Community Approaches to Health and Covid-19

I have been struck by the differential impact of Covid-19 on different communities. Black people in the UK are 4 times more likely to die from Covid-19 as white people, and when taking other socio-demographic factors into account, the risk of a Covid-19 related death for black people is still 1.9 times greater than white people (White and Nafilyan, 2020). The effect is not just restricted to the UK; the same effect has been seen in the USA, where predominantly black counties suffered significantly higher Covid-19 infection rates and deaths (Millett et al, 2020)


These statistics are alarming. From a biomedical perspective, the risk for black people who have contracted Covid-19 is nearly twice as great, whilst structural racism, socio-economic  disadvantages and other social determinants mean black people are more likely to contract the disease in the first place. Black people in the US are significantly less likely to trust physicians (Armstrong et al, 2007), are more likely to exhibit vaccine hesitancy (Razai et al, 2021), and are more likely to work in “essential” jobs, or roles that require in-person interaction that cannot be done from home (Dyer, 2020). The typical low pay of these types of roles mean that workers are less able to take time off, or practice protective measures such as isolating at home (Public Health England, 2020), and this impacts not just black communities but all those people in lower paid, “essential” and in-person jobs. 


The Covid-19 pandemic had disproportionate impacts on low-income families (Bitler et al, 2020), of which the results will be felt for years, possibly for generations. Even before the pandemic, life expectancy was stalling and inequalities were worsening in England (Taylor-Robinson, 2019), and the Covid-19 pandemic only served to amplify these inequities. Children, especially those living in low-income families have suffered significantly, with evidence showing that the pandemic caused low-income families’ expenditures to increase, whilst expenditures of higher income families decreased.


For many children living in poverty or in low-income families, schools are not just a place to learn, but to eat healthily. School closures meant that for many of these children, it wasn’t just their education that has been put on hold, but their nutrition too, which will only serve to widen the existing gaps in food security and learning (Van Lancker and Parolin, 2020).


There are efforts to redress these inequalities that have been growing over the past decade, and exacerbated by the Covid-19 pandemic. In “Build Back Fairer”, the Covid-19 Marmot Review, community approaches to health are recommended in an approach “based on the principles of social justice” (Marmot et al, 2020), in order to reverse these growing inequalities. Proposed measures include increasing funding for public health alongside an expanded focus on the social determinants of health, recognising that poverty, deprivation, employment, ethnicity, social class and culture strongly influence health and our individual perception of it.





Armstrong, K., Ravenell, K.L., McMurphy, S. and Putt, M., 2007. Racial/ethnic differences in physician distrust in the United States. American journal of public health, 97(7), pp.1283-1289.


Bitler, M., Hoynes, H.W. and Schanzenbach, D.W., 2020. The social safety net in the wake of COVID-19. National Bureau of Economic Research. (No. w27796).


Dyer, O., 2020. Covid-19: Black people and other minorities are hardest hit in US. BMJ, p. m1483. doi: 10.1136/bmj.m1483.


Marmot, M., Allen, J., Goldblatt, P., Herd, E. and Morrison, J., 2020. Build Back Fairer: The COVID-19 Marmot Review. The Pandemic, Socioeconomic and Health Inequalities in England. London: Institute of Health Equity.


Millett, G.A., Jones, A.T., Benkeser, D., Baral, S., Mercer, L., Beyrer, C., Honermann, B., Lankiewicz, E., Mena, L., Crowley, J.S. and Sherwood, J., 2020. Assessing differential impacts of COVID-19 on black communities. Annals of epidemiology, 47, pp.37-44.


Public Health England, 2020. COVID-19: understanding the impact on BAME communities. Available at: (Accessed: 11 May 2021).


Razai, M.S., Osama, T., McKechnie, D.G. and Majeed, A., 2021. Covid-19 vaccine hesitancy among ethnic minority groups. BMJ, p. n513. doi: 10.1136/bmj.n513.


Taylor-Robinson, D., Barr, B. and Whitehead, M., 2019. Stalling life expectancy and rising inequalities in England. The Lancet, 394(10216), pp.2238-2239.


Van Lancker, W. and Parolin, Z., 2020. COVID-19, school closures, and child poverty: a social crisis in the making. The Lancet Public Health, 5(5), pp.e243-e244.


White, C. and Nafilyan, V., 2020. Coronavirus (COVID-19) related deaths by ethnic group, England and Wales: 2 March 2020 to 15 May 2020. Office for National Statistics.


Whitehead, M., Taylor-Robinson, D. and Barr, B., 2021. Poverty, health, and covid-19. BMJ; 372:n376

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