Conversation with Ben Humberstone, former ONS
A conversation with Ben Humberstone, Head of Population Studies, Kantar Public, UK – formerly Head of Health Analysis and Live Events at the ONS (Office for National Statistics)
The Office for National Statistics (ONS) is the National Statistical Institute for the UK, responsible for collecting, analysing and disseminating official statistics for the UK's economy, society and population. It provides vital evidence which underpins some of the government’s most important social policies, affecting millions of citizens across the UK and beyond.
Since the onset of the COVID-19 pandemic, the ONS has played a pivotal role in supplying regular and timely evidence on the prevalence of the virus and its impact on the health, wellbeing and economy of the country. Kantar Public was commissioned by ONS to conduct the COVID-19 Infection Survey (CIS) - the flagship surveillance study on coronavirus incidence and antibody prevalence in UK communities.
Ben Humberstone, who recently joined Kantar Public from ONS, explains the importance of this work in driving decision making during the COVID-19 pandemic, and how this evidence will continue to underpin social, economic and health policy as the UK continues its recovery.
PUBLIC: As part of your previous role at the ONS, you were responsible for measuring the prevalence of COVID-19 mortality and morbidity from the onset of the pandemic. Could you tell us how this data was used to assess the social impact of COVID-19?
Ben: The pandemic has produced a real change in the recognition of the importance of data and analysis. The public have come to expect decisions to be made based on sound evidence in time to have impact, and as social scientists, our role has never been more important or valued. There is a risk that numbers obscure the real impact on people, but by understanding the lives of people behind the numbers we can help manage public health.
At the start of the pandemic, it became clear that while in the UK we had good data on COVID-19 related hospitalisations, intensive care admissions and deaths, the broader social and economic context was missing. This was a really important information gap.
To focus public health measures effectively and assess the impact of lockdowns, politicians and other decision makers needed to understand who was at risk of contracting COVID-19, who would need hospital treatment (like ventilatory support), and who was ultimately at risk of dying. It became apparent that there was no single source of data that could answer these questions and provide a clear picture of the types of people who were at risk, and the changes that would be needed to support and protect them.
To undertake this risk factor analysis, the ONS needed to link data from multiple sources including the population Census, death registrations by hospitals, and primary care (family doctor) records.
This would enable the analysis of clinical outcomes and underlying health conditions against demographic, social and economic characteristics in a way that wasn’t possible from a single source.
Analysis of the linked data enabled us to identify the following social and economic risk factors associated with COVID-19:
As this insight emerged, the ONS was able to advise the government, the National Health Service and community groups about who was most at risk. This resulted in a range of interventions to try and keep people safe, and to reduce the spread and impact of the virus.
The ONS was also able to assess the success of these interventions by regularly repeating the analysis to check whether the patterns were changing, and to look for any unintended consequences. Practical changes were made to the layout and capacity of public transport, and enhanced personal protective equipment (PPE) standards introduced in health and care settings. The insight was used to help inform which parts of the economy could be reopened and when.
This was a powerful illustration of the impact of using multi-source linked data and analytical skills to unlock new insight and improve public health in a pandemic. By understanding the social and economic context of COVID-19 risk, it was possible to make better decisions.
PUBLIC: The COVID-19 Infection Survey (CIS) is the first large-scale study to highlight the prevalence of self-reported ‘long COVID’ at a national level. 5 Why is this information so critical for national and local economic recovery plans?
Ben: The effects of the coronavirus pandemic will be with us for many years. The impact will be felt across society and the economy, by those who have lost family, friends and colleagues, and those who have lost their jobs or businesses. The public health impact will be felt through changing priorities in health services, such as the postponement of elective treatments and cancer screening; and it will be felt by those who experience long-term health effects as a result of COVID-19, including ‘long COVID’.
Looking at the impact of long COVID specifically, the first stage in addressing the resulting public health issues is to assess how many people have long COVID and what the risk factors are. We can estimate the social and economic impact of long COVID, but only if we know how it affects people’s lives.
This knowledge will also help identify the potential demand for treatment, the optimal location of clinics, and the types of support people will need to recover. And it will help identify the impact on employment and the cost of supporting those who are unable to work.
COVID-19 is a new disease, so the medical definitions and diagnosis of long COVID are still being developed. However, we know from long COVID support groups what kinds of impact people are experiencing, including their ability to undertake caring responsibilities and work.
Including a question about long COVID in the CIS made it possible to gather information on the duration and types of symptom experienced, along with an assessment of the impact on day-to-day activities. It was important for this information to be self-reported as it is not dependent on diagnostic tests, or whether someone has had a positive COVID-19 test: both things that can vary according to the availability of health services.
