Why Have Britain’s Ethnic Minorities Been Hit Harder by COVID-19? It’s Hardly a Mystery

Another example of denial of the links between minority status and socioeconomic factors as a way to minimize the influence of systemic and other issues affecting socioeconomic outcomes and thus health. Not an either/or but an and:

COVID-19 is a disease that can strike anyone. A recent study of 5,700 sequentially hospitalized COVID-19 patients in a New York City health network, for instance, found that patients’ ages ranged from single digits to 90-plus. Roughly 60 percent were male. About 40 percent were white. Nine percent were Asian. And 23 percent were black.

As Coleman Hughes recently noted in Quillette, black people are overrepresented among American COVID-19 fatalities overall. In Chicago, for example, black people account for more than 70 percent of COVID-19 deaths, despite comprising just 30 percent of the local population. But this doesn’t necessarily tell us much about the disease itself, because “black people are more likely than white people to die of many diseases—not just this one. In other cases, the reverse is true. According to CDC mortality data, white people are more likely than black people to die of chronic lower respiratory disease, Alzheimer’s, Parkinson’s, liver disease, and eight different types of cancer.”

In the UK, too, COVID-19 has had a disproportionate effect on communities that get lumped in under the (somewhat dated) term “BAME”—black, Asian, and minority ethnic. The Intensive Care National Audit and Research Centre has reported that 34 percent of a studied group of 6,720 critically ill COVID-19 patients self-identified as black, Asian or minority ethnic. By way of comparison, the comparable figure for a group of 5,782 patients with non-COVID-19 viral pneumonia tracked between 2017 and 2019 was about 12 percent. Moreover, as the Telegraph reports, “despite only accounting for 13% of the population in England and Wales, 44% of all [National Health Service] doctors and 24% of nurses are from a BAME background. Of the 82 front-line health and social care workers in England and Wales [who] have died because of COVID-19, 61% of them were black or from an ethnic minority.”

The release of these numbers prompted an official inquiry. And last week, the Labour Party appointed civil-rights campaigner Doreen Lawrence to head up its own review of the issue. A BBC article entitled “Coronavirus: Why some racial groups are more vulnerable” informs readers that the issue might be rooted in the “physiological burden from the stresses caused by racism and race-related disadvantage, such as the frequent secretion of stress hormones.” London Mayor Sadiq Khan recently wrote an article in the Guardian, demanding that more data be collected. However, he didn’t wait for such data before suggesting that the issue is rooted in “the barriers of discrimination and structural racism that exist in our society.”

I’m a refugee from Afghanistan who came to England as a child in the back of a refrigerated truck. So I know a little bit about these issues. I also know that the above-described statistical disparities may well be related to factors that have nothing to do with racism. Firstly, as everyone in the country knows, BAME communities are disproportionately urban. Specifically, they tend to live in Britain’s larger cities, such as London, Birmingham, and Manchester—often within populous urban wards. Contagion rates are high in these areas, in part because it’s easier for an epidemic to spread in a big city than in the country’s sparsely populated (and disproportionately white) countryside.

Secondly, BAME groups in the UK tend to have more aggravating health conditions, known as comorbidities. Given the epidemiological data, this is of enormous importance. In the aforementioned study of 5,700 COVID-19 patients in New York City, for instance, the leading comorbidities were found to be hypertension (57 percent of all patients), obesity (42 percent), and diabetes (34 percent). Overall, a stunning 94 percent of patients in the study had at least one comorbidity. And 88 percent had more than one.

According to 2006 data, South Asians in the UK are up to six times more likely to develop type-2 diabetes as compared to white people, and black people were up to five times more likely. Similarly, as the BMJ has reported, people of South Asian and Black ethnicity “are known to have worse cardiovascular outcomes than those from the white British group”—in large part because of the “significant” effect of differences in average hypertension levels.

Thirdly, immigrant households are far more likely to contain more than two generations living under one roof. (The authors of a 2017 report found that 70 percent of surveyed white households in the UK containing people aged 70-plus didn’t contain younger individuals. The comparable figure for black households was about 50 percent. For South Asians, it was 20 percent.) In such circumstances, social isolation is more difficult, and grandparents are put at risk of catching infectious diseases from (possibly asymptomatic) younger relatives. From the beginning of this pandemic, intra-household contagion has been a leading form of COVID-19 transmission. The bigger the household, the more people get infected in each cluster.

Fourthly, the problem of getting public-health information to citizens is compounded in the case of those immigrants who have limited English abilities. There is much less official information in Somali, Hindi, Farsi, or Pashto, for instance. There is lots of “fake news” circulating on WhatsApp groups, which is especially problematic in the case of those who don’t understand information coming from official channels in English. Much of this fake-news information flow flies under the radar of public officials.

Finally, as noted above, BAME workers make up a disproportionate share of National Health Service medical staff. A fifth of nurses and midwives, and a third of doctors, are from BME backgrounds. In many cases, these actually represent employment success stories. But as one would expect, these cohorts also tend to be younger, and so are disproportionately employed in entry-level roles and front-line care, as opposed to working in specialized clinics or managerial positions.

An objective assessment of such issues is welcome. But the government’s fact-finding project should take into account the underlying factors, as opposed to simply echoing some of the unhelpful generalizations that now have become common currency in the media.

The public-health policies that are put in place in coming years will affect our ability to withstand the next pandemic. And we should be mindful of the manner by which they impact different communities in different ways. Such a discussion would not only help save lives, but also help spark a larger discussion about why such differences continue to exist, and, more generally, what factors have prevented BAME communities from sharing in the benefits that come with social integration.

Source: Why Have Britain’s Ethnic Minorities Been Hit Harder by COVID-19? It’s Hardly a Mystery

For background:

Kamrul Islam doesn’t dare visit his local supermarket. Over the last few weeks, he said three of his closest friends fell ill with the coronavirus shortly after shopping there. One friend’s mother became seriously unwell after contracting the virus and died.

The 40-year-old former cab driver says a day doesn’t go by when he isn’t aware of a death or infection of someone he knows. While the coronavirus has spread widely across the UK, the pandemic has taken a huge toll on the area where Islam lives, the east London borough of Newham, which has recorded the worst mortality rate in England and Wales.

The borough’s rate – 144.3 deaths per 100,000 people – is closely followed by Brent in north London (141.5), and Newham’s neighbour Hackney (127.4), according to figures published by the Office for National Statistics. The data confirms what Islam has suspected all along: people living in the poorest parts of the country are dying from Covid-19 at a much higher rate than those in the richest.

On Islam’s road and neighbouring street, 22 people have died after contracting coronavirus. “Every day I get a message from someone in my community telling me of people who have died. They are young and old. It’s been really tough,” Islam said. His wife, who wished to remain anonymous, said: “You hear sad stories of people dying and no one was with them. It does affect people mentally.”

The deaths from the coronavirus include Betty and Ken Hill, who were together for more than 40 years and died hours apart; Dr Yusuf Patel, who was the fifth GP to succumb to the virus in the UK; “exceptional” secondary school English teacher Dr Louisa Rajakumari; and Abdul Karim Sheikh, the former ceremonial mayor who founded one of the first mosques in the area.

About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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