A PHE review into factors behind disparities in COVID-19 outcomes published on 2 June found that death rates from the virus were highest among people from BAME groups.
The review found that people of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity had between 10 and 50% higher risk of death when compared to White British people, with people of Bangladeshi ethnicity facing around twice the risk of death compared with people of White British ethnicity.
The review was criticised as a 'missed opportunity' by the BMA, which said it confirmed disparities that were already widely reported but failed to offer solutions.
A second PHE report, released on 16 June after pressure from doctors' leaders, politicians and others, found that racism, social and economic inequalities and increased prevalence of diseases such as obesity and diabetes may be behind the unequal impact of COVID-19.
PHE chief executive Duncan Selbie called the report's findings 'humbling' - and said the clear message from stakeholders including more than 4,000 people with 'a broad range of interests in BAME issues' was that 'tangible actions, provided at scale and pace, with a commitment to address the underlying factors of inequality' were vital.
The review set out seven recommendations:
- Ethnicity data collection and recording in NHS and social care, including 'mandatory collection of ethnicity data at death certification', with data shared among local health and care organisations to 'mitigate the impact of COVID-19 on BAME communities'.
- Involve local communities in research to understand the social, cultural, structural, economic, religious, and commercial determinants of COVID-19 in BAME communities and develop 'readily implementable and scalable programmes to reduce risk and improve health outcomes'.
- Improve access, experiences and outcomes of NHS, local government and integrated care systems commissioned services by BAME communities with equity audits, health impact assessments, incorporation of equality into quality systems and better representation of BAME communities at all staff levels.
- Development of 'culturally competent' occupational risk assessment tools to reduce employees' risk exposure to and acquisition of COVID19, particularly for key workers.
- Culturally competent COVID-19 education and prevention campaigns, working in partnership with local BAME and faith communities.
- Accelerate efforts to target culturally competent health promotion and disease prevention programmes for non-communicable diseases promoting healthy weight, physical activity, smoking cessation, mental wellbeing and effective management of chronic conditions.
- Ensure COVID-19 recovery strategies 'actively reduce inequalities'.
Health Foundation chief executive Dr Jennifer Dixon welcomed the report's backing for a 'properly funded strategy to tackle the wider circumstances in which people live - including education, job opportunities, working conditions and housing, which shape underlying health and vulnerability to COVID-19'.
But she warned that 'further concrete action' was needed from the government, warning that the report did not offer specific proposals to tackle entrenched discrimination and racism identified by stakeholders as a key driver of ill health.
NHS Confederation chief executive Niall Dickson also highlighted the need for 'decisive action'. He warned that as the UK emerges from the COVID-19 pandemic, there was a 'high likelihood' that inequalities would worsen as a massive backlog of routine work delayed by coronavirus affected 'the most disadvantaged hardest'.
The PHE review makes clear that respondents to its consultation exercise warned consistently that 'without explicit consideration of ethnicity, racism and structural disadvantage in our responses to COVID-19 and tackling health inequalities', the UK risked misunderstanding the reasons for poor health outcomes - and that potential solutions could fail as a result.
It warned that action to improve the lives and experiences of BAME communities was key to building 'resilient, cohesive communites' as the UK moves out of the first stage of the pandemic.