The latest estimates show: 6
The measurement and assessment of the impact of long COVID is just one example of how the COVID-19 Infection Survey is helping to manage the pandemic. It provides a robust representative measure of infection rates, and will also be used to track the efficacy of vaccines.
This enables decision makers to have both a measure of what is currently happening and the ability to model potential outcomes.
PUBLIC: This study revealed that people in their 30s and 40s are particularly at risk of suffering from ‘long COVID’. What are the implications in terms of preventative health communications?
Ben: We found that the 35 – 49 age group has the highest prevalence of long COVID. 7 This is significantly younger than the age profile for those experiencing hospitalisation and death because of COVID-19. It is an important finding as it demonstrates the likely impact that long COVID will have on the workforce, and enables an assessment of the potential cost of treatment and to the economy.
The other important implication of the age profile for long COVID is that it appears to be impacting groups who previously assumed that they were at low risk from COVID-19.
The analysis of the CIS shows that long COVID affects all age groups.
The assumption that risk is associated with old age and ill-health has shaped attitudes among younger people. This has resulted in vaccine hesitancy and reluctance to follow social distancing and other measures brought in to help manage the pandemic, for example mask wearing.
The elevated risk of suffering long-term effects has now been included in communications targeted at the younger age groups, to ensure that they understand the risk to their own health, irrespective of whether they have underlying health conditions.
PUBLIC: You looked at the impact of COVID-19 on specific groups of the population that experienced social isolation during lockdowns. How was this evidence used to inform public interventions?
Ben: Regular population studies have been vital in observing change over the period of the pandemic. Identifying the groups in society who are at most risk of social isolation has been important so that the harm caused by lockdowns can be balanced against the benefits of managing the spread of the virus, and so that support services can be targeted.
The ONS studies found that in the first three months of 2021, 1 in 5 adults in Great Britain were experiencing some form of depression. 8 This had more than doubled since before the pandemic.
This pattern was more pronounced among younger adults, rising to 4 in 10 among women aged 16 to 29. There was a greater risk of depression for those living in the most deprived areas and among those with disabilities.
Health inequalities are profound and are having a huge impact on the lives of citizens. These inequalities existed before the pandemic and they have been exacerbated by COVID-19. The patterns in risk that have been identified during the pandemic in many countries around the world correlate with deprivation.
Traditionally, public health policy focussed on how to improve life expectancy; it has recently been shifting to extending life lived in good health.
The social determinants of health are now recognised as having an important role to play in addressing health inequalities. According to information from the Health Foundation, what makes us healthy includes: good work, our surroundings, money and resources, housing, education and skills, the food we eat, transport, family, friends, and communities. 9
In that respect, the multiple aspects of the COVID-19 pandemic and the government responses have affected public health in many ways, with a particular impact on those deprived of several of these essential resources.
Understanding this is at the core of good public health policy.
In 2018 the Chief Medical Officer for England, Dame Sally Davies, proposed the creation of a health index to “track progress in improving health and health outcomes, to and beyond 2040 with a new composite Health Index that reflects the multi-faceted determinants of the population’s health and equity in support of ensuring health is recognised and treated as one of our nation’s primary assets.” 10
As a result, ONS has produced a Health Index that focusses on health not as the absence of disease, but as a concept capturing the broad social determinants of health. 11
The Health Index is one tool to help create a “currency” for health, where the value of policy initiatives from across government are measured in terms of the impact that they will have on public health, whether for example this is transport, housing quality or access to green space.
Putting public health at the heart of decision making will have an impact on health inequalities, but this relies on having good quality evidence. This is where we come in as social scientists and analysts.
Producing good quality evidence can save lives, it can reduce health inequalities, and it can improve public health and economic outcomes.
1. Ethnic differences in COVID-19 mortality during the first two waves of the pandemic (ONS)
2. COVID-19 related deaths by occupation in England and Wales (ONS)
3. Why have Black and South Asian people been hit the hardest by COVID-19? (ONS)
4. COVID-19 related deaths by disability status in England and Wales (ONS) 5. The COVID-19 Infection Survey (CIS) is the largest regular survey of coronavirus infections and antibodies, providing vital information to help the UK's response to the pandemic. The ONS works with other organisations, including Kantar Public, to collect and process the data for this study which is sponsored by the University of Oxford.
6. Prevalence of ongoing symptoms following COVID-19 infection in the UK (ONS)
7. Prevalence of ongoing symptoms following COVID-19 infection in the UK as of 1 April 2021 (ONS)
8. Coronavirus and depression in adults in Great Britain, January - March 2021 (ONS)
9. Infographic “What makes us healthy” (The Health Foundation)
10. Annual report of the Chief Medical Officer, 2018 on ‘Health 2040 – Better Health Within Reach’
11. Health Index for England (ONS)
