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Race, inequity and mental health impacts on healthcare workers during Covid-19

- Wits University

The Covid-19 pandemic revealed global health inequities prompting scholars to interrogate how these inequities manifested in racial and gender dynamics.

Furthermore, health professionals, pressured to perform under adverse circumstances were victim to these inequities, with significant effects on mental health in healthcare settings.

Professor Stephani Hatch, who leads the Health Inequalities Research Group at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, delivered the keynote address at the 2022 Sefularo Sheiham Memorial Lecture on Health Equity, hosted by the Wits School of Public Health on 4 October.

The annual lecture commemorates medical giants and health activists, Dr Molefi Sefularo and Professor Aubrey Sheiham, both Wits alumni, who were united in the advocacy for social justice, especially in public health.

The 2022 lecture was titled Race, Inequity and Mental Health in the time of Covid-19: Benefits and Lessons from Mixed Methods Approaches in the United Kingdom.

Hatch has delved into the health inequalities present in the UK’s publicly-funded National Health Service (NHS), with an emphasis on race and the intersection of other social identities. She has noted profoundly increased mental health challenges among healthcare workers, especially black women. 

Through a mixed methods approach in the Tackling Inequalities and Discrimination Experiences in Health Services study, Hatch and her team found that 30 percent of black healthcare workers did not have access to personal protective equipment (PPE) at the height of the Covid-19 crisis in the UK, and reported a higher incidence of harmful workplace experiences. These experiences resulted in “moral injuries”, adversely affecting mental health.

“The way to tackle these major challenges is to understand the systemic failures of the healthcare system, and to implement inclusive policies. ‘Diversity’ is the bare minimum. We need to tackle practices that reinforce racism and inequality,” said Hatch.

Indeed, Hatch is leading the development of the Health and Social Equity Collective to raise awareness, increase knowledge production and dissemination, and improve action and outreach. Furthermore, she leads equality, diversity and inclusion initiatives within healthcare settings.

Following Hatch’s presentation, Professor Mary-Ann Davies discussed intersectional health inequities from the South African perspective. Davies is a public health specialist in the Western Cape Department of Public Health, who is responsible for epidemiology and surveillance, and was extensively involved in the Western Cape Covid-19 response.

Davies found glaring health inequalities in the Western Cape (which could be transposed across South Africa), much like what was revealed in the UK. In South Africa, these inequalities were particularly acute in the poorest urban subdistricts.

“We also saw that the stringent lockdown measures in the country made things much, much worse for people, especially in poorer socio-economic contexts,” she said.

Furthermore, rapid health surveys, such as the National Income Dynamics Study – Coronavirus Rapid Mobile Survey (NIDS-CRAM) study showed a distinct increase in depressive symptoms, and indeed “an increase in depressive symptoms in those who had never reported depression before.”

Davies noted the link between the economic crisis brought about by the pandemic, food insecurity and a striking increase in mental health. “We have seen a higher number of acute admissions in mental health wards in 2022. These are people who require hospitalisation, so we can only imagine the real and alarming occurrence of depression and other mental health conditions,” said Davies.

Both Davies and Hatch emphasised the importance of “pathways to care”, which entails follow up mental health services, and extended community support.

“We need better safety nets for people. There are huge barriers in sustaining necessary care,” said Davies.