Ethnic inequalities in health

A handful of studies have now clearly documented that there are marked ethnic inequalities in COVID-19 related deaths, both in the UK, and elsewhere.

For example, in the UK, a local authority with twice the average number of ethnic minority people has a 25 percent higher death rate. And while there may be some variation in the size of the risk across specific ethnic minority groups, the risk is higher for each of them including White minority people.

No matter how shocking these inequalities are, they are not a surprise. Rather, they reflect ethnic inequalities in health that have been documented for decades.

For example, it is estimated that Black Caribbean, Pakistani and Bangladeshi people have between six and nine fewer years than White British people of disability life expectancy.

So, how do we understand these ethnic inequalities in COVID-19 related mortality?

Four sets of explanation have been offered. The first three of which are closely interrelated.

First, ethnic minority people are more likely to be exposed to the virus. This is because they are more likely to both live in urban areas, where spread of the virus is more likely, and to be employed in sectors that increase their risk of exposure to the COVID-19 virus, such as transport and delivery, security, cleaning, health and social care work.

So consequently, ethnic minority people are more likely to be infected with the virus.

Second, once infected with the virus, ethnic minority people are more likely to be vulnerable to complications. This is because of underlying and long-standing social and economic inequalities that are faced by ethnic minority people, and which have been documented to increase risk of ill health and mortality for everyone.

Third, ethnic minority people are more likely to have underlying health conditions that increase risk of COVID-19 complications and mortality, such as diabetes, high blood pressure and coronary heart disease.

But it's important to recognise that these health conditions are patterned by the social and economic inequalities faced by ethnic minority people. They are part of the nexus of inequality faced by ethnic minority people that I've just summarised.

The fourth set of explanations resort to common sense understandings of ethnicity as reflecting biological, genetic, or cultural differences. This is a line of thinking that risks taking us back to a time of scientific racism, but one that is clearly illustrated by recent investigations into the role of vitamin D deficiency and its genetic underpinnings. A possibility that remains under consideration by researchers, despite clear evidence to the contrary.

In fact, when considering such an agenda, we should ask ourselves the very simple

question - What could possibly be the genetical, cultural similarities, between an ethnic minority family living in Tower Hamlets, and another living in Detroit, Michigan? Both of whom face an increased risk of COVID-19 related complications of mortality.

More likely than having shared genetic and cultural risks is that they 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.

Those are the similarities that policy and research efforts should be paying attention to.

Indeed, behind the range of risk factors experienced by ethnic minority people is a key consideration, is typically absent from investigations into ethnic inequalities in health.

The inequalities are faced by ethnic minority people are driven by entrenched, structural and institutional racism and racial discrimination, which operate across the different dimensions of people's lives and accumulate, over time, leading to deepening inequalities across a person's life course.

And this points to the importance of considering the greater harms done to ethnic minority people as a result of government responses to the coronavirus pandemic because of their greater risk to be in precarious, economic, educational and social positions.

What does all this mean? In the short term, we should not, we cannot progress in our response to the coronavirus pandemic without paying close attention to modifying policies, prevent them aggravating ethnic inequalities. This is crucial.

In the medium term, the outcomes of the COVID-19 pandemic points to the need to establish a wide independent inquiry into ethnic inequalities in health, and one that moves to focus on recommendations to address the fundamental causes of these long-standing and profound inequalities.