Guidance

Mitigation of risks of COVID-19 in occupational settings with a focus on ethnic minority groups – consensus statement from PHE, HSE and FOM

Updated 26 March 2021

Applies to England

Introduction

The review of disparities of risk and outcomes of coronavirus (COVID-19), carried out by Public Health England (PHE) showed that there is an association between belonging to some ethnic groups and the likelihood of testing positive and dying of COVID-19. The review did not account for the effect of occupation, co-morbidities or obesity. Since the review a wide range of research has explored the pathways that cause ethnic inequalities and have shown that this is a complex relationship, and the relative importance of different pathways in COVID-19 ethnic inequalities is not well understood.

This is a consensus statement from PHE, Faculty of Occupational Medicine (FOM) and Health and Safety Executive (HSE) on how best to mitigate occupational risks, and specifically the known disproportionate impact of COVID-19 on ethnic minority groups. This consensus statement follows the PHE report Beyond the Data and was developed through a multi-disciplinary-cross sector group subsequent to a request by the Scientific Advisory Group for Emergencies (SAGE) that PHE, HSE and FOM were requested to consider mitigation of risks of COVID-19 in occupational settings with a focus on ethnic minority groups.

This statement recommends with moderate confidence that all individuals, including those from ethnic minority groups, should have the same approach to risk management in the workplace. It recommends reinforcement of, and implementation of, existing workplace guidance and legislation across the whole workforce, with particular support to small and medium employers and sole traders where individuals of ethnic minority groups may be over-represented. Employers, as part of their statutory duties, should ensure that a workplace risk assessment is completed as part of an overarching risk management strategy for all settings and should cover all employees, including identification of those with increased vulnerability to COVID-19 infection.

Some workers may require, or seek, health assessment and advice in relation to work. This is often initially with their general practitioner whose opinion may be communicated by the worker to their employer, often as certification (a Fit Note). For a small number of workers, assessment by an Occupational Health (OH) practitioner who has specific knowledge of the workplace is necessary. Access to an OH service is usually arranged by the employer. Occupational health assessments should be supported by a standardised individual clinical risk assessment tool to support mitigation for individuals in the workplace.

Strong stakeholder engagement is important, with a coherent approach to messaging and communication of all COVID-19 information and working with ethnic minority communities to improve levels of understanding of both risks and their mitigation in communities with higher rates of infection and death.

Main conclusions

1. Occupation is one of many factors which may increase the risk of exposure to COVID-19 infection. It is important that the approach to controlling risk in relation to occupation is delivered in a way that ensures it is equitable, recognises the range of risk factors, and is fully accessible to all staff from all backgrounds to help identify and manage risks, including those from ethnic minority backgrounds.

2. It is the employers’ duty to manage risk in the workplace. Employers have a legal duty to protect all workers from harm by delivering workplace risk management for all staff, regardless of ethnicity or diversity. In this case, an equitable approach recognises that staff may have a variety of baseline risks (for example, their age, sex, deprivation, obesity and diabetes) and, where appropriate, this needs to be considered in the workplace risk management discussion.

However, there should not be an expectation of disclosure of confidential medical information by individuals as part of this process unless as part of normal practice such as healthcare settings. Those who carry out these individual discussions on behalf of the employer should be trained and encouraged to understand, appreciate and interact with people from cultures and/or belief systems other than their own. ‘Culturally competent’ conversations with employees should address their individual concerns related to risk, vulnerabilities and their individual situations (see appendix).

3. Measures that protect against the risks at work for the entire population, apply equally to people from ethnic minority groups. Work place risk mitigation is best addressed through consistent and effective implementation of existing Health and Safety Executive (HSE), HMG and other guidance for employers, including recent guidance on COVID-19. This should apply to all workplaces, including small and medium sized enterprises (SMEs) which may have higher proportions of staff of ethnic minority groups in employment. Workplace guidance should ensure that control measures address the risk of exposure to COVID-19 and should be applied to all workers, rather than specific actions targeted at individuals of ethnic minority groups (to reduce risk of stigmatisation, perceptions of being unfairly targeted and inequality of opportunity).

4. The main risk factors (for example, age, sex, obesity, multiple long-term conditions) for COVID-19 are often clustered within individuals, the workplace and communities, and as such approaches to risk reduction for ethnic minority groups should take into account this broader context of risk, and the importance of a ‘whole pathway’ or holistic approach, to be effective.

