COVID 19 and Social determinants of health. By Tina Murphy

For the past 17 years, I have led an organisation that work to improve the health of African communities at a grassroots level and I have come to understand that African communities bear the burden of ill-health and my question have constantly been “why”? Yet I had no answer to my “why” until at my adult life I decided to go to the University to study Public Health and I got an admission in Canterbury Christ Church University. I did not go to the University to aspire to get better job opportunity, I went there for knowledge and an answer to my “why” so that collectively as a community we can find a solution if it is within our reach.

Within couple of months into my first year, I found the answer to my “why” in one of the modules titled The SOCIAL DETERMINANTS OF HEALTH. Social determinants of health framework examine the “causes of the causes” of health inequalities. According to Marmot (2005), it is the forces and systems that shape the conditions in the places where people are born, live, work, learn, and play . The question is, do the health system really take this into account when delivering healthcare to individuals?
There are numerous ways social determinants of health translate to the poor health outcomes faced by individuals. There is the structural vulnerability which is a term medical anthropologist use to explain how broader power, relationships and local hierarchies affects the health problems faced by individuals. This term applies to people who are poor, racially stigmatised people (BAME communities), people with disabilities and people who are incarcerated.

In other words, the unequal positions of individuals from the BAME communities in society, is likely to put them at greater risk of exposure to the virus. Their ability to live healthy lifestyles may be hindered and they may therefore be unable to access healthcare when they need it due to inadequate information or lack of health literacy in some communities.

COVID-19, an infectious disease caused by a newly discovered corona virus started in 2019. The entire world soon realised the seriousness of the virus and each Country implemented drastic measures to limit the movement of people so as to contain the spread of infection. There was a total lock down.

Most businesses had a large “Closed” signs on their doors and many took to remote working and some embarked on creative projects virtually. On the other hand, people regarded as essential key workers still had to go to work despite the fact that people were told to stay at home and maintain social distancing. Those who work in transportation like buses and rail, carers, NHS nurses and Doctors and those who operate grocery stores could not stay at home .

The news of a Black woman who worked with London rail that was spat at and later died as a result of Covid-19 related illness, highlighted the risk to those working at the front-line, majority of whom are individuals from the BAME communities. This also remind us that many people who perform low-paid occupations do not have the luxury of working from home.

People who fall in the category of essential but low-paid jobs, such as home care workers that goes to people’s homes or work in residential homes may find it difficult to maintain a safe social distance and they therefore come into frequent contact with people who may be infected. If they do develop symptoms, they may not want to stay at home and self-quarantine, for fear of losing their job and even If they can afford to quarantine, they may live with family in multi-generational households and therefore risk exposing others, including individuals who fall into higher risk groups to the virus.

It is not just individuals who must still go to work to provide essential services that face unique risks in the situation of COVID-19, according to BBC news closing of schools and workplaces means that women and girls and even in some cases men were in lock down with their abusers. People who needed medical care for other diagnosis, avoided doing so for fear of being infected with COVID 19 in the hospital.
Some individuals from the BAME communities who are yet to regularise their stay in the UK are particularly vulnerable. These individuals may be reluctant seeking medical help if they present with severe symptoms of COVID-19 infection for fear of being detained or apprehended in hospitals and risk deportation.

Those who are living in deportation detention facilities are at a highest risk of exposure because of their confinement, they may be unable to practice social distancing because of the conditions of where they reside. From my experience of working with asylum seekers in the UK, one can be justified to say that majority of those in these deportation detention facilities are individuals who are from the BAME communities.

COVID-19 has also been used to stir up racist sentiments and actions against minority groups, particularly those from China, by referring to the virus as a ‘Chinese virus.’ This is not the first time that politicians and the general public have associated disease with foreigners, which leads to discrimination in certain communities and leave others with the false sense that they are immune. This was also the case during the HIV epidemic when the HIV virus was regarded as African virus and Africans were associated with HIV.

COVID-19 is not an equaliser as it disproportionately harms people from the BAME communities especially those with diagnosed and undiagnosed underlying illnesses
The time has come for health practitioners and public health in particular to think of the conditions affecting people’s lives and their structural vulnerability so as to understand how these conditions can worsen health problems for vulnerable individuals from the Black and ethnic minorities
Doctors and nurses treating COVID 19 patients from BAME communities are faced with the challenge of addressing individual manifestations of other diseases resulting from larger social inequalities that have weakened the patient’s immune system.

Marmot (2005) in his article on the Social determinants of health inequalities, advocated for an upstream approach, where practitioners need to look upstream to the places where health begins, such as one’s home or workplace.

With the unprecedented effect of COVID 19 on the BAME communities, I hope each local authorities and their Public Health team will endorse structural competence or an upstream approach through advocacy and engagement with community grassroots organisations that are continually undermined.

The COVID-19 pandemic presented new tests to understanding how upstream or structurally competent approaches can be executed in times of crisis when front line health care workers themselves were at delicate risk of exposure, when advocacy and voluntary organisations worked remotely in order to continue providing support for their communities while facing economic uncertainty, when hospitals faced shortages, and when health care systems was overwhelmed. I hope we have all learnt one or more lessons that we can apply in our different organisation’s transition and transformation strategies .