Liz Green, Laura Evans and Sumina Azam look at Wales’ lockdown and how it affected the nation’s health.
Implemented on 23rd March in the UK in response to the COVID-19 pandemic, the ‘Staying at Home and Social Distancing Policy’ (informally known as ‘lockdown’) aimed to curb the spread of the virus and help to protect the population in Wales.
A recently published Health Impact Assessment (HIA), carried out by the Wales Health Impact Assessment Support Unit (WHIASU), part of the WHO Collaborating Centre on ‘Investment for Health and Well-being’, Public Health Wales, explored the wider impact of the policy across a range of vulnerable groups including older people, children and young people, and identified a wide range of both positive and unintended negative impacts across a breadth of policy areas such as health and care and the economy over the short, medium and long term.
Undertaken in real time, the aim of the HIA was to better understand the wide-ranging impacts of the policy and help improve knowledge around how the effects may have manifested themselves across the country.
HIA is a process that provides a systematic, evidence-based framework for assessing the social, biophysical and environmental impacts of policies, proposals or plans on people’s health and well-being. As a tool, it promotes the identification of both positive and negative or unintended impacts and notes any measures to maximise opportunities for health and minimise detrimental impacts.
So what did it find?
The policy has had an unintended negative impact for the economy due to the closure of non-essential businesses for example, leisure and hospitality. This has led to a number of population groups being furloughed or losing core streams of income – for example, one third of under 25s work in those sectors which shut down.
“Other negative impacts identified included the spread of misinformation via social media.”
Of concern is an increase in health harming behaviours (snacking and alcohol consumption) and the reduced use and / or access to health care services, which may result in increased illness and mortality from non-COVID-19 health conditions in the short and long-term.
The ability for Wales to achieve active and sustainable travel policy goals could be negatively affected by the reduction in public transport usage due to an increase in car use post lockdown, as returning workers feel less exposed to the virus in their own car.
Other negative impacts identified included the spread of misinformation via social media which could increase fear and anxiety about the virus, and the effect of crowded or poor quality housing on existing health conditions such as asthma and mental well-being.
A wide range of population groups have been affected by the policy including low-income households and employees in sectors that closed due to the restrictions, although this has been partially mitigated by national support measures (e.g. furloughing); older people; critical key workers who are more likely to be unable to work from home and have more contact with the public and patients; Black, Asian and Minority Ethnic (BAME) groups who have been disproportionately affected by COVID-19; women; and babies, children and young people.
“There was reduction in car use… and some improved air quality and environments but this seems to be becoming more transient and temporary.”
All groups in society have been impacted negatively by social disconnection as a result of reduced interpersonal and social contact, which evidence suggests can cause isolation and loneliness.
However, it was not all negative. The HIA identified that the policy has had a positive impact through changing behaviours to reduce interactions between people, thereby reducing the transmission of COVID-19 and protecting public health.
Other positive impacts included the protection of more vulnerable individuals through the mobilisation of communities to provide support and increased volunteering numbers; the legislation ensured that food for children eligible for free school meals was continued and accommodation was allocated for those who were homeless.
The policy has led to an increase in digital technology use and enabled people to continue working and studying, to access key services and stay connected with others during the restrictions.
During the lockdown period, there was reduction in car use, with reduced levels of nitrogen dioxide (NO2) reported in some areas of Wales, and some improved air quality and environments but this seems to be becoming more transient and temporary.
The assessment also identified several opportunities to promote health and well-being and reduce inequalities for the future. For example, increased flexible working practices; the promotion of healthy behaviours, with support for active travel; increased digital technology use; building on and harnessing the role of the third sector and social mobilisation to support each other; and support for sustainable economic development that places the health and well-being of the population at its centre.
Moving forward, effective monitoring of the impacts of the policy on the people of Wales is required with more analyses of evidence, data and health intelligence essential so that we obtain more clarity about the impact of policies such as this on people’s lives and livelihoods, in order to inform any future decision-making and policy response measures.
Ongoing mental health and well-being support is crucial, along with making sure that those most affected in society receive the greatest support.
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The HIA has highlighted gaps in the evidence on the impact of COVID-19 and policy responses on the population of Wales. Therefore, looking towards the future, further research is needed, for example in relation to the indirect impacts on overall population morbidity and mortality, the longer term impact on mental well-being and impacts on specific population groups such as babies, children and young people, and BAME groups.
In addition, it must be noted that the impacts of easing and reintroducing restriction measures are currently unknown, therefore this needs to be explored by decision makers; embedding HIA in future policy-making and planning processes can help to better understand these impacts.
The unprecedented situation has demonstrated that a wide-scale rapid response can be taken to protect the population. The HIA findings can be used by decision makers to mitigate the negative impacts and enhance the positive impacts and opportunities, and inform and support future action such as reintroducing the policy in the event of subsequent COVID-19 pandemic waves.
The findings have key significance for Wales, as they offer organisations and those responsible for determining future recovery and renewal plans explicit insight into how the policy has impacted the population and can also inform strategies throughout the coming months and years.
Whilst the pandemic has drawn attention to some of the key issues faced, and exposed where action needs to be taken, Wales does have a unique opportunity with the Well-being of the Future Generations (Wales) Act 2015, which provides a distinct policy framework for the formation of an integrated and sustainable approach to addressing COVID-19, protecting population health and well-being and promoting economic and societal recovery.
The Act can help us to consider COVID-19 response in tandem with additional challenges, such as deprivation and poverty, and the implications of Brexit, future trade agreements and climate change.
The full ‘Staying at Home and Social Distancing Policy’ HIA report can be accessed here.
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