Racism, ethnicity, and COVID-19 related inequalities in the UK

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Laia Bécares, epidemiologist and James Nazroo, sociologist

Ethnic minority people in the UK are at increased risk related to the Covid-19 outbreak, resulting from the underlying social and economic inequalities, which are intertwined with structural racism. There is an urgent need to consider the impact of racial discrimination in scientific and policy discussions.

A woman, protected by a mask, in front of a mural in central London depic­ting a National Health Service woman carer – Source : unknown (help us find her : defacto@​icmigrations.​fr)

There is now convin­cing evidence that marked ethnic inequa­li­ties in COVID-19 related compli­ca­tions and deaths exist in the UK, as well as elsew­here. In the UK, initial evidence came from growing public and media recog­ni­tion that a large propor­tion of the NHS and care staff who were dying were not white. Then a report by The Inten­sive Care National Audit and Research Centre showed that 35% of COVID-19 related admis­sions to inten­sive care were of ethnic mino­rity people, and that ethnic mino­rity admis­sions were slightly more like to die in critical care (for example, 48.4% of White patients died in critical care compared with 55.3% of ethnic mino­rity patients). While more recent analysis of 106 heal­th­care workers who have died from covid-19 showed that 63% were from an ethnic mino­rity back­ground, and just over half were not born in the UK.

In the context of an esti­mated non-white ethnic mino­rity UK popu­la­tion of 14% at the 2011 Census, this seemed like a large over-repre­sen­ta­tion. This impres­sion was rein­forced by analysis of data released by the NHS, which suggested meaningful increases in death rates for ethnic mino­rity people after taking into account diffe­rences in age struc­tures and place of resi­dence, and in data showing that geogra­phical varia­tions in risk of COVID-19 related morta­lity are strongly asso­ciated with the propor­tion of the popu­la­tion who are from an ethnic mino­rity group. Impor­tantly, although the evidence suggests that there may be some varia­tion in the size of the risk across specific ethnic mino­rity groups, it also suggests that this risk is higher for each of them, inclu­ding White mino­rity people. That is, the increased risk of COVID-19 related morta­lity is present across all groups whose iden­ti­ties are subject to racialisation.

Precarious employment and vulnerable health conditions

There has been much public debate about what might be driving these ethnic inequa­li­ties in risk of COVID-19 related compli­ca­tions and death. Perhaps not surpri­singly, central to these debates has been the like­li­hood that the increased risk results from the under­lying social and economic inequa­li­ties that are faced by ethnic mino­rity people. That is, most ethnic mino­rity groups are more vulne­rable to, and have poorer prog­nosis from, COVID-19 infec­tion, because they are more likely to : have poorly paid and inse­cure employ­ment ; live in over-crowded, multi-gene­ra­tional housing ; and live in deprived neigh­bou­rhoods with high rates of concen­trated poverty and increased pollu­tion levels (Byrne et al. 2020).

Ethnic mino­rity people are also more likely to be employed in sectors that increase their risk of expo­sure to the COVID-19 virus. An over-repre­sen­ta­tion of ethnic mino­rity people can be found working in trans­port and deli­very jobs, in secu­rity guard jobs, as health care assis­tants, hospital clea­ners, social care workers, and in nursing and medical jobs. Not only do these occu­pa­tions increase risk of infec­tion, some of these are also occu­pa­tions that have been the last to receive supplies of the personal protec­tive equip­ment that is intended to reduce the risk of trans­mis­sion of the COVID-19 virus. It is of note that people in these occu­pa­tions have now been deemed key workers, but for decades ethnic mino­rity people working in these jobs have endured job inse­cu­rity, low pay, and discrimination.

The negative consequences related to COVID-19 [that are faced by ethnic minority people] are amplified by long established pre-existing ethnic inequalities in health, both of which are driven by social and economic inequalities.

In addi­tion to increased expo­sure to infec­tion because of their over-repre­sen­ta­tion as key workers, and increased vulne­ra­bi­lity to COVID-19 because of social and economic inequa­li­ties, ethnic mino­rity people are also more likely to have the under­lying health condi­tions that have been linked to increased risk of COVID-19 compli­ca­tions and morta­lity, such as asthma, diabetes, high blood pres­sure, and coro­nary heart disease. These health condi­tions are socially-patterned, so the social and economic inequa­li­ties faced by ethnic mino­rity people described above, lead to an increased risk of deve­lo­ping these health condi­tions. As a result, it is appa­rent that the increased risks asso­ciated with COVID-19 infec­tion that are faced by ethnic mino­rity people are now a core component of wider ethnic inequa­li­ties in health, and that the nega­tive conse­quences related to COVID-19 are ampli­fied by long esta­bli­shed pre-exis­ting ethnic inequa­li­ties in health, both of which are driven by social and economic inequalities.

