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Racism is a public health issue. This has been undeniable since the advent of the health inequalities movement. Yet, the increasing traction of the Black Lives Matter protests and their juxtaposition with the realities of the COVID-19 pandemic has brought it to the forefront of the world’s imagination.

In April, analysis by the Guardian found that 19% of patients who had died in hospital with COVID-19 were Black, Asian and minority ethnic (BAME). This was followed by an Office of National Statistics report on 7 May, which further confirmed the devastating reality that black people are more than four times more likely to die from COVID-19 than white people.

On 2 June, months after knowing the devastating impact COVID-19 was having on BAME communities, the government-ordered inquiry ‘Disparities in the risk and outcomes of COVID-19’ was released by Public Health England. It confirmed what was already known: British people from minority ethnic groups are the worst affected by COVID-19.

The inquiry failed to add anything new to the discussion. It stated that ‘these analyses were not able to include the effect of occupation […] comorbidities or obesity’. It made no attempt to analyse the underlying socioeconomic or health causes of the disparities. Its publication is a belated and symbolic gesture that accompanied by inaction will not contribute to improved health outcomes for BAME people.

An article in the Health Service Journal stated that a section from an earlier draft of the report which detailed contributions of over 1000 organisations and individuals on the underlying causes of the inequality had been removed, effectively censoring evidence of structural racism.

The report simply restated the outcomes without investigating solutions which shows that the government is complacent in the continued death of BAME people. The government is ignoring the influence of structural racism and relinquishing any responsibility that these outcomes could have been prevented with their intervention. This is not good enough.

So, why are more BAME people dying of COVID-19?

BAME people are more likely to be working in frontline roles, including healthcare. According to the Institute of Fiscal Studies over a third of black African people are employed in key worker roles. BAME people are more likely to live in housing which is poor quality or overcrowded and are overrepresented in homeless family figures. BAME people are more likely to live in cities and thus have greater reliance on public transport. These factors leave BAME people at increased exposure to coronavirus.

Ethnic minority groups experience poorer overall health, are more likely to have a long-term health condition, in addition to poorer access to and quality of healthcare services. This greater burden of disease increases their likelihood to die from COVID-19.

It is vital to also consider those who because of their immigration status have No Recourse to Public Funds – cannot receive welfare support, furlough payments or accommodation if they become homeless. Those in this situation, and their children, have no lifelines to maintain their health.

The underlying current of all these factors is socioeconomic disadvantage – poverty – as a result of racial biases that exist within the fabric of society and government policy.

The marginalisation, stress and poverty that accompany racial discrimination have profound effects on the health of BAME people. The effects of COVID-19 highlight the inextricable links between structural racism and health inequality.

Shared Health Foundation supports calls on the government to investigate causes of the stark inequalities in COVID-19 outcomes, claim responsibility for the lack of preventable action taken to protect BAME people’s lives, and offer solutions to build a more equal society.

contact@sharedhealth.org.uk

Before all this (the big C word) kicked off I found myself sitting in London listening to a man I had long admired. In fact, I was sat in a rather grand hall in Westminster with Michael Marmot delivering his summary of the nation’s progress to addressing health inequalities over the last 10 years. Marmot’s report about fairer societies published 10 years ago had been the background and constant for the last decade, almost like the bass note in a piece of music. Marmot had set the tone and progression for action.

10 years ago I was hearing from his own mouth the reality that he and his team had found during their review. 10 years is a long time. 10 years ago my eldest child, who now towers over me, was looking for tooth fairy money. 10 years ago he and his brother had discussed whether they would be friends with children with black teeth (an observation on the poverty born out where they live). Spring 2010 was before “Bake Off” had hit our screens and Gordon Brown was still (just about) Prime Minister. Marmot took to the stage to pronounce his take on progress for the last 10 years.

The answer came as a mixture of relief, shock and anger.

