Coronavirus (COVID-19): Strategic Framework update February 2022: equalities and fairer Scotland impact assessment

Key Findings

The COVID Recovery Strategy provided a detailed description of the impact of the pandemic across protected characteristics and socio-economic disadvantage. Their summary findings are reproduced below. Full details can be accessed in the relevant documents including the COVID Recovery Strategy documents, ^[6] a review of evidence^[7] and slide packs across protected characteristics.^[8]

• Older people, men, disabled people and minority ethnic groups are more likely to have died from COVID. This reflects a more extensive experience of bereavement among particular groups. Older people and women are more likely to experience Long COVID.
• Greater impacts on mental wellbeing have been reported for young adults (especially young carers), disabled people, women, minority ethnic groups and LGBT+ groups, while the reported experience of isolation has been greater among disabled people, older people and minority ethnic groups.
• Disabled people and older people have experienced loss of, or reduction in, access to services, with associated impacts on their wellbeing.
• Women have experienced an increased burden of domestic and caring responsibilities, and have been at heightened risk of domestic violence.
• There have been disproportionate negative impacts on the employment of young people, older adults in the workforce and disabled people. Women and ME groups are less likely to have experienced negative impacts on their income and employment than men and majority ethnic groups, although gaps persist in employment and pay.
• Disabled people, women and minority ethnic groups have reported greater concerns with their financial security as a result of the pandemic, with the greatest concerns among disabled women and women from ME groups.
• Negative impacts on learning have been greater for disabled and minority ethnic groups.

The Strategic Framework Evidence Paper^[9] also provides a wide range of evidence of the key impacts of the pandemic on different groups with protected characteristics in Scotland, including mortality, vaccination rates, mental health, work and personal wellbeing. Key summary issues from the analytical paper and other evidence are noted below.

Age

• Older people, and particularly older men are at greater risk of death while older people and particularly older women are at greater risk of Long COVID. Older people are also at greater risk of social isolation and loneliness. As a result, older people will benefit from opening up of society but will also be relying on broader public adherence to protective measures to enable them to live their lives without significant anxiety
• Older people, especially older disabled people, will have been subject to strict regulations in Care Homes, lower access to key health services and high levels of bereavement in the pandemic. Framework responses will need to continue to ensure that health and care strategy is formulated to protect older people in terms of both their physical and increasingly their mental health.
• Children and Young People (especially young carers and those in LGBT+ groups) have experienced greater impacts on mental wellbeing as a result of the pandemic and the public health measures required in response. Young people have also been more financially vulnerable to economic shocks which will have further increased mental stress.
• While older people have very high vaccination rates progress decreases through age bands with vaccine hesitancy greater amongst younger people (18-?), teenagers and their parents. High levels of vaccine take-up is needed across all age bands to maintain population immunity.

Disability

• Disabled people and people with learning disabilities of all ages, were at greatest risk of severe illness or death from COVID and have also experienced interruption to health, social care and community services, with associated impacts on their wellbeing.
• Disabled people have reported greater concerns with their financial security as a result of the pandemic, with the greatest concerns among disabled women and women from ME groups.
• Changes in protective measures may disproportionately impact on disabled people with greater vulnerability to the virus in terms of their willingness and confidence to live their lives.

Gender Reassignment

• Trans people are a small cohort of the population who tend to have greater health inequalities and poorer mental health. The benefits of opening up will be positive for this group but there is an ongoing need to improve access to trans healthcare.

Pregnancy and maternity

• Studies from Scotland and the UK show that pregnant women are no more likely to get coronavirus (COVID-19) than the general population, but are generally more susceptible to infection. ^[10]
• However, vaccination coverage remains much lower amongst pregnant women than amongst non-pregnant women of a comparable age; of the 4,064 women who delivered their baby in October 2021, 43% had received any COVID-19 vaccination prior to delivery. By contrast, 85% of all women aged 18 to 44 years had received any COVID-19 vaccination by 31st October 2021.^[11]
• Self-isolation is particularly difficult for pregnant women or women with new-born children. It is important that the Framework recognises the different needs of this group.

