Evidence Into Action - A review of the report by Public Health England into disparities in risks and outcomes of COVID-19 between ethnic groups and by level of deprivation
This is a briefing paper jointly authored with Jabeer Butt, Director of the Race Equality Foundation.
This briefing highlights two statistical findings found in the back of the first PHE report and adds a third based on our analysis of other information contained in that report. The two findings concern PHE’s estimates of the infection fatality rates (IFRs), that is, the risk of dying from COVID-19 among people who have tested positive for the virus. Our analysis draws on summary information provided by PHE to calculate the infection risk, that is, the chance of catching the virus (confirmed by a test).
The purpose of this is to show that both parts of the overall (population) risk – of infection, and of dying when infection has been confirmed – are higher for BAME groups than for the White British population. This helps focus attention on where action is needed.
The report recommends the following steps that need to be taken now.
1. The scale of the higher risk faced by men and the differences on show here, mean that both analysis and practical interventions should consider men and women separately. The different impact of deprivation on their infection fatality rates (IFRs) mean that working-age people and pensioners should also be considered separately.
2. PHE and NHS England should co-produce targeted information campaigns directed at BAME older people, at the same time as NHS England ends the haphazard provision of community language interpreting in primary care by properly funding interpreting provision.
3. The Department of Health and Social Care (DHSC) and the Department for Digital, Culture, Media and Sport (DCMS) should increase support now for those voluntary and community organisations currently working with BAME older people, particularly as evidence suggests many of these organisations are currently suffering a loss of income, staffing and volunteers, hampering their ability to provide the support that is often key. The lack of ring fencing of central funds, and the slow pace of release of these funds, compare poorly with the local (though smaller-scale) action taken in many urban areas.
4. Local authorities and their health and care partners should take action to address inadequate housing, as this is more likely to hamper the ability of BAME older people to self-isolate after a positive test, resulting in the higher rate of infection for these communities persisting, whilst it declines for others.
5. The belated publication of a risk assessment framework for health care workers and the greater attention to the suitability of PPE equipment as well as its availability are all welcome. But more needs to be done more quickly to better protect key workers in health care as well as taxi drivers, security guards and others. Risk assessment should also address whether BAME nurses and doctors are more often scheduled to work on COVID wards. Collective risk should therefore be analysed and published by hospital trusts on a monthly basis, including the steps that have been taken to mitigate risk. As the economy as a whole begins to open up, the Department for Business, Energy and Industrial Strategy (BEIS) should provide guidance to all employers on assessing risk faced by BAME employees and require them to identify mitigation.
6. The Test and Trace service in particular, but the testing infrastructure as a whole, needs to do better in encouraging BAME people to come forward for testing. We know from experience with screening for issues such as breast and prostate cancers, that ‘screening’ programmes have been less successful at securing the involvement of BAME communities, with the consequent later detection often resulting in poorer outcomes. Once again, working with trusted intermediaries as well as ensuring that the social and economic consequences of a positive test are addressed are key actions to be taken now by DHSC, the Treasury and DCMS.
7. Finally, the limitations of data currently recorded suggest that immediate action needs to be taken to improve the recording of ethnicity, so we are better able to understand the impact of pandemics, and access to and the impact of health care as a whole, on communities such as Gypsy, Roma and Travellers as well as other communities such as Somalis. DHSC should make decisions now to ensure that, across the health care system, data is collected that can be presented both in disaggregated fashion as well as aggregated to compare with data from the forthcoming Census in 2021. This should be accompanied by regulators such as the Care Quality Commission assessing how this data is being used to improve the quality of care for BAME communities.
About this report
A Briefing Paper by Peter Kenway of the New Policy Institute and Jabeer Butt of the Race Equality Foundation.