Covid-19: PHE review has failed ethnic minorities, leaders tell BMJBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2264 (Published 08 June 2020) Cite this as: BMJ 2020;369:m2264
All rapid responses
Re: Covid-19: PHE review has failed ethnic minorities, leaders tell BMJ. But Nobody HAS DEFINED the terms.
Nowhere do I find any definition of the terms, FAITH, ETHNICITY, MINORITY, BAME.
Even the nine experts from Birmingham (Rapid Response to this news item) are silent.
Does no one know that so-called BLACK people are products of numerous distinct genetic groups?
Does no one know that even the term ASIAN can mean different things?
Did you know that TURKEY is mostly in Asia, with merely a sliver in Europe?
Did you know that those called Bangladeshis TODAY, were, before 1971, labelled Pakistanees? And if they were born before 1947, they were labelled Indians?
Did you know that thousands who call themselves Muslims here in England, if they return to their motherland Pakistan, will be called Ahmadiyyas? Faith, you say. What faith?
INDIANS? Did you know that you are using a legal term which tells you nothing about somebody’s genetic make-up? The term does not even have a use in sociology.
Chinese nationality. Han? Tibetan? Another?
Japanese nationality. Really. Ainu? (Caucasians) Other Japanese?
Dr JK Anand
Competing interests: No competing interests
More than eighty percent of the global population identify to a particular faith.1 As a result, faith-based practices are extremely important to individuals and these communities act as a source of psychological and physical support amidst the ongoing COVID-19 pandemic.2 Census data from England & Wales suggest that faith status is intrinsically linked to ethnicity, with a higher proportion of minority ethnic groups identifying to a particular faith (Asian: 86.1%; Black Afro-Caribbean: 84.7%) compared with the White population (65.5%).3 This is of importance as current evidence in particular within the UK and USA suggests that ethnic minority groups bear a disproportionately heavy burden of morbidity and mortality amidst the COVID-19 pandemic.4,5 Further analysis from the UK Office for National Statistics (ONS) shows that when taking age into account, COVID-19 related deaths has had a disproportionate impact on those who identified with particular faith groups.6
Iacobucci highlights the need for greater exploration into risk factors for disparities in outcomes as well as potential protective mechanisms.7 In light of the findings around ethnicity, faith-based organisations may represent a vital communication channel in reaching more traditionally insulated and at-risk ethnic communities, hence providing a unique opportunity for positive health education.
The most recent ONS summary on the relationship between religion and health demonstrated statistically significant differences in the prevalence of self-reported physical and psychological morbidities as well as lifestyle choices between faith groups.8 This is a complicated topic, in which existing inequalities have been amplified, and will need further detailed study both in terms of understanding putative aetiological risk factors for COVID-19 and measures to reduce risks at individual and population perspectives.
Engage, educate and empower
During the phased return to the new normal in the post COVID-19 era, it is imperative that public health policymakers engage, educate and empower faith-based organisations to provide support in tackling COVID-19 and diseases more generally:
Engage – Supporting public health surveillance and utilisation of local intelligence
There is precedence for utilising the social capital of faith-based organisations amidst international infectious disease outbreaks. Public health campaigns and initiatives integrated with local faith groups improved the identification of Ebola cases/contacts and reduced subsequent viral spread through influencing cultural practices.9 Across the UK there is already an emergence of local initiatives to utilise the crucial knowledge base held by faith-based organisations to identify opportunities for positive public health intervention during the COVID-19 pandemic.10 This understanding of local community networks will be invaluable in prevention, disease transmission surveillance and protecting vulnerable populations by engaging during and after COVID-19.
Educate – Improving understanding of public health guidance and encouragement of health promotion opportunities
In addition, there are numerous examples of global faith-based organisations who have dedicated time to offer bespoke guidance educating their respective congregations covering important topics such as spiritual gatherings, respectful delivery of ceremonies for those deceased and virtual rather than physical support during congregation and mass.11–14 Culturally sensitive and specific education of public health measures (including shielding, social distancing and infection prevention advice) is likely to prove invaluable in preventing second peaks of cases globally and locally. Additionally, if adequately supported by local health protection teams, educational activities provided by faith-based organisations may also provide opportunities to clarify concerns, hesitations or misconceptions about engaging with research. This is urgently needed to improve understanding of inequalities in outcomes of COVID-19.
