Professor Kevin Fenton, London Regional Director for Public Health England

The impact of COVID-19 has been felt by every one of us, and it has been particularly devastating for those who have lost friends, loved ones or have even become seriously unwell themselves.

But since the start of the pandemic, we have seen that devastation felt more heavily in some communities than others. Black, Asian and minority ethnic communities have all been disproportionately affected, with higher case rates and higher numbers of deaths.

Health inequalities have long been felt by these communities for a wide variety of reasons, but the tragic impact of the global pandemic has shone a spotlight on these longstanding and deep-rooted issues.

Professor Kevin Fenton

Data analysis has shown that age, geographical location and gender can all affect the risk of becoming infected, experiencing more severe symptoms or higher rates of death. But ethnicity has also been one of the key determining factors in health outcomes from COVID-19.

PHE data analysis has shown that ethnic minorities were worst affected by COVID-19

PHE analysis of case rates and mortality data published in February showed that in London, Asian populations were worst affected during the second wave, followed by Black communities. This followed a similar pattern to the first wave, where our report, Beyond the data: Understanding the impact of COVID-19 on BAME groups, showed both Asian and Black communities experienced significantly higher case rates and increased risk of death.

Overall, the data showed that:

• At around the peak of the first wave, Black Londoners had around two and a half to three times the risk of dying with COVID-19 (within 28 days) compared to their White peers, and people of Asian ethnicity had up to twice the risk.

• During the second wave, Asian Londoners had 1.7 times the risk of dying from COVID-19 (within 28 days of diagnosis) compared to their White peers, and for Black Londoners the risk was 1.5 times higher.

The reasons for these disparities are complex, but analysis has shown:

• People of Black, Asian and other minority ethnic groups may be more exposed to COVID-19 and therefore are more likely to catch the virus. This could be the result of factors associated with ethnicity, such as occupation, population density, use of public transport, household composition and housing conditions;

• For many Black, Asian and other minority ethnic groups, especially those in poorer areas, there is a higher instance of chronic diseases and multiple long-term conditions. Many of the pre-existing health conditions which increase the risk of having poorer outcomes from COVID-19 are more common within these groups.

Ethnic minorities are also less likely to come forward for the vaccine

This disproportionate impact become even more concerning when you consider that individuals from communities hardest hit by the pandemic are also statistically less likely to come forward for the vaccine.

Health inequalities infographic 2021

The reasons for this are wide-ranging, sensitive and complex, but they include a mistrust of health authorities, misinformation spread in communities and simply poor access to reliable information and healthcare advice.

It has been clear throughout the pandemic there is an urgent need to address these issues in order to improve the outcomes for these communities and make us more resilient to COVID and future threats more generally.

Collaborative cross agency initiatives are underway in London to tackle these issues

In London, we have put together a programme of collaborative cross-agency work to directly tackle these issues, which we know are longstanding and will not be changed overnight.

These initiatives have included:

• The Community Champions scheme – Over £23 million is being allocated to 60 councils and voluntary groups across England, including seven of London’s worst-hit boroughs, to expand work to support those most at risk from COVID-19 and boost vaccine take up.

• London’s Public Health Faith and Community Forum – which routinely has over 200 representatives taking part in its monthly meetings.

• London’s Health Equity Group – its membership is drawn from London’s faith and community groups, the business sector, as well as national experts to monitor progress addressing health inequalities and support action on the ground.

• Multi-lingual information and communications – Advice, information and alerts relating to COVID-19 have been produced in a wide variety of channels and languages under the Keep London Safe campaign to ensure that all Londoners can access important information relating to the pandemic.

True cross-system collaboration is needed to effectively tackle inequalities: the NHS, Local Government and the Greater London Authority, faith communities and voluntary and community sector organisations all have a role to play

We have also seen great successes in scaling up community testing, key worker testing and local contact tracing, helping staff in the transport network to be as safe as possible, as well as the incredible efforts from the Boroughs to help vulnerable people and those who need to self-isolate.

Action on inequalities requires true cross-system collaboration, and it is important to point out the fantastic efforts of our system partners, like the NHS, Local Government and the Greater London Authority.

Working in co-ordination through the London Health Equity Board, the commitments of these organisations have been significant:

• The London Association of Directors of Public Health (ADPH London) working group -ADPH published a position statement on 15 February 2021 acknowledging racism as a public health issue. A working group is in place to progress action plans which will enhance actions already taking place at local and regional level to reduce the disproportionate impact of the pandemic.

• GLA’s Map of Community Views – Community insights support policy and programme design at the GLA. 20 roundtable discussions have been held with communities disproportionately impacted by COVID to understand gaps in support and feed back to relevant City Hall teams and identified a range of key issues.

• Vaccine awareness Town Hall meetings – The GLA has coordinated a series of ‘town hall’ meetings focused on improving awareness of accurate information about vaccines.

• London Community Response Survey – a weekly questionnaire sent to a cohort of frontline civil society organisations from April 2020. The results of which are being used alongside a range of other pieces of intelligence to inform the pan-London response to the COVID-19 pandemic.

Finally, our work with faith communities and voluntary and community sector organisations illustrates how we can work together with communities to address issues like misinformation and myths, mistrust of the health system and wider vaccine hesitancy.

But there is still more to do

I truly believe this engagement work will be critical in our efforts to tackle inequalities in the future. But there is still so much more to do.

We have seen the challenges faced by our communities, not only in the immediate impacts of COVID-19, but wider consequences like worsening physical and mental health, social disruption and economic anxiety.

The disproportionate impact has also led to feelings of despair, anger and sadness, as well as causing some people to disengage from the pandemic and become hesitant about having the vaccine.

The importance of addressing these hesitancies and encouraging vaccine uptake could not be more vital, particularly if we want to continue the careful lifting of restrictions this summer and a return to normal life.

In order to do this, we must listen to people’s concerns and address them. That power is in our hands and every one of us can help by sticking to the rules, taking up the vaccine when it is offered and encouraging others from within our community to do the same.