Calls made for ‘monumental shift’ to address local health inequality

Calls for a ‘monumental shift’ in how to tackle local health inequality are being made by the voluntary sector in Hackney.

Jake Ferguson, CEO of non-profit Hackney Council for Voluntary Service (CVS), addressed a meeting of health bosses this week urging a “collective system response” on the issue.

Hackney has long been known to have some of the worst health inequality in London, with one of the highest mortality rates for Covid-19 in England and Wales, according to the Office for National Statistics (ONS).

Ferguson said: “We are acutely aware that across the country, BAME communities have been overrepresented in the deaths.

“Clearly, it’s showing that those from different communities are more likely to be affected, and that is illustrated in the deaths of healthcare staff. It is sad we are in this situation.

“I would like to see a seriously co-produced strategy to address health inequality. Not just professionals in the NHS or in the council, but to work with the voluntary sector to create something different, so we’re not having this conversation next time there’s a national emergency.

“For too long, inequality has been a side issue, and it needs to be front and centre. It’s absolutely key – kids getting access to IT, not being able to study at home, mental health patients overrepresented particularly in African Caribbean communities – we’re not really talking about it.

“We need to make a monumental shift and have a rethink about how we go forward. In terms of inequalities, I think we’re lagging behind.”

Hackney has the third highest Covid mortality rate in England and Wales, according to the most recent ONS figures.

In the ONS report, which shows that residents in more deprived areas are dying at double the rate of those in more affluent neighbourhoods, Hackney has 127.4 deaths per 100,000 people involving Covid-19 between 1 March and 17 April 2020 – just over 3.5 times the average for England and Wales.

A recent study by the Intensive Care National Audit and Research Centre (ICNARC) showed that over a third of people becoming critically ill with coronavirus are from black or minority ethnic backgrounds, despite making up only 14 per cent of the UK population.

Public Health England statistics from 2017 show that men in Hackney spend on average 21 years of their lives in ill health, second in London only to Tower Hamlets, with women in the borough spending even longer in sickness at 24 years.

Cllr Randall Anderson, who chairs the City of London & Hackney’s integrated commissioning board, also warned of further equality concerns over the move to digital GP appointments, as the system that attempts to guard against the transmission of the virus “doesn’t work” for people without proper internet access.

Honor Rhodes, a lay member of City & Hackney clinical commissioning group (CCG) also urged a focus on the “Covid generation” of children impacted by the virus and the lockdown, adding that the resultant “growing and significant inequality attainment gap [will] last their lifetime unless we find a way to remedy it”.

David Maher, managing director of City & Hackney clinical commissioning group (CCG), said: “I accept all of Jake’s comments. I think there’s a lot of work to be done on understanding the impact of Covid disproporaionately on our BAME community. I agree entirely, and I think that work is continuing.

“There are risk assessments processes happening with staff and we obviously need to think about risks within our communities, how public health data is used, and how we use different strategies with communities whom we know may be more vulnerable.

“In terms of inequality, I agree entirely. It’s part of the reason that we established an integrated care programme was to try to think through at a very deep level how we approach our communities’ needs adequately.”

Maher added that he “didn’t have a clear answer” on a solution to digital exclusion, saying the roll-out of free wifi across city districts, or the distribution of cheap mobile devices or tablets, were all options to think through in partnership with local authorities.

The CCG director added that the preparation of a dedicated report on inequality was a “more than reasonable ask”, committing for one to be prepared by July, adding: “These are things that our colleagues are thinking about all the time, so there is some work happening in Public Health already in relation to our communities and our staff.”