Who Is Hit The Hardest – Why Is The Death Toll Rising?

After adjusting for age, men and women from all ethnic minority groups (except females with Chinese ethnicity) are at greater risk of dying from COVID-19 compared with those of White ethnicity. Black males are 4.2 times more likely to die from COVID-19 than White males, while Black females are 4.3 times more likely to die from COVID-19 than White females

Read those statistics again. Did you wonder, “Have I read this incorrectly?” Unfortunately, you haven’t. Although we are all living through a pandemic, we are not all experiencing it equally. Minorities are disproportionately affected by the coronavirus and are over-represented in both mortality rates and intensive care units.

After taking account of age and other sociodemographic characteristics and measures of self-reported health and disability at the 2011 Census, the risk of a COVID-19-related death for males and females of Black ethnicity reduced to 1.9 times more likely than those of White ethnicity

Once the above adjustments are made to the differences between BAME and white ethnicities the disparity may become smaller, but a large gap remains. So the logical question is, why? Genetic variations cannot be the sole reason for such a severe difference, so what is the explanation?

“Black males are 4.2 times more likely to die from COVID-19 than White males, while Black females are 4.3 times more likely to die from COVID-19 than White females”

Let’s take a closer look at the following to narrow down our rationale:

Historical inequalities

Historically, those from a BAME background belong to a lower socioeconomic group, and it is well-evidenced that those of lower economic standing are more vulnerable to ill health. What the coronavirus has proven is that disproportionate poverty rates, which often lead to poorer conditions and overcrowded housing, are putting ethnic minorities at a greater risk of contracting the virus. Looking into overcrowding as an indicator, 30% of Bangladeshi households are overcrowded, 16% of Pakistani households and 15% of Black African households are overcrowded compared with White households at 2%. Under these conditions, it is impossible to self-isolate or observe social distancing, and therefore the virus can and will spread rapidly.

Occupation

Black and other minority ethnic groups make up a significant proportion of frontline workers who are considered essential in combating the virus. One in five people working for the NHS in England is from an ethnic minority background, these numbers increase when looking at doctors and nurses in isolation.

Key workers are typically exposed to the frequent use of public transport because these jobs tend to be lower skilled and more manually intensive requiring more interaction in their physician place of work. This means those belonging to this group are more likely to be diagnosed with coronavirus. Where occupation coincides with racism is where we see the most devastating results. Race-related bullying has been a long-standing problem within the medical field. A survey by the Royal College of Nursing in May 2020 showed that only 43% of ethnic minority nurses reported receiving adequate eye and face protection equipment, compared with 66% of White British nurses. Bullying within the healthcare profession results in BAME staff being excluded from safety equipment or not being provided with adequate protection. In the war against COVID-19, protective equipment is essential, but with racism dictating who is offered such protection, those from a BAME background will inevitably have increased chances of contracting the virus.

“43% of ethnic minority nurses reported receiving adequate eye and face protection equipment, compared with 66% of White British nurses.”

Access to health and fear

Inequalities in health care for BAME groups have always existed; the COVID-19 pandemic isn’t creating these inequalities, but rather uncovering how serious they are. Those from a BAME background are at greater risk of chronic disease and multiple long-term health conditions – some of which are aggravated by deprivation. Improvement in early diagnoses and the management of known long-term conditions affecting particular groups is essential, and the death toll reflects where these are overlooked or where significant investments are not made.

“From birth to life expectancy, there is already a 12-year disparity [between BAME and white ethnicities], what the coronavirus has done is served as a mirror to inequalities we already knew existed, what is sad is that it has taken a pandemic for us to recognise this” – Dr Nighat Arif

Fear of diagnosis of COVID-19 and a lack of trust within the healthcare system means the likelihood of BAME groups getting tested in a timely manner is significantly lower than their White counterparts. Many reasons fuel distrust in the healthcare system, ranging from prejudice, previous experience of not being listened to, or fear of the legacy of human testing on people of colour.

Racial discrimination can also alter the quality of one’s life through stress, and negative impact on mental and physical health. Actual discrimination or the anticipation thereof stops early intervention or intervention at all. For many BAME groups, when the opportunity for early intervention is missed, many opt for a home remedy to avoid entering into a healthcare system they believe is “not designed for people who look like them.” This adds considerably to the likelihood of fatality from the coronavirus.

“Daily we are seeing, doctors, nurses and care workers from various ethnic minority groups being affected, I am anxious every day and so grateful when I wake up without temperature or a cough or breathing difficulties – I have to be thankful for each day” – BAME GP

“Racial discrimination can also alter the quality of one’s life through stress, and negative impact on mental and physical health.”

Systemic racism

“I am surprised that people are surprised if you look at any health data across minority communities – the virus is unveiling the true realities of our society and racism is a matter of life or death” – Kehinde Andrews, professor of Black studies, Birmingham city university

What must be clarified is that being from a Black or minority ethnic group in itself does not make you more likely to be diagnosed with the coronavirus in the sense that the colour of your skin isn’t the reason for the uptake of the virus. Different BAME groups are also impacted in different ways – for example, Black Africans are more susceptible to the virus because of the high volumes of frontline workers whereas those from a Bangladeshi community it is typically due to underlying health conditions.

Although it cannot be conclusively noted as the sole reason, one factor that does tie our current considerations together is the impact of structural and endemic racism which materialises in inequality, lower socioeconomic status and the perpetuation of fear and distrust in the healthcare service.

 If nothing else, the coronavirus has exposed systemic racism within healthcare, which can now be addressed. All the evidence presented highlights the dangerous and destructive nature of ignoring structural inequalities. Governments in the western world who have been hit the hardest by rising death tolls need to be proactive about addressing these inequalities and speak to the real facts which have led to substantial death within the BAME community. Real change must be transformative and all-inclusive –  otherwise, papers and commissions will just become rhetoric and lives will still be lost.