Disparities in the Impact of COVID-19 in Black and Minority Ethnic Populations: Review of the Evidence and Recommendations for Action

The question of why more people from black and ethnic minority (BME) backgrounds appear to be at greater risk of hospitalisation and deaths with COVID-19 – and the need for urgent action in order to address this – has become one of the most urgent issues in this pandemic in the UK. It suggests that the reasons why some BME groups appear to be at greater risk of dying with COVID-19 are complex with interplay between socio-economic disadvantage in BME populations, high prevalence of chronic diseases and the impact of long-standing racial inequalities being key explanations. The Marmot Review in February 2020 highlighted that people from disadvantaged backgrounds or deprived areas, and BME backgrounds, were not only more likely to have underlying health conditions because of their disadvantaged backgrounds, but they were also more likely to have shorter life expectancies as a result of their socio- economic status (including greater representation in poorly paid and insecure employment). Bangladeshi men and Pakistani women were identified as groups with the lowest life expectancy. Housing conditions, including overcrowding is also likely to have had an impact on vulnerability to COVID-19. Overcrowded households among BME populations are also much more likely to be multigenerational, making social distancing, self-isolation and shielding much more difficult, and increasing opportunities for within-household coronavirus transmission. We also know that ethnic minorities have been over-represented in key worker jobs during COVID-19: transport and delivery jobs, health care assistants, hospital cleaners, social care workers, taxi drivers, security guards, and in nursing and medical jobs. These occupations have been frontline jobs with increased the risk of exposure, infection and death. There have also been concerns that some of these occupations have been the last to receive supplies of personal protective equipment. Rates of mortality have also been higher in BME heath care workers. Racial inequalities has been a recurring theme with doctors and nurse surveys experiencing difficulty getting access to personal protection equipment. The long-awaited report from Public Health England on ‘Understanding the impact of COVID-19 on BME groups’ highlighted a pervasive concern among stakeholders: that the experience of racism, discrimination, stigma, fear and trust among black and ethnic minority communities, including key workers within the National Health Service, made BME groups more vulnerable to COVID-19. It is also important to consider the social and economic consequences of COVID-19 on ethnic minority groups. There is considerable evidence that COVID-19 has amplified pre-existing inequalities. Bangladeshi, Pakistani, Black African and Black Caribbean men are all much more likely to have had jobs in shutdown industries, such as the restaurant sector and taxi driving. These communities are already afflicted with high rates of child poverty with nearly half of Black children and well over half of Pakistani and Bangladeshi children living in poverty. The COVID-19 pandemic is not just a health crisis; it is also a social and economic one, which in turn will also have a longer term impact on health. It is already clear that this burden of the pandemic is not equal across all population groups; we may all be weathering the same storm, but we are not in the same boat. In this report, we make a number of recommendations to address the greater risk of adverse health outcomes in BME populations. These include recommendations with immediate impact on the course of the pandemic (to mitigate the differential risk of exposure, infection and transmission, and to inform local outbreak control strategies) and longer-term action to reduce health inequalities.Submitted to The UK Government and the People of Great Britain & Northern Ireland by Sir David King, former Chief Scientific Adviser, UK Government, Chair of Independent SAG