This year, the MWF Katherine Branson Essay Prize had an outstanding level of entries from medical students across the country. We have chosen to feature all entries on our website as they are all written to a very high standard.
Here are some entries on the essay title:
COVID-19 has thrown a stark light on inequalities in healthcare. What are the challenges that we face and how can we tackle these to move towards a more diverse and inclusive society, that’s fit for the future?
Entry 1 : Written by Zina Alkaisy
‘This disease is not a great leveller’. Emily Matlis’ powerful summation of the effects of COVID-19 back in April 2020 are still ringing true today. The pandemic has amplified the many health inequalities that already existed within our society, leading to disastrous consequences for many communities. At present, public health policy is largely reactive and attempts to address the issues we face downstream. We need to reframe our approach and establish a health infrastructure that empowers us all to live better.
COVID-19 has shed light on the many modifiable factors that contribute to poor health in our population, among which obesity is the most pertinent for our population. Evidence shows that obesity is a significant risk factor for severe COVID-19 disease and death; with the risk increases progressively alongside BMI increases . It’s no secret that people in more deprived parts of the country have faced a significant increase in obesity rates compared to those in the wealthiest areas . Furthermore, data shows that people in the most deprived areas are more than twice as likely to be admitted to hospital for obesity-related health problems; with women faring particularly poorly. A fruit and vegetable (F&V) subsidy alongside an educational campaign would improve access to and knowledge of healthy eating without stigmatising lower income groups; as may be the case with a voucher scheme. A voucher scheme in this scenario would be inadequate as vouchers can lead to users feeling embarrassed or ashamed, do not account for migration or movement of users and most importantly suggest that healthy eating is something only low-income populations struggle with; but data shows this is not the case. A subsidy sends a clear message that easier access to F&V should be a priority for everyone, not just small sections of our society. I am pursuing this policy with my local elected official in Northern Ireland as I believe it could lead to positive, long-lasting change for people’s health across the region.
There is a wealth of data to show that healthy pregnancies improve outcomes for future generations and yet women are disproportionally affected by socioeconomic inequalities, which in turn impacts their health and that of their children . In fact, over the past decade female life expectancy has fallen in areas of high deprivation in England. However, pregnancy offers a unique opportunity to address inequalities in health due to ongoing contact with healthcare professionals during this period. The benefits of physical activity for both mother (improved mood, cardiovascular function, and reduced risk of GDM) and baby (reduced fat mass and improved stress tolerance) are countless  and yet many pregnant women do not get the recommended 150 minutes of moderate intensity exercise with 2 strength training sessions per week . By building on the work done by organisations such as Moving Medicine and the Active Pregnancy Foundation, healthcare professionals can support pregnant women in making positive decisions regarding their wellbeing. If the tools freely provided by the aforementioned organisations were more widely utilised and incorporated into undergraduate curriculums across health disciplines, preventative practice in maternity care could be the new norm. Exercise is a vital component of our overall health but people from lower socioeconomic backgrounds face greater barriers when seeking to prioritise physical activity. By working with pregnant women, often a highly motivated group, the democratisation of exercise edges closer. Women will be empowered to form habits that their children will then mirror, thus closing the gap on health inequalities in our communities.
These are just two examples of the many initiatives we can champion to address inequalities in health. It's important to recognise that the solutions to these issues are not outside of our grasp; in some cases the bulk of the groundwork has already been laid and projects simply need investment and promotion from relevant bodies in order to succeed.
For our society to be fit for the future, it requires a contribution from all of us. Everybody deserves a seat at the table and to feel that their health and wellbeing matter. We can achieve this through acknowledging where we have gone wrong, making positive changes to remedy historical errors and supporting our communities throughout this process.
A policy and campaign manager from the Non-Communicable Disease Alliance described the pandemic as “a wrecking ball, revealing how interconnected health conditions and the determinants of them are” . We now have a once in a generation opportunity to rebuild and it’s imperative we take advantage of it.
- Public Health England. Excess Weight and COVID-19: Insights from new evidence. London: Public Health England; 2020. Available online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907966/PHE_insight_Excess_weight_and_COVID-19__FINAL.pdf
- The King's Fund. New analysis reveals stark inequalities in obesity rates across England [Internet]. 2021. Available online: https://www.kingsfund.org.uk/press/press-releases/new-analysis-stark-inequalities-obesity-england
- Thomson K, Moffat M, Arisa O, Jesurasa A, Richmond C, Odeniyi A et al. Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis. BMJ Open. 2021;11(3):e042753.