Health inequalities had gotten worse in the past decade. Life expectancy for women in the poorest area had actually dropped, something that should be unheard of in modern societies and the number of children living in poverty had risen. Matrix after matrix flashed up. Increases in street homelessness, increases in family homelessness and families living in B&B accommodation and increase in the number of people living in housing unfit for human habitation. The day passed in a blur of charts, pictures and chat. Discussion that prison is the worst place for young people who mostly come out more deprived, dejected and hardened. I heard lived stories of attending school and being hungry all day and testimonies from teachers despairing of the circumstances of the children sitting in front of them. The link between disability and poverty. That one almost predicts the other. The link between universal credit and real hardship.

The day was slightly surreal. Grand building, vegan food, fancy tea and coffee and the ever present drum beat of the research findings.

To be honest it was with relief that I heard the overall message that things had gotten worse. Relief because on the ground in the hard pressed places of Greater Manchester where we work it has felt like it has got worse. The decade has seen universal credit rip through the area. Zero hour contracts have increased where previously good solid jobs like working for parks and gardens at the council has become a zero hour life.

On the ground it has felt like there are no consequences to being a rubbish landlord or employer. On the ground the decade has seen those suffering from childhood grooming emerge into complex adult survivors. On the ground it has felt forgotten.

And so it was a relief that the learned, wise, diligent man of Marmot and his team had found it, counted it and were now saying it. Speaking truth to power.

The benefits system has been designed to make poor people poorer. We have to break that being disabled means you must be poor. It is unacceptable for mortality rates to climb and life expectancy to fall. There is nothing just in a society that can not see its own people.

I can’t state causation but it does not require any imagination to know that austerity has really, really hurt.

Marmot spoke like we had been seen, he was making the invisible visible.

The anger that boiled up in me was restrained to the social niceties of the event. And yet you wanted to scream.

IT IS NOT GOOD ENOUGH.

IT IS NOT GOOD ENOUGH.

IT IS NOT RIGHT.

I got on a train and let my head be.

Months later back in Manchester, even during lockdown, the work carries on.

The Shared Health Foundation started because it is not good enough and we will carry on.

• Our work with homeless families to get the system changed, to make the system better, to stop so many people finding themselves in this place, to ensure children in temporary accommodation get education and support and keep their health still goes on.
• Our work with parents and carers of under fives in areas of deprivation to help them look after their children and give them health, still goes on. (Lockdown has proven this difficult but we are pursuing). Families who if they followed the healthy eating advice Marmot says they would have to spend 70% of their income on food.
• Our work with children and young people struggling with mental health often caused by, made worse by and continued by poverty and the life events that come with poverty, still goes on.
• Our work in training health staff to be able to really excel in these hard pressed areas through our GP training scheme, GP support and nurse events, still goes on.
• Our work in Focused Care bringing real solutions to patients in general practice who are the least and the lost, who are complex and beautiful, who’s clinical staff really want to help but are not sure how, still goes on. In the last 3 years 5,000 households in Greater Manchester in the most hard pressed areas have had Focused Care alongside them.

Our work in continuing to speak and write and talk about poverty and its impact, still goes on.

Marmot is a stark call out of the current reality. A call to action so that the next 10 years will be different. He has given us the how.

Now we must do.

Dr Laura Neilson

A perspective for Mental Health Awareness Week.

Mental Health Awareness Week has been accompanied by a cascade of newspaper reports and social media posts encouraging people to talk more openly about their mental health. Nurturing a society with positive attitudes towards their emotional wellbeing and a tendency to accept and support those around them who are struggling is invaluable. However, framing mental health issues in this way places the responsibility of finding solutions on the individual. This approach has the potential to undermine the social determinants of mental health.

Mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical environments in which people live. – WHO

Mental health disorders can be attributed in large part to the life circumstances in which they arise. Across a lifetime distress can find its roots in exposures as babies, trauma in childhood and stressful employment in adulthood.

Financial problems, poor housing and breakdown of relationships all cause emotional stress. Poverty increases the likelihood of someone encountering adversity and eradicates the financial and social safety net to catch them.

This is what leads people to despair.

But – governments can provide a safety net in the form of welfare provision and adequate funding for support within the community.

