Inequality lessons from the Covid inquiry
As the Covid inquiry publishes it first report, we highlight how inequalities rob a nation of its resilience and its capacity to cope with future shocks
Was the Covid pandemic a ‘black swan’ event? The term was coined by the author Nassim Nicholas Taleb, who defined a Black Swan as an event that is highly unlikely, has massive consequences, and cannot be foreseen. Taleb argued that Covid did not fit this definition, because some form of pandemic was not only foreseen but was in fact expected.
The problem, as the first report of the Covid inquiry (published last week) points out, is that we were planning for the wrong pandemic. I was working on emergency planning in the Department of Health in the mid-2000s, at which point a flu pandemic was the main risk for which government was preparing. A coronavirus pandemic was not on the radar, despite the fact that a coronavirus outbreak (SARS) had infected 8,000 people and killed almost 800 between 2002 and 2004.
Pandemic planning also fell short in another area. Not enough attention was paid to the ways in which health inequalities and inadequate public services would drastically undermine our ability to prepare for, and respond to, a pandemic. And health inequalities were to rise sharply over the following decade, while public services were to become significantly more underfunded and overstretched. Consider the second paragraph of the Covid inquiry report’s executive summary:
In 2020, the UK lacked resilience. Going into the pandemic, there had been a slowdown in health improvement, and health inequalities had widened. High pre-existing levels of heart disease, diabetes, respiratory illness and obesity, and general levels of ill-health and health inequalities, meant that the UK was more vulnerable. Public services, particularly health and social care, were running close to, if not beyond, capacity in normal times.
The report explicitly criticised pre-pandemic emergency planning on the grounds that it “failed to account sufficiently for the pre-existing health and societal inequalities and deprivation in society”.
Sir Michael Marmot told the Guardian that he had predicted that a pandemic “would expose the underlying inequalities in society and amplify them”. The Covid inquiry report confirmed that this prediction had been borne out: “Societal damage has been widespread, with existing inequalities exacerbated and access to opportunity significantly weakened.”
Marmot continued: “The lesson to me is that to prepare for the next pandemic, we need to prepare to improve the health of the population. But the health inequalities have got bigger. We’re in a worse state now.”
This is not a problem that is confined to pandemic planning, or even to public health. There’s a broader issue. As I argued in 2022, inequality is a strategic risk for the UK, but people who think about inequality and people who think about risk aren’t talking to each other. The government needs to start thinking about inequalities as an underlying driver of many of the risks for which is it planning, and to realise that tackling these inequalities is therefore one of the most effective ways to mitigate many of those risks. The recent creation of a chronic risk register (as distinct from the National Risk Register, which focuses on acute risks) is a good opportunity to do this.
Such a cross-government approach to mitigating risks by tackling inequalities would dovetail neatly into the cross-government approach that needs to be taken on inequalities in pursuit of the new government’s five missions, which we set out - and argued the case for - in our recent report, Deepening the Opportunity Mission.
More broadly still, an intrinsic lack of resilience is a feature, not a bug, of our current form of capitalism. One of the constant refrains of emergency planning when I worked on it 20 years ago is that our economic system is vulnerable to shocks because everything is done on a just-in-time basis. We saw this with global supply chains during the Covid pandemic, and Friday’s global IT outage was a timely reminder that the systems on which we depend are both enormously fragile and deeply interconnected.
The same dynamic is at play when it comes to dealing with other unwelcome side-effects of our economic model - such as rampant socio-economic inequality. We paper over the cracks just enough to avoid meltdown - but this sticking plaster approach is predicated on the overly optimistic assumption that none of the shocks on our risk registers will materialise. And when they do, things fall apart.
The coming years will almost certainly be defined by more shocks. There might be a few black swans, but most of them are predictable - from more pandemics and conflicts to the worsening impacts of the climate crisis. The trajectory that we’re on will see levels of inequality continuing to increase - as we argued in The Canaries - and this will both exacerbate other risks and be magnified by them.
It’s imperative that we start thinking about tackling inequality as an urgent priority that is not only morally necessary and key to achieving our societal goals, but is also a non-negotiable part of our approach to risk mitigation.
The only objective of these enquiries seems to be to Identify the causes and apportion blame.
While all this investigative groundwork obviously has to be completed first, should it not then become secondary to a more desirable and positive main objective of setting out solutions, together with the timetable for achieving and completing them. And accelerating them in instances where some solutions are already under way, but progressing at glacial speed.
It looks like the Covid enquiry may be an example of that first sentence and the Post Office enquiry an example where the second may be applicable?
It is a feature of neoliberal capitalism that resilience is squeezed out in the same of ‘efficiency’, where efficiency means maximising short term financial returns. Resilience includes having spare capacity and duplication, both of which are seen as waste. One can see it in businesses, infrastructure, public services and in society itself ‘ - the resilience of individuals, families and communities. The cynicism of neoliberal capitalism is that expects the state to bail it out when the inevitable occurs, be it the financial crash or COVID. Profits privatised and costs socialised. The greatest impact falls on those least able to bear it.