Weeks into the pandemic, a disturbing pattern started to emerge. On social media news was being shared about medical staff dying from Covid-19. The pictures were overwhelmingly of people of colour, mourned by their families, friends and communities. It soon became clear that ethnic minorities were disproportionately dying from the coronavirus.
“The pandemic really shone a light on inequalities and, in fact, it was so distressing to see how fast those inequalities appeared,” Kevin Fenton, the president of the Faculty of Public Health (FPH) and one of the world’s leading public health practitioners, tells Spotlight.
It was Fenton to whom the government turned to understand what was happening and why people of colour were more likely to die from Covid-19. He was commissioned to review the evidence and produced a report in June 2020 that found an association between structural factors such as housing, income, work and the experience of racism, and the higher mortality rates for BAME (Black, Asian and minority ethnic) groups. This was not the first pandemic Fenton had faced. “I started my career at the beginning of the HIV/Aids pandemic and it in fact shaped why I went into public health, and the work and the values that I bring to my work today,” he says.
The NHS quickly issued guidance that ethnicity was to be considered as a factor when assessing the risk to individual members of staff. However, it would not be a factor in prioritising the vaccine roll-out to the general population six months later.
Fenton, 56, was born in Glasgow and grew up in Jamaica. He has spent 30 years working in public and community health at a population level, including roles in Jamaica, the United States and the UK, and work globally. “I felt that that was what I was being called to do, but also what I was going to be passionate about doing,” he said. As well as being the elected president of the FPH, a membership organisation for public health professionals, Fenton is the London regional director at the Office for Health Improvement and Disparities, the regional public health director at NHS London and the statutory health adviser to the Mayor of London.
“Improving health and tackling inequalities are exactly what we do as public health practitioners and it is absolutely important for us, as practitioners in public health, to be honest about how we describe those inequalities,” Fenton says. The FPH is charged with setting the standards for public health specialists in the UK.
“Structural discrimination and racism is a public health issue, a major public health challenge, and we believe that we can bring a public health approach to addressing these issues,” he says. That includes developing anti-racist strategies, providing training and capacity building to health and care staff, working with communities to help them and the FPH understand the impacts of racism and discrimination, and developing programmes that work for communities. “A big part of my practice, and what we promote as a faculty, are those community-centred approaches,” he says. “Because you have better sustainability, better engagement and better longevity of your work if communities are at the centre of what you’re doing.”
He and his colleagues at the FPH are working to turn what he describes as the “legacies” of the pandemic into developments in public health practice. Typically, healthcare only accounts for about 10 per cent of population health and well-being, according to the Health Foundation. The biggest determinants are socioeconomic factors such as having a decent home, a good job, and strong relationships with people and your community. These were also the issues highlighted in Fenton’s report on Covid-19 and race – people of colour are less likely to have all of these “protective factors” due to the impact of structural discrimination and racism.
One of the challenges that emerged during the pandemic, particularly for communities of colour, was the lack of trust in the systems that were working to protect them. “[We saw] the trend in declining trust in government accelerate during the pandemic,” Fenton says. That trend has also affected trust in doctors and nurses, and information and communication has become much more complex in the social media age.
Inequalities for, and within, communities of colour existed before the pandemic and persist today. In April Parliament’s Women and Equalities Committee issued a report heavily criticising inequalities and discrimination in maternity care, while the Mental Health Act is undergoing reform to address huge discrepancies in treatment; black people are four times more likely to be sectioned under the act than white people, for example.
Fenton says it is important that public health practitioners are “clear about our voice and our evidence” and that they understand the channels they are using to communicate with people. “We cannot, as a profession or as a specialty, stay still, because the world around us is changing really quickly. And a key part of good professional practice is understanding those changes, and moving along with them, leveraging them for the good of society.”
While public health practitioners focus on the public at large, many of the decisions that affect people’s health are made by a relatively small number of politicians. The Conservative government dropped its white paper on health disparities in January; Labour, meanwhile, has pledged to tackle inequalities and make the UK a “Marmot Country”, based on the work of the health inequalities expert Michael Marmot.
The health workforce is particularly important to Fenton’s approach. The workforce is the “greatest asset” the health system has, he says, and “taking care of the workforce” should be a priority. That means creating workplace environments that really support and value staff across healthcare, public and community health. Public health has pioneered the opening of the profession to practitioners without medical training, to enable them to become public health specialists, which is seen as best practice globally and means the workforce can move towards being representative of the communities it serves. “Other countries are far more deliberate, far more expansive in their use of community assets, and linking community assets to traditional and non-traditional services to improve health and well-being,” says Fenton.
He also believes public health and addressing inequalities are crucial to supporting the NHS, by implementing programmes like smoking cessation services that tackle a significant pressure on healthcare. But, he adds, the current crisis in the NHS demands a response from beyond the healthcare system. That means creating good jobs, helping young people to develop the skills that will keep them healthy throughout their lives, and supporting community organisations to promote health at the earliest stage.
“Health is wealth. So, we have a vested interest in not only creating and supporting healthy citizens, but recognising that when the economy is better, everybody has health benefits as well,” he says.
“For all of us that have gone through the Covid pandemic, we will be changed,” he adds. That includes the deaths of hundreds of thousands of people, the millions that were infected and the impact of long Covid. For public health, Fenton says, there are legacies that have to be changed as a result of that experience, including addressing inequality and building a better health system.