Underpinning racial discrimination

Behind this complexity, however, is a key consi­de­ra­tion that is typi­cally absent from inves­ti­ga­tions into ethnic inequa­li­ties in health. The social and economic inequa­li­ties that are faced by ethnic mino­rity people are driven by entren­ched struc­tural and insti­tu­tional racism and racial discri­mi­na­tion. An expla­na­tion of ethnic inequa­li­ties in health that stops at social and economic inequa­li­ties and doesn’t acknow­ledge how these inequa­li­ties have been, and continue to be, shaped by histo­rical and current processes of colo­ni­sa­tion under­pinned by racism, is limited in its ability to gene­rate an unders­tan­ding of, and solu­tions to, ethnic inequa­li­ties. A myriad of studies in the UK and elsew­here have now docu­mented the role of racism in patter­ning inequa­li­ties in educa­tion, employ­ment and income, housing, and proxi­mity to pollu­tion. In addi­tion, expe­riences of racial discri­mi­na­tion have been linked to a nume­rous mental and physical health outcomes, inclu­ding asthma and hyper­ten­sion (Nazroo 2003, Wallace et al. 2016, Williams et al. 2019). Impor­tantly, these processes do not operate in isola­tion, they co-occur and sequen­tially lead to deepe­ning inequa­li­ties in many domains across a person’s life course, and are trans­mitted from one gene­ra­tion to the next.

Exclu­ding racism – the root of ethnic inequa­li­ties in COVID-19 infec­tions and related morta­lity – from scien­tific and policy discus­sions around the deter­mi­nants and impli­ca­tions of the coro­na­virus pandemic can lead to dange­rous and inef­fec­tive inves­ti­ga­tions and policy inter­ven­tions. These include un-evidenced reduc­tio­nist approaches that ques­tion whether ethnic inequa­li­ties in COVID-19 might be due to biological/​genetic or cultural diffe­rences, a line of thin­king that risks taking us back into a time of scien­tific racism, but which is, for example, reflected in a recent call for research on this issue. 

Before we respond to such an agenda we should ask ourselves the simple ques­tion : ‘what could possibly be the biolo­gical or cultural simi­la­ri­ties between an ethnic mino­rity family living in Tower Hamlets, London and another living in Detroit, Michigan, both of whom face an increased risk of COVID-19 related compli­ca­tions and morta­lity?’. More likely than having shared genetic and cultural risks, is that they will both live in disin­vested neigh­bou­rhoods with high levels of pollu­tion and concen­trated poverty, with inse­cure and under­paid employ­ment, and in over­crowded condi­tions with substan­dard levels of housing. Chances are that they have had their lives shaped by insti­tu­tional and struc­tural racism, and have expe­riences of racial discri­mi­na­tion deeply embedded in their lives. These are the simi­la­ri­ties that policy and research efforts should be paying atten­tion to. And these are all caused by systemic racism. Given this, the increased risks faced by ethnic mino­rity people from COVID-19 should not have been unex­pected, as appears to have been the case, they could and should have been anticipated.

Excluding racism – the root of ethnic inequalities in COVID-19 infections and related mortality – from scientific and policy discussions around the determinants and implications of the coronavirus pandemic can lead to dangerous and ineffective investigations and policy interventions. 

That Public Health England has been tasked by the UK Govern­ment to review ethnic inequa­li­ties in COVID-19 related outcomes could be a signi­fi­cant and impor­tant shift of focus, espe­cially when contem­po­rary policy work around inequa­li­ties in health have largely ignored the ques­tion of ethni­city. However, in its imple­men­ta­tion it is crucial that this review consi­ders how current inequa­li­ties relate to long­stan­ding ethnic inequa­li­ties in health and, in doing so, the ques­tion of racism as an under­lying driver of these inequa­li­ties must not be side-stepped. Simi­larly, the review must also focus on the greater harm done to ethnic mino­rity people as a result of Govern­ment responses to the coro­na­virus pandemic and move quickly to consider how these greater harms might be mitigated. 

The justi­fi­ca­tion for these measures is that their esti­mated effect on redu­cing the impact of the COVID-19 pandemic on the NHS, by protec­ting its capa­city to provide care for people who become seriously ill as a result of a COVID-19 infec­tion, would offset their acknow­ledged extre­mely nega­tive economic, social, health and psycho­lo­gical impacts. That is, the nega­tive is on average judged to be worth the esti­mated direct health bene­fits. However, the situa­tion facing ethnic mino­rity people is far more preca­rious than ‘the average’, as detailed above, meaning that these measures are certainly having a more nega­tive effect on ethnic mino­rity people in both the short and the long term. In addi­tion, some of the more puni­tive dimen­sions of ‘lock­down’, such as changes in the Mental Health Act, police surveillance, and discon­ti­nuity in the clinical mana­ge­ment of pre-exis­ting condi­tions are also going to more adver­sely impact on those with racia­lised identities.

Unless racism is named and discussed as a system of oppres­sion that patterns the chances of expo­sure to and morta­lity from COVID-19, and ethnic inequa­lity is consi­dered in the response to the coro­na­virus pandemic, the Govern­ment risks further increa­sing ethnic inequi­ties in social and health outcomes in the UK.

One step further

Laia Bécares is a Senior Lecturer in Applied Social Science (Social Work and Social Care) at the Univer­sity of Sussex.

James Nazroo is Professor of Socio­logy at the Univer­sity of Manchester, Deputy Director of the Centre on Dyna­mics of Ethni­city (CoDE).

To cite this article

Laia Bécares and James Nazroo, « Racism, ethni­city, and COVID-19 related inequa­li­ties in the UK », in : Solène Brun et Patrick Simon (eds.), Issue « Inéga­lités ethno-raciales et pandémie de coro­na­virus », De facto [Online], 19 | May 2020, online since 15 May 2020. URL : https://www.icmigrations.cnrs.fr/2020/05/13/defacto-019–02/?lang=en


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