Coronavirus (COVID-19): evidence gathered for Scotland's route map - equality and Fairer Scotland impact assessment

4. Summary of the Impact of COVID-19 on Protected Characteristics and Socio-Economic Disadvantage

This section sets out a summary of the social, health and economic impacts of COVID on protected characteristics and people living in socio-economic disadvantaged circumstances. Full details have been published in two reports: Equality and Fairer Scotland Duty Assessment of the Health and Social Impacts of Covid-19^[6] and Economic Impact of Coronavirus led Labour Market Effects on Individual and Households^[7]. In addition, four slide packs have been provided to summarise information on age, sex, race, and disability. These reports are based on a range of published statistics, literature, research evidence and views identified through stakeholder engagement. Full references for points made in the summary below can be found in these published documents, which are available on the Scottish Government Equality Analysis webpage^[8]. Additional evidence on the impact of COVID on vulnerable children and young people has also been published with further evidence due in July^[9].

Given the unprecedented nature of the pandemic there are gaps in knowledge and in the evidence base. We are developing data, research and understanding of lived experience as we move forward.

COVID-19 is an extreme shock to normal life that has affected everyone but, as described below, the harms caused by the pandemic are not felt equally by all groups in society. The impacts of COVID-19 build on top of structural and systemic problems which mean that some adults and children are more likely to have segregated, precarious, impoverished, unsafe life experiences than others; and which may have been made worse by COVID-19. A return to the pre-COVID-19 world is unlikely to be the optimal result. Likewise, implementation of the Route Map can only be part of the answer: it will take longer term economic and social renewal from COVID-19, centred on the principles of equality and human rights, to tackle deep seated structural changes.

The analysis below gives a summary of the impact of COVID-19 by protected characteristic and socio-economic disadvantage. But it is important to remember that people do not neatly fit into single boxes. Every adult, child and every family will display a combination of different protected characteristics and household income. Although the analysis below focuses on each of the protected characteristics and socio-economic disadvantage, we do not underplay this variation. It is important for us to remember both the intersectionality of protected characteristics and the wide range of family circumstances that influence the barriers people face and their lived experience of poverty, inequality and/or discrimination.

Poverty has higher prevalence across protected characteristics. For example, risk of poverty is much higher for women, disabled people, minority ethnic people, lone parents, and children and young people. We know that work does not fully protect against poverty, with 60% of adults in poverty being in work^[10]. The effects of COVID-19 will layer on top of existing structural imbalances and are predicted to be particularly severe for people on low incomes, who are more likely to have poorer health and are also more likely to be in insecure work without financial reserves. The roles of people actively employed as key workers since lockdown measures were introduced include many that are characterised by low and/or unstable income. In addition, the Institute for Fiscal Studies estimates that low earners were seven times more likely than high earners to have worked in a sector that has shut down as a result of the lockdown^[11]. This, coupled with the cramped accommodation without private outdoors space and more frequent smaller purchases that are common to households experiencing poverty, could significantly increase the chances of infection during lockdown and early release phases. Figures from National Records of Scotland show that people in the most deprived areas were 2.1 times more likely to die with COVID than those living in the least deprived areas^[12].

People on low incomes often lack the space, resources and/or flexible working arrangements needed to meet the unexpected childcare requirements resulting from school and Early Learning and Childcare (ELC) closures. This creates a risk that the education attainment gap could widen as parents do not have the financial or other resources to support children. Fuel poverty levels may increase and be exacerbated by the current crisis, as those staying home every day will require greater use of domestic energy. Lower income households are also less likely to have a broadband connection, may lack access to smart devices (phones or tablets) or sufficient data, and may rely on libraries and other community resources now closed to make use of the internet. This may leave them without access to home learning materials, justice procedures, advice, information, job or benefits applications, shopping, and entertainment.

Women across the range of protected characteristics face multiple discrimination, including disabled women, women from Black and Ethnic Minority (BME) communities, refugee and asylum seeking women, lesbian, bisexual and trans (LGBT+) women, and older women^[13]. In the pre-COVID-19 labour market, women were unequal in terms of pay, participation and progression due to a variety of drivers including occupational segregation, job valuation, discrimination, and time available to work^[14].

