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Public Health England Review: Covid-19 Disparities

Volume 803: debated on Monday 8 June 2020

Commons Urgent Question

The following Answer to an Urgent Question was given on Thursday 4 June in the House of Commons.

“With your permission, Mr Speaker, I will make a Statement.

As a black woman and the Equalities Minister, it would be odd if I did not comment on the recent events in the US and protests in London yesterday. Like all right-minded people, regardless of their race, I was profoundly disturbed by the brutal murder of George Floyd at the hands of the police. During these moments of heightened racial tension, we must not pander to anyone who seeks to inflame those tensions. Instead, we must work together to improve the lives of people from black and minority ethnic communities. It is in that spirit that we approach the assessment of the impact of Covid-19 on ethnic minorities. If we want to resolve the disparities identified in the PHE report, it is critical that we accurately understand the causes, based on empirical analysis of the facts and not preconceived positions.

On Tuesday, my right honourable friend the Secretary of State for Health and Social Care confirmed to the House that Public Health England has now completed its review of disparities in the risks and outcomes of Covid-19. The review confirms that Covid-19 has replicated, and in some cases increased, existing health inequalities related to risk factors including age, gender, ethnicity and geography, with higher diagnosis rates in deprived, densely populated urban areas. The review also confirmed that being black or from a minority ethnic background is a risk factor. That racial disparity has been shown to hold even after accounting for the effects of age, deprivation, region and sex.

I thank Public Health England for undertaking this important work so quickly. I know that its findings will be a cause for concern across the House, as they are for individuals and families across the country. The Government share that concern, which is why they are now reviewing the impact and effectiveness of their actions to lessen disparities in infection and death rates of Covid-19, and to determine what further measures are necessary.

It is also clear that more needs to be done to understand the key drivers of those disparities and the relationships between different risk factors. The Government will commission further data research and analytical work by the Equalities Hub to clarify the reasons for the gaps in evidence highlighted by the report. Taking action without taking the necessary time and effort to understand the root causes of those disparities only risks worsening the situation. That is why I am taking this work forward with the Race Disparity Unit in the Cabinet Office, and the Department of Health and Social Care, and I will keep the House updated.”

My Lords, my criticism of the Government’s Answer is that even after the PHE review of disparities and risks and outcomes related to Covid-19 failed to include recommendations, the reply again talks about trying to understand the causes of disparities. Let us be clear: coronavirus thrives on inequality, and inequality thrives on inaction. Let us have no delay for research on causes but real action now to protect BAME people at risk from the virus. Will the Minister tell the House what actions the Government are taking to mitigate the very real risks BAME communities face right now?

My Lords, it is important that we understand the various drivers of the disparities and the relationship between different risk factors. It has been accepted that the report has some limitations; for example, the ethnicity analysis does not adjust for comorbidities such as the underlying health conditions of hypertension and obesity. It is imperative that we do the next stage of looking at the data and the connections to ensure that we fill in the gaps of understanding and developing new policies so that we act on a proper and scientific basis; otherwise, we risk making matters worse, which no one would want us to do.

New research today shows that more than half of pregnant women in hospital in the UK with coronavirus complications are from a black, Asian or minority ethnic background. Will the Minister commit to an urgent investigation into this?

My Lords, all aspects that are affecting black and minority ethnic people will be looked into by the Minister for Equalities. The Equalities Hub is now the central point to look at these matters. Action has been taken in relation to making sure that employers are risk assessing, including when employees are pregnant and could be at higher risk from the virus.

My Lords, the Public Health England report makes it clear that deprived communities are being disproportionately affected by Covid-19. Does the Minister agree that it is imperative that the Government redouble their efforts to reduce health inequalities between the richest and the poorest in society, fulfilling the Prime Minister’s levelling-up agenda? How might that be achieved?

My Lords, the PHE review indeed makes it clear that those who are in the most deprived neighbourhoods are more likely to die as a result of Covid-19 than those who are in more affluent areas. The Minister for Health outlined on 4 March that the Government are committed to levelling up and to looking at health inequalities, particularly in deprived neighbourhoods where we see early-onset diseases and avoidable mortality at their highest rates. The Government are committed to getting to the bottom of that and to acting upon it.

My Lords, Table 2.1 in the review shows that in the north-east a greater proportion of the excess deaths were due directly to Covid-19 than elsewhere. It also seems that our least well-off communities were the worst affected. I echo the calls of my noble friend Lady Hayter and the noble Baroness, Lady Pidding, for action to be taken on the basis of not just this report but all the other work that has been done on health inequalities, particularly by Professor Marmot and his review.

