How we can shape #BuildBackBetter

Share Line

Twitter COVID-19, LongITools and #BuildBackBetter. The links and lessons between a global pandemic and our #Horizon2020 research project. #exposome


In late 2019, a Coronavirus “COVID-19” had surfaced in Wuhan, located to the East of China. What followed has been a devastating battle against a global pandemic, reaching to every corner of the world and changing life as we knew it.

In Europe, the disease officially hit major countries by the end of January, with the first deaths in February. By March, it was clear that Europe had to act, and what followed was sporadic ‘lockdowns’ as some European nations followed the approach taken in Asia, by closing industry and telling people to stay at home. As the world still grapples with the pandemic, the spread to the Global South and the threat of a second wave, the term “Build/Building Back Better” has dominated what recovery should look like. Coinciding with the world’s ongoing climate, biodiversity and ecological crisis, there are lessons we can learn to build a better planet, and lessons LongITools will help uncover.

If COVID-19 has taught us one thing, it is that the interconnectivity between the external exposures of our environment (built environment, air pollution, socio-economic deprivation, lifestyle choices such as smoking, diet and access to physical activity) has led to unequal health outcomes to COVID-19. But measures such as lockdown and the reopening of places, have opened the eyes to the possibility of what is achievable in creating healthy and attractive spaces. There is a real opportunity to Build Back Better.

There is growing consensus that air pollution exposure is linked to higher COVID-19 cases. Analysis undertaken by the World Economic Forum analysed the link between fine particulate matter and cases in the Netherlands. The study found that if areas with the highest amount of fine particulate matter had the same amount as the areas with the lowest, there could have been 83 fewer cases, 24 fewer hospital admissions and ultimately 19 fewer deaths.1 Similar studies conducted from data in Northern Italy,2 and the United States3 showed comparable results.

But lockdown saw a decrease in the amount of air pollution within places. With people staying at home and planes grounded, there is considerable evidence that the amount of nitrogen dioxide pollutants, commonly linked to transport, had vastly reduced.4 With the easing of lockdowns, urban centres have restricted the access of vehicles, instead using street spaces to enable the hospitality industry to reopen. And office workplaces are realising the power of working from home. The evidence of starting to Build Back Better is there. However, policy needs to ensure a balance. Working from home is great if you have the space, reliable internet and a garden. Swapping car park spaces for bar outdoor seating creates vibrant places, but could it risk an increase in alcohol related health problems?

There is also evidence of the link between cardiovascular and metabolic diseases and COVID-19. Patients with COVID-19 who also have cardiovascular diseases are at higher risk of morbidity and mortality.5 There is also a link between general obesity-related diseases and the hospitalisation of individuals with COVID-19.6 The UK government, for example, have recently responded to this with a new Obesity Strategy.7

What lessons will LongITools help us learn from the pandemic?

It is therefore clear that both external environmental factors and pre-existing health conditions play a part in the inequality of COVID-19. This is where the LongITools can help uncover other lessons. Through analysis of the interplay between external environmental factors and how they react with internal biological factors to increase the risk of cardiovascular and metabolic diseases. The findings, and therefore policy options for intervention across different stages of the life course to prevent this increased risk can have valuable lessons for our COVID-19 recovery.

The main aim is to align health in all policies approaches to develop interventions to reduce the link between those external factors and cardiovascular and metabolic diseases. In doing so, interventions from LongITools, focused on air pollution and the built environment for example, could provide better health protection against coronaviruses  in turn reducing the number of people at risk of increased mortality if another coronavirus hits. Whilst LongITools may be a five-year project, its findings will contribute to Build Back Better for long-term health and policy improvement.

When we look to Build Back Better, it is crucial to use these lessons to understand and respond to the interplay between different factors and health inequalities. The world has given us a wakeup call. It’s time to answer it.

by Mitchell Salter




2Environ Pollut. 2020 Jun; 261: 114465. doi: 10.1016/j.envpol.2020.114465.

3Rachel C. Nethery, Benjamin M. Sabath, Danielle Braun, Francesca Dominici. Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study. 

4 and

5Circulation. 2020;141:1648–1655. DOI: 10.1161/CIRCULATIONAHA.120.046941 and Int J Cardiol. 2020 Jul 1; 310: 167–168. doi: 10.1016/j.ijcard.2020.03.074.