Women are overrepresented in health and social care jobs and unpaid caring roles, and COVID will have increased their workplace risk. However, death rates are similar for men and women, and much higher for men after age differences are taken into account. Domestic abuse may increase as a result of lockdown and it may be harder for some to access the usual routes to support and safety. The vast majority of lone parents are women; three-quarters of lone parent households were already financially vulnerable in 2016-18 and more likely than average to be in unmanageable debt.

As a result of COVID, women are disproportionately impacted in terms of employment^[15]. Women are the majority of those employed in many 'shut down' sectors and are over-represented in many of the sectors where median hourly pay will fall below the current rate of the real living wage if employers do not bridge the 20% shortfall for furloughed staff. Women earn less than men on average and are less likely to be eligible for sick pay. Caring responsibilities may make it harder to maintain or take on employment. Research by the Institute for Fiscal Studies has found that mothers are more likely than fathers to have quit or lost their job, or to have been furloughed, since the start of the lockdown. Compared with fathers, mothers are spending less time on paid work but more time on household responsibilities. The differences in work patterns between mothers and fathers have grown since before the crisis. In 2014/15, mothers were in paid work at 80% of the rate of fathers; now this is 70% of the fathers' rate. Mothers in paid work used to work an average of 73% of the hours that fathers worked; this has fallen to 68%. Mothers and fathers used to be 'interrupted' during the same proportion of their work hours; now mothers are interrupted over 50% more often^[16].

Mental health in the UK worsened substantially as a result of the Covid-19 pandemic – by 8.1% on average and by much more for young adults and for women which are groups that already had lower levels of mental health before Covid-19^[17].

Pregnant women, particularly those over 28 weeks pregnant, are deemed to be of higher risk of severe illness and are asked to strictly follow physical distancing guidance^[18]. For some women this may lead to increased anxiety and loneliness at a crucial life-stage^[19]. We know from previous research that employment-related difficulties disproportionately affect pregnant women in the work place, and we can assume that this has continued to be the case during COVID. Maternity services have continued throughout the pandemic, although the way that some of those services are delivered has changed. While it is too soon to fully understand the clinical impact of the changes to lifestyle and services, both positive and negative, that may have resulted from this, it is likely that for some pregnant women the reduced socialisation and added stress during the COVID period caused by concerns about health and employment will likely have had a negative impact on their physical and mental health.

We already know that mental distress and illness are common in pregnancy and the first postnatal year, affecting up to one in 5 women, and the period after childbirth is a uniquely vulnerable time for development of severe mental illness for certain groups of women (Jones et al, 2014). There has also been a review looking at pregnant women during infectious disease outbreaks which suggests they are more vulnerable to anxiety and disruption. In the context of COVID-19, we know that women's mental health is more likely to be negatively impacted by COVID-19, and women as a group already had lower levels of mental health before the pandemic. Those with high childcare duties have shown noticeable deteriorations in well-being, with women more affected than men^[20]. New mothers and single parents, in particular, are most likely to have been impacted by the isolation and reduced social contact driven by the pandemic. Loneliness is also a risk factor for poorer mental health^[21] and wellbeing, which might be particularly relevant for single parents.

Older people are more likely to have underlying health conditions, making them more susceptible to the severe negative health effects of COVID-19. Nine in ten deaths involving COVID-19 in Scotland have been among those aged 65+ and two-fifths have been among those aged 85+. Around half of people in the shielded group are aged 65+. Older people are also more likely to live alone, less likely to have internet access and less likely to use it even if they do have it, which has potentially significant implications for their wellbeing during lockdown. They are also more likely to live in care homes or be receiving care at home, both of which have seen significant service changes during lockdown. Many older people have faced disruptions as family members are unable to visit or provide unpaid informal care and support.

Children and young people: many families will experience increased financial hardship with impacts for the current and longer term health and wellbeing of children. Some children and young people may be at a greater risk of neglect, physical abuse, emotional abuse or sexual abuse in the home and increased experience of domestic abuse as a result of increased family pressures and school and ELC closures. This has implications for their current health and wellbeing, but also without the support, we know such adverse experiences can impact their long-term health and wellbeing into adulthood. Some children and young people may have experienced poorer mental health and wellbeing as a result of ELC and school closures and as they return to these settings.

