COVID-19 has thrown a stark light on inequalities in healthcare. What are the challenges that we face and how can we tackle these to move towards a more diverse and inclusive society, that is fit for the future?
Essay by Sylvia Manimaran
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane." - Martin Luther King (March 1966)
The COVID-19 pandemic over the past two years has seen the pre-existing healthcare inequalities embedded in society further widen. Although no individual was untouched by the effects of the pandemic, it is fair to say COVID had a disproportionate impact on many who already experience disadvantage and discrimination within society. Recent events have expedited the need to tackle these deep rooted issues in view of creating both an inclusive healthcare system and society for all.
Socioeconomic Deprivation
Evidence from multiple analyses suggests a strong correlation between area based deprivation levels and incidence and mortality from COVID-19. The deprived areas in England had over double the mortality rate due to COVID than the least deprived locations.1 Dissecting this further, reports show a larger proportion of those admitted from May 2021 critically ill with COVID in intensive care units were from the most deprived quintile of areas (32.1%) than the least deprived (11.0%).2 This was a pattern reflected pre-pandemic among those admitted with viral pneumonia thus demonstrating that COVID has not produced new inequalities but has rather caused additional challenges to those already suffering health inequity.
Black, Asian and Ethnic Minority (BAME) Communities
Another group disproportionately impacted by COVID-19 are those from BAME backgrounds. Reports published found that the risk of death from COVID is higher in BAME groups and when including age, Black males were 4.2 times more likely and Black females 4.3 times more likely to experience a COVID related death than White ethnicity males and females.3 Those of Bangladeshi and Pakistani, Indian and Mixed ethnicities had a statistically significant raised risk of death involving COVID compared with those of White ethnicity. Of note, analysts were unable to include occupation, comorbidities nor obesity as factors within these reports which is a shortcoming as these domains are known to be associated with greater risk exposure. Consequently these figures, although by no means insignificant, should be taken in context with their limitations.
Mental Health
Over two-thirds of adults in the UK report feeling somewhat or very worried about the effect COVID-19 on their life.4 Groups which previously faced barriers to accessing mental health services are also the ones struggling the most with their mental health during the pandemic. Those who already live with mental health problems alongside physical conditions, older adults, individuals who have experienced trauma or abuse, those living in poverty and from BAME communities are all at higher risk of suffering mentally due to the pandemic.5
Failure to improve access to care will further worsen the inequality these individuals face. For example, services for children were inadequate before the pandemic. In England, the vacancy rate of consultant psychiatrists in child and adolescent mental health services is almost double that of the national average.6 The predicted 33% rise in demand of mental health services over the next three years is not something the NHS are currently equipped for.7
Conclusion
The pandemic has highlighted a whole host of health inequities prevalent in society and this essay has only scratched the surface of three key challenges. To overcome the difficulties faced in deprived areas and by those of BAME background, the government must assess the needs of such vulnerable groups and prioritise the implementation of targeted support programmes to alleviate the impact of the virus. These groups are more likely to experience higher rates of ‘Long-Covid’ and other long-term adverse outcomes which has the potential to increase rates of long-term disability, deepening health inequalities.
Accessible financial support for those in socioeconomically deprived locations are required for both patients and their local health services. Education via schools and public health campaigns is a powerful tool and one of the most important modifiable social determinants of health that will have lifelong impacts on health outcomes, economic wellbeing and overall life expectancy.8
Accessibility and funding for mental health services need to be re-evaluated. With financial investment, public health teams within local authorities are able to develop and coordinate a mental health framework according to local need. Long Term Plan commitments to invest in community mental health capacity should be resumed, so that those with mental health problems can access the help they need locally.5 Poor mental health is strongly associated with worse physical health thus posing a long term, uphill battle in caring for those impacted by the pandemic.
All these measures are only a starting point in tackling the discussed health inequalities in the future, kickstarting the evolution of healthcare into a diverse and inclusive environment.
References:
- gov.uk. 2020. Deaths involving COVID-19 by local area and socioeconomic deprivation - Office for National Statistics. [Online] Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19bylocalareasanddeprivation/deathsoccurringbetween1marchand31july2020 [Accessed 2 March 2022].
- org. 2022. ICNARC – Reports. [Online] Available at: https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports [Accessed 2 March 2022].
- gov.uk. 2020. Coronavirus (COVID-19) related deaths by ethnic group, England and Wales - Office for National Statistics. [Online] Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020 [Accessed 2 March 2022].
- gov.uk. 2020. Coronavirus (COVID-19) related deaths by ethnic group, England and Wales - Office for National Statistics. [Online] Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020 [Accessed 2 March 2022].
- Allwood, L. and Bell, A., 2020. Covid-19: understanding inequalities in mental health during the pandemic. [Online] Centreformentalhealth.org.uk. Available at: https://www.centreformentalhealth.org.uk/sites/default/files/2020-06/CentreforMentalHealth_CovidInequalities_0.pdf [Accessed 2 March 2022].
- ac.uk. 2021. Workforce figures for consultant psychiatrists, specialty doctor psychiatrists and Physician Associates in Mental Health. [Online] Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/workforce/census-2021-completed-draft.pdf?sfvrsn=191319cb_2 [Accessed 2 March 2022].
- The Strategy Unit. 2020. Mental Health Surge Model. [Online] Available at: https://www.strategyunitwm.nhs.uk/mental-health-surge-model [Accessed 2 March 2022].
- org. 2021. Mitigating the impact of Covid-19 on health inequalities. [Online] Available at: https://www.fva.org/downloads/bma-mitigating-the-impact-of-covid-19-on-health-inequalities-report-march-2021.pdf [Accessed 2 March 2022].
