The relationship between physical and economic health has never been more crystal clear or more necessary to tackle. The United Kingdom is at a pivotal point in tackling the Covid-19 pandemic, one which could accelerate inter-generational health and economic inequalities.

The economic divide between the North and South of England has been exacerbated to the extent that it resembles the sharp contrasts in living standards between West and East Germany during the Cold War.

Our Northern Health Science Alliance report, COVID-19 and the Northern Powerhouse: Tackling inequalities for UK health and productivity which is published today, shows how the pandemic has crept up and hit the North of England with devastating effects.  This is because the region had already been hit hard through its chronic ill health, a hollowed-out economy and reduced, paper-thin local government structures.

The report tells of patients admitted to hospital with Covid-19: 45% in England were from the most deprived 20% of the population. Covid-19 admissions to critical care were also far greater in the most deprived regions, with over 50% of admissions coming from the 40% most deprived areas

Over half the North now has a lower life expectancy than the worst area in the South, so it is unsurprising mortality rates during the first wave (March to July 2020) were higher in the North than the rest of England, with an extra 57.7 more people per 100,000 dying due to all-causes. At the same time as this has had a terrible impact upon people’s lives it has also cost a potential £6.86bn in lost productivity.

On top of that, economic outcomes (particularly unemployment rates) were hardest hit in the North while reductions in mental wellbeing across the North of England alone are estimated to cost the UK economy up to £5 billion in reduced productivity.

These figures are largely based on the first wave of the virus so they to be regarded as conservative assessments of the impact of the pandemic more broadly. The second wave has already had a far greater impact on the North than the first.

It has been widely recognised by the Government that for the UK to excel after the end of the Brexit transition period, it needs to level up the country by tackling decades of under-investment in the regions while supporting the country and future generations. Only then will these areas begin to prosper to their full potential.

But doing that requires a physically and mentally fit workforce. The industrialists and politicians of the nineteenth-century recognised that a population’s health was key to its economic success and that remains just as true today as it will for future generations. A concerted eff­ort is required to ensure that the productivity gap experienced by today’s workforce does not persist to hamper children and young people in years to come.

The report looks at contributing factors and finds that austerity has disproportionately aff­ected the Northern Powerhouse, particularly in its areas of high deprivation. It estimates that reductions in the core spending power of local authorities in the Northern Powerhouse by £1 per-head in fact cost £3.17 per-head in lost productivity (measured by GVA), equivalent to around a £2bn loss in GDP per-year

At the same time, pre-pandemic child health, a key predictor of life-long health and economic productivity, was poor and deteriorating. Since the pandemic began, adverse trends in poverty, education, employment and mental health for children and young people have been exacerbated.  The productivity gap between the Northern Powerhouse and the rest of the country is likely to worsen for subsequent generations without a Covid-19 recovery strategy that prioritises families with children.

The Covid-19 pandemic puts the whole levelling up project in immediate danger. Instead of levelling up, without immediate action its health inequalities will see the North’s towns and cities instead levelling down as ill health, child poverty and mental health issues are also compounded by the pandemic.

People in the North are not waiting for Government to fail in its levelling up project. Of course, they desperately want it to succeed, but they also know that lip service will never be enough. The North was failed by New Labour and it has been ravaged by austerity under the Tories and Coalition government. The closure of Sure Start Centres reversed gains made by those fighting child poverty, disproportionate cuts to the poorer local governments of the North sliced away further at return to work schemes, child health services, and mental health support – and in the communities where it was needed most and where it had the potential to help the most.

When levelling up is examined, it needs to be looked at across the board. This includes significant investments in the North’s key assets, such as its excellent universities, research-intensive NHS hospitals and its prime capabilities, such as health innovation, zero carbon technologies and manufacturing. All of this would bring in good quality jobs, stimulate the economy, retain talent and draw in investment.

Levelling up must also about reversing unequal funding cuts to local authorities. Instead, local government must be empowered to make sure that they can help the populations under their charge to have the best start in life. It must be about making sure that public health is properly funded to tackle health issues before they become chronic; about ensuring that schools are equipped to teach their children properly and guaranteeing that people in work can afford to heat their homes and feed their children.

And this needs to happen now. Alongside the pandemic there is a wave of mental and physical health problems which need eff­ective, targeted interventions to halt the devastating sweep of Covid-19 and its impact on the North of England’s economic prosperity. You cannot separate mental and physical health from economic success: health is wealth, and wealth is health.

Hannah Davies is Health Inequalities lead for the NHSA and a co-author of the COVID-19 and the Northern Powerhouse: Tackling inequalities for UK health and productivity report.

You can read it here – https://www.thenhsa.co.uk/app/uploads/2020/11/NP-COVID-REPORT-EMBARGOED.pdf