There are almost certainly biological and psychological mechanisms that translate adversity and stress into severe distress and disorder. But rather than thinking of the consequences as ‘brain disorders’, which suggests that ‘the brain’ is primary, these conditions could equally be called ‘social adversity disorders’ – Nikolas Rose

To find solutions to mental health problems we need policies directed at the social conditions which produce them and comprehensive support which meets the emotional, social, health, nutritional and psychological needs of our population. Below is a summary of national strategies which could have a significant impact on mental health inequalities.

Evidence suggests that these country level policies have the potential to improve the mental health of a population.

The emotional impact of COVID-19 is undeniable – in a recent survey by the National Board of Italian Psychologists 80% of people said they needed psychological support to overcome the effects of the pandemic. As society rebuilds it is critical that governments implement policy which considers the social determinants of mental health.

#MentalHealthAwarenessWeek

TheLemonadeProject.org.uk

At the time of writing, COVID-19 has taken the lives of over 33,000 people in the UK. The wrath of health inequalities in the UK is still prevalent during these times and rules the life expectancy outcomes of the poor. The death rate in deprived areas is twice as high as in richer areas.

People living in poorer areas are more likely to die of coronavirus because of a myriad of issues. These poorer areas are generally more densely populated with key workers (bus drivers, cleaners, nurses) unable to work from home and are therefore more likely to catch the virus. Social distancing is difficult in high rise flats with no gardens and with an added complication of using public transport to travel to work. The higher the density of population, the harder it is to be socially distant.

Those in low-incomes roles generally do not have the luxury of working from home compared to more affluent areas and careers and therefore put themselves at risk to simply earn a living.

People who live in poorer areas are also more likely to die from Covid because of pre-existing health conditions and have worse health than richer areas. This is due to lack of quality healthcare, higher stress levels, higher levels of poverty etc. It’s no surprise that because Salford is the 18th most deprived local authority and has 4 in 10 children living in poverty, that it has one of the highest Covid death rates outside of London.

The Inverse Care Law unfortunately is still present in the UK where the quality of healthcare is inversely related to the local health need i.e. deprived areas on average have worse health care than richer areas.

This shows the level of deprivation is directly linked to the death rates in the UK.

Covid deaths have also affected the BAME community with those from ethnic backgrounds twice as likely to die from the virus.

“Examining the possible reasons, it says that a third of all working-age Black Africans are employed in key worker roles, 50% more than the share of the White British population. Additionally it says Pakistani, Indian and Black African men are respectively 90%, 150% and 310% more likely to work in healthcare than white British men.”

Health Inequalities in the UK is not a new story, nor will it disappear over night. Shared Health’s aim is to reduce the impact that poverty has on people’s health. Our work with Homeless Families, young people’s mental wellbeing, carers for under 7’s and GPs working in deprivation are needed now more than ever.

If the past 10 years of austerity have taught us anything, it’s that the poorest always get hit the hardest. That’s just not fair.

We are here to work at grassroots level to create new innovative projects and to work with councils to create policy change at regional and national level.

Contact@sharedhealth.org.uk

The media focuses on rough sleepers, homeless beggars and the overall homeless crisis in Manchester. It is only more recent that hidden homelessness has become a talking point, particularly as families make up the numbers of hidden homelessness.

From Manchester alone there are 1,500 families in dispersed housing located across other boroughs such as Oldham, Rochdale and Salford and there are over 100 families living in B&Bs.

When presenting homeless it does not mean you are perceived as homeless in the eyes of the system. It is only when you are awarded ‘duty of care’ by the council you are labelled homeless in the system. However, it is not an emergency as you now have a roof over your head wherever that may be. This is where hidden homelessness comes into play. The system has no compassion and it is becoming a make do scenario over and over with no acknowledgement of isolation, regression and decline in all aspects of a homeless family’s life. The system is bursting at the seams.

Once you have been given temporary housing you can be there for more than 2 years and this is where the dramatic effects of hidden homelessness start to unravel. You are told it is temporary and you could move at any given time so don’t get comfortable, DO NOT try to make a home inside, but you are also told to make links, change schools and register at doctors. Your life is in complete limbo and you have no control.

