When we learned the fatality rate for COVID-19 was far higher among people from more socioeconomically deprived areas, there was rightly a sense of outrage. Mitigating the impact of COVID-19 on deprived communities should be a key concern for government and health care leaders. But the unequal impact should not have come as a surprise.

Not everyone has the same opportunity to live a healthy life, and one key driver for these health inequalities are the inequalities in society itself. The story is not new. But COVID-19 has thrown it into sharper focus.

This long read looks at the link between health and income. It explores the nature of the economic shocks experienced in recent years, including those stemming from COVID-19, and the consequences these might have on people’s health. It then considers how we might use the current crisis to build a fairer and healthier society.

Key points:

• Income is associated with health: people in the bottom 40% of the income distribution are almost twice as likely to report poor health than those in the top 20%. Poverty in particular is associated with worse health outcomes. This is especially the case for persistent poverty.
• Income and health can both affect each other – lower income is associated with more ‘stressors’ which can harm health and allow fewer opportunities for good health. Poor health can limit the opportunity for good and stable employment and so affect income.
• The pattern of employment loss and furloughing by income suggests that the future economic consequences of COVID-19 may be borne by those on lower incomes. This in turn risks an additional long-run burden on health.