New recommendations to protect BAME communities from the disproportionate impact of COVID-19 have been issued to help “close the gap” in health inequality.
Culturally-tailored public health messaging, bespoke test, trace and isolate strategies and priority testing for BAME workers are some of the immediate measures which should be put in place to protect the lives of ethnic minorities from the increased threat of the virus.
The South Asian Health Foundation (SAHF) has also called for mandatory occupational risk assessments for all BAME workers.
Other priorities highlighted by a new report by SAHF in collaboration with the Centre – ‘COVID-19 in Black, Asian and Minority Ethnic populations: An evidence review and recommendations from the South Asian Health Foundation’ – include moves to protect migrants, closing immediate educational gaps and strengthening science.
The review was launched after evidence emerged suggesting marked ethnic inequalities in the risk of hospitalisation and adverse outcome from COVID-19 infection.
In response, as well as a wide-ranging series of recommendations, the report has provided an overview of the current evidence on ethnic inequalities in the impact of COVID-19 and discussed potential explanatory factors for these observations.
According to the findings, there was a marked risk of hospitalisation for COVID-19 in BAME populations. In fully adjusted analysis, Black and South Asian groups appear at greatest risk of death from COVID-19, the review found.
The reasons behind these findings, according to the review, were biological (e.g. existing health conditions), behavioural factors (e.g. lack of awareness/understanding of social distancing) and structural, including inequality related to housing, income, occupation, cultural, health care and education.
COVID-19 cases have not been evenly distributed geographically, with densely populated urban areas such as London and Birmingham particularly hardly hit, the review stated – in England and Wales 60 per cent of the Black population and 50 per cent of Bangladeshis live in London.
Socioeconomic factors in BAME groups was suggested to be a primary reason for poorer health and social disadvantage. BAME populations are more likely to live in overcrowded and multigenerational co-habitation, according to the review. In the short term, it is recommended temporary housing availability could be made available to facilitate self-isolation of symptomatic individuals or their family members. In the long term there is a need for increased investment in new and existing affordable housing and social housing aimed at disadvantaged communities, the review said.
The review is also calling for occupational risk assessment for all at risk staff, including BAME individuals, and measures to protect them, including arrangements to work from home, reduced exposure-working practices; temporary furloughing of staff and guaranteeing that sick leave will not adversely affect employment status.
As well as the immediate recommendations, the review has issued long-term actions to reduce structural inequality. A set of culturally-specific recommendations have also been set out relating to employers and retail, places of worship and community centres, religious festivals and schools as well as funerals and burials and weddings.
Professor Kamlesh Khunti, a Professor in Primary Care Diabetes and Vascular Medicine at the University of Leicester, leads the Centre for BME Health and NIHR ARC East Midlands. He is also a trustee of the SAHF.
Professor Khunti said: “It’s clear that a comprehensive multi-sectoral approach – supported by strong policy action – is needed to tackle the multiple and complex structural, biological and behavioural reasons driving the disproportionate impact of COVID-19 on ethnic minority communities. These recommendations are key to reducing health inequalities related to COVID-19.”
Professor Wasim Hanif is a Professor of Diabetes and Endocrinology, Consultant Physician and Clinical Service Lead in diabetes at University Hospitals Birmingham NHS Foundation Trust and also a SAHF trustee. He added: “To mitigate further disparity in COVID-19 outcomes for BAME groups now and in future pandemics, and to close the gap on future health inequality, there are a number of immediate and longer-term actions that must be taken.”
SAHF Chairman of Trustees, Professor Kiran Patel, Chief Medical Officer and Consultant Cardiologist at University Hospitals Coventry and Warwickshire NHS Trust said: “COVID-19 has impacted on all corners of society, with growing evidence to suggest that the burden of the pandemic is not equal across population groups. This review has examined the available evidence and offers some achievable recommendations designed to save lives.”