The COVID-19 pandemic has cast into stark relief the unacceptable health inequalities that BAME communities in the UK have experienced for decades. In a country with one of Europe’s worst death tolls, death rates from COVID-19 are highest among people of Black and Asian ethnic groups.
A review by Public Health England shows that people from ethnic minority backgrounds constitute 14 per cent of the population but account for 34 per cent of critically ill Covid-19 patients and a similar percentage of all Covid-19 cases. They also had between 10 and 50 per cent higher risk of death when compared to white British men and women.
The reasons for this are complex. People in BAME communities are more likely to be key workers, doing frontline jobs at a time when millions were keeping safe by working from home. They are more likely to have comorbidities, such as cardiovascular disease and diabetes, which make it more difficult to recover from COVID-19. Those from ethnic minority groups are more likely to be concentrated in poorer areas, live in overcrowded housing and in inter-generational households.
Many of these factors are driven by health inequalities that affect BAME communities disproportionately and have existed for many years. Sir Michael Marmot highlighted the lack of progress in his most recent review of health inequalities for the Health Foundation, published in February 2020. As Duncan Selbie, the then Chief Executive of Public Health England, explained, the impact of COVID-19 replicated existing health inequalities and, in some cases, increased them.
The PHE report makes a number of recommendations, including the mandatory collection of ethnicity data on death certificates and the development of ‘culturally competent’ risk assessment tools, which are particularly important for patient-facing roles such as nurses.
Clinical recommendations in the report include:
- 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.
However, many believe that these steps, although important, will only have a limited impact until society addresses the racism and discrimination experienced by communities and, more specifically, by BAME key workers as a root cause affecting health and the risk of disease. In its review, Public Health England said it was clear that many BAME groups lack “trust of NHS services and health care treatment”. As a result, they are less likely to seek care until their health has deteriorated.
Pharmacies have a critical role to play. Many are located at the heart of the most deprived communities with a high proportion of BAME families and are well placed to break down barriers in the way of timely access to healthcare. Prof Mahendra Patel, a member of the English Pharmacy Board, says: “Bigger factors such as poor housing, access to education and job opportunities are obviously central to affecting health. But beginning at ground level in our communities, we can really make a difference.”
By Martin Barrow
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