Following the coronavirus outbreak, the Government identified 1.5 million people as vulnerable, and asked them to stay indoors. What is the geographic spread of these people, what does it mean for the development of the crisis over the coming weeks, and where should support and attention be targeted?
For now, the pandemic seems to be concentrated mainly in cities. Because the population in urban areas lives more densely, cities have a greater potential to turn into hotspots for the contagion and diffusion of disease. But looking at age and health characteristics shows significant differences in the size of “at risk” populations (those who are older or with health conditions) between the country’s largest cities and towns. This suggests that some places are more vulnerable than others.
Demographics: which cities are the most vulnerable?
Because they generally have a weaker immune system and a higher propensity to suffer from underlying chronic illnesses, older people are particularly vulnerable to the severe effects of COVID-19.
Some cities and large towns have much larger shares of older people than others. As shown by the map below, places with older populations tend to be either coastal or in the north of the country. In Blackpool and Worthing, more than 16 per cent of the population is aged over 70, while, in Slough and Oxford, this figure is 7 and 9 per cent respectively.
Figure 1: Proportion of population aged over 70, 2018
Source: ONS, 2020. Population estimates, 2018 data.
UK cities also have wide disparities in health outcomes
Of course vulnerability to diseases such as COVID-19 does not depend solely on age – people with pre-existing health conditions are also more at risk. Life expectancy gives a general indication of the health of an area, and there is wide variation in this indicator across cities and large towns.
Life expectancies are far higher in the south of England than elsewhere in the country (see Figure 2). On average, a child born in Dundee would be expected to live six years less than a child born in Reading. Gaps in life expectancies are usually explained by socioeconomic differences between, and often within, places. These differences are often driven by variations in the prevalence of certain health conditions, such as cardio-vascular diseases or cancer, as well as higher rates of avoidable deaths (e.g. alcohol or drug-related).
Figure 2: Life expectancy at birth, 2018
Source: ONS, 2020. Life expectancy at birth and at age 65 by local areas, 2016-18 data.
More specific health outcomes, such as the number of deaths from respiratory diseases are also a good indicator of susceptibility to COVID-19. The virus is known for affecting the lungs, and in some cases resulting in breathing difficulties which have the potential to develop into more severe illnesses such as pneumonia. People with heart and lung conditions such as lung cancer or pulmonary disease are more exposed to these severe effects of COVID-19.
When looking at the standardised mortality ratio from respiratory diseases, a similar North/South divide exists.
Figure 3 shows that even when controlling for age, the number of deaths from respiratory diseases is much higher in northern cities and large towns such as Hull, Middlesbrough, Blackburn or Preston.
Figure 3: Deaths from respiratory diseases in England, 2013-2017 (Standardised Mortality Ratio, England= 100.0)
Source: Public Health England, 2020.
Overall, these three indicators – age, life expectancy and deaths from respiratory diseases – reveal wide spatial inequalities across the country. They suggest that it is northern cities and large towns such as Liverpool, Blackpool, Burnley in the North West and Sunderland, Newcastle and Middlesbrough in the North East that are likely to have higher shares of more vulnerable people.
These patterns may cause particular strain on the NHS in certain parts of the country
Looking at the number of hospital workers as a proxy for intensive care unit beds across cities shows some are better equipped to deal with an influx of patients in need of critical care than others. This is a particular issue in some places that have relatively large numbers of at risk residents identified above. While Cambridge, Exeter and Worthing have more than 600 hospital workers per 10,000 population, Barnsley, Wigan, Burnley and Sunderland have fewer than 300.
As the crisis unfolds, the Government will no doubt be using similar data to decide how best to marshal and allocate resources. The experience in London to date shows how even relatively well-resourced systems can risk being overwhelmed and require additional capacity. It will need to be swift in its actions to ensure this isn’t magnified in some of the most at-risk cities.
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