5. Clinical risk stratification tools, such as those included in NHS Employers risk assessment guidance, can be used, as a part of a clinical assessment process, recognising the additional risk factors, in occupational health/primary care for some employees, including those of ethnic minority groups, to assist decision making about suitable deployment at work.

6. Existing clinical risk stratification tools and those in development, once available, may be a useful UK-wide support tool to clinical and occupational health conversations about risk with individuals.

7. The importance of involving ethnic minority groups in all aspects of a culturally competent response to risk reduction, including in framing research questions, participating in research projects, sharing findings and implementing recommendations, is endorsed.

8. Engagement with employers to reinforce preventive messages to reduce risk of acquisition both in the community and in the journey to and from the workplace may reduce the risk of spread of COVID-19 in the workplace.

The working group recommended several actions to mitigate risks:

a) Reinforce and re-communicate existing government COVID-19 guidance and advice to employers on their responsibilities to their employees.

b) Engage with stakeholders to support embedding action across all (relevant) population groups.

c) Other recommended key actions include:

A culturally competent approach to risk management for all including individuals of ethnic minority groups.

Strengthened and co-ordinated communication and engagement with ethnic minority communities and engagement with specialist media on transmission risk. An effective social marketing campaign aimed at reaching communities to clearly outline actions that individuals need to take to mitigate risk from COVID-19. This should include the range of multiple socio-economic, clinical, cultural and behavioural risks factors that individuals (including ethnic minority groups) may face, and should be available in different languages, accessibility formats, use diverse and inclusive imagery, and disseminated through a variety of channels to maximise reach to many communities and sectors. This campaign should also include those who support employees on rights and responsibilities and employers (including SMEs).

Further research is required to understand the risks of acquiring infection by occupation type and the interaction of this with non-occupational factors. The work should also include the impact of other factors on the health outcomes from COVID-19 disease including timely access to healthcare services, management of long-term conditions and the effectiveness, optimisation and use of risk assessment tools by clinicians. A consistent approach to clinical risk assessment tools could be developed to support clinical judgements in occupational health, primary and secondary care settings. Whilst the workplace is an important location for understanding transmission of COVID-19 infection, it is also important that transmission mechanisms in the community and in the home are understood to enable all potential routes to be considered when researching the relative contribution of each potential transmission source. Further research is also required at the systems level to understand the complex interactions between social, personal, biological and environmental factors leading to any differential outcomes in particular groups of individuals.

These actions alongside the consistent and equitable application of existing guidance for workplace risk management, summarised in the group’s conclusions, will contribute to the mitigation of risks of COVID-19 in occupational settings for all workers.

Appendix

Culturally competent key principles for the workplace

Cultural competence is defined in many ways but fundamentally it is the ability to communicate and interact effectively with people regardless of difference. It’s about understanding the way we deliver health care and responding to the needs of our diverse population. Cultural competence is a key aspect of providing both quality and safe care.

Cultural competence applies to individual behaviours but also organisational systems, processes and culture.  Being ‘culturally competent’ means having the knowledge and skills to be aware of one’s own cultural values and the implications of these for making respectful, reflective and reasoned choices. Cultural competence provides a framework and set of approaches to help ensure that the needs of all people and communities are met in a responsive and respectful way.

The following are 5 essential elements recommendations to consider in culturally competent key principles for the workplace.

Value diversity

Valuing diversity means accepting and respecting differences. Even how one chooses to define family is determined by culture. Diversity between cultures must be recognised, but also the diversity within them. People generally assume a common culture is shared between members of racial, linguistic, and religious groups, but individuals may share nothing beyond similar physical appearance, language, or spiritual beliefs.

Cultural self-assessment

Through the cultural self-assessment process, staff are better able to see how their actions affect people from other cultures. The most important actions to be conscious of are usually taken for granted.

Consciousness of the dynamics of cultural interactions

There are many factors that can affect cross-cultural interactions. There often exists an understandable mistrust towards members of the majority culture by historically oppressed groups.

Institutionalisation of cultural knowledge

The knowledge developed regarding culture and cultural dynamics must be integrated into every facet of a service or agency. Fully integrated cultural knowledge is the only way to achieve sustained changes in service delivery. Communities are not static, there is a need for continual ongoing development to reflect emerging communities and changing needs.

Adapt to diversity

The fifth element of cultural competence specifically focuses on changing activities to fit cultural norms. Cultural practices can be adapted to develop new tools for treatment – ie, a child or family’s cultural background provides traditional values that can be used to create new interventions.

Full report

See full report on Mitigation of risks of COVID-19 in occupational settings with a focus on ethnic minority groups.