Submissions to statutory reviews of the Impact of COVID-19 On BAME Communities
Preamble:
According to the analysis from the Office for National Statistics (ONS), black men and women are between 4-5 times more likely to die from coronavirus when compared with white people. After accounting for age, wealth and factors such as disability, the ONS analysis shows that the risk of death for black men and women who contract Covid-19 was 1.9 times more likely than white men and women. Similar results were reflected for men from Bangladeshi and Pakistani ethnic groups who were 1.8 times more likely to die than white males. For women from the same ethnic backgrounds, the risk of death was 1.6 times more likely. The ONS recognised that “Differences in the risk of dying from the coronavirus across ethnic groups may be driven by differences in a group’s demographic and socioeconomic profile; existing evidence indicates that most ethnic minority groups tend to be more disadvantaged than their white counterparts.”
The ONS further posited that “These results show that the difference between ethnic groups in Covid-19 mortality is partly a result of socioeconomic disadvantage and other circumstances, but a remaining part of the difference has not yet been explained.”[1]
In an effort to provide further insight into the disproportionate impact of Covid-19 on the BAME community, the National Church Leaders Forum (NCLF) makes this submission in the hope that it will contribute meaningfully to the quest to better understand and find solutions to this subject. The NCLF submission is derived principally from the contributions of various African and Caribbean medical and health professionals, academics, researchers, Church leaders and other individuals who participated in a zoom conference organised by NCLF on 11th May 2020.
Social, demographic, economic and political factors contributing to BAME ill-health
It is already well established that most ethnic minority groups tend to be disadvantaged socioeconomically and in their health. People from black and minority ethnic backgrounds are more likely to live in deprived areas, unemployed, employed and over-represented in customer-facing, low-paid jobs such as bus drivers, cleaners, hospital porters etc where they cannot work from home. Around 1 in 10 Black African women work as nurses/carers, compared to around 1 in 30 White British women[2]. These factors increase the risk of catching coronavirus. Workers from BAME communities are also more likely to live in overcrowded homes, increasing the risk for their families too.
Historically national health services have developed around, and have focused on, the health needs of the White majority. This has indirectly acted to exclude ethnic minorities from both health and social care services. This unequal access to care also places ethnic minority groups at a disadvantage which has resulted in ethnic minority groups generally having higher mortality & morbidity rates[3]. This is coupled with the fact that a disproportionate number of people from BAME backgrounds have underlining health issues which make them more likely to have worse outcomes from infection with Coronavirus, both in terms of disease prognosis and mortality. For example, type 2 diabetes, obesity, cardiovascular disease (CVD) and other respiratory diseases[4].
Interestingly, a Sky News analysis suggests that 62% of all those who have died in the NHS since the start of the coronavirus outbreak are from a BAME background. They include cleaners, hospital porters, nurses and intensive care doctors – all of whom are now known to be at a potentially greater risk by the National Health Service (NHS)[5]
Participants at the NCLF consultation identified the underlisted relevant issues which are linked to the socioeconomic and demographic factors outlined above, as possible contributors to the disproportionate impact of covid-19 on BAME community:
- There were indications that given the shortage of personal protective equipment (PPE) for frontline workers, many of the BAME workers seemed to have felt compelled to continue to work without PPEs. Many have felt disempowered in the sense that if they did not work within high-risk zones/service delivery, they will suffer much lack and inability to care for themselves and their families. Many such workers are with visas and leave to remain authorisations which do not allow them recourse to public funds. Some others did not have the confidence to challenge the situation of having to work without PPEs for fear of losing their jobs.
- The experiences of disadvantage and deprivation have contributed to the situation where many BAME communities do not trust public institutions and therefore refuse the science/evidence which are guiding government actions and strategies for Covid-19. This is in addition to already existing situations where some BAME individuals, such as refugees and asylum seekers, are afraid to seek medical help as well as possible language barrier. Such individuals therefore lack the confidence to access NHS services.
