There has been widespread concern that the coronavirus pandemic and measures to tackle it are having a disproportionate effect on certain sections of the population, some of whom may already experience considerable health inequalities. We know there are a number of risk factors for Covid-19: older age groups, men, those with underlying health conditions or a weak immune system, smokers and the obese appear to be most at risk. However, the weekly Office for National Statistics figures that started to appear in May, showing that the impact of the coronavirus is much higher for people from Black, Asian and Minority Ethnic (BAME) backgrounds, those on lower incomes and those living in socially deprived areas, present a particularly sobering account of differential impact.
Concerns had already been raised and a small team of us in the ARC South London decided to hold a community Zoom event to discuss the impact of Covid-19. The aim of the event was to give service users, carers and representatives of community organisations in South London, working across the protected characteristics [age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership and pregnancy and maternity], a chance to share their experiences. In order to make it action-oriented, we decided to link this event into a UK Parliamentary call for evidence on issues raised by the Women and Equalities Committee in its inquiry on ‘Unequal impact: Coronavirus (Covid-19) and the impact on people with protected characteristics’.
We only had a week to organise the event if we were going to submit evidence into the Parliamentary call, so we quickly produced a flyer which was extensively circulated to patients, the public and community organisations. We also used Twitter to target people more broadly who have an interest in health inequalities and contacted local clinical commissioning groups. Within a week the event was full and there was a waiting list, which eventually saw 52 diverse groups and individuals participate on the 27 April 2020
The focus of the event was to discuss key questions on impact raised in the Parliamentary call for evidence and any actions the Government could take when it next reviewed the Coronavirus Act. Over the course of two hours a number of striking themes emerged which showed that many groups who already face discrimination and health inequalities in society were being further impacted by the virus. This raised the danger that existing health inequalities, could get considerably worse in the future.
Issues raised by the participants
Zoom participants talked about Covid-19 dramatically increasing fear and isolation for pregnant women as a vulnerable group, with appointments cancelled, birth choices restricted and women too scared to come into hospital. Particularly, strong concerns were raised about the treatment of BAME pregnant women, who are already far more likely to die in childbirth than white women. Doulas who support women in childbirth spoke about verbal and emotional abuse of BAME women and poor treatment, that women felt was being driven by racist attitudes.
Other issues that were raised were to do with the need for much improved information and communication and access to emergency, outpatient and other hospital appointments for different groups. BAME people said as they had a higher than average risk from the coronavirus they were fearful of attending outpatient appointments or attending with other symptoms, or going to get medication or blood tests. They were also concerned about the impact of Covid-19 on conditions like sickle cell.
Participants with disabilities or from disability organisations also raised concerns about their ability to use health services because of a lack of help in using transport and being able to use direct payments or personal budgets to fund assistance in a flexible way. They were also worried about discrimination occurring in attending hospital and whether they would be treated fairly because of their disabilities or learning difficulties and be able to get proper access to medical ventilators. A participant from a Healthwatch also raised access issues about primary care because of digital exclusions for a number of vulnerable groups and older people. She was worried this could affect people trying to submit benefit claims.
Reduced access to services
The loss of face to face services was also being keenly felt by various groups of people. Some mental health service users described how difficult it was to suddenly lose all their mental health appointments (community services, GP, therapy etc), when there was a lack of information about the 24/7 crisis lines which were meant to be in place. The Metro charity working with LGBT+ people, said that attendance in their mental health drop-in groups for young people or those with HIV status had also decreased considerably. The concern was that individuals from LGBT+ groups might be less comfortable using online services in the home environment rather than attending groups outside the home. More generally, concern was raised about support for groups such as blind people, and evidence some people had been struggling to socially distance safely, disabled pupils with special educational needs who were not receiving the same level of educational support compared to their non-disabled peers and groups like travellers who moved around a lot.
Actions recommended in response to the Parliamentary call
Various ideas were discussed about actions that could be taken that were submitted into the Parliamentary call Community Zoom event final submission Some key areas were:
- The need to get targeted information to different communities and particularly to BAME groups, to reassure them about what services they could use safety in terms of hospital appointments
- healthcare organisations to take an equalities approach to ensuring access to acute, primary, emergency and mental health services for groups across the protected characteristics
- The provision of physically and emotionally safe maternity services and to address racism and poor treatment
- People being able to say goodbye to loved ones in a safe way and to be able to hold culturally appropriate funeral services
- The need for personal protective equipment and testing to be available for personal assistants providing care in the home.
What the community Zoom event showed is that groups across the protected characteristics are being affected in many different ways during the pandemic. These groups are often already facing health inequalities in society and yet their voices are frequently not heard in public involvement and engagement initiatives. This event showed that working in partnership with diverse groups and communities is an urgent area that all organisations working in healthcare and research need to address, if the very specific challenges of Covid-19 are going to be dealt with successfully in the future.
By Dr Josephine Ocloo, ARC South London, diversity and inclusion lead (with thanks to PPI Coordinator Savi Hensman and all others who helped to organise or contributed to the event)