By Roxana Diba
Image credit: mentalhealthtoday.co.uk
On the 2nd of June, the UK government finally released their report on the disturbing disparity in COVID-19 related mortality rates in black and ethnic minority (BAME) communities relative to the white population. It did not say much, and nothing more than we already knew. That is, that those of Asian and African descent have a 10-50% greater risk factor for not just acquiring COVID-19 but dying from it. If anything, this is an understatement – another report by the London School of Hygiene and Tropical Medicine observed a 71% increase in COVID related deaths for black people in Britain and 64% increase for Asian groups.
You’d be forgiven for thinking that ‘it is all genetics!” because seemingly, that’s all the British government could bring itself to suggest; the report ignored other possibilities and omitted any recommendations on how to confront these issues. However, since the 1970s academics in the field of genetics have largely corroborated that there is no biological basis for race, finding more genetic variation within races than between them. Admittedly, there are particular genetic mutations more prevalent amongst certain geographic groups, which can affect responses to pharmaceuticals and create a greater risk of developing some diseases. However, most disorders are a combination of hereditary factors and influences from a lived environment. For instance, sickle cell anaemia is more prevalent in a blurred geographic region containing African, Middle Eastern and Southern European groups, due to the advantage it imparts in surviving malaria, a common disease for these areas.
In BAME individuals there is no substantiated evidence to suggest an inherited weakened immune response to COVID 19. What is observed instead is certain disorders occurring more frequently amongst BAME people, like cardiovascular disease, type 2 diabetes and hypertension. While Public Health England failed to control for these potential comorbidities in their report, other studies have. A paper published in the European Respiratory Journal confirmed the poorer outcomes found in patients suffering from co-occurring disorders. You could say that these conditions imply a genetic basis for the virus mortalities, but the fact that these illnesses are influenced so much by environmental factors tells another story. Diet, access to healthcare and exercise are the leading predictive factors for the aforementioned diseases. These socioeconomic determinants have a significant role in disease outcomes, so much so that studies looking at the associations of race and disease often find that by controlling for socioeconomic factors race is no longer significant.
Despite the conservative party recently assuring the UK that “this is one of the best countries in the world to be a black person” the Windrush report released in March highlighted just how prevalent institutional racism is in the UK. This discrimination denies black and ethnic minorities equal rates of pay, access to the highest-earning jobs, and equal education. Where there are economic disadvantages health problems follow; nutritious diets are expensive, as is access to gym facilities, and healthy housing. These reasons may explain why a quarter of patients in critical care are likely to be from an economically deprived region of the UK, whilst a tenth of patients live in some of the most affluent areas. Furthermore, BAME people often suffer from inadequate healthcare, being less likely to use GP services, due to a variety of factors including a lack of accessible information, language barriers and longer appointment waits.
These are not the only ways structural racism establishes health inequalities, however. The British Medical Association reported in a survey that BAME doctors and nurses were more likely to feel pressured to see high-risk patients despite lacking appropriate personal protective equipment. Additionally, BAME NHS staff were found to be less likely to voice their concerns about poor workplace safety compared to their white colleagues. Even when personal protective equipment is provided it is often unsuitable for Sikhs and Muslims wearing beards for religious purposes, as the facepieces are not designed to fit around facial hair. Therefore, the death rates among NHS staff largely parallel the findings of the UK in general – of the doctors that have died of coronavirus, 94% were BAME, whilst only accounting for 44% of staff.
Why BAME UK doctors do not feel comfortable raising issues with their employers is a deeply concerning reflection of how BAME employees are treated in the UK. After the survey, the BMA asked for a further investigation by Public Health England to suggest why this was, but this was not carried out in their report.
Although the UK government may find genetic factors to be a useful scapegoat in the increased COVID-19 related deaths amongst BAME people it is unlikely that biology plays a significant role. The conservative party are reluctant to let the public associate a culture of systemic racism and economic disadvantages with increased COVID mortalities (as it would mean they might have to do something towards targeting austerity). However, the evidence is indisputable. As placards have read at black lives matter protests around the world, “racism is a pandemic too”. Fighting coronavirus includes fighting the factors that enable it. The UK must take accountability for institutional racism and tackle the socioeconomic disparities it produces; including employment, education, and healthcare.