Assessing policy to address the medium-run impact of COVID-19 on income and health inequality with models informed by the history of disease outbreaks

Lead Research Organisation: University of Glasgow
Department Name: Business School

Abstract

This research aims to assess the medium-run implications of COVID-19 on income and health inequality, and possible policies that aim to mitigate these effects. The medium run is important because the impacts of COVID-19 on inequality are expected to persist for many years. Understanding how inequality changes over the medium run, and assessing mitigation policies beyond the short term, requires information on the evolution of income and health inequalities several years after an outbreak. To achieve this, we will combine models typically applied to modern datasets with quantitative data from historical periods that, unlike contemporary data, cover extended post-outbreak periods. We will use records from Glasgow since the end of the 19th century, covering a period of intense and volatile economic activity, as well as multiple disease outbreaks. We choose Glasgow because it is a large city demonstrating similar inequalities to those seen today, and because administrative records for Glasgow provide detailed relevant information.

Our approach is the following. We will use a modelling framework that has been shown to be effective in capturing income inequality and the effects of recessions on this inequality. We will extend the modelling approach to also include health inequalities and ensure that both income and health inequalities are represented accurately using recent datasets. To set up the model so that it captures the effects of outbreaks on inequalities, we will use historical data from earlier times that include large disease outbreaks. The model will then allow us to examine the effects of different policy interventions for households with different socioeconomic characteristics.
 
Description First, by examining historical pandemics in the UK and the US, we find evidence of a common pattern of elevated mortality and recurrent outbreak risk lasting nearly two decades following the main waves [significant new knowledge]. This analysis is based on a novel dataset that we compiled using municipal public health records from eight major UK cities to study the effects of the 1918-19 influenza pandemic [this is a novel resource identified as part of the project], as well as datasets for the US (1900-1956) and for England and Wales (1838-2000). We develop a new statistical model of how death rates change over time after the main waves of a pandemic and analyse post-pandemic disease-specific mortality and outbreak risk [new research method developed]. Evidence from a period without recent advances in medicine and public health allows us to uncover the underlying epidemiological risk and thus highlight the importance of intervention. Understanding the mechanisms underpinning this persistence is an open research question [important new research question opened up].

Second, we have studied how vaccine refusal responds to disease experience, using a historical natural experiment. Specifically, we examined whether mortality during two smallpox epidemics in Glasgow between 1900 and 1904 mattered for later smallpox vaccine refusal following its legalisation in Scotland in 1907. We find that in small areas of Glasgow where mortality during the epidemics was lower, later vaccine refusal was higher, suggesting that complacency driven by lower experience of a disease contributes to vaccine refusal [significant new knowledge]. Our findings can aid policymaking by revealing impacts of complacency on vaccine refusal, supporting the design of more effective vaccination strategies.

Third, using modelling analysis of the medium-run implications of COVID-19, we find persistent increases in wealth and health inequality, amplifying existing inequalities and implying increased vulnerability to risk [significant new knowledge]. These changes are accompanied by increases in health inequality, in the form of a worsening of health for those with already lower wealth and/or health, and strengthening the relationship between wealth and health. These changes lead to inequality in exposure to post-pandemic income risk and, in particular, an increase in the vulnerability of those who already had low wealth before the pandemic.

Fourth, we report findings relating to public insurance policies for those with low wealth to mitigate income losses during the post-pandemic period. In the short run, such interventions reduce the proportion of households who are forced into low consumption. However, because they disincentivise investment in wealth accumulation for those with low wealth, they increase wealth inequality and, in the medium run, the probability of forced low consumption. Nonetheless, such interventions incentivise investment in health for those with low health, and thus help to reduce health inequality [significant new knowledge]. Our finding that interventions to insure income losses in the short term do not fully address the increase in wealth and health inequality, highlights the importance of research to investigate policies that mitigate risk exposure and increase resilience of income [important new research question opened up].
Exploitation Route Our outcomes are valuable for academic researchers who wish to:
1. Explore the time evolution of risk following a catastrophic event, by using our modelling framework;
2. Study aspects of mortality associated with historical epidemics, by using our datasets and methods;
3. Study wealth and health inequality jointly and in a quantitative framework, by using our modelling framework of the joint determination of health and wealth across the population;
4. Inform analysis of post-pandemic economic outcomes and economic policy by considering the extent and form of wealth inequality;
5. Inform analysis of post-pandemic intervention to mitigate health inequalities, by considering the extent and form of health inequality, and its dependence on wealth and on income risk.

