The collateral impacts of COVID-19 on public health
Emmanuel Rivière, Director of International Polling and Political Advisory, and Editor-in-chief of PUBLIC, Kantar Public
COVID-19 is categorised as a pandemic due to its global, cross-continental dimension. The Greek prefix ‘pan’ (signifying ‘whole’) could well also be attributed to the multi-faceted aspects of the health crisis and its impacts on people’s lives – whether or not they have been infected by the virus itself.
In this article, Emmanuel Rivière, Director of International Polling and Political Advisory at Kantar Public, draws on recent research conducted in 10 countries to demonstrate the many ways in which the COVID-19 crisis has affected our lives and health, possibly with lasting consequences.
As we enter the second half of 2021, citizens in many countries around the world – although sadly not all – welcome with relief the news announcing a decline in the number of COVID-19 cases. There is hope that the progress of vaccination programmes will translate in more countries into decreasing infection rates.
In these countries, people are now able to enjoy the progressive release of the restrictions and safety measures that have affected daily routines for so long. Our lives and our minds have been submerged by the COVID-19 ‘tsunami’ for more than a year now; but as the flood waters of the pandemic recede, relief is mitigated by the discovery of extensive collateral damage.
Mixed feelings are evident in the findings of the study conducted by Kantar Public to explore the possible collateral impacts of the pandemic and its consequences. The main takeaway from this research is the multifaceted nature of the collateral damage caused by the crisis, with learnings that relate to a multiplicity of domains where significant impacts are observed: health behaviour, access to healthcare and the continuity of the health system, morale and mental health, working conditions, and intergenerational divisions.
Starting with our everyday life – which was hugely impacted by the lockdowns imposed in many countries – changes to people’s daily routines have been diverse and significant. Perhaps the most predictable was the decrease in physical activity, due to the limitations on outdoor exercise and the closure of sports facilities.
This impact was not mitigated by the extra time freed up by the restrictions on travel and resulting working from home for many people. In almost every country covered by our study (except New Zealand), more people report a decrease in physical exercise than an increase during the lockdown periods. On average, about 3 in 10 people say their physical activity decreased, from 22% reporting this in the US, up to 36% in Poland.
Instead, additional personal time was spent on hobbies (23% on average), but also on screens: half of the people surveyed indicate an increase in screen time, particularly students (71%). This was not exclusively an effect of remote working: manual workers (50%) homemakers (46%) and retired people (36%) also significantly increased their screen time.
Source: Kantar Public's global public health study, May - June 2021
The extent of potentially harmful changes in people’s eating habits might have been less predictable: a quarter of respondents report having increased the amount of food eaten during the lockdown periods. This change is observed across all ten countries surveyed, from 18% of participants in the Netherlands, to 32% in the UK.
Certain combinations of these lifestyle changes could have long-term consequences for people’s health.
Our study reveals that a third of the people who indicate a decrease in physical activity, also consumed a higher quantity of food. In total, about 10% of our respondents report a worrying combination of decreased activity and increased food consumption.
Looking at the evolution of tobacco and alcohol consumption is also critical to understanding the impact of COVID-19 lockdowns on public health. While fewer than 10% of respondents in the different countries indicate having smoked more during lockdowns (with the exception of Spain at 12%), more people reported an increase in alcohol consumption (12% on average across the ten countries).
This increase in drinking habits impacted a larger share of the population in New Zealand (15%) and the UK (17%). It has also been more prevalent among younger adults (17% of people aged 18-34) and some occupations (19% of managers).
For some individuals (14% across the ten countries), the closure of bars and restaurants resulted in a decrease in alcohol consumption.
The reported changes to daily routines may lead to mid- to long-term consequences, especially for those people for whom these lifestyle changes have been significant. These individuals may need some time to break these bad habits and return to a healthier lifestyle – in particular when it comes to addictive behaviours such as alcohol consumption. However, these collateral effects are not, unfortunately, the most worrying of those revealed by our study.
In many countries, the need to mobilise health resources for the more serious cases of coronavirus, resulted in a reallocation of the healthcare workforce. As a consequence, some appointments, treatments and medical examinations were postponed, if not cancelled.
This had a significant impact on the general population, as revealed by our study. Among the 10,000 people interviewed, about 40% experienced one of these scenarios, up to 52% in Spain.
While people were less impacted in Germany, Australia, and the Netherlands, it is still the case that a third of respondents experienced cancelled and/or delayed medical appointments.
While 3 in 10 people reported that their appointments had been cancelled or delayed by healthcare professionals or hospitals, it appears that the problem did not stem exclusively from decisions taken by medical staff: 1 in 4 people said they had personally decided to avoid or postpone their medical appointments, sometimes because of difficulties in simply booking one.
In most cases, delays and cancellations impacted diagnostic consultations, tests or scans; less frequently, treatments or surgery.
It remains to be seen how these postponed treatments and diagnoses will affect the population’s health and the risks of serious disease in the months and years to come.
In any case, this is certainly a source of concern for people. When asked about their own health assessment, almost half of those who experienced delayed appointments for treatment (i.e. about one fifth of the total population), fear that it will have a negative impact on their health, and 15% think this will definitely be the case.
The COVID-19 crisis has not only had a physical impact on people’s lives – presenting a serious health threat, restricting personal freedoms and access to healthcare, and resulting in revenue loss for some – it has also been an emotional burden for many.
It is no exaggeration to say that people have been deprived of many moments of happiness. More than a quarter of respondents mention having suffered a decrease in quality time with family; more than half, a decrease in quality time with friends. This latter situation has been particularly prevalent in France (62%), UK (63%) and above all Spain (74%).