Empower – Ensuring risk minimisation and safe return to new normality
Language and cultural factors often represent substantial barriers in healthcare access and implementation of public health strategies over the longer term. Current strategies should not only take a central role in preventing a second peak, but also in empowering social support systems such as faith-based organisations to recover and flourish in the post-COVID era. Such organisations should feel sufficiently partnered by health protection teams to return to a new normal as soon as practically possible, whilst ensuring social-distancing and other public health advices are followed closely.
Need for action:
There is clearly an urgent need for policy experts and faith-based organisations to engage in collaborative dialogue to improve the implementation of public health measures for the management of COVID-19 through joint preventative action. Facilitating such discussions ensures that local public health teams can: 1). broaden their opportunities in COVID-19 surveillance; 2). enhance case and contact tracing; 3). improve implementation and uptake of public health advice; and 4). enable research partnerships, particularly in hard-to-reach communities, to understand better the complicated sociocultural factors driving inequalities in COVID-19 and other diseases. Public health bodies will want to mitigate risks and empower faith-based organisations to return to a new normal safely during and after the COVID-19 pandemic, as their role in rebuilding social cohesion in our communities will be pivotal going forward.
1 Hackett C, Grim BJ. The Global Religious Landscape. 2012.
2 The Social Care Institute for Excellence. Safeguarding people in faith communities. SCIE online Resour. 2018.https://www.scie.org.uk/safeguarding/faith-groups/communities (accessed 6 Mar2020).
3 NOMIS. LC2201EW (Ethnic group by religion) - Nomis - Official Labour Market Statistics. https://www.nomisweb.co.uk/census/2011/lc2201ew (accessed 24 May2020).
4 Bhala N, Curry G, Martineau AR, Agyemang C, Bhopal R. Sharpening the global focus on ethnicity and race in the time of COVID-19. Lancet (London, England) 2020; 0. doi:10.1016/S0140-6736(20)31102-8.
5 Public Health England. Disparities in the risk and outcomes of About Public Health England. 2020www.facebook.com/PublicHealthEngland (accessed 18 Jun2020).
6 Office of National Statistics. Coronavirus (COVID-19) related deaths by religious group, England and Wales - Office for National Statistics. 2020.https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri... (accessed 26 Jun2020).
7 Iacobucci G. Covid-19: PHE review has failed ethnic minorities, leaders tell BMJ. BMJ 2020; 369: m2264.
8 Office for National Statistics. Religion and health in England and Wales - Office for National Statistics. 2020.https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/rel... (accessed 24 May2020).
9 Marshall K, Smith S. Religion and Ebola: Learning from experience. Lancet. 2015; 386: e24–e25.
10 West Midlands Combined Authority. COVID-19 Faith Conference Call. 2020https://beta.wmca.org.uk/what-we-do/covid-19-support/ (accessed 24 May2020).
11 Church of England. Coronavirus (COVID-19) guidance for churches | The Church of England. 2020.https://www.churchofengland.org/more/media-centre/coronavirus-covid-19-g... (accessed 24 May2020).
12 Sikh coalition. CDC Guidance for Businesses and Gurdwaras. 2020.https://www.sikhcoalition.org/blog/2020/update-cdc-guidance-businesses-g... (accessed 24 May2020).
13 British Islamic Association. Covid | British Islamic Medical Association. 2020.https://britishima.org/covid/ (accessed 24 May2020).
14 Interfaith UK. COVID-19 and Funerals - News - The Inter Faith Network (IFN). 2020.https://www.interfaith.org.uk/news/covid-19-funerals (accessed 10 Jun2020).
Competing interests: No competing interests