Intended for healthcare professionals


Covid-19: Government race review “misused evidence,” says Marmot

BMJ 2021; 373 doi: (Published 22 April 2021) Cite this as: BMJ 2021;373:n1063

Linked Opinion

Structural racism is a fundamental cause and driver of ethnic disparities in health

  1. Gareth Iacobucci
  1. The BMJ

A review commissioned by the government that dismissed the notion that structural racism may have contributed to poor health outcomes among ethnic minority groups during the covid-19 pandemic was guilty of a “misuse of evidence,” a world expert on health inequalities has said.

Michael Marmot, director of the Institute of Health Equity at University College London, said that the Commission on Race and Ethnic Disparities,1 chaired by Tony Sewell, failed to acknowledge that racism could account for the “adverse distribution of socioeconomic characteristics” that cause health inequalities when it selectively quoted his evidence.

But although the report has been roundly condemned for concluding that there was “no evidence of systemic or institutional racism” in the UK,2 Marmot said the reaction to it had given him some hope. “Because of their misuse of evidence, it has been widely criticised,” he said. “That makes me hopeful that the truth, the evidence, can actually carry the day. We need the evidence out there, we need people discussing it, and we need to get our national politicians responsive to it.”

Marmot was speaking at an online Westminster Health Forum event on 20 April, where he also argued that the UK’s high excess mortality during the covid-19 pandemic was caused by austerity policies, increased social and economic inequality, and cuts to public services over the past decade that had left the UK “unhealthy coming into the pandemic.”

He said, “If you look at mortality from all causes . . . it was clear from the beginning of the pandemic that it would expose the underlying inequalities in society and amplify them. And then of course the pandemic makes the inequalities worse.

“When asked to comment about this, I said ‘We have to address structural racism.’ I was struck when the [Sewell] report said there isn’t any racism in Britain. They quoted . . . my 2010 report as saying, well, it’s largely socioeconomic. But the [Sewell] report couldn’t put together that racism perhaps could account for the adverse distribution of socioeconomic characteristics.”

Marmot said data from his two recent reports produced with the Health Foundation, The Marmot Review 10 Years on and Build Back Fairer: The COVID-19 Marmot Review,3456 showed how the “regressive nature” of cuts to public services since 2010 had contributed to the poorest communities being hit hardest by the pandemic.

“I think of health as a measure of societal success,” he said. “Pre-pandemic, life expectancy was stalling, inequalities were increasing, and life expectancy for the poorest people was falling. And during the pandemic we had the highest excess mortality. What’s the link? I suggest . . . poor governance and political culture, increasing social and economic inequalities, the reduction in spending on public services.”

He added, “We’ve got to fix these problems. What do I mean by poor governance and political culture? Well, if you’ve heard the word sleaze lately . . . corruption, social and economic inequalities increasing, reduction in spending on public services, and the fact that we were unhealthy [before the pandemic]. My criterion for good governance is to put a fair distribution of health and wellbeing at the heart of all government policy.”

Marmot cited specific recommendations in his most recent review to narrow the health gap, which also relate to his 2010 report: to reduce inequalities in early years and education, to “build back fairer” for children and young people, to create fair employment and good work for all, to ensure a healthy standard of living for all, to create and develop healthy and sustainable communities, and to strengthen prevention of ill health.

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