As we await the findings of the NHS England and Public Health England inquiry into the disproportionate impact of COVID-19 on Black Asian and Minority Ethnic (BAME) communities, it is imperative that policy-makers, public agencies and researchers maintain a broad focus on the underlying determinants of susceptibility to the virus and not allow the physiological risks to be separated from their social exposures.
Provisional analysis as of 7 May 2020 from the Office for National Statistics (ONS) has shown that the risk of death involving COVID-19 in some ethnic minority groups is significantly higher than that of those of White ethnicity. Confirming trends identified in earlier analysis, the ONS analysis charts that when taking into account age in the analysis, Black men and women are more than 4 times as likely to die from a COVID-19-related death than people of White British population. People of Bangladeshi and Pakistani, Indian, and Mixed ethnicities also had statistically significant raised risk of death involving COVID-19 compared with those of White ethnicity. This disproportionate burden of COVID-19 among BAME groups in Britain mirrors the picture emerging elsewhere, including the United States, Sweden and Spain.
In our recent submission of evidence on COVID-19 and the disproportionate infection and mortality rates for BAME groups, we set out why the UK government response, including its emergency legislation in the Coronavirus Act 2020, overlooks the inequalities broadly experienced by ethnic minorities.
Despite long-standing evidence that increased health risk in UK ethnic minorities reflects underlying inequalities in housing, employment and income, medical ‘experts’ continue to propose various biological (and even genetic) ‘explanations’ for this pattern. A recent piece in the British Medical Journal opined that “BAME individuals… lack knowledge on the importance of a balanced and healthy diet containing all essential micronutrients that are required to boost immunity and prevent infectious diseases”.
This ignores the overwhelming weight of evidence that ethnic inequalities in health are driven by social, economic and political divisions, and reinforces harmful (and flawed) conceptions of cultural essentialism which deflect responsibility onto the victims of structural discrimination (Williams and Mohammed, 2013).
It is true that the disproportionate burden of COVID-19 among BAME undoubtedly reflects greater levels of pre-existing chronic health conditions in these groups (Byrne et al. 2020: 76). Yet these higher levels of chronic illness are themselves the product of socioeconomic disadvantage and other manifestations of racial discrimination (Nazroo 2017).
From the post-war to the present, both institutional and personally-mediated racism have channelled new migrants into the lowest rungs of the UK’s segmented labour market (Meer, 2020; Qureshi, 2019). As in most countries, institutional racism in the UK ‘unwittingly’ allows White people to gain more from the education system, the labour market, and the health system (Hill, 2015), while also affording marginal attention to the racial dimensions of policy responses in health and other sectors (Salway, 2020).
It is for these reasons that COVID-19 and the UK Government response have the potential to amplify existing socio-economic disparities and racial discrimination that undergird ethnic health inequalities. The same factors that predispose people from ethnic minorities to live and work in circumstances that engender chronic ill health are those that will make it harder for these same people to protect themselves from COVID-19 by social distancing. Ethnic minority households are more likely to be overcrowded and multi-generational, minority groups are grossly overrepresented in institutional settings where social distancing is ineffective and impracticable, and they are more likely to be in keyworker occupations where they are compelled to continue at work (Byrne et al., 2020, p.28, 51, 85, 143-6, 149).
Worryingly, we anticipate extremely disproportionate economic impacts from the lockdown that will amplify these social inequalities. As noted above, ethnic minorities have been incorporated into the UK’s segmented labour market in ways that direct them predominantly towards sectors offering few job protections, including a lack of provision for sick leave and sick pay (Qureshi et al., 2014). As such we expect the recently announced loosening of social distancing measures to place BAME groups at the forefront of social exposures, working in occupations that cannot be performed from home. Indeed, the ‘stay alert’ message itself illustrates disinclination to take these inequalities into account.
It is deplorable – but sadly unsurprising – that The Independent’s BMG poll found people from BAME households are almost twice as likely as White British people to have lost income and jobs.
Moving beyond the peaks months, we urge the UK government and devolved administrations to focus on the social determinants of health, and demand action on long-standing inequalities. In order to secure sustained public health preparedness, the UK needs a long-term commitment to improving social protection and social equity for all our communities.
This blog post first appeared on Discover Society on April 30th.
Nasar Meer is Professor of Race, Identity and Citizenship at the University of Edinburgh and a Commissioner on the Post-COVID-19 Futures Commission convened by the Royal Society of Edinburgh (RSE). @NasarMeer
Kaveri Qureshi is a Lecturer in Global Health Equity in the School of Social and Political Science at the University of Edinburgh. @KaveriQureshi
Ben Kasstan is a medical anthropologist based at the Department of Sociology & Anthropology at the Hebrew University of Jerusalem, and affiliated with the University of Sussex. @kasstanb
Sarah Hill is a Senior Lecturer in the Global Health Policy Unit at the University of Edinburgh. @sarahhilltop
Byrne, B., C. Alexander, O. Khan, J. Nazroo, and W. Shankley (eds). (2020). Race and inequality in the UK: State of the nation. Bristol: Policy Press.
Hill, S. (2015) ‘Axes of health inequalities and intersectionality’, in: K. Smith, C. Bambra and S. Hill (eds) Health inequalities: critical perspectives. Oxford: Oxford University Press.
Meer, N. (2020) ‘Race and Social Policy: challenges and contestations’, Social Policy Review, 32, 5-23.
Nazroo J (2017). Ethnicity, social inequality and health. Socialist Health Association blog, 17 December. URL: https://www.sochealth.co.uk/2017/12/31/ethnicity-social-inequality-health-2/
Qureshi, K. (2019) Chronic illness in a Pakistani labour diaspora. Durham: Carolina Academic Press.
Qureshi, K., et al. (2014) ‘Long‐term ill health and the social embeddedness of work: a study in a post‐industrial, multi‐ethnic locality in the UK’, Sociology of Health & Illness, 36(7), 955-969.
Salway, S. et al. (2020) ‘Transforming the health system for the UK’s multiethnic population’, British Medical Journal, 368.
Williams D. and Mohammed S. (2013) ‘Racism and health I: Pathways and scientific evidence’, American Behavioral Scientist, 57(8): 1152–1173.