As COVID-19 was picking up pace across the South of England in early March, those of us in the North looked down southwards uncertain about what this meant for us.

By mid-March and lock-down people were scared by what they saw coming, and rightly so. The virus was heading up the spine of the country at a rapid pace. Then a second factor struck. It became clear that inequalities were becoming a big factor in death rates from the virus. Multi-morbidities factored highly, so the high sickness rates of people living Northern England were likely to cause a significant problem.

How right they were. Analysis this week of Covid deaths in the region by the Northern Health Science Alliance (NHSA) in collaboration with the NIHR Applied Research Collaborations (ARCs) in the North East & North Cumbria and Greater Manchester, showed just how badly the virus had hurt the North of England. It was a triple whammy: death rates from the illness, death rates from all causes and on job losses.

Over half the North has a lower life expectancy than the worst area in the South, according to research by the Northern Universities Public Health Alliance. The health inequalities between North and South are deep, entrenched and continue to worsen according to research in the Lancet. Deprived areas in the North have higher incidences of heart disease, rates of obesity, type 2 diabetes, respiratory conditions, which have emerged as risk factors for mortality from the virus – so COVID19 has hit its communities hard.

In Greater Manchester, widely considered a success story of the North, the NHSA analysis shows the change in the percentage of population aged from 16 to 64 claiming unemployment related benefits from March 12 to April 9 this year rose from 4.2% to 6.7%, compared to a rise from 2.2% to 3.9% over the same time in the South East. This rise in job losses is evident across the North of England. Unemployment rates have a proven link to mental health and suicide and are a strong indicator of future health inequalities.

Caroline Flint, former MP for Don Valley and ex-minister for Public Health under Tony Blair, says: “I take two lessons from this analysis of the impact of COVID-19. Firstly, we need to work much harder to reduce health inequalities and enable communities to be healthier over time and less vulnerable to pandemics. Secondly, we need to rebuild sustainable employment in those regions less protected by well paid, white collar jobs.

“That means more than ever we need to look to better paid and skilled manufacturing jobs to offer a better life in the North.”

Compounded by COVID, unemployment looms large over the region, ill health is prevalent, and it is damaging. The NHSA’s Health for Wealth report showed a third of the productivity gap between the North and South is due to ill health, which puts the UK in a worrying position as it gets through and then recovers from the pandemic.

Newcastle University Public Health Professor Clare Bambra says: “The Northern hotspots should be prioritised as COVID testing roles out and new NHS investment and public health investment should target those areas most affected. To avoid a parallel mental health pandemic, economic and social measures to ‘level up’ the regions need to be implemented as soon as possible.”

The North’s economy has huge growth potential and levelling up had been a central premise of the Government’s strategy pre-COVID. It is now even more vitally important that Government moves ahead with its levelling up agenda to put in place the solid infrastructure that can support the region’s economy. In addition to housing, education, and transport, this includes crucial investment in public health, health innovation and supporting those with health issues in the workplace and making the most of relationships already in place between local NHS, local government, and social care.

Post-COVID work needs to be done to help the North. This is not about the region asking for handouts, it is an investment in the future of the UK.

The potential of this investment is highlighted in today’s report from NESTA which shows the scale of imbalance in R&D investment in the regions. There is £4bn missing in R&D investment, money which could have leveraged a further £8 billion from the private sector. This is inexcusable when health innovation, manufacturing and materials, energy and digital have been highlighted as prime capabilities for the Northern Powerhouse.

Key to growing the North is ceding control from the centre. The COVID crisis has illustrated the power of local relationships, the swift setting up of the Lighthouse Lab at Alderley Park in Cheshire being one of many examples where regional networks have been able to operate quickly and effectively.

Dr Kath MacKay, Managing Director of Alderley Park, comments: “The Lighthouse Lab was established at an unprecedented pace in the fight against COVID-19. Taking the labs from initial concept through to testing patient samples in under three weeks would not have been possible without us leveraging our strong relationships across the region in areas such laboratory design, skills, operations and logistics. It is a real testament to the scientific capability, expertise, talent and enthusiasm that exists in the Northern life science community.”

As the Government looks to rebuild post-COVID, it must pay close attention to where it can support the health and wealth of the region and support local authorities, the NHS, and metro mayors to make decisions based on the needs of their population. Even when these mayors are of different political colours.

For the North has exceptional assets. This includes more world-class universities than France, Spain and Italy combined, high-performing NHS hospital trusts, powerful local connections and knowledge. It has a low cost of living, space and enormous potential. Inequalities cannot be allowed to hold it back, government must invest to make sure it lives up to that potential.

The author is head of health inequalities for the Northern Health Science Alliance.