Health gap between rich and poor visible in corona mortality rate

A recent report by the national statistical office, Statistics Netherlands (CBS), showed that, for the 10.000 Covid-19 deaths that occurred during the first wave of 2020, the 20% population group with the lowest income were twice as likely to die from the virus than the 20% with the highest income. CBS further reported that this death rate disparity between the two income groups also applies for other causes of death, unrelated to corona, in the Netherlands.

Worldwide, the corona crisis has brought to light the depth of the gap between the rich and the poor, and it has amplified it further in terms of both health as well as access to wealth and the capacity to recover from the crisis in economic terms. As a January global report from Oxfam International claims: “the virus has exposed, fed off and increased existing inequalities of wealth, gender and race.” This panorama is also visible in the Netherlands, where, in the spring of 2020, double the number of corona deaths occur in the lowest income groups than in their richest counterparts, with as much as almost three times more deaths in the younger ages (under 70), low-income groups, according to the CBS report.

The data published by the CBS also accounts for the relation between migration backgrounds and Covid mortality rates. There is little difference between all the Dutch regions in terms of corona deaths and income groups; the disparity is consistent in the whole country. However, death rates for people of non-western migration backgrounds, which were overall slightly higher than of residents of Dutch descent, were even more visible in urban areas, especially the three biggest cities Amsterdam, Den Haag and Rotterdam. And within those groups, there was an apparent prominence in specific migration backgrounds, such as those of Turkish and Surinamese descent, as opposed to residents of Moroccan or Antillean background; for them, the risk was roughly the same or lower than for populations with Dutch backgrounds.

The CBS report explains the links between low-income groups and higher mortality rates as unsurprising, given the fact that this phenomenon was noted already before the Covid-19 pandemic. For the corona crisis, the higher death rate may be explained by a sum of differentiating factors in lower-income groups, including lifestyle (more smoking, less exercise, unhealthier diets and higher obesity rates), smaller housing and the fact that people with a low income are more often employed in sectors where it is not possible to work from home or to properly adhere to the corona measures at work.

Still, the CBS report emphasizes that is not yet possible to formulate unambiguous explanations and conclusions, given the fact that there could be many variables at play, and that populations with non-western migration backgrounds are not one single homogeneous ethnic group, but several populations with their own diverse traits and therefore there may be many different possible explanations for health variables. Maria van den Muijsenbergh, professor of Health Inequalities at Radboud University Nijmegen, suggested in De Volkskrant that, besides variables of income and lifestyle, there could be a certain degree of inability in the healthcare system to connect with patients from different cultures.

In any case, and regardless of the possible causes, the report paints an accurate picture of the existing link between health problems, death rates and income levels in the country. Beyond mortality, the CBS warns that health costs go further than death for a high number of patients, and this could potentially lead to “greater socioeconomic inequality among those who have not died from Covid-19”. While the CBS report only includes the first wave of the pandemic in 2020, further research is still needed to analyze the following waves, for which the Netherlands was better prepared. At the same time, more research is needed to evaluate potential future health problems linked to income disparities, especially since the global income gap is becoming ever wider than before the pandemic.

Written by Juan Álvarez Umbarila