You will find a complete range of our monographs, muti-authored and edited works including peer-reviewed, original scholarly research across the social sciences and aligned disciplines. We publish long and short form research and you can browse the complete Bristol University Press and Policy Press archive of over 1400 titles.
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This chapter examines the regional impact of the COVID-19 economic crisis. Through analysing ONS data it examines regional trends in furlough rates, unemployment rates, and wage levels. The chapter shows that the negative economic impacts of the pandemic were higher in the North. Productivity costs to the UK economy from higher COVID-19 mortality (Chapter Two), mental health morbidity (Chapter Three) are calculated and it is found that the North was disproportionately affected. The chapter also explores the differing levels of COVID-19 restrictions and finds harsher lockdown restrictions were experienced in the North.
This chapter concludes by reflecting on what can be done to reduce health inequalities. Drawing on international case studies of when inequalities in health have been reduced, this chapter outlines what public policy response is needed now to reduce regional health inequalities so that they do not increase for future generations and in any future pandemics.
This chapter describes the pre-pandemic context of inequalities in health and wealth in England. It provides a brief historical overview of the North–South regional health and economic divide. This chapter also introduces the reader to the core concepts and theories which underpin the rest of the book including: the deprivation amplification thesis, intersectionality, and the syndemic pandemic concept. It discusses common approaches in the field of health geography to understanding place-based health inequalities, including: compositional, contextual, relational and political economy approaches. It concludes by providing a summary for each of the following chapters of the book.
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Whilst the COVID-19 pandemic affected all parts of the country, it did not do so equally. Northern England was hit the hardest, exposing more than ever the extent of regional inequalities in health and wealth.
Using original data analysis from a wide range of sources, this book demonstrates how COVID-19 has impacted the country unequally in terms of mortality, mental health and the economy.
The book provides a striking empirical overview of the impact of the pandemic on regional inequalities and explores why the North fared worse.
It sets out what needs to be learnt from the pandemic to prevent regional inequality growing and to reduce inequalities in health and wealth in the future.
This chapter examines regional trends and inequalities in the ‘parallel pandemics’ of mental health, hospital pressure, and long COVID. Using mental health survey data, NHS prescribing data, NHS hospital data, and official estimates of long COVID prevalence, the chapter shows that these three parallel pandemics have been regionally unequal with worse outcomes in the North. In addition, the analyses reveal stark intersectional inequalities in self-reported mental health by ethnicity and gender in the North.
This discussion chapter places the results from the empirical analyses in Chapters Two–Four within the wider conceptual and empirical context. It sets out how the regional inequalities in health and wealth that have been identified during the pandemic reflect longer-term health divides across the country. Drawing on the conceptual material outlined in the introductory chapter, this chapter reflects on how, through the concepts of the syndemic pandemic, intersectionality and of deprivation amplification, COVID-19 had such an unequal regional impact.
This chapter presents original analyses of regional inequalities in COVID-19 mortality in the first year (pre-vaccine) of the pandemic. Using mortality data and a conceptual model to guide the analyses, this chapter demonstrates that COVID-19 deaths were higher in the North of England. It also demonstrates that this higher mortality in the North was not just a case of higher levels of area-level deprivation, but a case of deprivation amplification.
In this section, we present a set of analytical themes and considerations derived from our analysis of the three empirical cases in England and Canada. The intent is to elucidate the implications of our research on how we understand the medical doctor–healthcare reform nexus and to test our theoretical model’s ability to explain key variations and points of convergence across the cases.
We first examine the impact on healthcare reforms of the deals and policy parameters set at the inception of PFHS. We identify foundational elements that set the scene for future debates and negotiations between the government and medical doctors in the development of reforms. Contextual factors push governments into this most significant health reform, and the creation of PFHS is a revelatory moment. It shows how the two protagonists become engaged in a common endeavour with different expectations and abilities to influence the architecture of the system. The spirit of the initial agreement and the growing interdependence between governments and the medical profession has enduring implications for their future relationship.
Second, we delineate how governments address core policy dilemmas in the context of PFHS. Manifestations of the agency of governments within the mediated space of reforms are shaped by intense political pressures to respond to dilemmas such as escalating costs and problems with access to care. They also interface with the medical profession’s reactions to reformative propositions. On the one hand, governments need to secure the collaboration of a powerful insider, the medical profession, and mobilise a diversity of policy instruments that go beyond coercion.
Healthcare is central to the functioning of contemporary states, so much so that political scientists have coined the term ‘mature healthcare states’ (Tuohy, 2012; Ferlie and McGivern, 2013). Our research focuses on the role of medical doctors in reforms within mature healthcare states. Narratives of network governance in the last 30 years highlight governments’ inability to achieve policy changes and objectives on their own (Rhodes, 1996; Torfing, 2005). They need the expertise and agency of non-state actors to bring about policy innovations and change. As suggested by Rhodes (1996), governing without governments opens up a rich dynamic where state, non-state, traditional and non-traditional policy actors, each with their own projects and preferences, reinvent society. Our research looks at the prospect of joint policy-making in healthcare, focusing on the specific case of the relationship between governments and medical doctors in healthcare reforms.
Tensions and conflict persist in the network narrative of governance, but can, in principle, be transcended by setting up adequate, effective and collaborative modes of governance (Ansell and Gash, 2008). The political and policy modus operandi embodied in the network governance narrative is associated with the challenge of achieving consensual politics in a landscape of potentially conflicting preferences, values and interests. Our research empirically probes these tensions and the difficulties of achieving consensual politics while responding to governmental demands for major change. The basic intuition of network governance is that a participatory and open policy process becomes a predominant principle of policy-making in contemporary states as the legitimacy and scope of coercion is reduced.
As an epilogue, we completed this analysis just before the COVID-19 pandemic. We have since been able to observe the commitment and dedication of front-line clinicians, medical doctors and others healthcare professionals and workers in dealing with extraordinary and immense pressure to deliver care, often at considerable risk to their own health. In a sense, the commitment of medical doctors confirms one of the key findings of our study: the discrepancy between medical politics and the day-to-day accommodation between the medical profession and the healthcare system. It is self-evident that healthcare systems would greatly benefit if the dedication and willingness seen in clinical matters could percolate to policy level decision-making. This is the main reason we stress that joint policy-making is not just a responsibility of medical doctors, but also of governments that need to find a way to adequately mobilise medical doctors at a collective or policy level.
Beyond this, COVID-19 has become part of the distal context that could trigger policy shifts and radical healthcare reforms. This major public health crisis has created a significant burden on government finances, led to an important reorganisation of resources in healthcare systems – including the delay of essential care such as cancer treatments – and generated an extra burden on some healthcare professionals now facing increased fatigue and burnout (Denning et al, 2021; Gemine et al, 2021). It has also revealed how painfully inadequate healthcare systems have become in dealing with public health issues.