Poor people were hit hardest by Covid – and poor people living in the north of England were hit hardest of all – because of government cuts to health services in the years leading up to the pandemic, experts have said. The worst affected were poor people in northern England from minority ethnic backgrounds, said Prof Sir Michael Marmot as he gave evidence to the independent Covid inquiry on Friday. He added that based on previous pandemics and research, this was “entirely predictable” but that the government had failed to learn or listen. “The UK entered the pandemic with its public services depleted, health improvement stalled, health inequalities increased and health among the poorest people in a state of decline,” he said. Until 2010, life expectancy in the UK had been increasing at about one year every four years. This trend had continued for all of the 20th century. But in 2010 there was a break in the curve, said Marmot. “The rate of improvement slowed dramatically and then stopped improving,” he said. The 2010 reduction in improvement was more marked in the UK than in any other rich country except Iceland and the US, he said. “That’s really dramatic.” The second issue, he added, was that the “social gradient in health got steeper, so the inequalities got bigger, and particularly for people from the north-east. “What we saw was a decline in life expectancy for people in the bottom 10% of deprivation in every region of the country,” he said. “I can’t overstate it. It’s really shocking to those of us in the health field, as well as to ordinary people.” Marmot also found that the funding of the healthcare system was inadequate after 2010. “Pre-pandemic, the number of people waiting for NHS treatment was already twice as high as it had been in 2009. There were already vacancies for doctors and nurses, putting great pressure on existing staff. And there was already real concern over pay for doctors and nurses: before the cost of living crisis nurses’ pay had gone down by 5% over the period from 2010.” Marmot was particularly critical of the government’s decision to cut health spending more in poorer areas than in wealthier ones. “The greater the deprivation of the area, the steeper the cuts in social care spend,” he said. “In the most deprived 20% of areas, it went down by 32%. In the least deprived, it went down by 3%. “Now, arguably, the greater the deprivation, the greater the need,” he added. Prof Clare Bambra, who also gave evidence, said Covid “acted synergistically with existing social, economic, and health inequalities to exacerbate and amplify the impacts of the pandemic but also the impacts of those existing inequalities.” She added: “People were unequally exposed to the virus. For example, key workers, many of whom are from minority ethnic groups.” Bambra said the government failed to learn from previous pandemics and research that showed people from lower socioeconomic backgrounds and people living in areas or regions with higher rates of deprivation, and people from minority ethnic groups and those with disabilities were much more likely to be severely affected by a respiratory pandemic. “A lack of consideration of pre-existing social and ethnic inequalities in health in our pandemic plans may have meant that our responses were unable to mitigate the disproportionate impact experienced by minority ethnic low socioeconomic status, and other socially excluded communities,” she said.