID-19, and those with an already diagnosed long-term health condition are experiencing severe disruption to their lives and their normal clinical management.
During the crisis, those with the lowest household income are six times less likely to be able to work from home and three times less likely to be able to self-isolate. I recently spoke to Sandra, a nursery teacher in Southwark who is currently looking after the children of keyworkers. Despite low pay, Sandra supports her brother who is self-isolating with an underlying health condition. Yet she told me that her job is only secured until next month, with the crisis and government regulations leaving her employer stuck between a rock and a hard place. If Sandra loses her job, her diet and that of her self-isolating brother may suffer. Any pre-existing physical health conditions they might have– be they diabetes, high blood pressure or chronic pain – could be severely affected, as could their mental health.
To compound matters, a change of lifestyle or financial circumstance due to COVID-19 could result in people developing long-term health conditions much quicker. In a household where one person lives with diabetes, asthma, kidney, liver or lung disease, everybody will need to exercise caution. Will we have an epidemic of chronic disease on our hands, once the first COVID peak has passed? There is reason to believe we might.
It is clear to us that we need to urgently explore strategies to mitigate this risk and reduce the economic and social disadvantage of people living with underlying ill-health. To do this, we need to look at how people living with a long-term health condition might engage with society, how they can continue or return to work in a world where COVID-19 exists, and what their ‘new normal' could look like when the country re-opens.
Our focus is on stabilising the circumstances of people who are not classed as clinically highly vulnerable (the shield group), but are struggling to cope in the mid-term, due to income, housing or health. This is why we are developing a twelve-month plan which aims to pre-empt where people might 'fall through the cracks' of the quickly evolving support system that the Government, civil society, businesses and volunteers are putting in place.
Firstly, we are ‘actively listening’ to our partner organisations rooted in our communities, seeking out mid-term plans to work with them beyond food provision. Alongside our five-year commitment to Pembroke House in Walworth, we are providing response funds to High Trees Community Trust, helping employment and housing support clients in Tulse Hill to remain connected to the outside world.
We are also providing urgent assistance to organisations in our place via the London Community Response Fund and to individual organisations like Studio X, who are growing their impact during this crisis through remote entertainment, infused with mental health support.
We know that people from Black, Asian and minority ethnic (BAME) communities have the cards stacked against them in multiple ways, leading to worse health outcomes, and this has been brought into sharp focus by the COVID-19 pandemic. The intersection of isolation, financial hardship, caring responsibilities, unemployment and precarious work is coupled with a greater burden of long-term health conditions and is hard to ignore. This is why we are working with BlackThrive to understand the needs of BAME communities within our place and identify any gaps in the response from Government and community organisations. We will place more emphasis on racial equality in our programme strategy going forwards.
Finally, we are preparing for the future by exploring what our place will feel like for people living with long-term conditions during a recession; how the economic landscape will impact on the rapid onset of further long-term conditions and what can be done to cushion the blow. It is clear that future models of support will be hybrid or digital-first, rather than the default being face-to-face delivery. Our programme will focus on ways to scale remote approaches that do not widen the health inequality gap.
Before the crisis, we knew that our financial health, housing and work can, at their worst, cause people to lose up to 15 years of healthy life years. We are determined not to let this gap between advantaged and disadvantaged areas grow further. To keep up to date with our work on the social determinants of health, sign up for our newsletter.
Programme Director: Barbara Reichwein
23 April, 2020
As a funder, our priority is to support our partners and the communities most affected by COVID-19. Our Portfolio Director, Louise Mousseau, sets out the actions we've taken to date and how we're adapting our work in response to a changing environment.
25 February, 2020
Our Programme Director for multiple long-term conditions, Barbara Reichwein, reflects on persisting health inequalities ten years on from the Marmot Review.