Covid-19: Increased risk among ethnic minorities is largely due to poverty and social disparities, review finds

Recommendations

The report makes 13 recommendations for action across government, all of which have been accepted by the prime minister. These include ensuring that NHS trusts implement plans for the next stage of the pandemic that reflect the latest evidence about ethnic disparities and risk factors, as well as updating the list of “shielded” patients in line with improved knowledge of the factors that put people at greatest clinical risk.

Recording ethnicity as part of the death certification process should become mandatory, “as this is the only way of establishing a complete picture of the impact of the virus on ethnic minorities,” the report says.

It also calls for government departments to monitor the effects of their policies on people from ethnic minority backgrounds, to continue to work at pace to develop new policy interventions to mitigate covid-19 disparities, and to improve public health communication to enable interventions to be delivered successfully to everyone.

Build confidence

The report notes that “further work is needed to partner with health professionals to dispel myths, reduce fear and build confidence among ethnic minority people.” The government “will need to keep sharpening its focus on rebuilding trust in government messaging, tackling misinformation and anti-vaccination narratives and encouraging engagement with NHS services,” it advises.

Trish Greenhalgh, professor of primary health care services, University of Oxford, said, “It is encouraging that a government report is considering what might be called the structural causes of inequalities as well as the [possibility of] biological ones. In other words, a person from a black or south Asian background may be more likely to develop covid-19, and more likely to become seriously ill and die from it, not just for biological reasons—eg, more likely to have comorbidities such as diabetes—but also, and perhaps primarily, for reasons linked to poverty and social injustice.”

However, Chaand Nagpaul, BMA council chair, complained about the delay in the government’s response. People from ethnic minority backgrounds had not seen any change in the disproportionate effects of the virus on their lives, he said.

“Today, as we sit amid a second wave of infections, we know that about a third of those admitted to intensive care are not white—showing no change since the first peak. Meanwhile, black and Asian people have been found twice as likely to be infected compared to white people,” Nagpaul explained.

He added, “There needs to be more tangible action right now to protect BAME [black, Asian, and minority ethnic] people. This could include providing resources to support individuals and businesses to ensure they have right protective equipment and to ensure their workplaces are covid secure. With higher numbers of BAME people in low paid employment or living in deprived areas, it is vital to offer adequate funding that encourages individuals to be tested and to self-isolate if infected, given evidence that many feel that financial loss acts as a deterrent to do so.

“The Community Champions scheme is welcome, but we need to see the reality of culturally competent public health and disease prevention strategies with ownership and trust in communities now, so that there are necessary behaviour changes to prevent more from coming to harm.”