Racism is the key to understanding ethnic inequalities in COVID-19 – despite what UK government says

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By James Nazroo and Laia Becares

We’ve known for some time that people from ethnic minorities in the UK are several times more likely to be admitted to hospital or die from COVID-19. A new report authored by Baroness Doreen Laurence and commissioned by the Labour Party has found that the disease has thrived among minority communities because of inequalities driven by structural racism.

This contrasts significantly with the government’s own recent and disappointingly bland report on the issue. Produced by the Race Disparity Unit, this report recognised that a range of factors such as where ethnic minorities are likely to live and what kinds of jobs they are likely to do help explain the disparate outcomes. It also pointed out that part of the excess risk was unexplained. However, it didn’t once mention racism as a potential explanation.

What’s more, one of the unit’s main expert advisers, Dr Raghib Ali, has publicly argued that racism isn’t a factor and that suggestions that it was were based on “subjective” accounts not “objective” evidence. In fact, he even seems to imply that this kind of systemic racism doesn’t exist because, he claims, ethnic minority groups have “both better overall health and lower rates of all-cause mortality than white groups” (meaning the risk of death once age is taken into account).

Having conducted our own study of the evidence, we agree with the government and Ali that we must deal with socioeconomic inequalities to address ethnic inequalities related to COVID-19. But if you look at the broader data on health, you can see that these inequalities absolutely are driven by racism and racial discrimination.

First, the evidence demonstrates that there are extensive ethnic inequalities in health in the UK. Any reading of academic, peer-reviewed research shows this. For example, robust research shows that babies of Indian, Pakistani, Bangladeshi or Black Caribbean origin are more likely to be low birthweight than white infants.

Meanwhile, Bangladeshi people have around 7.5 fewer years disability-free life expectancy than white British people. Pakistani men have six fewer years and Pakistani women have nine fewer years. Indeed, most ethnic groups identified by the UK census have lower disability-free life expectancy than the white British group. These inequalities are also present for a range of health outcomes, such as diabetes, heart disease, hypertension and mental illness and wellbeing.

Certain data published by Public Health England do indicate that people from ethnic minorities have a lower risk of death (pre-coronavirus) once their age is taken into account. But this is calculated using ten-year-old census data and doesn’t account for (often older) people who have migrated to another country since then, and so this is a very problematic estimate. Ali could only have concluded that ethnic minority people have better health by subjectively cherry picking his sources of evidence and ignoring the majority of high-quality objective evidence.

Discrimination hurts

In addition, there is also extensive objective evidence that illustrates how racism, operating at structural, institutional and interpersonal levels, is prevalent in our society and impacts people’s lives. Countless studies in the UK have shown discrimination occurring in the areas that are related to the socioeconomic factors thought to be behind the greater risk of COVID-19 to ethnic minorities. This includes in hiring processes, in education, in housing transactions, in criminal justice, in healthcare and in interpersonal interactions.

And evidence from numerous peer-reviewed academic papers also shows specifically that experiencing racism is bad for health. Racism, and knowing you may be a victim of racist discrimination or abuse, sets in train a stress response that can produce short-term damage to mental health and longer term harms to mental and physical health. Conversely, denying the role of racism in generating the inequalities in our society contributes to the oppression experienced by ethnic minority people.

For an official scientific adviser to Minister for Equalities Kemi Badenoch to deny the importance and perhaps existence of structural racism raises questions about what opportunities the government will create to tackle the COVID-19 inequality and the factors that underlie it. Yes, we should be trying to understand and address the socioeconomic inequalities. But it is also important to thoroughly and wholly address how racism negatively shapes the lives and opportunities of ethnic minority people in the UK.

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