The pandemic has hit everyone hard, but our investigation shows poorest communities are likely to suffer worst in the fallout to come. Sam Ferguson reports.
Annamaria Marlborough has been suffering for nine months.
Even before the virus hit, the grandmother from Norwich had been fighting chronic asthma.
“I’ve had it for a long time, but over the last two years it was out of control,” she said. “I’ve been on a lot of steroids to fight it.”
Annamaria caught coronavirus in March but is still reeling from the aftereffects.
“I've been through hell at home,” she added.
“Since Covid, I've had eight courses of steroids and antibiotics. I've just gotten over a relapse that lasted eight weeks. My husband is 72 and has PTSD. He doesn’t know how to look after me and his illness affects him in so many ways.”
She has been told her ongoing illness is likely to have been caused by what is becoming known as ‘long-Covid’.
Doctors warn deprived communities will likely be disproportionately affected by the condition as the virus further widens the health gaps between rich and poor.
“People in more deprived areas and communities are being affected more by the virus, so it doesn’t take much thought to realise that long Covid is going to have a disproportionate effect on these communities,” said Dr Tim Morton, chair of the Norfolk and Waveney Local Medical Committee.
The 15-year gap
Even before the virus came, people living in richer areas of Norfolk could expect 15 more years of healthy life than those in deprived areas.
Women in the affluent Eaton area of Norwich can expect a healthy lifespan of 70.9 years. But in the poorer City Centre West area of the city, including Heigham Grove, that age falls to 58.4.
For men, the gap is even wider. The healthy life expectancy for men living in the City Centre West is 55.2, compared with 70.8 in Eaton.
County-wide the gap broadens to 16.8 more healthy years for women in the most affluent areas, like Sprowston East in Broadland, and 17.9 more for men.
In parts of Great Yarmouth, healthy life expectancy and deprivation rates are among the worst in Norfolk.
GP Jamie Wyllie works at the Millwood surgery in Bradwell and is the former medical director of Great Yarmouth and Waveney Primary Care Trust. He said the gaps between rich and poor would “inevitably widen” as a result of the virus, and likened front line practice to "waiting for a storm".
Millwood surgery covers areas like Bradwell, Gorleston, Belton and Southtown. But even within its limits a gap of more than 10 years exists, with healthy life expectancy for men ranging from 56.3 in parts of Southtown to 66.9 in parts of Bradwell. For women, the gap between healthy life expectancy in the two areas is 7.1 years.
“Income is the biggest single determinant of health,” said Dr Wyllie. “Poverty predicts ill-health.
“Statistically, you will die younger if you’re poor. You will die younger if you’re male."
“What drives the gap between richest and poorest is cancer, cardiovascular disease, respiratory disease, and drug and alcohol addiction.”
Men from affluent areas of Norfolk, like Sheringham in North Norfolk, have a minimum life expectancy of at least 78.1, while those from more deprived areas, like Yarmouth Parade, will have a maximum life expectancy of 78.3.
Similarly, women from affluent areas can expect to live until at least 83.3, while those living in the poorest areas have a maximum life expectancy of 82.9.
Tracy Williams, vice chair of the Norfolk Health and Wellbeing Board, said how healthy you are should not depend on where you live.
"Locally, we are focussing on key conditions including stroke, diabetes and mental health in order to deliver real, measurable change by improving health outcomes for people," she added.
"As well as providing free NHS health checks to people aged between 40 and 74, vaccination programmes and routine cancer screening we need services that better empower and motivate people to take increasing responsibility for their own health and wellbeing."
Another hope in the fight against health inequalities is the roll out of the Protect Norfolk and Waveney project, geared to target vulnerable people from deprived areas for different types of treatment. The project relies on a data sharing tool that allows the CCG, Norfolk County Council and hospital trusts to share patient data in order to contact those suffering from ailments like diabetes.
Patients are contacted to arrange tests, screenings and other care. Dr Jeanine Smirl, clinical director of Norfolk and Waveney Primary Care Network, said using such tools was a key part of the fight against health inequalities.
"I think this (pandemic) has absolutely shone a light on health inequalities, and it is making them worse," she added. "Men and women are dying younger because they live in deprived areas, and the healthy life gap is even worse. We need to be prepared to meet these issues head on."
Four times as many cases in poorer areas
The poorer parts of Norwich, King’s Lynn and Great Yarmouth have had four times the amount of coronavirus cases as the more affluent neighbourhoods.
Data up to December 11 shows 4,100 cases had been recorded since March in urban areas ranked in the poorer half of the index of mass deprivation (IMD). That compares to 1,063 in the wealthier areas.
Norfolk County Council’s public health team has said evidence suggests health inequalities are affecting the outcomes of Covid sufferers and have made tackling such inequalities a key priority.
A spokesman said: “Reducing health inequalities is not a simple or quick process. It will require hard work and commitment and must involve addressing wider issues that affect health, including housing, employment and crime, with community-based approaches driven by councils, the voluntary sector, police, public sector employers and businesses.”
Meanwhile government data show dwindling budgets pushed down the amount spent on public health by the council fell by 12pc since 2016-17.
Former North Norfolk MP and coalition care minister Norman Lamb has urged the government to plan for what is coming.
“Urban or rural, there are areas of Norfolk where there is really quite entrenched poverty," he said. "Health risks are higher, such as smoking. It is factors like this that affect your ability to remain fit and healthy and so forth. What’s important is healthy living years and the ability to enjoy life. There are huge differences in our county, and they are desperately well entrenched.”
Tomorrow: How Covid hit our mental health
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