Pre-existing social inequalities contributed to the UK recording the highest death rates from Covid in Europe, a leading authority on public health has said, warning that many children’s lives would be permanently blighted if the problem is not tackled. Sir Michael Marmot, known for his landmark work on the social determinants of health, argued in a new report that families at the bottom of the social and economic scale were missing out before the pandemic, and were now suffering even more, losing health, jobs, lives and educational opportunities. In the report, Build Back Fairer, Marmot said these social inequalities must be addressed whatever the cost and it was not enough to revert to how things before the pandemic. “We can’t afford not to do it,” he said. “It is simply unacceptable that we say it’s OK for children to go to bed hungry … we’ve got some incorrect notions about the necessity of austerity … What is the society we want? We want to guarantee the health and wellbeing of all members and the fair distribution of health and well being. We simply can’t afford not to do it. The government debt is no excuse. We know that is incorrect understanding of economics.” He painted a grim picture, underscored by statistics that showed the most-deprived families are worst hit. Men and women living in overcrowded conditions in the most deprived areas of the country are the most likely to die from Covid. Carers and those who work in the leisure and service industries have the highest death rates under the age of 64. People from black, Asian and ethnic minority groups who work as taxi drivers, bus drivers, security guards, carers and other low-paid occupations have a higher risk of death. Children and young people living in deprived areas had suffered disproportionately from lockdown, he found. “One of the effects of the pandemic was to increase the educational divide,” said Marmot. In the least deprived schools, few children were behind as a result of closures. In the most deprived, children were reported as four to six months behind. There had been “dramatic increases in food insecurity”, he said, and high rates of unhappiness or depression, particularly among young people. Young people were also at greater risk of losing jobs in the pandemic. Marmot was fiercely critical of the government, which had failed to act on his report in February showing austerity policies had already damaged health and cut life expectancy in England. “Before the pandemic, life-expectancy increase had stalled, inequalities were increasing, and life expectancy for the poorest people was going down,” he said. “That was a measure that society wasn’t doing well. And then the high excess mortality during the pandemic is simply a measure of society not doing well.” The recommendations from his report addressed the reasons, he said, relating to governance and political culture as well as the widening gulf between those who have power, money and resources and those who do not. “We have to reverse the reduction in spending on public services – as I said we were ill prepared. We were unhealthy coming into the pandemic. Which means that we have to put the fair distribution of health and wellbeing at the heart of all government policy.” Funding for public health had been slashed during the austerity years. “The budget for Public Health England was cut after its foundation in 2012 by 40% and the spending on public health in local government was cut by about £800m. “So back in February/March, when we should have been setting up a national test, trace and isolate system, public health should have organised it,” he said. But it did not happen that way. First of all, the policy was not to do it at all, he said, and then it was to hand it to a private company “and it doesn’t matter if the person running it doesn’t have any expertise, because we know private solutions are always better than public solutions so we’ll give it to the private sector to manage. “Colossal error. We should have used public health, local public health – fund them properly, get them to do it.” Jennifer Dixon, the chief executive of the Health Foundation, said there was no doubt the pandemic would be taking a toll for years to come. “Mitigating the damage caused by the pandemic to education, employment and income must be at the heart of the government’s plans for recovery and levelling up. “For young people, this means practical help to find employment and training to access better quality jobs. As we rebuild, these measures are vital to ensure that the generation of young people who have lived through the pandemic don’t continue to feel its impact on their health throughout the rest of their lives,” she said. “It is absolutely unacceptable that in a country of such means there is such a strong divide between the richest and poorest in society. This report should serve as an important call to action for the government to invest in the health of this nation in the long term as, in these challenging uncertain times, closing the gap has never been more important,” said the BMA board of science chair, Prof Dame Parveen Kumar.