In the answer to the issue of low vaccine roll out in Tower Hamlets, compared to the national average. First, I look at the issues behind this problem, as well as possible theoretical solutions. Second, I look at a practical solution, a community-orientated vaccination program being rolled out in the London Borough of Kensington and Chelsea, the ‘Al – Manar Model.’
‘Racial Health Disparities and Covid-19 – Caution and Context’
“Disparity figures without explanatory context can perpetuate harmful myths and misunderstandings that actually undermine the goal of eliminating health inequalities. Such a clarifying perspective is required not just for Covid-19 but also for future epidemics.”
Merlin Chowkwanyan, Adolph Reed – NEJM 16 July 2020
PART 1: THE THEORY
Against disempowering ‘Racecraft’: Let’s talk facts and lived experiences
Figures on the Covi-19 Pandemic have shown that BAME communities are disproportionately affected. This racial disparity, particularly in Tower Hamlets is largely a proxy for poverty, the lack of socioeconomic status and the segmentation of the workplace. Looking at facts and lived experiences, on a group level, someone who self identifies as BAME is more likely to grow up poor, more likely to have a low income as an adult, and more likely to in frontline work. Characteristics shared with left behind demographics in our working-class communities.
We also know that people who live in poverty are more likely to have certain health conditions, that make them more vulnerable to Covid-19, including high blood pressure and diabetes. And in turn members of these groups face discrimination from medical professions and others, through misdiagnosis or poor quality health care. For example the racial disparity in maternal mortality rates in the United Kingdom. Black British mothers were five times more likely than white mothers to die in pregnancy or within the first six weeks after childbirth. The risk of dying from pregnancy-related causes was also three times higher for mothers of mixed ethnicity than for white mothers, and twice as high for women of Asian ethnicity.
The problem is that when we use just solely use race as a shorthand for all the above, we run the risk of performing what is called, ‘Racecraft, a term brought into academic parlance by the sociologist Karen Fields and historian Barbara Fields.
We see a similar sleight of hand with discussions about Covid-19 racial disparities. Treating issues around Covid-19 as innate rather than structurally constructed. This goes against the academic and public policy consensus, of their being no real biological foundation to race. The fixation around racial disparities is leading some commentators and elected officials, down some questionable paths, rather than dealing with the matter at hand. The focus should be dealing with structural issues, the barriers to health care and the way we administer public health.
An approach is needed to reorientate public health around the communities it serves, rather than the needs of bureaucrats and decision-makers. An empowering agenda, transferring agency to left-behind communities, removing the inequalities they face, investing in those communities. Any remedies that do not challenge current hierarchies (economic/social/political) is bound to fail.
“Covid disparities do not reflect the mysteries of human biology, but the brutal truth of health under [Neoliberal] capitalism”.
Dean Robinson – Associate Professor of Political Science – University of Massachusetts
PART 2: THE PRACTICE
The Al-Manar Neohealth Model: The community at the heart of public health and vaccination
After discussions with community stakeholders in Mile End ward about low vaccine roll out in Tower Hamlets. I decided to visit the centre with observers to the Al-Manar community centre in Kensington to look at a community approach to Covid-19 vaccination.
Al-Manar community centre sits on the border of Kensington and Chelsea and Westminster. The areas around Al-Manar
Golborne, Dalgarno, Notting Dale and Westbourne wards had some of the highest rates of Covid-19 infections in the country. These are also wards with some of the highest levels of deprivation in London. These wards have significant minority populations from Portuguese, North African, Eritrean, African Caribbean origins. Often accommodated in high-density housing, with limited public space for recreation.
Local GPs, Neohealth, recognising the need to establish relationships with organisations that are trusted locally; reached out to Al-Manar, who was simultaneously looking for a way of accessing reliable information on COVID-19 and vaccination for their communities. To establish the conversation, a series of community engagement seminars were organised jointly. These then formed the basis for further cooperation and the establishment of a pop-up vaccination site at Al-Manar.
Working with volunteers selected by Al-Manar, Neohealth has organised for these volunteer’s training, which includes:
- In-person training
- E-Learning modules
- Shadowing at a fixed vaccine site
- Buddying up with trained medical students
- And finally enabling the volunteers to become vaccinators
Throughout there is a process of ongoing transfer of capacity to Al-Manar, with medical oversight at all times, so that Al-Manar, will become empowered to identify and help assist in resolving health challenges in the community. As a result of this local residents have convenient doorstep service. That is characterized by calm efficiency and the ability to raise and discuss concerns with experts. As the conversations had here been seen as the start of a ripple effect providing accessible reliable information. As well as making healthcare itself more accessible.
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