Public Health England has admitted the Covid-19 pandemic has laid bare ‘humbling’ inequalities, as it finally published delayed recommendations on reducing black, Asian and minority ethnic (BAME) deaths.
The first report from PHE’s rapid review, published 2 June, confirmed that BAME people have a higher Covid-19 death risk in the UK but faced criticism for being ‘a whitewash’ after it emerged that 69 pages of stakeholder recommendations were omitted.
The review recommendations, which have finally been published today, outline seven key actions to mitigate the risks caused by health inequalities, including the mandatory collection of ethnicity data on death certificates and the development of ‘culturally competent’ risk assessment tools.
The report said that the Government must ‘mandate comprehensive and quality ethnicity data collection and recording as part of routine NHS and social care data collection systems, including the mandatory collection of ethnicity data at death certification’.
Data must be ‘readily available’ to local health partners to ‘inform actions to mitigate the impact of Covid-19 on BAME communities’, it added.
PHE added that the Government must ‘accelerate the development of culturally competent occupational risk assessment tools’, which are particularly important for key workers ‘in contact with’ those infected with coronavirus, such as GPs.
The report said stakeholders ‘pointed to racism and discrimination experienced by communities and more specifically by BAME key workers as a root cause affecting health, and exposure risk and disease progression risk’.
And that ‘historic racism and poorer experiences of healthcare or at work may mean that BAME individuals are less likely to seek care when needed or as NHS staff less likely to speak up when they have concerns about PPE or testing’.
’For many BAME groups lack of trust of NHS services and health care treatment resulted in their reluctance to seek care on a timely basis, and late presentation with disease,’ it added.
Among key clinical recommendations, the report suggested:
- strengthening targeted programmes for chronic disease prevention;
- culturally competent and targeted health promotion to prevent chronic diseases and multiple long-term conditions;
- targeting the health check programme to improve identification and management of [multiple long-term conditions] in BAME groups; and
- targeted messaging on smoking, obesity and improving management of common conditions including hypertension and diabetes.
The report concluded that coronavirus recovery strategies must ‘actively reduce inequalities caused by the wider determinants of health to create long term sustainable change’.
It said: ‘Fully funded, sustained and meaningful approaches to tackling ethnic inequalities must be prioritised.’
In a letter accompanying the report, PHE chief executive Duncan Selbie said that it ‘confirms that the impact of Covid-19 has replicated existing health inequalities, and in some cases, increased them’.
He added that the insights ‘make for humbling reading’ and that ‘tangible actions’ must be delivered ‘at scale and pace’ to address the ‘underlying factors of inequality’.
It comes as the BMA called for GPs to have ‘urgent’ access to occupational health services to support Covid-19 risk assessments in practices earlier this month.
Last week, practices were told that they should ensure they risk-assess BAME staff in order ‘to consider if they should see patients face to face’.
NHS England released updated guidance on how employers can assess the risk to BAME workers from Covid-19 last month but stopped short of endorsing a specific scoring tool.
PHE’s seven main recommendations in full
- Mandate comprehensive and quality ethnicity data collection and recording as part of routine NHS and social care data collection systems, including the mandatory collection of ethnicity data at death certification, and ensure that data are readily available to local health and care partners to inform actions to mitigate the impact of COVID-19 on BAME communities.
- Support community participatory research, in which researchers and community stakeholders engage as equal partners in all steps of the research process, to understand the social, cultural, structural, economic, religious, and commercial determinants of COVID-19 in BAME communities, and to develop readily implementable and scalable programmes to reduce risk and improve health outcomes.
- Improve access, experiences and outcomes of NHS, local government and integrated care systems commissioned services by BAME communities including: regular equity audits; use of health impact assessments; integration of equality into quality systems; good representation of black and minority ethnic communities among staff at all levels; sustained workforce development and employment practices; trust-building dialogue with service users.
- Accelerate the development of culturally competent occupational risk assessment tools that can be employed in a variety of occupational settings and used to reduce the risk of employee’s exposure to and acquisition of COVID-19, especially for key workers working with a large cross section of the general public or in contact with those infected with COVID-19.
- Fund, develop and implement culturally competent COVID-19 education and prevention campaigns, working in partnership with local BAME and faith communities to reinforce individual and household risk reduction strategies; rebuild trust with and uptake of routine clinical services; reinforce messages on early identification, testing and diagnosis; and prepare communities to take full advantage of interventions including contact tracing, antibody testing and ultimately vaccine availability.
- Accelerate efforts to target culturally competent health promotion and disease prevention programmes for non-communicable diseases promoting healthy weight, physical activity, smoking cessation, mental wellbeing and effective management of chronic conditions including diabetes, hypertension and asthma.
- Ensure that COVID-19 recovery strategies actively reduce inequalities caused by the wider determinants of health to create long term sustainable change. Fully funded, sustained and meaningful approaches to tackling ethnic inequalities must be prioritised.
Source: Public Health England: ‘Beyond the data: Understanding the impact of COVID-19 on BAME groups’