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Scaling COVID-19 against inequalities: should the policy response consistently match the mortality challenge?
  1. Gerry McCartney1,
  2. Alastair Leyland2,
  3. David Walsh3,
  4. Dundas Ruth2
  1. 1 Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
  2. 2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  3. 3 Glasgow Centre for Population Health, Glasgow, UK
  1. Correspondence to Gerry McCartney, Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, UK; gmccartney{at}


Background The mortality impact of COVID-19 has thus far been described in terms of crude death counts. We aimed to calibrate the scale of the modelled mortality impact of COVID-19 using age-standardised mortality rates and life expectancy contribution against other, socially determined, causes of death in order to inform governments and the public.

Methods We compared mortality attributable to suicide, drug poisoning and socioeconomic inequality with estimates of mortality from an infectious disease model of COVID-19. We calculated age-standardised mortality rates and life expectancy contributions for the UK and its constituent nations.

Results Mortality from a fully unmitigated COVID-19 pandemic is estimated to be responsible for a negative life expectancy contribution of −5.96 years for the UK. This is reduced to −0.33 years in the fully mitigated scenario. The equivalent annual life expectancy contributions of suicide, drug poisoning and socioeconomic inequality-related deaths are −0.25, −0.20 and −3.51 years, respectively. The negative impact of fully unmitigated COVID-19 on life expectancy is therefore equivalent to 24 years of suicide deaths, 30 years of drug poisoning deaths and 1.7 years of inequality-related deaths for the UK.

Conclusion Fully mitigating COVID-19 is estimated to prevent a loss of 5.63 years of life expectancy for the UK. Over 10 years, there is a greater negative life expectancy contribution from inequality than around six unmitigated COVID-19 pandemics. To achieve long-term population health improvements it is therefore important to take this opportunity to introduce post-pandemic economic policies to ‘build back better’.

  • Epidemiological methods
  • Health inequalities
  • Mortality

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  • Twitter Alastair Leyl @AlastairLeyland.

  • Contributors The idea for the paper was generated by GM and RD. RD and AL undertook the analysis. The paper was drafted by GM and RD. All authors provided substantial critical work on the manuscript and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. RD and AHL are funded by the Medical Research Council (MC_UU_12017/13) and Scottish Government Chief Scientist Office (SPHSU13).

  • Correction notice This article has been corrected since it first published online. The ‘Funding’ statement has been corrected.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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