Hertfordshire councillors look at health inequalities in wake of Covid-19 pandemic

Black women are more than five times more likely to die while pregnant – or after childbirth – than white women, councillors have been told.

And that is just one of the health inequalities affecting Black, Asian and Minority Ethnic (BAME) communities that were highlighted as part of a day-long scrutiny by Hertfordshire County Council, on Tuesday, November 23.

During the day, councillors looked at the impact of the Covid-19 pandemic – where health inequalities were put into sharp focus.

And they looked at the steps that were being taken to address the systemic issues that are affecting the health and wellbeing of BAME communities.

That included the work of a new ‘BAME health equalities working group’ – which brings together the county council, health and community organisations – to develop strategies to reduce health inequalities.

And it highlighted work of groups offering T2 diabetes lifestyle coaching, such as the ADDA Club – as well as the Covid Recovery Black Asian Minority Ethnic Project and steps being taken elsewhere to improve maternity services.

Following the meeting, chair Cllr Judi Billing said she hoped the meeting would prove to be an ‘important step’ in improving health inequalities.

“We have known from data and anecdote for many years that there are BAME inequalities in outcomes in health,” she said.

“But we haven’t necessarily known why – or how it happens or how it links to other things such as poverty, inner-city life or pollution.

“Covid-19 has brought them very much to the fore because of the particularly awful outcomes for Black and Asian people in terms of deaths and vaccine take-up.”

Detailed recommendations from the panel following the hearing are yet to be finalised.

But Cllr Billing said it would lead to further work for the county council – in partnership with other organisations, including the NHS.

They also highlighted suggestions of systemic weaknesses in the National Health Service and poor underlying health in some communities.

National data, from May 2020, suggested that at times those from an Asian or Asian British background were 4.8 times more likely to test positive for Covid-19 than people of white ethnicity.

And compared to white males, it suggested Covid-19 deaths recorded among Black African men was 2.3 times greater; Bangladeshi men was 1.9 times greater; Black Caribbean men was 1.7 times greater; and for Pakistani men 1.6 times greater.

Countering some misconceptions, director of public health Jim McManus stressed that there was no biological reason why BAME people are at greater risk of Covid-19 infection or death – and that there was no difference in treatment outcomes when people got treatment.

But he highlighted the role of greater exposure – through work, public transport and multi-generational households – the risk of serious illness because of poorer underlying health and socio-economic factors.

Public health measures implemented locally through the pandemic highlighted at the meeting included funding of screens in taxis, increase in stop smoking services, support for BAME staff in care home settings and a healthy weight programme.

Meanwhile, the panel also heard that Covid-19 vaccination rates continued to be lower amongst BAME communities.

The latest data presented to the panel showed that at the beginning of last month (October), 89.4 per cent of the white British residents (over-18) in Hertfordshire had had at least one Covid-19 jab.

But that figure was just 73 per cent amongst the county’s BAME population.

And data from this month (November) suggested that amongst the over-50s, 95.8 per cent of white British residents had at least one vaccine – compared to 85.5 per cent of all BAME groups.

Oyinkansola Ojo-Aromokudu, who is a lay member of the Herts Valleys CCG board, highlighted variations in vaccine uptake and experiences of primary care.

And among the factors she highlighted were expectations of healthcare, trust and mistrust and barriers to information, which could include language and finance.

Meanwhile, Kristy Thakur, head of community and people wellbeing at the county council, outlined the ongoing work of the ethnic minority vaccine hesitancy group in boosting vaccination levels in Hertfordshire.

That has included work with public health and the NHS professionals, as well as 23 organisations who have had a share of £100,000 to help tackle vaccine hesitancy and to explore barriers to take-up.

Events and webinars, buddy schemes and pop-up vaccination days, leaflets, telephone advisors and transport to vaccination suites were all reported to be among the steps to boost vaccine take-up.

Meanwhile, additional data presented to the panel showed that Black and Asian women had a higher risk of dying in pregnancy.

For white women the risk of dying in pregnancy was reported to be seven in 100,000.

But for Asian women the risk was almost double – at 13 in 100,000. And for Black women it was more than five times higher, at 38 in 100,000.

In addition, it was reported that 88 per cent of maternal deaths in the UK related to SARS-Cov-2 – which is the virus that causes Covid-19 – were from ethnic minority groups.

At the meeting members of the panel were told that ‘Hertfordshire Maternity and Neo Natal Care services’ had now tailored communications to reassure women to seek help, if concerned.

And they heard they were conducting continuous surveys, in a bid to improve services and care for BAME women.

They are also said to be promoting vitamin D supplements and offering support to staff from the BAME communities.

Recommendations from the scrutiny panel are yet to be finalised, but councillors did highlight the need for further scrutiny of issues relating to maternity services.

They also pointed to the need for ‘services to understand people’, rather than for people needing to understand services’, as well as the importance of language used.

It was also suggested that there needed to be more specific work around diabetes – to see if greater support could be offered to those who are newly-diagnosed.

And while the vast amount of ongoing work into vaccination levels was noted, it was suggested that all of this research be brought together and fed into public heath.