On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a global pandemic. With over five million infected people and more than 343,000 casualties across 213 countries (World Health Organization 2020b) so far, the crisis has become the most devastating challenge in recent history (Raoofi et al. 2020). Although COVID-19 is a viral disease, a variety of non-biological factors, particularly health inequalities and the social determinants of health (SDH), can affect its prevalence and consequences within communities.

Health equity and addressing SDH are the cornerstone value of any health system (The Lancet 2020). SDH are the non-medical factors that influence health outcomes. Where individuals live, the level of education, work conditions, career, age, along with socioeconomic status and race, all have a tremendous influence on their health status (World Health Organization). The social gradient in the proportion of life spent in ill health is significant, “with those in poorer areas spending more of their shorter lives in ill health” (Marmot 2020). Even in countries like England with a world-known equitable national health system (Mossialos et al. 2017), inequalities in life expectancy have widened and life expectancy fell in the most deprived communities, while the amount of time spent in poor health has increased in the last decade (Marmot 2020; The Lancet 2020). As a result, “the country has been moving in the wrong direction”, and “lives for people toward the bottom of the social hierarchy have been made more difficult.” (The Lancet 2020).


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