A Simplified Ethnic Minority Risk Assessment Process

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I recently returned to nursing and the NHS to help with Covid. I also am a track and tracer tier two, although since starting back in the NHS I’ve let this slide. 

Early on in the pandemic, speculation about how badly Covid-19 affected those from ethnic minorities was rife but once identified, interest and how best to assess the risk and protect these workers started.

There is a great system which many use and I share it here. Just to be clear I am not claiming any glory, this system is not mine to claim, but this article spreads the word (especially to my worldwide audience) and helps those from less informed backgrounds of where to start with these complex ethnic minority risk assessments.

Before I start though – I wanted to say a word about things which cannot be quantified – language proficiency, culture, integration etc. These are not covered in the assessment – the ethnic minority assessment is a medically based assessment although we all recognise sociological issues will have influence too.

Why Treat Ethnic Minority differently?

Because of statistics.

These show, that nonwhite or non-native people (and other groups such as travellers)  have been disproportionately affected by Covert-19 in the UK.

I first heard of this when a friend who works in intensive care told me that every single patient was nonwhite. She couldn’t understand it. Since then statistics have endorsed this.

Once the statisticians realised the problems, work started to develop a system to simplify and quantify the risk to ethnic minorities and recommend control measures.

Now there may be other methods that I am unaware of. However, I belong to the occupational health specialist practitioner group on Facebook and other groups. Plus I have a number of friends in this arena. We use the ALAMA process with modifications/recommendations tweaked to reflect our own workplaces. The process is most effective for clinical or caring staff. That is, workers dealing with people who are more likely to have Covid-19.

ALAMA Website1

Most clinicians use the ALAMA guidelines.

  1. First to assess risk (based on gender, body mass index, race, pregnancy, and underlying health conditions)
  2. Quantify individual risks into high, medium, low risk of having a serious effect on the worker (vulnerability).
  3. In each risk group there are simple control methods to adopt.

To do the assessment, it helps if you have medical or nursing training because sometimes you have to make a clinical judgement based on conflicting factors. But if you have nothing else – follow the guidance.

The website look really complicated at first – writing, colours, numbers, lists. Do not be daunted. I will make it easier for you.

First, make a coffee/tea/whatever and spend time reading before attempting the assessment. Try it on yourself. Or a fictitious person. Or your mum. It’s not as difficult as it seems. Once you understand it, then you can focus on the parts relevant to your organisation and to your employees.

Doing the assessment

Infographic of risk reduction framework for NHS
NHS infographic

Tools you need

A discussion/questionnaire with the person you want to assess. There is a downloadable questionnaire on the ALAMA website

In order to make a ethnic minority risk assessment ask each person the following health questions:

  1. Gender
  2. Ethnicity (see the list in ALAMA guidelines)
  3. Age
  4. Body mass index
  5. Health conditions: there is a list of the most relevant health conditions to Covid-19 in Table 1 of the ALAMA guidelines (asthma, diabetes 1 and 2, others)
  6. Pregnancy 

Method

For each answer you have to add or subtract years to a person’s age. For example: if female, your can immediately take 8 years off current age.

So if I were 30 (and I wish I were) with no other health issue or problems, I would have a Covid age of 22 years which becomes my risk number.

First Client/Patient/Worker assessment

  1. Go through the questions on the questionnaire (see link above or develop your own) with the person and add/subtract years depending on their answers. Don’t worry about the total at this stage. It’s easier to do it when you have collected all the facts.
  2. Each health problem adds more years to your Covid age according to the ALAMA guidelines.
  3. Go to the bottom of the ALAMA guidelines to find where the Covid age belongs . 
  4. The final column in gives workplace considerations, i.e. what you should do as an employer to protect their workers.The categories of risk are broad – so use your judgement to move up a category if their health is borderline. Justify your decision – say why you are moving someone up or down.

Example:

I am 30, female (minus 8 years), say, I am massively overweight with a body mass index of 42 (add 10 years) and I have type 2 diabetes but not had any blood tests (add 9 years). 

Calculate my Covid age: Do the math – (30 – 8 + 10 + 9) Covid Age = 41

You can see a Covid age of 41 is in the Moderate Risk category, that is, “Those who are much less likely to develop severe disease if Covid-19 infection occurs.”

Control Methods

Use the Covid age to decide the vulnerability level and the recommended workplace controls within the guidelines.

Optional Other Tools For Ethnic Minority Risk Assessment

  1. Always check the websites for the latest version as the guidance is being updated daily. Downloads and printed copies may be out of date.

With grateful thanks to ALAMA for allowing free sharing of the research and guidance for the assessments.

One of the contributors to the UK Occupational Health Practitioners Facebook Group – Michelle Moore developed her own spreadsheet with calculators, guidance embedded and with Michelle’s permission I add it here for download – COVID Age RA V2

Please check it all works before using it though – sometimes formula’s get broken in downloads. Discard after 3 months.

Conclusion

I hope this helps dealing with Covid-19 but remember – this is just a process. Things change. People and medical opinions change. Always refer to the online link (rather than print) for the most up to date version of the tools here. 

If you have any other tools I can add or comments on this article please email me via the comments sheet.

Remember

  1. Much of government advice is advisory and not mandatory
  2. Work related Covid-19 infection is reportable under RIDDOR (mandatory)

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