Our outcomes are useful for individuals working in policymaking or policy advising organisations who aim to design policies to mitigate:
1. Recurrent outbreak risk;
2. The implications of the pandemic on wealth and health inequality, both via the effects on income and health during the main pandemic waves, and via increased exposure to income risk after the main waves for those with initially low wealth and health.
Sectors Healthcare,Government, Democracy and Justice,Other
 
Description Contribution to Response to Scottish Government Inquiry
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
 
Description Practitioners use our research to explain disease recurrence risk
Geographic Reach North America 
Policy Influence Type Contribution to new or improved professional practice
 
Description Review of our work in a systematic review of COVID-19 inequality written for a policy-oriented outlet
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in systematic reviews
 
Description Adam Smith Business School Internship Scheme
Amount £1,615 (GBP)
Organisation University of Glasgow 
Sector Academic/University
Country United Kingdom
Start 01/2021 
End 05/2021
 
Description University of Glasgow College of Social Sciences College Research Fund
Amount £866 (GBP)
Organisation University of Glasgow 
Sector Academic/University
Country United Kingdom
Start 05/2021 
End 07/2021
 
Title Code for briefing note "Medium-run wealth inequality following COVID-19." by Angelopoulos, K., Lazarakis, S., Mancy, R., Schroeder, M. (2021). 
Description This entry refers to an online repository which contains the code for the briefing note "Medium-run wealth inequality following COVID-19." The repository contains all codes for data cleaning, and modelling analysis described in the paper, allowing any interested party to reproduce the results in part or in full. Several txt files are inserted throughout the folder structure, describing the content and function of different parts of the code. All code is written in MATLAB and STATA. 
Type Of Material Computer model/algorithm 
Year Produced 2021 
Provided To Others? Yes  
Impact Researchers are free to use all or part of the codes provided in the repository in their own research. This allows researchers to easily adapt the economic model developed in the paper to alternative applications, thereby enabling new insights. 
URL https://github.com/maxschr90/2021-Angelopoulos-et-al.-Medium-run-wealth-inequality-following-COVID-1...
 
Title Data and code for "Briefing Note: Post-pandemic mortality dynamics: historical city-level evidence" by Angelopoulos, K., Lazarakis, S., Mancy, R. and Schroeder, M. (2020) 
Description This entry refers to an online repository which contains the data and code for the briefing note "Post-pandemic mortality dynamics: historical city-level evidence" The repository contains all code for the modelling analysis described in the paper, allowing any interested party to reproduce the results in part or in full. Several txt files are inserted throughout the folder structure, describing the content and function of different parts of the code. All code is written in MATLAB and R. Additionally, the repository contains a copy of the dataset: Deaths in the Medical Officer of Health Reports, Glasgow 1898 - 1972 which has been described in a separate entry. 
Type Of Material Computer model/algorithm 
Year Produced 2020 
Provided To Others? Yes  
Impact Researchers are free to use all or part of the techniques described in this repository in their own research. This allows researchers to easily adapt the statistical modelling techniques developed in the note to novel datasets, thereby enabling new insights. 
URL https://github.com/maxschr90/2020-Angelopoulos-et-al.---Post-pandemic-mortality-dynamics-historical-...
 