The increased time spent at home using the internet for digital learning also allows young people to stay in touch with their friends but, if unsupervised, some may find themselves at risk of online harms and interacting with strangers. Without effective remote schooling interventions and effective mitigating actions to support continuity in learning, long school closures could risk a long-term negative impact on the development and attainment of some pupils, especially those from a disadvantaged background, or those with additional support needs, or those who depend on school to develop their language skills in either English or Gaelic. This may be particularly felt by young people in families that lack access to resources such as home computing and internet access. Younger adults in employment are more likely to be working in hard-hit sectors, such as retail and leisure and entertainment, than older workers and to be working part-time or on less secure contracts (based on UK data). Younger people were more likely to be financially vulnerable and in unmanageable debt before the pandemic; recent surveys are indicating that under-35s are already resorting more than older people to overdrafts, borrowing and using up savings, and are more concerned about paying their rent.

The needs of all children and young people are likely to have been affected during this period, and for some, will be long lasting. Secondary health impacts, including mental health and wellbeing needs are likely to occur in the short, medium and long term and will require varying levels of support to address them^[22]. The continuation of universal health services, such as health visiting and school nursing, has provided a lifeline for some families to prevent them escalating into requiring statutory input, whilst containing the increased anxieties at this time^[23]. More families will have new or additional needs as a result of the pandemic. Mitigating against longer term health impacts, through supporting children and families at the earliest stage, will be crucial to minimise the potential health burden over time and improve health and wellbeing outcomes for all.

Disabled people: around a third of adults report a limiting longstanding health condition or illness^[24]; 29% of men and 34% of women in Scotland. According to Inclusion Scotland, disabled people face barriers across four dimensions: physical or environmental; attitudinal; communicational; and organizational^[25]. During the pandemic, disabled people are potentially at increased risk of health harm from COVID due to difficulties implementing measures to reduce transmission, as well as potentially increased risk of severe health effects due to pre-existing health conditions. The Scottish Government is aware that disabled people may face more difficulties accessing food and other essential supplies than the wider population and this may be further exacerbated as they are less likely to be online^[26], further compounding negative physical and psychological health effects. Individuals in receipt of social care may also be at greater risk of non-COVID related health harms if they have faced disruptions to formal health and social care arrangements as well as potentially losing the informal care and contact of family members.

Families with disabled members are more likely to be in poverty, meaning that the impact of any reduction in income is likely to be particularly harmful. There are also slightly higher proportions of disabled people working in some of the areas experiencing damaging impacts from COVID-19-related restrictions such as retail and hospitality and a slightly higher proportion of disabled people in employment are self-employed.

Being asked to stay at home and avoid face-to-face contact may be particularly hard for disabled people given that they were more likely than the general population aged 16+ to say they regularly stopped and talked with people in the neighbourhood^[27] pre-COVID. Scottish Commission for Learning Disability has specifically referred to how people with learning/intellectual disabilities^[28] are experiencing increased loneliness and social isolation during this time.

Some disabled people may have specific needs in relation to communication.

The importance of accessible communication was highlighted during the pandemic and this has been raised by a range of Disabled People's Organisations.

Children with complex healthcare needs are likely to require specific considerations as they move back into school and other social settings. Their healthcare needs have continued to be met routinely during the period of lockdown, and this learning should be shared with other settings to ensure that equity of access is not reduced or limited due to their condition.

Minority ethnic people are disproportionately employed in the NHS and other key worker industries^[29] and in some cases have a higher likelihood of living in multi-generational families^[30], both of which may increase the risk of COVID transmission and infection. They also have higher rates of certain underlying health conditions, such as diabetes and cardiovascular disease, which can increase the risk of severe health effects of COVID-19. Public Health Scotland has undertaken analysis to investigate whether COVID-19 outcomes vary by race or ethnic group and will continue to refine this work as additional data becomes available.

Prior to the pandemic, minority ethnic workers tended to be disproportionately employed in lower paid work, to experience higher prevalence of poverty^[31] and live in the most deprived areas^[32]. Previous economic recessions have disproportionately impacted minority ethnic employment and this may be repeated especially given that a higher share of the visible minority ethnic population work in the wholesale, retail, accommodation and food services^[33].

