With
warnings of a second wave of Covid19 infections a report going to the Community
and Wellbeing Scrutiny Committee on Tuesday September 15th (Virtual 6pm) assumes great
importance LINK. The committee continues under the chairmanship of Cllr Ketan Sheth
but with some changes in personnel including the inclusion of veteran health
campaigner Cllr Gaynor Lloyd, elected at the Barnhill by-election. They will
have the huge responsibility of assessing lessons from the way the pandemic has
been handled so far, preparations for dealing with a second wave, and addressing
the health and social inequalities revealed by the disproportionate impact on
Brent’s BAME population. A task, I would suggest, much more of a priority for Brent Council than the renaming
of a local park.
These
are some key extracts from the report:
BAME
populations in England and Wales are younger than white populations and as age
is a strong influence on death rates, it is important to take account of age.
When this is done:
·Black
males are 4.2 times more likely to die from a COVID-19-related death than White
males;
·Black
females are 4.3 times more likely to die from a COVID-19 related death than
White females
As
BAME populations tend to be more deprived, it is important to adjust for the
influence of deprivation in looking at the impact of ethnicity. Doing so allows
us to compare the risk for a black male living in an area of deprivation
compared to one living in an affluent area:
·Black
males are 1.9 times more likely to die from a COVID-19-related death than White
males;
·Black
females are 1.9 times more likely to die from a COVID-19 related death than
White females.
After
taking into account age and socioeconomic circumstances or deprivation:
·Bangladeshi
and Pakistani ethnic group males are 1.8 times more likely to die from a
COVID-19-related death than White males;
·Bangladeshi
and Pakistani ethnic group females are 1.6 times more likely to die from a
COVID-19-related death than White females
Possible
reasons for the disproportionate impact
There
are three possible reasons for the disproportionate impact of COVID on BAME
communities:
1.Increased
exposure to the virus
2.Increased
susceptibility to severe disease
3.Access
to and use of health care
Exposure
to the virus
1.Brent
BAME population are high users of public transport. Buses in particular
remained crowded during the pandemic as did bus stops in the Wembley and
Harlesden area.
2.Brent
BAME communities have high levels of inter-generational living with those at
risk including the elderly and those with long-term conditions being exposed
more than those in smaller households.
3.BAME
communities have high attendance to temples, churches, mosques and other places
of worship with large communal activities such as services, weddings and
funerals. These were implicated in spread elsewhere and it is likely were these
were factors in the early part of the epidemic
4.BAME
community members are less likely to be working from home and often in zero
hour contracts or cash in hand situations therefore less likely to be able to
social distance or self- isolate.
5.BAME
community members are more likely to be frontline workers and less likely to be
managers and able to influence their working conditions.
Susceptibility
to severe infection
1.While
levels of adult obesity are relatively low in Brent (compared to England), 50%
of residents are overweight or obese. It is estimated that over 11% of the
adult population has diabetes, compared to an England rate of 8.5%. Diabetes is
more prevalent in Black and South Asian patients, and our high levels of
diabetes may be one reason for the higher death rate seen locally.
2.Fewer
patients are recorded on their GP records as having high blood pressure than is
the case for England (12.4% compared to 14%). While this may indicate a lower
prevalence, the size of our Black and South Asian communities who would be
expected to have higher rates of hypertension might suggest under diagnosis. Of
those who are diagnosed, significantly fewer patients have their blood pressure
controlled in Brent than nationally.
Access
to and use of health services
1.It
has been hypothesised that more deprived communities may have poorer access to
health care and that this could have played a part in the pattern of mortality
(the inverse care law). Early in the pandemic, NHS England instructed primary
care to move away from face to face appointments in favour of telephone and on
line access. There was a concern that this model of care may have disadvantaged
the digitally excluded.
2.There
is some evidence from elsewhere that Black men were particularly unwell on
presentation to hospital and more likely to be admitted direct to ITU. This
could indicate a reluctance to seek help earlier or a more rapid progression of
disease in this group of patients. There is no evidence of poorer outcomes for
BAME patients admitted to secondary care locally. However the completeness of
recording ethnicity limits our ability to analyse this.
Themes
from the Church End and Alperton community engagement events
Church
End
·Participants praised
Northwick Park Hospital’s response to the pandemic.
·People
are still afraid to visit public buildings.
·Some
of are not fully informed of information/advice therefore educating residents
is crucial.
·Many
people are not wearing masks, particularly on Church Road. Messages around
facemasks need to be clear without offending people.
·Question
of whether health services play a key role for self-care and those with
long-term conditions (such as diabetes and hypertension)
·Need
to invest in Church Road and the local community, as the area is unappealing.
This is reflected by local drug dealing, crime, poor employment opportunities
and run down businesses.
·Many
people face multiple issues even before the pandemic including stress and
financial issues.
·New
people are approaching foodbanks.
·People
tested for Covid-19 are not reflective of the local community – question of
what we are doing to encourage people to take tests.
·Young
people face mental health issues, which is a primary reason for large
gatherings and house parties in the area. Young people are aware of the risks
but they are battling with their mental health. Need role models/influential
people from area through to communicate through songs and messages. Need to think
about education, prospects and access to networks.
·Access
to GPs online has been difficult, especially for those whose first language is
not English. Confidence in services is low.
·Older
people are more isolated now.
·Worry
that people are being forgotten about if they need medical help but don’t
engage with health services or local support. A helpline was suggested so
people’s needs can be explored to signpost them to support and services. Need
to build local people’s knowledge.
·Concern
over people who are not eligible for support services but housed in HMOs.
·Educating
and raising knowledge of landlords will help maintain hygiene standards.
·Need
to hear from those who have lost people. ·Attendees are happy to
be a part of the solution by working with us as community champions.
Alperton
·Messaging
needs to be reinforced and shaped for people who do not speak English as their
first language.
·Channelling
tailored messages through places of worship and Asian radios would be
effective. Could work with the Multi-faith forum.
·Measures
are not being followed on high road - displays and signboards are insufficient.
Signs on shops are usually handwritten. Some shops are doing well which could
be replicated by other shops.
·Need
to work with community leaders to identify vulnerable people eg create register
of HMOs.
·Strategy
needs to focus on prevention and long-term outcomes.
·Community
is pessimistic as opposed to central government, which changes guidelines
frequently.
·Many
organic community groups exist which need to be engaged with.
·More
enforcement needed where people aren’t following measures.
·Easy
to get GP appointments, however many people are nervous. They need health
services but uptake is low. Lack of internet and no phone line is another
issue.
·National
Covid-19 test system was down and busy highlighting the barriers to securing a
test. Testing may not be reflective of local communities – may need to
encourage people to take tests and raise awareness of sites.
·Issue
of people having symptoms but not getting tested due to risk of losing job or
income.
·There
are opportunities despite the negatives – people are walking and being active
whilst maintaining social distancing measures.
·Attendees
look forward to working with us to find solution
The meeting
can be observed here: https://www.brent.gov.uk/your-council/democracy-in-brent/local-democracy/live-streaming/
