It’s another distressing milestone to have reached. COVID-19 is hitting Black, Asian and Minority Ethnic (BAME) groups the hardest. Just over a third of COVID-19 patients admitted to critical care units are BAME. That’s almost three times more than the proportion of these groups in the UK’s population.
A substantial section of society that’s already discriminated against in so many ways is now facing a greater threat to its health than the white majority. Behind this level of disproportionate suffering lies a complex range of factors that needs untangling. Some of the reasons have their roots in entrenched socio-economic inequalities that already exist along racial lines. The story doesn’t end here. There’s another level of complexity. That’s because some ethnic minorities appear more susceptible to COVID-19 than others.
Per-capita, COVID-19 hospital deaths are highest among the black Caribbean population and several times more than those of the white British majority. After removing the role played by age and geography, Bangladeshi hospital deaths are twice those of the white British population. Pakistani deaths are almost three times as high and black African deaths almost as high as black Caribbeans.
Minority groups live disproportionately in places with a high population density, such as London and Birmingham where there have been more COVID-19 cases and deaths. However, ethnic minorities tend to be younger than their white British counterparts. Given that COVID-19 has a virulent effect on older people, one might expect this demographic trait to reduce the number of BAME individuals contracting the virus. And yet, even when geography and demographics are taken into account, non-white groups still have considerable numbers of excess deaths. So, what else is going on?
Key workers are at higher risk of infection because of the jobs they do. More than a fifth of black African women who are of working age are employed in health and social care positions. Indian men are 1.5 times more likely to work in health or social care roles than their white British counterparts. The Indian ethnic group makes up 3% of the working-age population of England and Wales and yet they account for 14% of doctors. There is therefore an increased likelihood that all these different groups will be working in places where there are higher concentrations of COVID-19 and a greater risk of contracting the virus.
The higher observed incidence and severity of COVID-19 in minority groups is also associated with socioeconomic, cultural and lifestyle factors. The type of work many do is likely to be low paid and less secure. Some jobs such as driving buses and taxis by their very nature mean there’s a higher risk of picking up infection.
There are wide variations in poverty rates by ethnic group. However, all minority ethnic groups have higher rates of poverty than the white population with housing costs raising poverty rates considerably. There is a clear correlation between poverty and poorer health and both of these factors feed into the risks of both contracting COVID-19 and not surviving from it.
Minority ethnic groups are more likely to live in overcrowded accommodation making self-isolation much more difficult. South Asian ethnic groups are much more likely to live in multigenerational households and that could make viral transmission more probable.
Having said this, overcrowding is not so prevalent for black Caribbeans and yet they have been facing the highest number of hospital deaths per capita. Inequalities in underlying health conditions and physical health are likely to play their part. Three quarters of England’s adult black population are overweight or obese. Black and south Asian ethnic groups have been found to have much higher rates of diabetes than the population as a whole. Older Pakistani men have also been found to have particularly high levels of cardiovascular disease.
Ethnic minorities in the UK face other disadvantages such as poor housing. Poor-quality homes that are damp, mouldy and noisy are associated with poor health. This can lead to respiratory conditions and cardiovascular disease. These kinds of underlying health problems make fighting COVID-19 infection even more challenging.
Drill down a little and you’re likely to find more than a little racism lurking behind most of these factors that make BAME groups particularly vulnerable to COVID-19. The impact of racism can also be much more obvious. A recent report from Public Health England noted that doctors from BAME backgrounds were three times as likely to say they had felt pressed into working without adequate protective equipment.
Historic racism could mean that people aren’t as likely to ask for care when they need it or to demand sufficient personal protective equipment, the report continued. It might also mean black and Asian people are less likely to speak up if they have concerns about health risks in the workplace.
Medical professionals writing recently in the BMJ have also raised other alarming potential factors. These include possible genetic predisposition and pathophysiological differences in susceptibility or response to infection. Potential susceptibilities would be things like increased risk of admission for acute respiratory tract infections, increased instances of Vitamin D deficiency, and the effects on immune systems of vaccination policies in one’s country of birth. Building a meaningful picture of these types of issues is not easy but could be very helpful to some Asian, African and Caribbean countries, for example.
What is clear is that the coronavirus thrives on inequality. If no action is taken then inequality will continue to thrive. Black mums-to-be are, for example, eight times more likely to be admitted to hospital with Covid-19 than white pregnant women.
NHS England has taken a step in the right direction by asking doctors and midwives to provide more checks and support to BAME pregnant women because of their greater risk from coronavirus. It’s a great initiative but the horse has, in effect, already bolted. Understanding and tackling the root causes of inequality are vital so that racial imbalances in the population’s health can be redressed once and for all.