Brexit, COVID-19 and climate change: mapping the impact of the ‘triple challenge’ on health and well-being in wales

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Coronavirus SARS-CoV-2 (COVID-19) pandemic The global pandemic has revealed the complex, interwoven relationships between health, well-being, equity, the economy, the environment, and society as a whole. In doing so, it has created new inequalities, but also exacerbated existing social and health inequalities and inequities (Dyakova et al. 2021; Marmot et al. 2020). High levels of morbidity and mortality have been witnessed across the world as a result of the pandemic, with the UK being particularly affected – both in terms of the impact on a range of specific vulnerable populations for example, older people and health and care workforces, but also in terms of the policies implemented to contain the virus (Institute for Fiscal Studies 2020; Public Health England 2020; United Nations 2021; Woodfine et al. 2021). This has resulted in major impacts for health determinants such as economic inactivity, education and mental well-being and for some populations for example older people and those from ethnic minority groups (Dyakova et al. 2021; Institute for Fiscal Studies 2020a, Public Health England 2020). Climate Change Climate change can affect positively or negatively health and well-being directly or indirectly through, for example, facilitating the amount of physical activity someone takes, their employment, health care services provision and infrastructure and the local environment (Watts et al. 2021). It can impact whole communities and residents in their entirety and dispersed populations, depending on the nature of extreme weather events such as flooding (Netherwood 2021). Children and young people may be affected, as well as those on low incomes and those in specific settings or employment, for example, farmers and agriculture workers (IPCC 2022; Netherwood 2021). Brexit Brexit affects not only the 66 million people who live and work in the UK and its devolved nations of Northern Ireland, Scotland and Wales, but also affects those who visit each year and who trade with the UK. Brexit can affect health and social care services and their workforces, the economy and lead to loss of access to funding to improve social and environmental infrastructure in communities (Fahy et al. 2017; UK Parliament, n.d.). It affects a wide range of population groups including non-UK EU residents, older people, those who work in industries highly exposed to trade and tariff barriers and men (Green et al. 2019).

Figure 1. Conceptual relationship between the three challenges and the wider determinants of health and policy making.

Figure 2. Methodological Process.

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Step 1: Screening – does the policy or plan have an impact on health and well-being? If so, who does it affect and how? Step 2: Scoping – what are the parameters of the HIA? How long will it take, what resources should it require, what are any deadlines, and what evidence should be gathered and appraised? Step 3: Appraisal – assessing the evidence gathered by synthesising it and analysing it to form a picture of impact. This evidence can include peer reviewed and grey literature, stakeholder evidence and routinely gathered statistics and data for example, government statistics and reporting. Step 4: Recommendations and reporting – construction of a report which includes the findings and any recommended actions that should be taken to maximise the positive impact and mitigate any negative impact Step 5: Review and reflection including monitoring and evaluation – this involves highlighting milestones to measure any changes in impact or if the predicted impacts were observed, reviewing the process and any impact which it may have had on decisions and future policies.

Figure 3. The triple challenge.

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Determinant: Healthcare service delivery Health Protection including intelligence, evidence, research and development Diet, alcohol, tobacco Types of employment Working conditions including health and safety and workers’ rights and equality Skills and employment Poverty – food, fuel, employment status Community, economic, and infrastructure investment for addressing inequalities Community infrastructure and resilience Divisions in communities Intergenerational relationships Environmental regulations Sustainable food supply, security, production Food security, cost, access, supply, and safety Transport and movement of people Mental well-being Access to services Communication and digital media Health and Social Care workforce including recruitment, retention New models of working

Population Groups: Those on low incomes Those at risk of unemployment/who are unemployed Children and young people/young adults Older People Black and Minority Ethnic Groups Those with existing health conditions including mental health and those in need of health and social care Those who need care in a community or acute setting Geographical groups – urban/rural settings Key occupations and critical workers including construction, outdoors workers such as farmers and health and social care services Coastal towns Immigrants, Refugees, and Asylum Seekers.

Figure 4. An example of the factors and impact of the triple challenge on environmental policy and regulations determinants of health and population groups.

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