Title Data and code for "How do pandemics end? Two decades of recurrent outbreak risk following the main waves. Two Decades of Recurrent Outbreak Risk Following the Main Waves." by Schroeder, M., Lazarakis, S., Mancy, R., & Angelopoulos, K. (2021) 
Description This entry refers to an online repository which contains the data and code for the research paper "How do pandemics end? Two decades of recurrent outbreak risk following the main waves. Two Decades of Recurrent Outbreak Risk Following the Main Waves." The repository contains all code for the modelling analysis described in the paper, allowing any interested party to reproduce the results in part or in full. Several txt files are inserted throughout the folder structure, describing the content and function of different parts of the code. All code is written in MATLAB. Additionally, the repository contains a novel dataset covering annual mortality rates from influenza across a number of British cities over the period 1895 to 1950. The mortality data is provided in Excel format, with a short description contained in the first sheet. 
Type Of Material Computer model/algorithm 
Year Produced 2021 
Provided To Others? Yes  
Impact Researchers are free to use all or part of the techniques described in this repository in their own research. This allows researchers to easily adapt the statistical model developed in the paper to novel datasets, thereby enabling new insights. The mortality dataset we assembled is also available for researchers to use, encouraging further research into the topic. 
URL https://github.com/maxschr90/Schroeder-et-al.-2021--How-long-do-pandemics-last-
 
Title Data and code for "Post-pandemic increases in inequality and risk exposure." by Angelopoulos, K., Lazarakis, S., Mancy, R., Schroeder, M. (2021). 
Description This entry refers to an online repository which contains the data and code for the research paper "Post-pandemic increases in inequality and risk exposure." The repository contains all codes for data cleaning, and modelling analysis described in the paper, allowing any interested party to reproduce the results in part or in full. Several txt files are inserted throughout the folder structure, describing the content and function of different parts of the code. All code is written in MATLAB and STATA. 
Type Of Material Computer model/algorithm 
Year Produced 2021 
Provided To Others? Yes  
Impact Researchers are free to use all or part of the codes provided in the repository in their own research. This allows researchers to easily adapt the economic model developed in the paper to alternative applications, thereby enabling new insights. 
URL https://github.com/maxschr90/2021-Angelopoulos-et-al.---Post-pandemic-Inequality
 
Title Data and code for: Local infectious disease experience influences vaccine refusal rates: a natural experiment 
Description Vaccination has been critical to the decline in infectious disease prevalence in recent centuries. Nonetheless, vaccine refusal has increased in recent years, with complacency associated with reductions in disease prevalence highlighted as an important contributor. We exploit a natural experiment in Glasgow at the beginning of the 20th century to investigate whether prior local experience of an infectious disease matters for vaccination decisions. Our study is based on smallpox surveillance data and administrative records of parental refusal to vaccinate their infants. We analyse variation between administrative units of Glasgow in cases and deaths from smallpox during two epidemics over the period 1900-1904, and vaccine refusal following its legalisation in Scotland in 1907 after a long period of compulsory vaccination. We find that lower local disease incidence and mortality during the epidemics were associated with higher rates of subsequent vaccine refusal. This finding indicates that complacency influenced vaccination decisions in periods of higher infectious disease risk, responding to local prior experience of the relevant disease, and has not emerged solely in the context of the generally low levels of infectious disease risk of recent decades. These results suggest that vaccine delivery strategies may benefit from information on local variation in incidence. 
Type Of Material Database/Collection of data 
Year Produced 2023 
Provided To Others? Yes  
Impact None that we are aware of. 
URL http://datadryad.org/stash/dataset/doi:10.5061/dryad.rbnzs7hfx
 
