On January 13 2021, it was reported that more than 100,000 people had died from coronavirus in the UK, with the figure for that day alone being 1,546 deaths. The UK has one of the worst coronavirus mortality rates in the world, at 151 per 100,000 people but now the roll-out of the vaccination is viewed as the best promise of halting the spread of the virus and ending the current lockdown. However, the communities which COVID-19 has affected the most have been excluded from debates about how to limit the spread of the virus, according to Professor Chris Phillipson, Dr Sophie Yarker, Dr Luciana Lang, Dr Patty Doran, Dr Mhorag Goff, and Dr Tine Buffel of the Manchester Urban Ageing Research Group. In this blog, they argue that given the unequal impact of COVID-19, a community-centred approach is now urgently needed to help stop the spread.

• The pandemic has highlighted and exacerbated inequalities in the UK, disproportionately affecting low-income neighbourhoods and Black, Asian and minority ethnic (BAME) communities.
• Building on existing networks and neighbourhood organisations, working with community leaders, and having a representative and diverse pandemic response team will be vital to developing community-based interventions.
• Any long-term strategy to combat the pandemic has to be rooted in addressing multiple forms of deprivation whilst strengthening neighbourhood-based organisations working at a grassroots level.

To date, the communities that have been affected most by COVID-19, have not been included in debates on how to limit the spread of the virus. Questions also remain about reaching out to these groups and ensuring the engagement of communities in the development of future policies regarding the pandemic. As a result, there is an urgent need for what might be termed a ‘community-centred’ model, as developed by Public Health England, to work alongside the implementation of mass vaccination and reinforce non-pharmaceutical interventions.

The pandemic has posed particular difficulties for many low-income neighbourhoods, at a time when they had already been weakened through job losses and reduced funding from local government. Neighbourhood-based inequalities have deepened in the context of COVID-19, with people (of all ages) living in the poorest parts of England and Wales dying at twice the rate from the disease compared with those in more affluent areas.

Working directly with communities

To create a community-centred response and adopt methods of co-production in low-income communities, using the skills and knowledge of local residents will be essential. These can: deepen our understanding of attitudes towards COVID-19 – especially amongst groups experiencing various forms of social exclusion; assist dissemination of advice and messaging about protection from the virus; and challenge negative stereotypes attached to particular groups by emphasising the skills and knowledge which they can bring to support work to control the virus.

Working with ‘informal’ and ‘formal’ leaders within communities will also assist in the uptake of pharmaceutical interventions and encourage people to stay as safe as possible. It should also help in stopping the spread of misleading/false information about vaccines through social media. One example of the importance of community leaders concerns the role of Imams, who in January 2021 delivered sermons in mosques across the UK which sought to reassure worshippers about the safety and legitimacy of COVID-19 vaccinations and remind them of the Islamic injunction to save lives. The move came amid evidence of anxiety within Muslim communities about the safety of vaccines, and concern about slow take-up in some parts of the UK.

Experts also suggest that COVID-19 pandemic management teams should incorporate community members into the planning, response and monitoring of standard operating procedures. They emphasise the importance of disseminating this work through the various networks within communities to ensure maximum support. Ensuring diversity in the membership of management teams is essential, especially regarding members of minority ethnic communities, and workers in low-income communities.

Additionally, building on existing networks and neighbourhood organisations will be vital in developing community-based interventions. Food banks, local businesses, and libraries are essential sites for conveying information and supporting older people during the pandemic. These can be complemented through support from existing organisations, for example, those linked with the UK Network of Age-Friendly Communities.

Recruiting ‘community advocates’ for those who may be unable to ensure their voices are heard will be an important approach to consider – particularly for those who may be vulnerable to having their interests overridden at times of crisis. Advocates could be drawn from existing organisations, for example, local Age UK branches, Good Neighbour and befriending groups and equalities organisations such as the LGBT Foundation. However, this would require resourcing to support training and financial assistance to advocates, an issue which might be considered by central government as well as local authorities.

Developing long-term community-centred policies

Some longer-term priorities for community-centred policies also need to be considered. Any strategy to combat the pandemic has to be rooted in addressing the multiple forms of deprivation affecting many communities in the UK. These, as the evidence shows, are drivers for transmission of the virus, notably through overcrowded households, with household members employed in high-risk occupations passing the virus across generations. Future action should be placed within a wider context of ‘community renewal’. COVID-19 has preyed on neighbourhoods damaged by cuts to basic services and social infrastructure, lack of investment in housing, and the rise of precarious forms of employment.

However, renewal must also come from ‘below’, with the strengthening of neighbourhood-based organisations. This will be especially important given the impact of three lockdowns in reinforcing social isolation amongst groups within the older population, individuals from the LGTB+ community, people with learning disabilities, and others whose networks have been depleted through losses arising from COVID-19.

COVID-19, as numerous reports have made clear, has exposed and exacerbated longstanding inequalities affecting BAME groups in the UK. Racism and discrimination also play an important role in this regard. Much of this was predictable given available knowledge about poverty, co-morbidities, poor quality housing, and low incomes, affecting many of those in South Asian and other minority ethnic communities. The question is why there was a failure to co-ordinate preventative forms of community-centred working with BAME groups from the beginning of the pandemic. Such targeted work, involving community leaders wherever possible, will be essential over the medium and longer term. However, this type of initiative will require additional sources of funding to support what are financially constrained organisations even in ‘normal times’.

Finally, COVID-19 has proved catastrophic for people in residential care. By mid-January 2021 in the UK, one-third of fatalities (32,000 people) were care home residents. This is an extraordinary figure which indicates a systemic failure to safeguard a highly vulnerable group.

Bold thinking is needed by the research and policy community about the future of residential and nursing home care: challenging rather than colluding with current models of care. Privatisation has proved a flawed model, but the public or not-for-profit sector does not provide a straightforward solution either. The way forward must certainly be to ‘downsize’ from ‘industrial scale’ care, potentially looking at placing the management of homes within a local authority framework. Crucially, all homes should be embedded in their surrounding neighbourhood. Developing viable models which provide some degree of protection for people will be challenging but the impact of COVID-19 has confirmed the urgent need for major reforms of the health and social sector, for this and many other reasons.

Take a look at our other blogs exploring issues relating to the coronavirus outbreak.

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