The COVID-19 pandemic will exacerbate those pre-existing health inequalities, and have the heaviest impact on the lives of people living in deprivation^[2]. The limited data already available (from the UK) suggests that low skilled men have the highest death rate among working age adults^[3]. Further research suggest that Black males and females are 4.2 and 4.3 times respectively more likely to die from a COVID-19-related death than White ethnicity males and females^[4].

It seems that most fatalities are amongst those with underlying illnesses such as high blood pressure, diabetes and heart or respiratory disease^[5],^[6],^[7]. The more socially and economically disadvantaged a person is, the more likely they are to suffer from these diseases^[8]. Diseases that are largely preventable.

This social gradient also applies to risks of mental ill-health, which will be exacerbated by isolation, fear, and insecurity^[9]. A survey from the Netherlands National Institute for public health and the environment (a EuroHealthNet member) found that more than a third of people say they felt much more anxious, despondent, stressed and lonely during the pandemic. About 20% are having more problems sleeping than before^[10]. In France, a survey from the public health institute (also a member) found that between 23-25 March, 27% survey respondents reported a state of anxiety; the factors contributing to this feeling include being in an unstable financial position, having a poor understanding of transmission of the virus, feeling of being ill-equipped to adopt to recommended measures, and having little confidence in public authorities^[11]. People in deprived areas are less likely to receive treatment for mental ill-health^[12].

The spread of the virus has highlighted the needs of migrants, asylum seekers, and Roma people who already experience discrimination and health inequalities. They make up just some of the 26% of people in Europe living in overcrowded spaces^[13]. In confinement, people are more exposed to interpersonal violence at home – notably women and LGBTI people.

We must be prepared for the economic and financial changes brought about by the pandemic, and their effects on health and wellbeing. Estimates suggest unemployment in the EU is forecast to rise from 6.7% in 2019 to 9% in 2020 and then fall to around 8% in 2021^[14]. Unemployment has a clear negative effect on health outcomes and mortality^[15]. The effects of increased unemployment, changes to social protection systems, and reductions in wealth and income on health outcomes will be complex^[16]. They will be felt most strongly by people in insecure and/or low skilled jobs – notably young workers and women. As individual countries and the European Union move their attention to economic recovery, we must pool knowledge and experience to highlight the long-term health effects of changing policy, and what can be done to make the recovery fair and health-promoting. The 2008 recession taught us that uncontrolled spending reviews have a major detrimental effect on societal goals, including economic growth.^{[17],[18],[19],[20],[21]}

The health inequalities we see today are unfair and unacceptable. EuroHealthNet’s vision is of a society in which all citizens enjoy their fundamental right to the highest attainable standard of health, without distinction of race, religion, or economic or social condition.

These inequalities are also incompatible with the peaceful, sustainable and prosperous societies we would want to achieve post-Covid-19.

Tackling health inequalities is at the core of EuroHealthNet’s mission.

_{[1] Inequalities in access to healthcare: A study of national policies; European Social Policy Network (2018)}

_{[2] https://www.bruegel.org/2020/03/how-covid-19-is-laying-bare-inequality/}

_{[3] BMJ; Covid-19: Low skilled men have highest death rate of working age adults; https://www.bmj.com/content/369/bmj.m1906;  BMJ 2020;369:m1906}

_{[4] Office for national statistics; Coronavirus (COVID-19) related deaths by ethnic group, England and Wales: 2 March 2020 to 10 April 2020 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020}

_{[5] Hans Henri P Kluge, *Kremlin Wickramasinghe, Holly L Rippin, Romeu Mendes, David H Peters, Anna Kontsevaya, Joao Breda; Prevention and control of non-communicable diseases in the COVID-19 response; https://doi.org/10.1016/ S0140-6736(20)31067-9}

_{[6] Martini N, Piccinni C, Pedrini A, Maggioni A; CoViD-19 and chronic diseases: current knowledge, future steps and the MaCroScopio project; Recenti Prog Med. 2020 Apr;111(4):198-201. doi: 10.1701/3347.33180; https://www.ncbi.nlm.nih.gov/pubmed/32319439}

_{[7] Wang B, Li R, Lu Z, Huang Y; Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis;Aging (Albany NY). 2020 Apr 8;12(7):6049-6057. doi: 10.18632/aging.103000. Epub 2020 Apr 8.;https://www.ncbi.nlm.nih.gov/pubmed/32267833}

_{[8] Courtney L. McNamara, Mirza Balaj, Katie H. Thomson, Terje A. Eikemo, Erling F. Solheim, Clare Bambra, The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health, European Journal of Public Health, Volume 27, Issue suppl_1, 1 February 2017, Pages 22–26, https://doi.org/10.1093/eurpub/ckw222}

_{[9] WHO, Social Determinants of mental Health, 2014 https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionid=2B47C1C22D 562D0C355B71D35DDA0949?sequence=1}

_{[10] RIVM; COVID-19 Research behavioral rules and well-being; https://www.rivm.nl/en/novel-coronavirus-covid-19/research/behaviour/behavioural-measures-and-well-being}

_{[11] Santé Publique France; Souffrance psychique et troubles psychiatriques liés à l’épidémie de COVID-19 et difficultés de la vie en confinement : les évaluer pour mieux agir ; https://www.santepubliquefrance.fr/presse/2020/souffrance-psychique-et-troubles-psychiatriques-lies-a-l-epidemie-de-covid-19-et-difficultes-de-la-vie-en-confinement-les-evaluer-pour-mieux-agir}

_{[12] https://www.health.org.uk/news-and-comment/charts-and-infographics/referrals-for-psychological-therapy-from-patients-in-deprive}

_{[13] In 2018, 26.2% of the European population with an income below 60 % of median equivalized income lived in overcrowded dwellings. Overcrowding rate by age, sex and poverty status – total population – EU-SILC survey 2018}

_{[14] European Commission; Spring 2020 Economic Forecast: A deep and uneven recession, an uncertain recovery; https://ec.europa.eu/commission/presscorner/detail/en/ip_20_799}

_{[15] https://www.bmj.com/content/369/bmj.m1557}

_{[16]https://www.ifs.org.uk/uploads/BN281-Recessions-and-health-The-long-term-health-consequences-of-responses-to-COVID-19-FINAL.pdf}

_{[17] WHO Europe; Economic crisis, health systems and health in Europe: impact and implications for policyhttp://www.euro.who.int/__data/assets/pdf_file/0008/257579/Economic-crisis-health-systems-Europe-impact-implications-policy.pdf?ua=1}

_{[18] Oxfam, A Cautionary Tale, The true cost of austerity and inequality in Europe, https://policy-practice.oxfam.org.uk/publications/a-cautionary-tale-the-true-cost-of-austerity-and-inequality-in-europe-301384}

_{[19] UN Report on austerity measures and economic and social rights; https://www.ohchr.org/Documents/Issues/Development/RightsCrisis/E-2013-82_en.pdf}

_{[20] Council of Europe, Safeguarding human rights in times of economic crisis; http://www.enetenglish.gr/resources/article-files/prems162913_gbr_1700_safeguardinghumanrights_web.pdf}

_{[21] 2016, Evolutions in Consumption Inequality and Poverty in Greece: The Impact of the Crisis and Austerity Policies; https://onlinelibrary.wiley.com/doi/abs/10.1111/roiw.12287}