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Is ethnicity linked to incidence or outcomes of covid-19?

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1548 (Published 20 April 2020) Cite this as: BMJ 2020;369:m1548

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Primary care accessibility of BAME populations may have affected their outcome during the pandemic of Covid-19

Dear Editor,

Sars-Cov-2 may infect primarily the respiratory system, but its weakest target has been proven to be our societies. The first true pandemic in the era of globalisation, has left the world facing off its inequalities which were brought into the surface, and posed an existential dilemma: what are we willing to do to protect our communities, even if we, personally, are not affected by the injustice.

According to reports by the Office of National Statistics (ONS) and Public Health England (PHE) Covid-19 has disproportionally affected members of the BAME (Black, Asian and Minority Ethnic) communities (1), (2). The factors contributing to these differences were multifarious. BAME people usually live in urban areas (where there are higher rates of infection). They tend to come from a lower socio-economic status; hence they reside in more deprived areas, usually in overcrowded households, holding jobs that can more easily expose them to the risk of infection (2). Issues were also identified to the level of care BAME people were provided with. The main ones were effective communication and cultural differences between the healthcare professionals and their patients, along with poor quality ethnicity data and accessibility to health care services (2).

The census of 2011 informs us that, within London, Lambeth has the largest black population and Newham hosts the most Asian people. I wanted to compare their accessibility to primary care services to that of the affluent borough of Kensington and Chelsea (K&C) (4).

Borough Area (km2) Total population BAME % GP practices
Kensington & Chelsea 12.12 156.197 7% Black, 4.9% Asian 43
Lambeth 26.83 325.917 25% Black, 7.8% Asian 47
Newham 36.21 352.005 72.9 % BAME (14% Indians) 69

Lambeth, with double the size of K&C, and twice its total population, has almost the same number of registered GP practices. In Newham, with triple the size of K&C, and twice its total population, there are no more than 1.5 times more practices.

If you live in an area, like Lambeth, where your closest GP practice requires a mean of 20 minutes travel with public transport (9), you even probably have to face severe delays once you get there, since a small number of practices has to care for a much larger population, and you cannot afford to miss a day or even some hours of work, then you would probably not choose to visit the health care services, unless absolutely necessary. It is this fundamental inequality in the accessibility of healthcare, between boroughs of different BAME populations, that feeds systemic racism.

How it does that? By creating two-lane citizens. On the one lane, there is better access to healthcare, that results to earlier diagnosis, treatment and recovery, a generally healthier community, that can invest their time and resources to further growth and influence. On the other lane, with a much more difficult access to healthcare, people are trying to balance between physical and economic survival, finding little space to contemplate any idea of growth and bettering of their community.

How did this reality translate during the pandemic? People failed to get their diagnosis early, therefore, they didn’t get the treatment they required, they could not self-isolate appropriately, and ultimately, they could not protect their family and communities.

What can we do to address this issue? We urgently need to improve access to healthcare for the BAME population, with more primary care services to more deprived areas.

Why? Because access to healthcare, stems from the most intrinsic parts of our humanity, and by denying it to some, actively or passively, we deny ourselves of any decent collective future.

References:

1. Ons.gov.uk. 2020. Coronavirus (COVID-19) Related Deaths By Ethnic Group, England And Wales - Office For National Statistics. [online] Available at:
2. Assets.publishing.service.gov.uk. 2020. Disparities In The Risk And Outcome Of Covid-19. [online] Available at:
3. 2020. [online] Available at:
4. Data.gov.uk. 2020. 2011 Census - Data.Gov.Uk. [online] Available at:
5. Royal Borough of Kensington and Chelsea, 2011. Health Care Services. Royal Borough of Kensington and Chelsea.
6. Nhs.uk. 2020. Gps - NHS West London (K&C & Qpp) CCG - NHS. [online] Available at:
7. Lambethccg.nhs.uk. 2020. GP Surgeries In Lambeth. [online] Available at:
8. Lmc.org.uk. 2020. List Of Newham GP Practices. [online] Available at:
9. Kanaroglou, P. and Delmelle, E., 2016. Spatial Analysis In Health Geography. International Journal of Geographical Information Systems.

Competing interests: No competing interests

07 July 2020
Pantelis Baniotopoulos
Medical student
King's College London
Strand campus