Avoiding a legacy of unequal non-communicable disease burden after the COVID-19 pandemic

Authors: Nason Maani, Salma M Abdalla, Sandro Galea

2020 was a difficult year for health. The COVID-19 pandemic brought a widespread but deeply unequal health burden, etched along racial and ethnic lines, reflecting longstanding socioeconomic inequalities. As the pandemic swept the world, these inequalities became differences in exposure to the virus and differences in pre-existing non-communicable disease (NCD) burden associated with an increased risk of severe COVID-19. The confluence of these factors—the spread of a novel infectious agent, the prevalence of NCDs that exacerbated disease severity, and the patterns of social inequality underpinning both—have led to the apt description of COVID-19 as a syndemic.

When we speak of the unequal impact of the COVID-19 pandemic, we are usually referring to differences in COVID-19 outcomes. However, it is becoming increasingly clear that the inequitable health consequences of the pandemic run deeper than COVID-19-related morbidity and mortality alone. In the short-term, these have included non-COVID-19 mortality increases for heart disease, diabetes, and dementia, substantial declines in mental health outcomes, particularly for those with the least assets, and cancellations of elective surgeries, including those for urgent cancer care.

As we enter 2021, we are now facing the risk that the health inequities wrought by COVID-19 will have long-tail, greater consequences for the burden of NCDs for decades to come. COVID-19 was accompanied by a recession in many countries, occasioned by the economic fallout from the spread of the virus and efforts to contain it. This burden was not shared equally, and there is ample evidence that the COVID-19 recession has widened socioeconomic gaps.