How COVID-19 Is Exposing Health Inequality in the UK

Daniel Davies
Photo credit: Alberto Duran Photography - Getty Images

From Men's Health

In recent weeks there’s been a lot of talk about how Covid-19 disproportionally affects members of the BAME community, and that talk has only grown louder since the release (Tuesday 2/6) of Public Health England’s (PHE) review into the disparities in risks and outcomes from Covid-19.

The report provides more analysis than action, and doesn’t recommend any direct measures, such as shielding additional parts of BAME communities, which is why the The British Medical Association, who represent Britain’s doctors, have described the review as “a missed opportunity” to instigate urgent action.

What it does do is confirm that because of the work they do, the areas they live in and because of the predominance of certain underlying health conditions, BAME groups have more chance of catching coronavirus, as well as being at a greater risk if and when they become infected.

You can read the report in full here, but we've picked out some of its key findings that demonstrate how Covid-19 is exposing health inequality in the UK.

What the Review Originally Set out to Do

When PHE’s original review was announced in early May, the public was promised a report that would provide insight into emerging evidence that COVID-19 disproportionately impacts certain groups, such as the BAME community.

PHE also said that they would engage a wide range of external experts and independent advisors, who represent diverse constituencies, faith groups, voluntary and community organisations, local government, academia, royal colleges and others. “We are committed to hearing voices from a variety of perspectives on the impact of COVID-19 on people of different ethnicities,” wrote professor Kevin Fenton, Regional Director of Public Health at PHE and NHS London.

What We Got

What we got was a review that was late, reportedly because of “worries” stemming from "current global events", which does confirm that there is a disparity between the health outcomes of white British and BAME communities, but which doesn’t provide any reasons for the disparities or make recommendations on how to address them.

In terms of engaging external experts and independent advisors, the review doesn’t include any of this evidence, which has led some to claim it has been censored. The Muslim Council of Britain (MCB), for example, has said that evidence it provided was not included in the final report – a decision it is yet to receive a reason for.

“To choose to not discuss the overwhelming role structural racism and inequality has on mortality rates and to disregard the evidence compiled by community organisations, whilst simultaneously providing no recommendations or an action plan, despite this being the central purpose of the review, is entirely unacceptable. It beggars belief that a review asking why BAME communities are more at risk fails to give even a single answer,” wrote the MCB’s secretary general, Harun Khan.

“The MCB is seeking further clarification from Public Health England as to why the report removed the submission from the MCB and others. It is imperative that the full uncensored report is published with actionable policies and recommendations as suggested by community stakeholders, and a full Covid race equality strategy is introduced to ensure that we don’t need to wait for another pandemic to tackle these long-term injustices.”

What It Says

Below, we’ve collected some of the key findings from the report that appear to confirm what had been previously reported: that health, wealth and structural racism are contributing to the disproportionate numbers of the BAME community who are dying from Covid-19.

On... Ethnicity

PHE’s review found that after accounting for the effect sex, age, living conditions and region play in death rates for Covid-19, people of Bangladeshi ethnicity had around twice the risk of death when compared to people of White British ethnicity. People of Chinese, Indian, Pakistani, other Asian, Caribbean and other Black ethnicities had between a 10 and 50% higher risk of death when compared to White British people.

Reasons given for this include: BAME people being more likely to live in urban areas, in overcrowded households, in deprived areas, as well as being employed in roles that expose them to higher risk. It may sound obvious, but BAME groups are also more likely than people of White British ethnicity to be born abroad, so cultural and language differences may also put additional barriers in the way of them accessing much-needed services.

On... Employment

The report does quote findings from The Health Service Journal, stating that of 119 NHS staff who have died from the virus – 106 of which were verified as active health workers – 63 per cent were from black, Asian and minority ethnic backgrounds. It also goes on to say that these figures are "disproportionately high", but gives no reasons as to why that is the case.

At the other end of the social scale, nursing auxiliaries and assistants, security guards and related occupations, as well as taxi drivers and chauffeurs were also found to have experienced a relative increase in deaths in 2020. This substantiates recent analysis from the ONS, which found that men working in low-skilled occupations, such as bus and coach drivers, chefs, sales and retail assistants, were at in increased risk of dying from COVID-19. Pakistan and Bangladeshi men are known to be the least likely to work in professional occupations and the most likely to work in low-skilled jobs, which would explain why they are at increased risk. Similarly, Black workers are most likely to be found working in ‘caring, leisure and other services’ jobs, other occupations where the increase in deaths was significantly higher.

On... Underlying Health Conditions

PHE’s review notes that people with underlying health conditions appear to be at a higher risk of poor outcomes from COVID-19 than people without these conditions. Some of these underlying health conditions, such as Type 2 diabetes and hypertensive disease are more prevalent in BAME groups, which suggests that they are at increased risk of Covid-19 being fatal.

