Covid-19 is still worsening health inequality. Why hasn’t anything been done?

Covid-19 is still worsening health inequality. Why hasn’t anything been done?

Covid-19 is still worsening health inequality. Why hasn’t anything been done?

Infection rates are creeping up again in the UK, but six months of failures have left little protection for the most vulnerable

The first wave of Covid-19 threw the UK’s existing health inequalities into stark relief. Black people were most likely to be diagnosed with Covid-19, and people from a Bangladeshi background were twice as likely to die from the virus compared with white British people. The Public Health England (PHE) review has only confirmed what we all knew anecdotally: Covid-19 hit the black and minority ethnic (BAME) population very hard, both in the community and among healthcare staff.

Now infection rates are creeping up again, and weekly data shows ethnic minority communities are once again being disproportionately affected by the virus. And yet nothing appears to have been done to reinforce their protection: there is silence from the government as to how and when it will implement PHE’s review recommendations.

We need urgent action to tackle the structural inequalities affecting these communities. If we fail, we risk sleepwalking into a nightmare version of Groundhog Day, witnessing another significant and disproportionate rise of Covid-19 related deaths among ethnic minority communities.

Health inequality goes back a long way. We’ve known for a long time that some BAME doctors, nurses and healthcare assistants in the NHS receive poorer treatment than their colleagues. This is a well-documented phenomenon backed by decades of research. During the first wave, ethnic minority staff had worse access to PPE, more trying shift patterns and greater exposure to Covid-19 patients. The recent surveys of staff by the British Medical Association and Royal College of Nursing lend credence to the fact that BAME staff continue to suffer from a lack of PPE. Too little was done to combat this in the years before the virus struck, and now we’re seeing the consequences of this neglect.

It is not just failed policy initiatives we have an abundance of, it’s laws too. In theory the UK has some of the most progressive laws on equality in the world. We have the Equality Act 2010, the public sector equality duty and equality impact tools, but none were evident in the government’s Covid-19 action plan, published in March. Had they been applied, the government may well have taken a more sophisticated and tailored approach towards public health, rather than the “protect the NHS” position that was adopted.

The original government action plan didn’t appear to focus very much on preventing people getting the virus. The government response of “people will get ill, we need to protect NHS” translated into political messages of “take it on the chin”, and “we need herd immunity”. It was a medical approach, not a public health approach, and it ignored existing inequalities and specific community sensitivities. Inevitably those on lower incomes, in more crowded housing and with long-term health issues suffered the most. This explains the high and disproportionate death toll in many ethnic minority communities.

Instead of protecting the NHS we should have focused our efforts on stopping people getting ill in the first place, with resources directed towards PPE for all public-facing workers (or those unable to work from home) and localised testing, tracing and support. Instead we’ve ended up in this tragic situation, with such a high number of potentially avoidable deaths. Have any lessons been learned? It looks doubtful.

Many measures that are being introduced, although well-meaning, fail to take into account the different backgrounds of the UK’s diverse population – for example, the NHS contact-tracing app. This is a fine idea in itself, but we need to recognise that there is a digital divide in relation to healthcare. Research from my own institution, the University of Bedfordshire, shows that older people, lower socioeconomic groups and BAME communities are less likely to use phone or online healthcare services.

The government is ignoring the digital divide elsewhere, too. It is ushering in other questionable policies, such as triaging access to urgent care through the NHS 111 free-to-call phone line. This is in no doubt intended to stop Covid-19 spreading in hospital waiting rooms, but it is a huge risk to those same communities that research has consistently shown have difficulty accessing healthcare by phone and online. The move to combatting Covid-19 with apps and a shift to online healthcare heightens the risks of exacerbating health inequalities for older people and black and minority ethnic communities. We need meaningful public engagement that focuses on building trust and compassion with local communities. This is best led at local level.

What we need above all is accountability. The UK government used to have a minister for public health, but that role was abolished in 2016, coinciding with continuing disinvestment in the public health budget. We need to resurrect this lost ministerial role and ensure that protecting the public’s health and tackling inequalities in health are at the forefront of government policy development. In short, we’ve had enough inquiries, recommendations, and more than enough laws. What we need now are clear actions and government accountability to ensure that widening health inequality is not one of the principal outcomes of Covid-19.

 Gurch Randhawa is professor of diversity in public health and director of the Institute for Health Research at the University of Bedfordshire

Creative Commons Disclosure

This article was originally published in The Guardian Click here to view the news story.

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Covid-19 is still worsening health inequality. Why hasn’t anything been done?

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