The Covid-19 pandemic has pushed the Irish economy into a severe recession. Apart from the direct impacts of Covid-19 on those who have died or recovered from the virus, what are the likely impacts of this economic shock on the health and wellbeing of the Irish population?
The evidence on whether recessions are good or bad for health is mixed. This is due to the complexity of health and wellbeing and the different natures of past recessions and policy responses.
It is clear, however, that recessions are bad for mental health, and that they can exacerbate existing inequalities in health and wellbeing. For example, evidence from the Growing Up in Ireland study has shown that the 2008 financial crisis was associated with a deterioration in child physical and mental health, and particularly among those who were socioeconomically disadvantaged prior to the crisis.
However, the current economic shock is different. The restrictions on social and economic life that have been put in place to protect public health are wide-ranging. This requires us to look more broadly at the evidence to come up with some clearer predictions and to identify some likely longer-term health policy challenges.
A unique dimension of the public health measures put in place to deal with the Covid-19 pandemic has been the physical distancing and social isolation measures. The additional restrictions on the movements of those aged 70+ have particular implications for their health and wellbeing, as set out in a series of recent reports from the Irish Longitudinal Study on Ageing.
There is a wide body of evidence documenting the negative association between loneliness, social isolation and health, and some very recent evidence on the negative mental health impacts of social isolation and quarantining measures. Social isolation is not just an issue for the older population; for young people in particular, important sources of support such as friends and teachers are less available at present.
Behaviours
Unemployment and loss of income can lead to changes in health behaviours, which in turn can affect our longer-term health. Some changes may have positive health effects – people spend less on tobacco and alcohol, and spend more time preparing their own food, sleeping and exercising. However, the evidence also shows that the stress of unemployment leads to poorer health behaviours.
Over and above the effects of unemployment and loss of income, the current disruption to everyday routines as a result of the pandemic may be expected to have broader impacts on health behaviours. Some people may have more time to engage in healthier behaviours, while others, juggling work and caring responsibilities, have far less time available.
For young people in particular, the closure of schools is of concern given evidence from the Growing Up in Ireland study that second-level schools play a key role in promoting positive health behaviours among adolescents.
A significant proportion of children and young people were not meeting WHO physical activity guidelines before the pandemic. This figure is likely to have increased in the absence of organised activities within or outside school, especially for those who lack access to gardens or other green space.
The built and natural environments are important determinants of our health. There have been substantial reductions in air pollution in urban areas as a result of the lockdown measures. However, as the public health measures are lifted and economic activity returns, trade-offs with health will need to be considered.
We already know that air pollution negatively affects our health, but there is also more recent evidence suggesting that the prevalence of severe Covid-19 disease is greater in those exposed to air pollution.
Public health measures such as the requirement to stay at home, and the 2km restriction for daily exercise, also increase the relevance of the local environment for individual health and wellbeing. We know that access to green and blue spaces is associated with positive health effects, but unequally distributed across the population.
Healthcare
It is clear therefore that the pandemic and associated economic shock will have major impacts on these “social determinants of health”, ie the non-medical factors that shape our health and wellbeing.
However, more immediately, the pandemic is impacting on access to healthcare. The re-orientation of the health service to increase capacity for the treatment of Covid-19 patients means that elective care has been postponed. There is also evidence that emergency presentations for non-Covid conditions have been much lower in recent weeks.
While primary care providers have adapted by using phone and video consultations, and enhanced facilities for medication prescription and dispensing have been put in place, delayed medical care for non-Covid conditions is likely to lead to a substantial increase in demand for care as the initial stages of the pandemic recede.
Policy responses have focused on the immediate threats to public health and the economy, by building capacity in the health service and supporting households and businesses in dealing with the economic shock. It is clear, however, that actions in other areas such as mental health, education and environmental policy will also be important in dealing with the broader and longer-term health effects of the pandemic and associated economic shock.
Dr Anne Nolan is an Associate Research Professor at the Economic and Social Research Institute