- Melzer K, Schutz Y, Boulvain M, Kayser B. Physical Activity and Pregnancy. Sports Medicine. 2010;40(6):493-507.
- Department of Health and Social Care. (2019). UK Chief Medical Officers’ Physical Activity Guidelines. Retrieved from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf
- Senthilingam M. Covid-19 has made the obesity epidemic worse, but failed to ignite enough action. BMJ. 2021;:n411.
Entry 2 : Written by Hannah Neitzel
It has been over two years since the COVID-19 pandemic started. On the 9th January 2020, the WHO reported that the cluster of cases of pneumonia in Wuhan is due to a novel coronavirus. Not only have millions of lives been lost, but the inequalities of the healthcare industry have been cruelly highlighted. The cause for these inequalities has been widely discussed and many have come to the same conclusion: socioeconomic differences encourage healthcare inequality.
The COVID-19 pandemic is not the first pandemic the world has seen. Edgar Sydnstricker investigated the incidence of the 1918 influenza epidemic and reported that both mortality and morbidity was significantly higher in groups classed as “poor” or “very poor” compared to those that are “well-to-do”. This finding stands in contrast to the statement “the flu hit rich and poor alike”, which he described as commonly used2.
Over a 100 years later, we are all too familiar with phrases such as “we’re all in this together” or “only together can we get through this pandemic” uttered by politicians on repeat. But we aren’t really: cases were highest amongst people living in deprived areas and in the second wave, low-income households were affected more than higher income ones. Has there been no progress in the last 100 years?
Education may be the biggest factor contributing to socioeconomic differences. Poor education can take various forms: large class sizes preventing students from learning at their own pace, inability to afford extra tutors or a lack of resources for students with learning disabilities. These factors lead to disadvantages when compared to students that had access to extra resources. Not only are individuals limited in their job and income opportunities, but the consequences of earning less money may result in poorer housing, more stress and an inability to relocate. This ultimately leads to an increase in mortality and morbidity for diseases that are only represented in mild forms in high income groups6.
A lack of quality education contributes to a reduced understanding of preventative measures and symptom presentation. Many patients from low income households present to healthcare services at a more advanced stage of illness compared to high income groups. This is due to the lack of knowledge about prevention and screening services such as vaccinations, as well as the inability to access specialised care.
Lastly, it is worth noting that poorer education may be a predictor of conspiracy beliefs resulting in mistrust of the government and ‘elites’ and their recommendations. This manifests in nonadherence to treatments and refusal of public health measures such as vaccinations. Indeed, the willingness to receive the COVID-19 vaccine was lower in low income groups.
Socioeconomic differences as a result of differences in quality of education do not only lead to health inequalities, but to a divide in society. Deprived areas lack financial opportunity and long term development, stopping high income earners from relocating there. Distrust in elites and financial barriers prevent low income families from moving to areas providing better opportunities. This prevents mixing of people from different backgrounds and contributes to an “us and them” mindset that breeds stereotypes and stigma, ultimately leading to a less diverse and inclusive society.
It is crucial to impose radical measures that improve inequality in education and subsequently socioeconomic differences. Increased funding has to be allocated to schools in deprived areas. This subsidy should be used for employing extra staff and training staff in helping students with applications for jobs and higher education programs. Funding should be used to provide counselling and personalised career advice. Counselling will help students that struggle with attendance and academic performance due to family problems, as well as promote self-confidence and mental health awareness.
Encouraging relevant companies to create apprenticeships instead of requiring university degrees, shifts the focus from academic ability to interpersonal skills which are less directed by the quality of education. Incentives should inspire companies to recruit in deprived areas and offer widening access programs into the industry.
Incitements to move to deprived areas should be provided. This could consist of specialised healthcare or providing spaces for cultural programs such as theatres or festivals.
These measures improve fundamental quality of education, allow better access to job opportunities and financial stability and allow deprived areas to thrive. By encouraging relocation, high and low income groups are being brought together leading to a mix of culture and backgrounds and creating a more united and diverse society. Considering the recent pandemic, it is more important than ever to be able to request help and support from those around you. Only by creating equal opportunity can we eradicate mistrust and animosity between social groups and strive towards a society fit for the future. Although this will be a slow process, we cannot allow another 100 years to pass before health equality is achieved.
 Who.int. 2020. Listings of WHO's response to COVID-19. [online] Available at: <https://www.who.int/news/item/29-06-2020-covidtimeline> [Accessed 4 March 2022].
