Covid deaths among BAME communities show a ‘timebomb’ of health inequality

Tim Maby, 12 May 2020

The government has announced an inquiry into why black and minority ethnic (Bame) people are four times more likely to die from Covid 19 than others. Dr Joe Aldred of Churches Together in England told a Religion Media Centre web seminar today that a “timebomb” of health inequality has been revealed by the pandemic.

Bame staff have disproportionate death rates in the National Health Service, said Dr Mehrunisha Suleiman of Cambridge University. They make up 42 per cent of doctors, but suffered 71 per cent of deaths in April. Twenty per cent of nurses are from the Bame communities, but 71 per cent of deaths among nurses were Bame. Research is now going on into whether the causes are the proportion of NHS staff, or living conditions, or the prevalence of health conditions such as diabetes, or even barriers to access to health services.

Ben Humberstone of the Office of National Statistics (ONS) told the seminar that so far they had found that outside the NHS the highest number of Covid deaths were occurring in the most deprived parts of the country and among lower-paid groups such as bus drivers, coach drivers and security guards, over-represented in the Bame communities.

The ONS is now analysing statistics in relation to faith, which also includes ethnic divisions. “When we factor religion into that, we don’t know what we’ll find, but it will probably be consistent with what we have already found,” he said. “Ethnicity is self-identified, a mix of race, religion, nationality as much as genetics and we need to be careful not to jump to genetic conclusions.

“It will be similar from a religion perspective. We’ll see similar groupings of the population who have slightly different patterns of Covid-19 and that may well reflect their social characteristics and how they live their lives rather than religious affiliation.”

Dr David Muir of Roehampton University, who is also convenor of the Pentecostal Churches’ Network, said the United States had similar health inequality issues with Bame communities. These problems were both structural and cultural and had been elaborated in many reports.

“We already know what the effects of prejudice, discrimination and institutional racism are on the mental and physical wellbeing of black and brown people,” he said. “The politics of the pandemic has merely amplified and put a mirror in front of what most of us already know anecdotally, or from the evidence that the government has been collecting for the past 20 years. Unless and until the structural and the cultural are understood in a politically sensitive way, we’re going to have more reports telling us what we already know.”

Dr Aldred said multiple factors were involved. It was not simplistic, but one could definitely say that “living under a white supremacy is bad for some people’s health”.

He said he had found a surprising lack of awareness of the structural problems among government ministers, for instance that there were more black men in prison than in university. “I’m taken aback that ministers are surprised — I’m surprised that they’re surprised,” he said. “But they are, which tells us something about who the policy-makers are, where they sit in relation to the challenges that we face . . . It is highly unlikely any time soon that our society will actually accept that race and class has a premium: it has a price on it.”

Many members of the Bame communities work in the caring professions and Dr Muir reported that one of his students, a care worker who had to deal with a Covid case, where the other residents were told to self-isolate, was ordered to go back without proper PPE (personal protective equipment). He was beginning to feel that we now had “a system that actually kills black and brown people”.

Dr Aldred said that it was now up to the communities’ health workers to ask themselves how they could keep themselves more safe. “Coming out of Covid, I hope we encourage the Bame communities to discuss, ‘How can I be safe here?’” he said. “So if I am a doctor or a nurse on the front line and I find myself being asked to work in an unsafe way, how do I summon up the courage to say, ‘I’m not doing that.’ Because of our place in our society, we remain a little scared, and whether you see it or not, it is part of the subliminal structural way that we live our lives.”

Several speakers acknowledged that socially  Bame people were not only suffering from lower pay and poorer housing, with families living in smaller spaces, but it was also community-based ways of life that would incline to more danger of cross-infection. Dr Aldred had been watching a live television feed of a black funeral in Birmingham and had to protest because 50 people were gathered together without any sense of social distancing.

Dr Suleman argued that it was still not enough to say that only cultural reasons were responsible for the higher number of Covid deaths in the Bame communities. It had also been found that people of Pakistani and Bangladeshi heritage suffered worse than those from an Indian background. Much more work was needed by virologists to identify the causes of the pandemic.

Dr Sukhpal Gill, a GP from the West Midlands, who is also president of the Sikh Doctors and Dentists Association UK, pointed out the high proportion of Bame deaths in his area. He said a British Medical Association survey of 16,000 doctors showed that many felt they did not have adequate personal protection equipment and twice as many Bame doctors complained that they did not feel confident of being able to report the problem. Dr Gill reported that the health service was now developing planning strategies about where staff were deployed in regard to their ethnicity, because of the disproportionate effect on Bame healthcare staff, which is now regarded as a  medical emergency.

Dr Gill was asked about the case of Dr Singh-Saluja of Quebec, who shaved his beard in order to achieve the correct fit of a special face mask to work in a high risk area with Covid patients.  He said there was great distress in the Sikh community that this was being described as a great sacrifice, as though someone had to give up their faith values to save lives. He believed the religious issue was clear, that  shaving facial hair is a ‘total no no’ and said a lot of Sikh communities did not support the doctor’s action. He continued: “I am rather empathetic to him however. It must have been a difficult decision. But there are alternative masks and kits available and the conversation should have been:  is it right to balance faith against the employer’s responsibility to supply the right kit and protection?”

The Religion Media Centre will arrange another video briefing when the ONS publishes its findings on the relationship between faith and Covid-19