Public Health England’s (PHE) report on the disparities in the risk and outcomes of COVID-19 has shown that Black, Asian and Ethnic Minority (BAME) people are disproportionately affected by the virus. However, the report has been criticised for failing to explain the reasons for the disparity and for failing to make “vital recommendations”.
THE REPORT FINDINGS
Mortality risk
The PHE inquiry confirmed that the risk of dying among those diagnosed with COVID-19 is higher in BAME groups than in white ethnic groups. People of Bangladeshi ethnicity who contract the virus are around twice as likely to die than people of White British ethnicity when the effect of sex, age, deprivation and region are taken into account. People of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity have between a 10% and 50% higher risk of death.
Death rate
The report also found that COVID-19 death rates were higher for Black and Asian ethnic groups when compared to White ethnic groups. This is in contrast to previous years, when the all-cause mortality rates were lower in Asian and Black ethnic groups. The inequality in COVID-19 mortality between ethnic groups therefore represents a reversal of that seen for all causes of death in previous years.
Compared to previous years, all-cause mortality was almost four times higher than expected among Black males, almost three times higher in Asian males and almost two times higher in White males. Among females, deaths were almost three times higher in this period in Black, Mixed and Other females, and 2.4 times higher in Asian females compared with 1.6 times in White females.
Diagnoses rates
When adjusted for age, the highest diagnosis rates of COVID-19 per 100,000 population were in people of Black ethnic groups (486 in females and 649 in males) and the lowest were in people of White ethnic groups (220 in females and 224 in males).
Combination of factors
The report notes the relationship between ethnicity and health is complex and the result of a combination of factors. Firstly, people of BAME communities are likely to be at increased risk of getting the virus as they are more likely to live in urban areas, in overcrowded households, in deprived areas and have jobs that expose them to higher risk.
People of BAME groups are also more likely to be born abroad compared to people of White British ethnicity, meaning they may face additional barriers in accessing services due to, for example, cultural and language differences.
Secondly, the report notes that people of BAME communities are also likely to be at greater risk of poorer outcomes once infected by the virus. For instance, some comorbidities which increase the risk of poorer outcomes from COVID-19 are more prevalent among certain ethnic groups. For example, people of Bangladeshi and Pakistani background have higher rates of cardiovascular disease than people from White British ethnicity, and people of Black Caribbean and Black African ethnicity have higher rates of hypertension when compared with other ethnic groups. Furthermore, it is noted that data from the National Diabetes Audit suggests that type II diabetes prevalence is higher in people from BAME communities.
Shortcomings
The analyses on death and diagnosis were not able to account for the effect of occupation, which is a significant shortcoming because occupation is associated with the risk of COVID-19 exposure and some key occupations have a high proportion of workers from BAME groups. The Institute of Fiscal Studies (IFS) statistics show that a third of all working-age Black Africans are employed in key worker roles, 50% more than the share of the White British population. Furthermore, Pakistani, Indian and Black African men are respectively 90%, 150% and 310% more likely to work in healthcare than white British men.
The analyses were also not able to include the effect of comorbidities or obesity. These are important factors because theyare associated with the risk of death and are more commonly seen in some BAME groups. Other evidence has shown that when these are included, the difference in risk of death among hospitalised patients is significantly reduced.
CRITCISMS
The report has been criticised for simply restating the increased mortality already highlighted in other research without investigating the reasons for the disproportionate effect of the virus on BAME people.
Dr Chaand Nagpul, chair of the British Medical Association (BMA), said “It is a statistical analysis, which while important, gets us no closer towards taking action that avoids harm to BAME communities. The BMA and the wider community were hoping for a clear action plan to tackle the issues, not a reiteration of what we already know.”
“More specifically, the report fails to mention the staggering higher proportion of BAME healthcare workers who have tragically died from Covid-19 – with more than 90% of doctors being from BAME backgrounds.”
The report has also been criticised for leaving out third-party submissions which reportedly highlighted structural racism and social inequality. The absence of discussion about structural racism and measures to protect BAME people has been described by Black, Asian and minority ethnic MPs as making a mockery of health secretary, Matt Hancock’s “black lives matter” statement in the House of Commons.
The report has also been criticised for failing to consider the impact of air population as a factor contributing to higher death rates from COVID-19 among minority ethnic groups. Minorities in the UK, US and elsewhere are known to experience higher levels of air population, and evidence from around the world points to air population as a factor which has contributed to increased coronavirus infections and deaths.
The disproportionate impact of COVID-19 on BAME people is not exclusive to the UK with the United States, Norway, and other European countries with large minority populations evidencing similar patterns. The pandemic has shone a light on systems of racial inequality worldwide and will require governments to take a critical inward look at the structures which continue to disproportionately endanger BAME people.
Rónán is an LLB and LLM (Human Rights and Criminal Justice) graduate from Queen’s University Belfast. His work focused on areas such as mass surveillance, sexual and gender-based violence, and the relationship between minorities and the UK criminal justice system. Since then he has spent time as a legal intern at REDRESS, London and Phoenix Law, Belfast.