Sydenstricker, Edgar. 1931. "The Incidence Of Influenza Among Persons Of Different Economic Status During The Epidemic Of 1918". Public Health Reports (1896-1970) 46 (4): 154. doi:10.2307/4579923.
 Larsen, Tim, Matt Bosworth, and Vahe Nafilyan. 2021. "Coronavirus (COVID-19) Case Rates By Socio-Demographic Characteristics, England: 1 September 2020 To 25 July 2021". Office for National Statistics.
 Patel, J.A. et.al., 2020. "Poverty, Inequality And COVID-19: The Forgotten Vulnerable". Public Health 183: 110-111. doi:10.1016/j.puhe.2020.05.006.
 Cookson, Richard, Carol Propper, Miqdad Asaria, and Rosalind Raine. 2016. "Socio-Economic Inequalities In Health Care In England". Fiscal Studies 37 (3-4): 371-403. doi:10.1111/j.1475-5890.2016.12109.
 Adam-Troian, Jais, Maria Chayinska, Maria Paola Paladino, Özden Melis Uluğ, Jeroen Vaes, and Pascal Wagner-Egger. 2021. "Of Precarity And Conspiracy: Introducing A Socio-Functional Model Of Conspiracy Beliefs". doi:10.31234/osf.io/mnfrd.
 Hyland, Philip, Frédérique Vallières, Todd K. Hartman, Ryan McKay, Sarah Butter, Richard P. Bentall, and Orla McBride et al. 2021. "Detecting And Describing Stability And Change In COVID-19 Vaccine Receptibility In The United Kingdom And Ireland". PLOS ONE 16 (11): e0258871. doi:10.1371/journal.pone.0258871.
Entry 3 : Written by Chloe Lee
The crisis response to the coronavirus pandemic has brought to light the gendered inequality in the health, financial security, familial dynamics, and safety of women in contemporary society. The gendered-based inequity of healthcare is influenced by pre-existing societal gender biases. This essay will examine how these inequalities materialise in healthcare and will recommend strategies to strive for a more inclusive healthcare system and society.
COVID-19 has exposed gender-based imbalance in the susceptibility of contracting the virus. Amongst society, women are valued as mothers and carers, with gendered stereotypes directing female employment into health and social care sectors (Blundell et al., 2020). Women represent “70% of the health and social workforce” worldwide (Su et al., 2021:90), this occupational hazard exacerbates the vulnerability of women to infection (Wenham, 2020:846). Underlying prejudicial processes encourage women into roles that increase their risk of exposure to COVID-19, as Su et al. report that of the positive cases amongst US healthcare workers, 73% were women. Due to behavioural distinctions, health outcomes from coronavirus also have clear variations between genders. Research has ascertained that morbidity and mortality rates from COVID-19 are greater amongst men, this may be attributed to biological factors (Marik et al., 2021:816), and more engagement in risky behaviours, i.e. smoking, and non-compliance with preventative measures, i.e. mask-wearing, (Ya’quob, 2021). There are distinct outcomes for women who survive the infection as they are at greater risk of suffering long-term COVID-19 complications, such as lethargy and dyspnoea (Ya’qoub, 2021). This demonstrates the clear gender distinctions in contracting transmissible diseases and direct health outcomes.
Women’s health is directly vulnerable during the pandemic, but there are also indirect health implications to consider. As healthcare services have been strained to meet the demands of a global pandemic, women’s sexual and reproductive health services have suffered as a result. Chmielewska et al. report a global reduction in access to prenatal care, reduced attendance to appointments, reduced clinic numbers, and redeployment of maternity staff have resulted in greater unplanned pregnancies, pregnancy loss, and maternal mortalities during COVID-19 (2021). There is evidence of gender-based health inequities during the pandemic, however, it is important to apply an intersectional approach in analysing the data. There exists a disparity in health outcomes between individuals within a gender, “88% of pregnant women who died during the first wave of the pandemic were from black and minority ethnic groups” (Chmielewska et al., 2021). Therefore, it is important to avoid generalising the health of genders as a whole; Black women are reported to be at a higher risk of mortality due to prevalence of pre-existing comorbidities, greater representation of healthcare workers, and pose a greater risk of economic instability due to ongoing social inequalities (Chandler, 2020:2). This shows that several variables contribute to the inequality of healthcare.
