The Curve Steepens: COVID-19 and the social gradient for UK workers
14 Apr 2020
It seems like we are all having to remember how to interpret graphs these days. Each day we look for signs that the COVID-19 graphs are ‘flattening’. When is a plateau different from a peak? How much should we read into two days’ figures? What is a logarithmic scale anyway? The flatter the curve, the better the news, it seems.
Sadly, not all the graphs are moving in the right direction. Those which tell us about how the pandemic is affecting those at the bottom of the so-called ‘social gradient’ look very much like they may get substantially worse before they get better. This seems to hold true whether we are looking at employment, income, health or a number of social indicators by which we measure equality in the UK.
But what, you might ask, is the ‘social gradient’? Here’s an example. In normal times it takes about 20 minutes to travel from Lancaster Gate to Mile End on the Central Line of the London Underground. This apparently simple trip from west to east London conceals a stark gap in life expectancy of 12 years, with Mile End being in located in Tower Hamlets, a London Borough where 44 per cent of households live in income poverty. The ‘gradient’ here illustrates that poverty, income, education and employment prospects are all important aspects of the social gradient in health. Before the pandemic, these were the issues with which many public health professionals and epidemiologists were preoccupied for much of their time. The ‘levelling up’ ideas being debated in the last election were also focused on the policy ‘levers’ which might be tugged at to reduce the widening gap in outcomes which the UK has witnessed over many decades.
The COVID-19 crisis has shed new light on the workings of the social gradient and shown that, wherever you look, the graphs are painting a gloomy picture. One area which has only recently come under scrutiny is an apparent gradient in ‘social distancing’. Some have argued that people in lower income groups have fewer opportunities to ‘distance’ themselves because of cramped living conditions in more densely populated urban settings or because people in some poorer BAME communities where living in extended families is more common are more susceptible to infection.
Other analysis shows that many ‘essential’ workers who are low paid (in social care and retail, for example) are more likely to be working in cramped conditions, without high quality protective equipment, and with an elevated risk of contracting the virus. It is also worth noting that around 2 million low paid workers are not eligible for statutory sick pay of £95.85 a week. In fact, a large share of UK workers with no sick pay eligibility are concentrated in sectors whose work exposes them to working in close physical proximity to others. For example, over half of those working in ‘Personal Care and Services’ occupations have no paid sick leave, with many facing the choice of going to work where distancing is hard or staying away from work with no pay. It is worth bearing in mind that, in addition to these challenges, over 10 million UK households have no savings and a further 3 million have savings of less than £1,500.
If, as expected, UK unemployment rises significantly during and after the crisis groups most affected will be young people and those in poorer households. Our report last week on ‘Getting Back to Work’ after COVID-19 illustrates very starkly the potential ‘scarring’ effects of this kind of unemployment shock and the lessons which we hope policymakers will learn from our experiences of the last three recessions. Much will need to be done if the graph of the social gradient in income and job quality is to be prevented from getting steeper.
But the ‘reach’ of the social gradient extends beyond even these domains. Much has been made of the challenges facing those UK workers who are now working at home because of coronavirus. IES has been carrying out survey research among this group of workers to see how their physical and emotional health has been affected, more of which later. But it is worth remembering that there is also a social gradient in ‘homeworking’. In recent Vox blog, new survey data from both the UK and the USA revealed that workers with higher earnings, in senior white collar and professional jobs were more likely than those in those in low paid manual or service sector jobs to be able to perform most of their work tasks from home.
In this context, working at home might be considered a privilege. Homeworkers are still, by definition, in work, they are maintaining their income and protecting themselves and their families through a form of remunerated social distancing. Yet, as our survey results last week illustrated, not all homeworkers are thriving. Musculoskeletal and mental health for many are being compromised and sleep loss, fatigue and financial concerns are prominent. Even within this group, we have found a ‘gradient’ in self-reported health outcomes with the young, those looking after elderly relatives and those in more precarious housing faring significantly less well than others.
Over 15 years since its publication, Sir Michael Marmot’s book, Status Syndrome, remains one of the most compelling expositions of the social gradient in health and one of the most profound influences on my own work and thinking. Once the pervasiveness of the social gradient is revealed to you, it can be hard not to see it everywhere. COVID-19 has, sadly, reminded us all of the social gradient’s continued relevance to research, data analysis and policy. It has also given us a hugely important lens through which to study the economic, social and labour market consequences of pandemics.
Any views expressed are those of the author and not necessarily those of the Institute as a whole.