Covid-19 and health inequalities

With talk of the current pandemic ‘being a great leveller’ the reality is that the Covid-19 pandemic is exposing health inequalities, nationally and globally. Having heard some of the impact first hand, Poppy Jaman, FRSA argues for short-term measures and longer-term learning.

Like many people, I have been struggling to sleep. Aware that staying connected is good for our mental health, I have made sure to call friends, family and colleagues during my time in lockdown. Their stories, and the conclusions they have brought me to, might go some way to explaining my sleeplessness; everything we took for granted is gone and everything we know about health inequalities is real.

Our age, gender, where we were born, where we live and work, are deciding factors in how much at risk we are of dying from the virus. I find myself questioning just how much of a difference my peers and myself have made in trying to change things for the better. Have we fought hard enough to secure a fairer distribution of money, power and resources to ensure that every one of us has equal access to good health?

The stories shared with me are just snippets of some of the human tragedies people are facing, unfolding every day. The 29 year-old Asian woman, a health key worker, who tells me she is glad to be working as her husband tried to strangle her last week. She is frightened if she gets ill she will be forced to stay at home with him. A 32 year-old Polish food factory worker who is the only one in his household working and cannot afford the rent; his parents have been advised to claim housing benefit, which they did and were unsuccessful. The Asian doctor in his 50s, wrestling with grief, guilt and anger after a friend he knew was struggling died by suicide. A Muslim elder confesses his fear of dying alone.

The assistant head of primary care, where more than 40% of staff are BAME, says orders of personal protection equipment are taking 72 hours to arrive. But services he is responsible for are only allowed to hold 48 hours’ worth of stock. And there are plenty more.

As has hit the headlines, the Intensive Care National Audit Research Centre report on Covid-19 in critical care contains data on all confirmed cases in NHS critical care but not those in the community, care homes or other settings. The data from this report shows 34% of UK critically ill patients with Covid-19 are from ethnic minorities; it is possible that ethnic minorities are physiologically at higher risk, but globally, non-white countries do not show greater numbers than majority-white countries.

A more likely explanation is that the poorest in our society happen to also be disproportionately ethnic minorities and that measures to protect the population from Covid-19 have failed to adequately protect those who are poorer and live in large families in smaller spaces, and have jobs that cannot be done from home. What is certain is that before this crisis, successive governments have not addressed the social determinants of health that are risking the lives of many.

In some parts of the health system most key workers – those most endangered by a lack of personal protective equipment (PPE) – are ethnic minorities. I am proud that a significant number of my family work in the health system, but I want to know that they are safe doing the jobs we need them to do.

Meanwhile, the visible leadership of the crisis has been disproportionately white and male, while news coverage suggests the frontline clinicians dying have been disproportionately BAME. We do not yet have firm statistics as the overall number of confirmed coronavirus cases nor deaths in the UK are being broken down by ethnicity. Sadly, this isn’t surprising; diversity and inclusion is almost always an add-on. This crisis shines a light on why it is critical to have diversity and inclusion in the workforce, at all levels, to ensure we are asking the right questions and considering all points of view. When we get it wrong, people die. 

There are actions the government could take immediately to address the significantly higher risks faced by large swathes of the population and ensure a more diverse, equitable and inclusive response to this pandemic crisis and beyond. For a start, it must ensure that equality data is monitored and collected, that this is shared across the health system nationally and locally and is analysed using diverse lenses to fully inform decision-makers locally.

It is also vital that the government builds and maintains trust,especially with people who feel these heath inequalities most painfully. A lack of transparency diminishes trust and creates unrest. We are all under huge stress and if under these tragic circumstances we feel our loved ones are literally not being counted it is going to deepen the grief and cause anger. We need information about who is dying from Covid-19 in all settings; in care homes, in the community and in prisons, not just in hospitals. This is not easy but it is crucial for helping us all to remain calm and following advice.

We need to be listening to and recognising the power of human stories, like the ones that keep me awake at night. Government needs to listen to and respond with information in an appropriate, targeted way, ensuring resources are allocated to communication plans that get messages into the heart of our diverse communities. Recent political campaigns demonstrate what is possible; the government has extensive experience in communicating effectively. It needs to use those skills to do the right thing.

Beyond these shorter-term measures, we need to strike a balance between the immediate response to the emergency and making sure we still have vital services for people in need in the future. The safe return to post-Covid-19 life needs to be informed by and include leaders from all genders, generations, BAME and socio-economic groups. Crucially, this needs to include the charity, social enterprise and voluntary sector because they work with and for many of these groups.

And we must honour the human experience by sharing the stories and not just the numbers. Behind each loss of life there is the weight of grief that we can shoulder together. Behind each tragedy there is human endeavour and kindness. If we know which parts of our community are suffering and how, we can reach out and offer help and hope. 

Crises in the past have led to lessons being learnt. After the Spanish flu, there was a huge leap forward in global public health. After injured soldiers from all socio-economic classes returned home after World War II, the UK recognised the need for a more equal access to housing and health; the NHS arose of this crisis. As we face the challenges of this pandemic, we must learn from this. I might sleep better knowing the legacy of coronavirus might be an end to the inequalities it has so starkly exposed.

Poppy Jaman OBE FRSA is a global ambassador for mental health in the workplace. She is a social entrepreneur; founding CEO of Mental Health First Aid England CiC and now leads the City Mental Health Alliance CiC.

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