The reality of hidden homelessness for the whole of Greater Manchester is scary. The numbers are rising rapidly and the resources are being utilised to maximum capacity yet nothing hugely impactful is being birthed. The outcome for a family who has gone through homelessness does not end when they are in settled accommodation because their financial, mental, physical and social states have been impacted along the way.

The Shared Health Foundation, council representatives and other organisations in Greater Manchester are coming together to bring a community of support to help reduce the negative experience of homeless families.

If you would like to get involved in our Homeless Family project then please email contact@sharedhealth.org.uk

Story written by Nadia from her lived experience.

Let me tell you about Jo…our Homeless Families Project Lead and her new adventure.

Jo is fueled by passion for her community, for equality, and for positive change.

After learning about a family’s story and their ongoing struggles in temporary accommodation, Jo’s passion was ignited and she started digging….

Through tireless working, Jo established there arecurrently 1200 homeless families in Manchester alone, an increase from 140 families, 2 years ago. The current figures equate to around 3000 children – and the numbers are ever increasing.

These families’ lives are disrupted greatly. They are moved to B&B accommodation for 1 to 6 weeks, before being ‘settled’ into temporary housing. More often than not, this is away from the place they know well, and their friends and family. Children are either uprooted from the school they know to new schools, or kept in their current school with the financial and travelling burden that comes with a move further away.

Lives are put on hold, whilst they hope for resolution to come. In practice this resolution often doesn’t come for several years. And there are around 160 new cases per month.

We don’t think that this can be the best way, and we will advocate for these families and are fighting for change.

In the meantime, Jo has come up with a plan – a plan to show value to kids and parents, to grow a community and to bring back fun! FOREST SCHOOL!

Jo explains: “Forest School provides an opportunity for children to explore their own ideas, creativity and understanding of the world they are in. By providing a setting where they feel secure, they are able to recognise their own talents and skills and grow in confidence, whilst having a little adventure”.

Last week, I was lucky enough to join her and her team at Forest School and it was ‘Families Week’, where parents, siblings, cousins, carers and anyone considered family was invited to join.

The children took such delight in showing their parents how to build swings, make ‘forest

stew’ (a lovely mixture of herbal tea, leaves, mud and sticks) and find loads of creepy crawlies hiding away in the undergrowth. They showed their families where the boundaries of their forest area were, boundaries they themselves had defined by where they felt safe.

New friends were introduced and skills learnt, taught forward.

In a few weeks, Jo is running ‘Bee Squad’ – a week long holiday club. I’m sure there will be a lot of fun had there too.

As Jo connects and builds the trust of the families she’s working with; hearing

more of the stories they need to tell, her drive to move this project forward grows.

We are learning more about how we can be stronger, more informed advocates and better meet the needs of our communities.

We will continue to strive for, and action, new ways to make impact and change – our adventure is just beginning.

Being an asylum seeker means you are fleeing persecution – you are scared, often alone and vulnerable. You are staying in a place you probably know very little about, with people you don’t know, and with systems that feel inaccessible and terrifying.

This week, I had the privilege of being part of the pilot Keeping Healthy course at an initial assessment centre for asylum seekers. This is where asylum seekers first enter the country and stay, on average, for about 3 weeks, whilst they wait for their application for asylum to be acknowledged.

My use of the word ‘privilege’ is quite deliberate. Over the course of the day we met with about 25 men, of different nationalities and with different spoken languages. But despite their marked differences, they were clearly comrades, having entered into a shared and arduous experience at a similar time.

They were incredible – they laughed together, made jokes and told tales of health ideas from their home lands. As we talked about the NHS and basic health literacy, they allowed us to hear parts of their stories with much candour and bravery. They had a thirst for knowledge (knowledge that we take for granted) and absorbed the information we were giving them readily, with excitement and gratefulness.

Afterwards, we received an email from one of the support workers, it read:

“Since you left, SUs [service users] have described the sessions as very informative, empowering, making them feel safer, reducing their vulnerability, a sense of belonging and making them feel better – improving their mental health.”

This is why we do it. But the privilege was all ours.