- There were anecdotal suggestions of discrimination and racism such as BAME frontline workers (professional and lower cadre staff) having not received expected support from white peers. There are also allegations of medical intervention coming too late to some BAME people; and also of less than optimal care received by some BAME people pre-hospitalisation and while in hospital.
What should government do to address the disproportionate impact of Covid-19 on BAME community?
- It is suggested that an observatory should be established to focus on ethnic health. The observatory should be able to influence the whole health system to recognise and respond to the ethnic variations in health; it should also address racism as a public health issue as well as an important determinant of health.
Part of the remits of the observatory suggested above would be to make it a statutory obligation for government/public bodies to conduct a race impact assessment on public policies. The health inequalities that have been referred to in this submission document should all be subject to impact assessment.
- There have been early stage/emerging scientific studies which seem to link vitamin D deficiency (and consequent weak immune system) among BAME people to the poor coronavirus/Covid-19 prognosis and mortality outcomes. It is hereby strongly suggested that the government should commission a study to ascertain the veracity of these claims and to act accordingly. If it is established that vitamin D has any positive role in protection against covid-19 then steps should be taken to make it widely available to the population, especially members of BAME groups.
It is worthy of note that the National Institute for Health and Care Excellence (NICE) recognises that Vitamin D plays important roles in the body’s immune responses and has made recommendations to prevent Vitamin D deficiency in adults which were last revised in September 2018. To prevent vitamin D deficiency, it advises that all adults living in the UK at increased risk of Vitamin D deficiency should take a daily supplement of 400IU (10 mcg) of vitamin D throughout the year, including the winter months. It also identified people at higher risk of vitamin D deficiency to include those with dark skin[6] (for example people of African-Caribbean, Asian or Middle-Eastern ethnic origin).
- Given the emerging link between the long standing social and economically disadvantaged situation of people from BAME backgrounds and the disproportionate impact of Covid-19 on them, it is imperative to ask that the government should continue to take measures to redress these inequalities. This should be through appropriate mechanisms and in collaboration with BAME communities.
- The government needs to demand that employers protect BAME workers (and indeed all employees) by following through with duty of care for their employees as stipulated in existing legislation.
- The government needs to investigate anecdotal suggestions of discrimination and racism such as BAME frontline workers (professional and lower cadre staff) having not received the support expected from white colleagues and supervisors. Allegations of less than optimal care received by some BAME people pre-hospitalisation and while in hospital should similarly be investigated, possibly through a panel of enquiry.
In carrying out the above investigation, it is suggested that the body responsible for such a task should include representatives of BAME led churches and faith groups, medical and health practitioners and other relevant specialists.
We trust this submission can provide further insights and make a contribution to your review and we look forward to receiving the outcomes of your work.
Very best Wishes
Yours sincerely
Pastor Ade Omooba MBE and Dr R David Muir
Co-Chairs
For and on behalf of NCLF – A Black Christian Voice
Pastor Ade Amooba 07956 007150 and Dr R David Muir 07530 780110
[1] The Independent, 7 May 2020: https://apple.news/AtXfua4AmRJqahPsRhF_jjA
[2] Brynin, M. and Longhi, S. (2015) The effect of occupation on poverty among ethnic minority groups, York: Joseph Rowntree Foundation. Available at:https://www.jrf.org.uk/file/46570/download?token=62qbLYOg&filetype=full-report
[3] ONS 2013 Ethnic Variations in General Health and Unpaid Care Provision, 2011, London: Office for National Statistics (ONS). Available at: http://www.ons.gov.uk/ons/dcp171776_318773.pdf
[4] Oldroyd J et al (2005). Diabetes and ethnic minorities. Postgrad Med J 2005;81:486–490. doi: 10.1136/pgmj.2004.029124. https://pmj.bmj.com/content/postgradmedj/81/958/486.full.pdf
[5] Sky News, 30 April 2020: https://news.sky.com/story/coronavirus-the-true-impact-on-uks-bame-community-may-never-be-known-11981419
[6] NICE 2020: Vitamin D deficiency in adults – treatment and prevention. https://cks.nice.org.uk/vitamin-d-deficiency-in-adults-treatment-and-prevention#!topicSummary