In February this year, I was delighted and honoured to return to college to give the Robinson Lecture and meet this year’s scholars. I came to talk about my life and career as an epidemiologist. Over the past decade, I’ve given hundreds of talks and lectures, all over the world. But I’ve done none since that evening at Robinson, which happened just before the full implications of the coronavirus pandemic became clear, and just before we all went into lockdown, where we remain as I am writing now.
As a Professor of Epidemiology I get calls and emails from journalists every day now, asking me to comment on the COVID-19 crisis, journalists are putting ‘professor’ and ‘epidemiology’ into Google and finding me, but I’m not the kind of epidemiologist that they are (usually) looking for. I’m a social epidemiologist, researching the social determinants of health and wellbeing, and inequalities in wealth. With my husband, colleague and co-author, Richard Wilkinson, I’ve been studying and writing about the impact of inequalities in income – the gap between rich and poor – on physical and mental health, human capital development and social relationships. When we compare health across different rich, developed countries, there is no association at all between average levels of income or spending on health care and life expectancy or mortality rates. Yet within each of those countries there is a strong gradient in health by income; in the UK you can expect to live about 8 years longer if you live in the wealthiest areas than in the poorest. This paradox shows how important relative social status is for health – it’s not the material wealth you and your family own that protects health but the status and social benefits (including a good early childhood and positive social networks) that go with it.
An infinitesimally-small silver lining to the current pandemic is that more people, and crucially more politicians and policy makers, now understand the importance of epidemiology – the study of the distribution and determinants of health – and public health research and practice. And whilst it is the infectious disease epidemiologists and modellers who are assisting governments worldwide to respond to the immediate crisis, social epidemiologists will be crucial in understanding the longer-term impacts of the crisis, the responses to it, the oncoming economic recessions and depressions, and the routes to an inclusive recovery that could lead us to a much better new ‘normal’.
My work now has two strands, one local, one international. All areas of the UK are now covered by district Gold Commands, coordinating local responses to coronavirus across the NHS, local authorities and others. Along with wonderful, talented and committed colleagues, I’m a member of a COVID-19 Scientific Advisory Group reporting the Bradford & Airedale Gold Command, as I’m part of a large and multifaceted research programme called Born in Bradford. We’re helping Local Authority and NHS partners to define and identify vulnerable groups, supporting the development of COVID-19 Situation Reports and analysing emerging trends of COVID-19 patients, as well as modelling scenarios to inform health and care service planning. We’re also measuring the impact of the COVID-19 response (lockdown, social distancing, self-isolation, school closures, remote working etc) on communities and families. We’re surveying pregnant women and families with infants, pre-school and school-aged children to assess difficulties, both practical and psychological, during the lockdown. We’ll repeat these over the coming year to build a longitudinal picture of impact. We will also be assessing and modelling the wider, indirect impacts of COVID-19 on health and care services and on our populations, for example looking at the effects of postponement of planned surgical and medical treatment, reduced routine population screening and childhood vaccinations, knock-on effects on other illness and death rates and the health and wellbeing of people who survive infection with COVID-19.
Internationally, I’m working within several over-lapping networks, including the Wellbeing Economy Alliance and the Club of Rome to develop scenarios, policies and movements for change. The coronavirus pandemic will change our societies and economies in profound ways and, amidst all the terrible consequences, the crisis presents an opportunity and responsibility to rebuild our societies better. We have a chance to refocus our aims towards sustainable and inclusive prosperity and actually achieving the United Nations Sustainable Development Goals for 2030, rather than trying to go back to business as usual. One of those goals, and key to achieving the others, is to reduce inequalities. To make the transition to a just and sustainable wellbeing economy will mean recognising planetary boundaries, replacing the current focus on limitless economic growth and redesigning the world economy to balance natural, social, human and built assets. This is a movement in which we can all play a part.
In 2009 I helped to found, and now chair, The Equality Trust to educate and campaign for greater equality. We have local groups working across the UK, including a very active Cambridge group, Cambridge Commons. I hope you’ll visit some of the websites linked into this article and join me in taking action for change.
In terms of health, happiness and measures of wellbeing, my research suggests that rich countries have got to the end of the social benefits of economic growth and rising material standards. Further improvements in the real quality of life now depend more on the quality of social relations in society than on higher levels of consumption. The evidence suggests that by narrowing income differences we can improve the social and psychological well-being of the whole population, an exciting prospect when our need for public health resilience, new economic models and environmental restraints on growth are pushing in the same direction.
Kate Pickett (née Chapman) (1984) read Archaeology and Anthropology at Robinson, then studied for an MS in nutritional sciences at Cornell and a PhD in epidemiology at UC-Berkeley. She is now Professor of Epidemiology, Deputy Director of the Centre for Future Health, and Associate Director of the Leverhulme Centre for Anthropocene Biodiversity, all at the University of York. She is a Fellow of both the RSA and the UK Faculty of Public Health. She is co-author, with Richard Wilkinson, of the best-selling and award winning The Spirit Level (2009) and The Inner Level (2018). Kate is also a founder and Chair of The Equality Trust and a Global Ambassador for the Wellbeing Economy Alliance. She tweets at @ProfKEPickett.