According to Close The Gap's recent report^[34], Black and Minority Ethnic women are more likely to work in a sector that has been shut down; more likely to be in insecure work which puts them at increased risk of loss of hours and earnings; and are concentrated in low-paid service sectors which are more susceptible to redundancies over the course of the crisis. This has the potential to further entrench labour market inequality for BME women who already face multiple barriers to good quality employment.

Recent reports, including from the Equalities and Human Rights Commission, have highlighted abuse against certain communities^{[35] [36]} during the current crisis. It has also been indicated that the crisis is being used as a justification for online hate crime^[37]. The Tackling Prejudice and Building Connected Communities Action Group and other stakeholders have consistently raised concerns about the perceived increase in hate crime in Scotland, on and offline, against all characteristics, but particularly against minority ethnic communities, since the onset of the COVID-19 crisis. Police Scotland have indicated that reports of hate crimes have been reducing in number, which they would partially expect as there is less physical interaction between people during lockdown measures, but that there is not the level of reporting of online hate crime that they would be expecting. Stakeholders have advised that this reduction in reporting is due in part to a reluctance to take up police time during the crisis.

It is suggested that online hate speech is a predictor for religious and racially aggravated hate crimes offline^[38]. This has been limited during Phase 1 when there has been a lower number of people outdoors. It is expected that that there may be an increase in the incidence of hate crime, particularly towards minority ethnic communities, as physical distance measures are relaxed^[39].

The issues mentioned above (disability, age, lone parenthood, race) are all linked to higher child poverty risk and hence to the 'priority families' that are the focus of Scottish Government child poverty programmes. Child poverty, already affecting one in four children in Scotland, is likely to be an even more pressing concern in the post-pandemic period. There will be a need to consider the range of harms and impacts that affected children and young people before COVID-19, as well as those that have emerged during the pandemic, particularly the ones with the potential to have lasting impacts.

Impacts related to sexual orientation are less understood. Evidence^[40] is mixed as to whether lesbian, gay, bisexual and people of other sexual orientation are more or less likely to be unemployed and/or more or less likely to be earning median incomes and as to their relationship to COVID impacted sectors. But evidence suggests that some existing inequalities, such as restricted access to healthcare and housing, may deepen and there may be issues if young people are forced to return to family homes with difficult or unsafe relationships or if previously high prevalence of poor mental health increases during the pandemic^[41].

Trans people are also likely to experience a number of specific health and social impacts including reduced access to gender-reassigning (affirming) health care including hormone prescriptions, and abuse from unsupportive families or partners. This could increase mental health problems such as depression and anxiety, which are already prevalent in the trans population.

The COVID-19 pandemic has impacted religious and belief communities in various ways, including the closure of places of worship leading to the cancellation of the worship services of various faiths and the closure of study groups and out-of-school settings such as Sunday schools, madrassas and yeshivas. Religious groups have been forced to forgo communal celebration of major festivals that are important to their practice over the year. For example, Christians were unable to attend Holy Week and Easter services; the Jewish community experienced Passover away from the Synagogue and the traditional Seder meals without close family and friends; Muslims have experienced Ramadan and Eid al-Fitr unable to gather together to pray and break the fast; and Sikhs were unable to mark the festival of Vaisakhi.

Although many challenges presented by COVID-19 are shared across Scotland, some communities will face particular disadvantages linked to place. People living in rural and island communities, for example, may be disadvantaged in terms of access to public and health services, maintaining food and supply chains, a higher cost of living, fuel poverty, a high reliance on tourism, part-time work or 'portfolio careers', an ageing population and more complex and expensive transport links. People living in areas of multiple-deprivation have a higher risk of poverty, fewer opportunities for social mobility and, in places, poor transport links. People living in some densely populated urban areas may have limited local greenspaces for exercise. Some of these differences have been intensified by the pandemic while some may ease as lockdown restrictions are lifted.

As noted above, people's lives combine a wide range of protected characteristics and family circumstances which will be lived out in different ways in different places. All of these elements can layer benefits and challenges, which can create inequality of outcome for individuals. This complexity illustrates the importance of engaging and understanding lived experience as a crucial element of understanding impact.