Race

• Some minority ethnic communities were at greater risk of COVID-19 infection and severe illness^[12]. Various work has shown the intersectional nature of this link with mediating factors including socio-economic circumstance and living in deprived areas as well as compounding factors related to higher work exposure, higher prevalence of linked diseases such as diabetes and reduced access to healthcare.^[13]
• Vaccination hesitancy has been identified amongst some minority ethnic communities. It is important that the Framework considers this and ensures that long terms plans are taken up by minority ethnic communities as appropriate with access tailored to meet the needs of different communities.
• Overseas nationals and people from minority ethnic communities resident in Scotland are likely to be more reliant on international travel measures to maintain family bonds. Any restrictions will have disproportionate negative impact on them which would need to be considered as part of the balance of harm.
• Gypsy/Travellers communities experience poor health outcomes. They were three times more likely to report 'bad' or 'very bad' health compared to the general population (15% and 6% respectively).The impact of the Framework on smaller communities should be an important aspect of the work.

Religion

• Places of worship play a significant role in the lives of people with religious affinity. Continuing requirement for face coverings during worship may be impacting negatively on worship, disrupting the communal experience, causing reduced attendance at places of worship and impacting community cohesion and wellbeing. There is evidence of people not returning to worship, with related economic impacts, especially for minority ethnic faith communities, such as Sikh and Hindu congregations, and smaller Christian denominations, e.g. Baptists.
• International travel restrictions may have greater impacts for minority ethnic faith communities, e.g. Muslims travelling for Hajj or other pilgrimages, and Hindus, Sikhs, and Muslims travelling for marriage / life events. If COVID-19 certification for international travel remains vaccination only (i.e. not a negative test result), this may impact on those faith communities amongst whom vaccine hesitancy has been higher. If managed isolation is required to be reintroduced at any point, consideration should be given to the higher levels of poverty amongst some minority ethnic faiths. A change to isolation at home model would be preferable rather than hotel quarantine that is more expensive. 49% of Muslims in Scotland are living in poverty after housing costs.^[14]

Sex

• The pandemic has highlighted that women have experienced an increased burden of domestic and unpaid caring responsibilities during the pandemic due to women's disproportionate role in providing unpaid care.^[15]
• Women also comprise a signficant proption of the health and care workforce.

• Women have also experienced greater mental health impacts^[16]. In February 2021, women with a lower household income were more likely to report that their mental health had got worse over the course of the pandemic (64% of women with a household income of less than £19,999 said this, compared to 55% of women with a household income of £40,000 and above).^[17]

• Domestic abuse and sexual violence has disproportionately affected women and children during the pandemic (and has done so historically) Any COVID-19 measures which require people to stay at home could increase the risk of domestic abuse. Over 80%^[18] of domestic abuse is committed by men on women.
• Any COVID-19 measures which require people to stay at home could lead to high burden on resident parents who cannot access friend and family support and lack of contact with children for non-resident parents. In separated families, the majority of resident parents are women and the majority of non-resident parents are men.

Sexual Orientation

• In common with many other groups, people in LGBT community are thought to have experienced high levels of social isolation and loneliness during the pandemic with significant impact on mental health, especially for younger LGBT who cannot access peer support. However data is currently limited.^[19]

Socio-Economic Disadvantage

• Those living in the most deprived areas have been more likely to die from COVID-19 than those living in the least deprived areas. By 31 July 2021 the rate of deaths in Scotland involving COVID-19 in the most deprived quintile (326 per 100,000 population) was 2.4 times the rate in the least deprived quintile (137 per 100,000 population). The size of this gap has widened from 2.1 to 2.4 across the period of the pandemic, and is greater than the deprivation gap of 1.9 in all-causes mortality^[20]. By May 2021, an estimated 1 million people in the UK self-reported being affected by Long COVID: those from more deprived backgrounds appear to be at particular risk^[21].
• Higher levels of anxiety and loneliness are reported by those with lower household incomes than by those with higher incomes.^[22]
• There is evidence that many jobs in lower paid sectors cannot be done from home. The Framework response around hybrid working therefore needs to take account of households who have less access to the resources required such as housing, heating etc.