Title Dataset: Deaths in the Medical Officer of Health Reports, Glasgow 1898 - 1972 
Description The "Medical Officer of Health Reports", provide valuable, historic insights into the state of public health in Glasgow. We utilize the reports compiled by the Medical Officer of Health (MOH) to gather information on mortality from different diseases. We catalogue annual mortality rates for different diseases for the city covering the years 1898 to 1972. 
Type Of Material Database/Collection of data 
Year Produced 2021 
Provided To Others? Yes  
Impact We used the data collected to write a policy brief on the effect of the 1918/19 Spanish Influenza on deaths from related diseases in Glasgow (http://eprints.gla.ac.uk/223896/). The findings defined a new avenue of research for the project which has already managed to attract some additional funding from 3rd parties. 
URL https://reshare.ukdataservice.ac.uk/854730/
 
Title Shapefiles of administrative boundaries, Subway and main rivers in Glasgow, UK, around 1910 
Description This collection consists of ESRI shapefiles for Glasgow around 1910: sanitary district boundaries in 1903 (Sanitary_Districts.shp, etc.) municipal ward boundaries in 1912 (Wards_1912.shp, etc.) registration district boundaries within the area of the City of Glasgow in 1913 (Registration_Districts.shp, etc.) routes of main rivers (River Clyde and River Kelvin) around 1915 (Rivers.shp, etc.) route of the Glasgow Subway around 1915 (Subway.shp, etc.) For details of shapefile construction, please see the descriptions in the following article: Angelopoulos, K., Stewart, G. and Mancy, R. Local infectious disease experience influences vaccine refusal rates: a natural experiment. Proceedings of the Royal Society B: Biological Sciences. DOI: 10.1098/rspb.2022.1986. Details of construction and references to original map sources are provided in the second paragraph of the section "Geographic conversion" in the online supplementary materials of the above reference. Further information about the boundaries is provided in the caption of Figure S1 of the supplementary materials. Additional contextual information is provided in both the main text and supplementary materials. 
Type Of Material Database/Collection of data 
Year Produced 2023 
Provided To Others? Yes  
Impact None that we are aware of. 
URL https://zenodo.org/record/7550897
 
Description Organised workshop jointly with staff from Bank of England 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact In June 2021, we organised a workshop with participation of stakeholders/practitioners and researchers, to disseminate our findings and as a forum to present developments of experts' understanding on inequality implications of the pandemic to a broader audience. The event was online, hosted by the University of Glasgow, Adam Smith Business School, and co-organised with colleagues from the Bank of England. The event included presentations/discussion of various aspects of COVID-19 inequality, with talks from the Chief Economist from the Bank of England, Andy Haldane, and economists at the Institute for Fiscal Studies and the London Business School. About 150 people registered, and about 90 joined the online event (presentations were made available online after the event for those who could not attend on the day). The audience included practitioners from various organisations (e.g. Bank of England, ONS, Glasgow City Region, economists working with the private sector), journalists and researchers from universities and research/policy institutes. Discussion of the event featured in the press (including e.g. Reuters, The Guardian).
Year(s) Of Engagement Activity 2021
URL https://www.gla.ac.uk/schools/business/events/archive/wew/headline_792043_en.html
 
Description Presentation at the Festival of Social Sciences 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Invited talk on post-COVID-19 wealth and health inequality at the Festival of Social Sciences, Glasgow, November 2022.
Year(s) Of Engagement Activity 2022
 
Description Public engagement event at Lancaster University 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Lancaster University Management School, Economics Webinar Series, presentation by Spyridon Lazarakis with topic "Pandemics and Inequality", open event, October 2021. Students participated asking questions and showing interest.
Year(s) Of Engagement Activity 2021
URL https://www.lancaster.ac.uk/events/the-economics-webinar-series-spyridon-lazarakis
 
Description Workshop organisation with third sector participation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Workshop on historical health inequalities (about 20 participants), which brought together academics working on public health, economics, history and geography from the Universities of Cambridge, Glasgow, Stirling and Edinburgh and individuals with practitioner and advisory experience at Glasgow Life, Glasgow City Archives and Public Health Scotland.
Year(s) Of Engagement Activity 2022