#covid19 #inequality #toxic

I and many others have woken to the frustration and disappointment of a return to a more stringent lockdown. But I know that for many in Greater Manchester, East Lancashire and West Yorkshire, this is even more acute given the impact on their celebrations for Eid. 

The announcement was shambolic. MPs and local politicians variously tweeting or facebooking contradicting pieces of information with no indication that they had any idea this was coming. 

BBC North West went as far as reporting that my local Director of Public Health (DPH) had said only the day before that no significant changes were imminent. This is not the fault of our local MPs or  our DPHs who are working with whatever information they have. 

But more worrying, is the extent to which this new lockdown announcement is continuing a narrative of blame that is both toxic and irresponsible.  

Hard on the heels of a return of the ‘fat shaming’ policy approachesare repeated statements that the lockdown is because people in the affected areas are “not abiding social distancing”. 

This may be true for some. For example, in my local area, texts from GPs alerting us as to a rise in cases ‘especially amongst 17-23 year-olds’ points to a level of frustration, claustrophobia and loneliness pushing younger people outwards to seek solace with their friends. Indeed this is considered as a factor across Europe, according to Hans Kluge, the World Health Organization’s Europe regional directorreported on BBC News today.

But other than supposition, what evidence is there to suggest that it is specifically because of these groups lack of adherence to social distancing that is the problem? 

Consider a tweet from Dominic Harrison, DPH in one of the most affected areas in England: “I do not think that there is any evidence that the northern towns now taking extra control measures are seeing rising rates because of exceptional local failures to social distance”.

Social distancing is only part of the problem. What other determinants of health matter here? 

In tackling local rises in cases, policy approaches must not focus on the individual as the primary source of either the problem or the blame. There are more than individual health-related practices at work here, and far more that the Government and its policy should be considering. 

Bambra et al. (2020) describe the devastating interaction of persisting toxic social conditions which contribute to uneven exposure to social determinants of health and unequal experience of chronic disease that has magnified the severity and impact of COVID19 in more deprived communities. They augment a framework which for any working in public health is very familiar, forcing us to continue looking upstream when we evaluate unequal health outcomes. 

It is not just individual level-health related practices (e.g. the decision or ability to effectively adhere to social distancing measures). It is not just the role of local social and community networks. It is also the interaction with uneven exposure to social determinants of health. What are your working conditions? Your housing? Do you have stable employment? Can you access services? But then look again, move further upstream. What are the political, economic and environmental conditions you live in. 

Source: See Bambra et al. 2020 

The areas affected by this new lockdown are relatively deprived. This is about social and economic vulnerability. It is about inequality. It is not about blaming individuals and their social distancing measures alone. Policies should emphasise this. Government statements should emphasise this. 

We should not blame each other. We should mobilise, and tackle the social, economic and political conditions that mean some are more vulnerable to a devasting disease while others, in their security, their stability, their position of power, can shift responsibility and instigate a toxic narrative of blame.