For other people in contrast, the lockdowns have been an opportunity to spend more quality time with their family. But in some cases (13% on average), time with family also meant increased conflict.
This doesn’t mean, however, that the COVID-19 crisis has had no impact on people’s morale. While 58% of respondents describe their current psychological wellbeing as ‘unchanged’ compared with before the pandemic and 16% say that it is better, we can’t ignore the fact that for 26% of people, their morale has got worse. At the time of our study, 68% of respondents across the 10 countries surveyed describe their psychological wellbeing as being excellent or good, 32% as fair or poor.
The factors affecting those whose mental health has worsened, remind us again of the multidimensional aspect of the crisis.
These individuals are mostly concerned about their income or money (particularly in households with children), and restrictions to their everyday life. Concerns about the illness itself came in second place, whether for oneself, close relatives or the wider community.
The response to this question reveals a wide range of concerns that represent just as many collateral effects of the COVID-19 crisis: uncertainties with regards the restrictions, loneliness, and job insecurity, as well as saturation with news content related to COVID-19.
Certainly, this accumulation of worries has exacerbated the impact of each negative effect. For some, the damage to mental health triggered further negative impacts, affecting their ability to work (42% of those who report a worsened wellbeing) and their productivity (44%).
As a backlash effect, poorer mental health has negatively impacted physical health for more than 6 out of 10 people concerned.
The self-assessment of a decline in one’s own mental health (26% of respondents on average) is more prevalent in UK (30%), Germany (33%) and France (37%). It is also more frequent in some demographic subgroups: women (30%), single adults living with children (31%), and above all people under 25 years old (36%).
It is one of the paradoxes of this COVID-19 crisis: a virus that represented a serious health threat mostly for the elderly, has had severe collateral consequences for the younger generation.
The expression “a sacrificed generation” has been used many times to describe the situation of older teens and young adults during the pandemic.
This was supported by evidence showing the significant psychological impact of the pandemic on young people. As well as highlighting the multiple ways in which the psychological wellbeing of young people has been affected, our study also shows that the collateral effects of COVID-19 on the younger generation were not limited to mental health.
The different restrictions imposed on the public since the onset of the pandemic, seem to have particularly affected this age group’s resilience – from lockdowns and travel restrictions, uncertainties and concerns about education for those still studying, as well as increased difficulties for those looking to enter the job market. This acute accumulation of painful circumstances is clearly reflected in our findings: 40% of respondents aged 18 to 24 years declare their state of mind to be ‘poor’ or ‘fair’, compared with the 32% average for the total adult population.
Similarly, 36% of these young adults report a worsening of their psychological wellbeing (vs 26% for the total adult population), 39% (vs 31%) are feeling uncertain, and 28% (vs 19%) are feeling lonely. This feeling of loneliness during the periods of travel restrictions, has been particularly intense for those students and young professionals living by themselves, away from their families.
Some of these young adults were able to spend the lockdown periods back in their family homes, and 42% enjoyed an increased quality time with their family. But for some, spending these confinement periods with their families did not always constitute ‘quality time’: this generation is also the one who experienced the most increased conflict with their families.
Furthermore, enumerating the multiple factors affecting the mental health of the younger generation during the pandemic, does not imply that they were protected from the physical health aspects mentioned earlier in this article. On the contrary, people aged 18 to 24 were most likely to have both increased their consumption of food (43% vs 26% on average) and decreased their physical activity.
Although not specifically linked to the 18- 24 age cohort, younger groups also experienced delayed and/or cancelled treatments. Although they seem less concerned by medical appointments than the older groups, a third of all age groups below 45 years experienced appointment delays or cancellations by doctors or hospitals. This proportion was around 25% for those aged 55 and over.
The implication is that among those adults who needed an appointment, half of this younger population group experienced a delay or cancellation, compared to only a third of those aged 55 and over.
It could be argued that younger generations are more resilient. But considering the unprecedented nature of this crisis, can we really say what will be the long-term impacts of such a combination of damaging circumstances? What is in no doubt, is that the most affected and fragile will need support. Also, that this support is paramount at this critical moment, when people enter adulthood and the labour market.
At the outset of the pandemic, as he was announcing a strict national lockdown, French President Emmanuel Macron declared several times: “We are at war”. A strange war, which kills the oldest and wounds the youngest… Macron’s dramatic choice of words to describe this unprecedented health crisis has been much debated, and will be for some time to come.
Whatever metaphor government leaders use would like to describe apply to the COVID-19 crisis in the future, we now know that it can’t be a simplistic one. Initially, it seemed that the difficult decisions taken by government and public authorities could be reduced to a trade-off between health and economy. Public opinion was overall mainly sympathetic to the decision to prioritise health, and to the resulting restrictions on personal freedoms.
What we have now learned from the past 18 months, and confirmed with our latest study, is that the choice is not simply between health and economy, but also between physical health and mental health; between immediate health emergency and longer-term health risks; and in some ways, between the older and the younger generations.
This complexity cannot be ignored by the general public. It carries with it important implications for public authorities in consideration of possible next waves of COVID-19, or future similar crises. It is highly unlikely that the same kind of fast and unequivocal consensus, initially observed in many countries, will be reached in relation to similar restrictive measures in the future.
Right now, not only do we need to future-proof our health systems to ensure they are geared up to face future emergencies, we also need to have the necessary democratic and ethical debate to ensure that the appropriate choices are made and accepted collectively .