Other key considerations this pandemic has posed on the gender-based health inequities are the consequences of the multiple government-sanctioned quarantines. The existing emergency of violence towards women and girls, for example, domestic violence, has seen a surge in the number of reported cases as the pandemic has restricted individuals to confined quarters. The UN Women have reported an alarming increase in the global reports of gender-based violence by 25% (UN Women, 2020:17). This figure will only reflect those able to report their cases as many women have struggled to contact support organisations, networks, or the police. In Italy alone, a domestic violence helpline reported a reduction in calls by 55% within the first two weeks in March (UN Women, 2020:4). COVID-19 has exposed the significant direct and indirect gender health implications, but how should we address these inequities to improve inclusivity in healthcare?
There are several strategies that should be adopted to promote diversity and tackle these gendered health inequalities. There needs to be greater representation of women of differing backgrounds in the workforces which tackle the COVID-19 response and policymaking (Wenham, 2020:847). Women can provide detailed insight into the inequities in health and social care, as they represent the majority of keyworkers, to address preventative and response measures in further outbreaks. Chandler suggests addressing intersectionality by forming smaller, community-based organisations (2020:11) to open a dialogue with minority groups to discuss issues concerning their community as their representation is currently neglected. Women’s social and health services require greater funding to improve outreach to women through online helplines and increase the availability of space in shelters and place emphasis on mental health services to support keyworkers and women who experience violence (UN Women, 2020:7). To provide evidence of gender disparity in healthcare, there needs to be reliable sex-disaggregated data collected to demonstrate how women are disadvantaged both in their health and social safety during COVID-19. We must learn from this pandemic to ensure the same mistakes are not repeated and to promote diversity and inclusivity both in society and in healthcare.
- Blundell, R., Costa Dias, M., Joyce, R. and Xu, X., 2020. COVID‐19 and Inequalities. Fiscal studies. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362053/ [Accessed: 27 February 2022]
- Chandler, R., Guillaume, D., Parker, A.G., Mack, A., Hamilton, J., Dorsey, J. and Hernandez, N.D., 2021. The impact of COVID-19 among Black women: evaluating perspectives and sources of information. Ethnicity & health, 26(1), pp.80-93. [Online] Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542278/pdf/nihms-1748466.pdf [Accessed: 28 February 2022]
- Chmielewska, B., Barratt, I., Townsend, R., Kalafat, E., van der Meulen, J., Gurol-Urganci, I., O'Brien, P., Morris, E., Draycott, T., Thangaratinam, S. and Le Doare, K., 2021. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. The Lancet Global Health, 9(6). [Online] Available at: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00079-6/fulltext [Accessed at: 21 February 2022]
- Marik, P.E., DePerrior, S.E., Ahmad, Q. and Dodani, S., 2021. Gender‐based disparities in COVID-19 patient outcomes. Journal of Investigative Medicine, 69(4), pp.814-818. [Online] Available at: https://jim.bmj.com/content/jim/69/4/814.full.pdf [Accessed: 4 March 2022]
- Su, Z., Cheshmehzangi, A., McDonnell, D., Šegalo, S., Ahmad, J. and Bennett, B., 2022. Gender inequality and health disparity amid COVID-19. Nursing outlook, 70(1), pp.89-95. [Online] Available at: https://reader.elsevier.com/reader/sd/pii/S0029655421002025?token=912184C7B9000CB1F590049685227034516CF0D005F0715DB4B7E2432FF16FFFD96A118A1D07020CFF65F99020779D3D&originRegion=eu-west-1&originCreation=20220306195022 [Accessed: 21 February 2022]
- UN Women, 2020. COVID-19 and Ending Violence Against Women and Girls, UN Women, pp.1-9. [Online] Available at: https://www.unwomen.org/sites/default/files/Headquarters/Attachments/Sections/Library/Publications/2020/Issue-brief-COVID-19-and-ending-violence-against-women-and-girls-en.pdf [Accessed: 2 March 2022].
- UN Women, 2020. Policy Brief: The Impact of COVID-19 on Women. [online] UN Women, pp.2-21. Available at: https://www.un.org/sexualviolenceinconflict/wp-content/uploads/2020/06/report/policy-brief-the-impact-of-covid-19-on-women/policy-brief-the-impact-of-covid-19-on-women-en-1.pdf [Accessed: 2 March 2022].
- Wenham, C., Smith, J. and Morgan, R., 2020. COVID-19: the gendered impacts of the outbreak. The lancet, 395(10227), pp.846-848.
- Ya'qoub, L., Elgendy, I.Y. and Pepine, C.J., 2021. Sex and gender differences in COVID-19: More to be learned!. American Heart Journal Plus: Cardiology Research and Practice, 3. [Online] Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045422/ [Accessed: 24 February 2022]