Diabetes: Diabetes was mentioned on 21% of all death certificates where COVID-19 was also stated, but in black and Asian groups it was reported in 45 and 43% of deaths. Thanks to data from the National Diabetes Audit, we already know that type-2 diabetes has an increased prevalence among BAME communities, which is another reason why BAME are at an increased risk of dying if they contract Covid-19.

Hypertensive Disease: Hypertensive heart disease refers to heart conditions caused by high blood pressure. In White ethnic groups the disease was listed on 17% of death certificates. Whereas in Asian, Black and Mixed ethic groups hypertensive disease was mentioned in 33, 40 and 35 per cent of death certificates respectively.

Obesity: The report claims that 7.7% of patients who were critically ill in intensive care units with confirmed COVID-19 were morbidly obese compared with just 2.9% of the general population. A recently published government report, confirmed black adults are the most likely of all ethnic groups to be classified as overweight or obese, which again would suggest that they at an increased risk of dying from COVID-19.

On... People Born Outside the UK and Ireland

PHE’s review acknowledges that members of society who are socially excluded, such as the homeless or vulnerable migrants, tend to have the poorest health outcomes, which is a consequence of them facing barriers in accessing services, as well as encountering stigma, discrimination and unconscious bias when they do.

However, the biggest relative increases in deaths from Covid-19 come from people who had travelled to the UK from predominantly black and brown countries. The number of deaths from people born in Central and Western Africa, in countries like Nigeria, Ghana and Somalia, were 4.5 times higher in 2020 than in 2014 to 2018. Death rates for people born in the Caribbean, South East Asia, the Middle East and South and Eastern Asia were more than three-times higher than the equivalent period in 2014 to 2018.

On... People Who Live in Deprived Areas and Environments

Mortality rates from Covid-19 in the most deprived areas were more than double that of people living in the least deprived areas. Covid-19 is exacerbating health inequality, and considering BAME communities are more likely to live in deprived neighbourhoods and to experience higher unemployment and poverty levels, as well as lower incomes, they’re bearing the brunt of that.

In April, London mayor Sadiq Khan wrote on how socioeconomic issues were one of the biggest underlying factors driving the disproportionate number of deaths in BAME communities. PHE’s report appears to confirm that. “It’s an uncomfortable truth that people from ethnic minority backgrounds are overrepresented in poor, overcrowded accommodation, or households with multiple generations under one roof,” wrote Khan, “and it’s a fact that they are more likely to live in poverty or work in precarious and low-paid jobs. Many simply don’t have the luxury of being able to work safely from home during the lockdown. All of this contributes to a BAME population with worse health than average, lower life expectancy and a greater prevalence of serious underlying health conditions, such as heart disease, asthma and diabetes.”

What's Missing

Most of the content included in PHE's review was already in the public domain, what we needed from it were recommendations on how the lives of Black and Minority Ethnic people can be protected, and how they can protect themselves, as well as some explanation of how structural racism, which existed long before Covid-19, has been exploited by the virus and led to disproportionate amount of BAME deaths.

“Either Black and Minority Ethnic lives matter or they don’t, and Ministers have prevaricated in commissioning a report that doesn't set out how working lives are to be protected," wrote Rehana Azam, GMB Union's national secretary.

“This report confirms what we already knew – BAME workers have made a disproportionate sacrifice during this pandemic."

What's Next

Because of the review's failings many commentators including the mayor of London and the We Need Answers Campaign Group have called on the government to initiate a public inquiry that would "provide key findings and offer clear recommendations for systemic or transformational change around the role of the public sector and race equality in Britain."

Speaking to The Guardian Sadiq Khan said: “This report alone is not nearly enough. We need to know now why the virus disproportionately impacts these communities and crucially, what is being done to stop it."

“The government needs to also review the impacts of their policies that have led to a hostile environment and measures like [migrants being left with] ‘no recourse to public funds’.”

What to Do If You Have Symptoms of Covid-19?

If you have symptoms of coronavirus you should use the NHS 111 Coronavirus service online. People are being urged to only call 111 if they cannot get help online.

To avoid infecting others, do not go to a GP surgery or pharmacy if you suspect you have coronavirus.

If you need urgent medical help that you cannot get online, call 111. In an life-threatening emergency call 999 for an ambulance.

Disclaimer: The information in this story is accurate as of the publication date. While we are attempting to keep our content as up-to-date as possible, the situation surrounding the coronavirus pandemic continues to develop rapidly, so it's possible that some information and recommendations may have changed since publishing. For any concerns and latest advice, visit the World Health Organisation. If you're in the UK, the National Health Service can also provide useful information and support, while US users can contact the Center for Disease Control and Prevention.

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