I assure noble Lords that the excellent work of Professor Sir Michael Marmot over the last 10 years or so will be reviewed and worked on by the Minister for Equalities, looking at all the different impacts and inequalities the virus has exposed in our communities.

My Lords, to judge the risks on both sides of this very difficult question we need precise information. I hope my noble friend will correct me if I am wrong, but I believe the statistics show that the 40,000 Covid deaths cover not only those who died from Covid as a primary cause but those who died with Covid as a secondary cause—in the same way that many men will die with prostate cancer but not necessarily from it. The distinction is crucial. Can my noble friend give a clear breakdown distinguishing between primary and secondary Covid deaths and say how many of those deaths would have been expected to occur within the next two years even without Covid? If she does not have that information, would she be kind enough to place it in the Library at the first possible opportunity?

My Lords, the Office for National Statistics has analysed the death certificates: on the death certificates where Covid is mentioned as a cause of death, over 95% had it as a primary or underlying cause. That does not exclude other underlying conditions; in March and April this year, over 90% of deaths from Covid had one other underlying health condition mentioned on the death certificate.

My Lords, it is very clear that we all agree that gross inequality and major deprivation are the underlying causes of the disparity. That must be dealt with societally in the long term. In the short term, does the Minister agree that we probably need targeted health campaigns, not blaming individuals but trying to at least do something in the short term about this division? That can be achieved not by daily press conferences but by very targeted help.

I am grateful to the noble Lord. Alongside this report there has been increased stakeholder engagement—particularly with the black and minority ethnic community—with faith leaders and representatives. As the Government are trying to ensure that the communication of the necessary public health information regarding hygiene and handwashing has been fully promoted within those communities, we are translating much of that advice into additional languages to ensure that that community has heard the messages it needs to hear now.

My Lords, black men and women are more than four times as likely to die a coronavirus-related death than white people. It is sad that of the 29 British doctors who have died of coronavirus during the pandemic, 27 were from ethnic-minority backgrounds. Research this week has revealed that 40% of BAME doctors surveyed said that risk assessments to prevent Covid deaths recommended by the NHS nationwide five weeks earlier have still not been carried out. Can the Minister explain why? Even Dr Chaand Nagpaul, the BMA Council chair, is calling on the Government to take urgent action to protect our BAME colleagues. Yet now, where care homes are concerned, the Government have just announced a new social care task force. Can the Minister explain why there are still care homes where staff and patients have not been tested—let alone on a regular basis—as the Government assured us they would be?

My Lords, the department wrote to all NHS trusts and clinical commissioning groups outlining that there should be risk assessments of their staff and that they should take into account whether they have black and minority-ethnic or other staff who were at particular risk so that additional precautions could be taken. That was included also in the NHS Employers guidance to ensure that protected characteristics were taken into account. We are aware that HR directors in various places are taking those actions and even redeploying staff. The advice and guidance have been clear that this is a factor to take into account along with other factors, as I have outlined, such as being pregnant.

My Lords, those of us throughout the world who have seen the savage murder of George Floyd will recognise the systemic evil of racism in society. Although I do not say that we are in the same position as the United States, we are far from guiltless in this country and we need to think about the systemic problems that the stain of racism places on us. Does the Minister agree that collecting figures on BAME deaths from Covid-19 without collecting the remaining epidemiological data on those citizens is a very poor piece of epidemiological work? It did not look at poverty, at overcrowded households or at employment in high-risk and low-paid jobs, and it reflects a systemic failure to grasp the weight of racism which impacts those communities. Is it not for the same reason a worry to the Minister that very few BAME senior scientists have been asked to serve on SAGE? I believe that they would have spotted these data gaps and tried to act on them.

My Lords, I join the noble Lord in expressing horror at the death of George Floyd. I can only agree with him about the evil of the systemic racism that we have seen in relation to the behaviour in that video. We are working at pace. The Race Disparity Unit has been collecting data. On the PHE review, we have accepted that there are not recommendations; there are conclusions. There are still gaps in the data and in the analysis that needs to be done. We are determined to get to the bottom of this, but we must do it on the basis of proper scientific evidence. I will take back to the Minister for Equalities the noble Lord’s representations about the inclusion of scientists from BAME backgrounds.

Sitting suspended.