Emerging evidence regarding the clear link between poverty and Covid-19 is as predictable as it is heartbreaking. National Records of Scotland data has revealed that people living in the most deprived areas of Scotland are more than twice as likely to die with Covid-19 than those living in the least deprived areas.

Inverclyde, the most deprived council area, has the highest death rate. It is clear that political claims that the pandemic is the ‘great equalizer’ are unfounded. Rather, the structural determinants of health – and death – are being starkly exposed and exacerbated.

There are many reasons for the association between higher levels of deprivation and increased mortality from Covid-19. People who are experiencing poverty are disproportionately affected by multiple chronic diseases such as high blood pressure, diabetes and respiratory diseases. This increases their vulnerability to infection from the virus.

Read more: Coronavirus: Police officers are stopping drivers travelling from England to Scotland

It is also the lowest paid members of our workforce - the cleaners, health and social care assistants, delivery drivers and supermarket workers - who increase their exposure to the virus daily when they leave their homes to undertake the essential work which enables the rest of us to remain sheltered at home.

Dense urban areas and crowded accommodation make it difficult to practice social distancing. Intersecting inequities must also be considered given the truly shocking burden of infection – and death – being faced by Black and Minority Ethnic people, particularly in deprived innercity areas. Overall, it is clear that those who are being most impacted by this virus are those who can least afford to weather it.

People living in areas of deprivation are likely to be struggling to access timely and appropriate healthcare. Indeed, there is significant and robust evidence to show that – even outside a pandemic - they have worse access to health services than those who live in more affluent areas. This has been termed the ‘inverse care law’: the ironic fact that those who most need health services are the least likely to have rapid access to them.

Read more: Coronavirus outbreak sees ten residents die at Bearsden's Mugdock House Care Home

Whilst data are yet to emerge, it seems probable that the pandemic is exacerbating existing inequities at the end of life. We know that people who live in areas of high deprivation are less likely to access specialist palliative care services such as hospice. They may be less likely to get GP support because, as the inverse care law shows, GPs in deprived areas are much busier.

They are also less likely to die at home which is where most people in the UK would prefer to die. Evidence of these inequities has provided the impetus to our current research project– Dying in the Margins – which looks at how experiences of poverty can affect people’s ability to die at home. We are partnering with the Deep End Group, a network of GP surgeries serving the 100 most deprived areas in Scotland. Currently, policymakers and the public have very little insight into what it is like to be dying while also experiencing serious financial hardship and living in a deprived area.

Health service access is only one aspect of end of life experience. Most of the care we receive at the end of our lives is provided by family members. However, carers in families experiencing poverty are more likely to be suffering ill health themselves. Family members whose work is low paid and insecure, or who have been made unemployed as a result of the lock down, may find the pressures of looking after a dying family member too much to bear.

Housing stock in deprived areas can be sub-optimal. There can be issues with damp, drafts and mould. Each year poor housing conditions leads to an excess of winter deaths, particularly for older people. There is also insecurity and uncertainty to contend with.

Those with less financial means are much more likely to live in rental accommodation or temporary social housing where they can be asked to move at a month's notice. More people than ever will be struggling to pay their rent as unemployment skyrockets. This is one reason why UK food banks are reporting unprecedented demand. A damp, cold house with little food in the fridge is unlikely to be a pleasant place to live, let alone die.

Covid-19 has brought both health inequities and death and dying into the political spotlight. Statistics showing that areas of high deprivation suffer higher mortality rates from Covid-19 are a stark reminder of the social determinants of health.

Ensuring people have good experiences at the end of life is not just about optimizing health services or accessing palliative care – although this is important. Tackling the social determinants of dying – addressing food insecurity and fuel poverty, improving housing stock and financial support for family carers – are more important now than ever. Afterall, dying has always been a social, rather than a purely medical experience.

Dr Naomi Richards is a Lecturer in End of Life Studies at the University of Glasgow