Older people have borne the brunt of deaths from COVID-19, whether in hospital or in care homes. At the same time, the coronavirus emergency sits alongside a crisis in many of the communities in which older people live. In this blog, Chris Phillipson, Camilla Lewis, Tine Buffel, Patty Doran and Sophie Yarker examine how the pandemic will affect older people living in areas of multiple deprivation.

• Over the last ten years, inequalities have increased within and between neighbourhoods.
• In order to address these inequalities, funding must be targeted at the most deprived areas, and local partnerships should work on place-based interventions.
• Alongside this, we need to challenge the ageism and age-based divisions that social distancing is likely to reinforce.

Where you live matters greatly for your quality of life in older age; it matters also for whether you are protected from COVID-19. The Marmot Review, examining changing health inequalities between 2010-2020, highlighted the increase in deprivation affecting many parts of England. Area deprivation is also associated with higher levels of social exclusion in later life, for example to services, participation in leisure activities, and relationships with friends and family. Quality of life will also be affected by housing conditions – especially important given restrictions imposed by social distancing. Nearly three-quarters of a million people 75 and over live in what are termed ‘non-decent homes’ – a higher proportion than any other age group. The most common reason is the presence of a serious hazard posing a risk to the occupants’ health or safety, such as inadequate heating or a fall hazard. Over a million over- 55s are living in a home with at least one such problem. It is hardly surprising that the Office for National Statistics (ONS) has reported that those living in the poorest parts of England and Wales are dying at twice the rate from COVID-19 compared with those in more affluent areas.

Double lockdown

As the impact of coronavirus grows, older populations who are social distancing may be doubly locked down – suffering the effects of social isolation whilst living in places affected by substantial cuts to public services. This challenges us to ask fundamental questions about the changing nature of our communities, and the responses necessary to assist older people during the pandemic. With the likely continuation of social distancing rules in some form, the implications for neighbourhood support requires urgent attention. The danger at the present time is that the pressures facing communities are being over- simplified through two competing narratives:

• The first portrays a romanticised view of neighbourhoods coming together against a ‘common enemy’, symbolised by the weekly applause for NHS workers, along with the deployment of an army of volunteers stepping forward to support vulnerable groups.
• The second highlights reports of outbreaks of unrest caused by the constraints of the lockdown, suspicion of neighbours flouting the guidelines, and selfish behaviour in supermarkets.

It is certainly the case that many social groups have emerged to provide support for those whose isolation has been compounded by COVID-19. In some cases, this builds upon existing voluntary and mutual aid organisations which have replaced services from the local welfare state. But it is important not to ignore evidence about the long-term changes affecting communities. Roughly at the same time as COVID-19 started to spread across the country, the Office of National Statistics (ONS) provided an update on its review of trends in social capital in the UK. The results highlighted significant developments over the past decade, with evidence of less positive engagement with neighbours, less help being given to groups such as older people, and a reduced sense of belonging to the communities in which we live.

The findings from the ONS should not come as a surprise: the last ten years has seen an upsurge in inequalities within and between neighbourhoods in the UK, with zones of affluence and poverty existing side by side. But the majority of attention has focused on growing disparities between income groups, rather than the impact on relationships in everyday life. COVID-19 and measures such as social distancing, will ‘stress test’ the ability of communities to work together to protect vulnerable groups. The pandemic underlines the degree to which social processes relating to inequality, discrimination and racism contribute to the distribution of illness and deaths caused by COVID-19. Social interventions in marginalised communities are now urgently required to strengthen defences against subsequent waves of the virus.

Community development policy

We would argue for a new community development policy to assist the most deprived neighbourhoods in the UK. The policy will need to comprise:

Funding:  Disinvestment in social infrastructure has resulted in the closure of libraries, day care and community centres. Such resources are essential for providing informal spaces for people to meet, and both support and empower vulnerable groups. Deep cuts to local authorities over the past decade have resulted in significant financial pressures on all public services. Local authorities suffered a 49.1% real terms reduction in central government funding from 2010 to 2018.

Areas of multiple deprivation must be prioritised in future government spending. Such funding will need to be complemented by a national strategy to tackle health inequalities, drawing on lessons from the Marmot Review, and studies showing the detrimental impact of neighbourhood deprivation on older people’s quality of life. Targeting older people at risk of isolation, by focusing resources on socially excluded places, must be an essential part of the government’s recovery strategy.

Locally based partnerships: Interventions which have the most impact are those designed to meet the specific needs of communities, in situ. A one-size-fits-all approach to community must be rejected, in favour of tailored support to meet the needs of different groups through encouraging dialogue between local residents, voluntary organisations and the public sector.

Local authorities need to give urgent attention to developing new models of neighbourhood working as part of their recovery strategies from the pandemic.  Such ways of working will encompass a variety of approaches, for example: advocacy, befriending, counselling, and organising social activities. These types of support have become essential in the current crisis and need to be strengthened over the longer-term. However, given the extent of the crisis affecting communities, a broader range of activities at a neighbourhood level should be encouraged, including: providing food co-ops, home repair services, financial advice, and protecting people from various forms of abuse.

Challenging discrimination: Coronavirus is disproportionally affecting groups based on age, ethnicity, gender, disability, and sexual orientation. Continued social distancing is likely to reinforce ageism and age-based divisions within communities. The number of deaths (direct and indirect) in care homes from COVID-19, and the delay in recognising the extent of the disaster, illustrates the extent of the crisis in social attitudes towards ageing. Older people are increasingly presented as a  burden in relation to the economy, pensions and social care – an issue which needs to be tackled at all levels of society.

We support the call from the British Society of Gerontology and the Centre for Ageing Better for a fundamental culture shift to challenge negative attitudes towards older people. Given the risk for greater age segregation occurring as a result of COVID-19, it is essential to foster contact between generations, challenge ageist stereotypes, and highlight the diversity of experiences in later life. We also urge the government to work with national and local equalities organisations to support older people who are facing intersecting pressures relating to ageism, racism, and sexism.

Take a look at our other blogs exploring issues relating to the coronavirus outbreak.

Policy@Manchester aims to impact lives globally, nationally and locally through influencing and challenging policymakers with robust research-informed evidence and ideas. Visit our website to find out more, and sign up to our newsletter to keep up to date with our latest news.