October 22, 2020

expert reaction to report looking at progress to address COVID-19 health inequalities, with a focus on ethnic minorities

A new report has looked at progress to address COVID-19 health inequalities, with a focus on ethnic minorities.

This Roundup accompanied an SMC Briefing.

Dr Hajira Dambha-Miller, GP and NIHR Clinical Lecturer in General Practice, The University of Southampton, said:

“This is a comprehensive and welcome first step with achievable and evidence-based recommendations. Further detail is still needed in explaining why BAME groups are more susceptible to worse outcomes.  I don’t think the report goes far enough in exploring the wider social factors that may contribute to viral transmission and death. Hopefully, studies like the one that we are leading will offer additional insights over the next few months.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“This is useful – this report reminds us that there has been ‘uneven spread’ of the virus dependent on where and in what kind of environments people live and the jobs they have and that these factors explain a substantial part of the ethnic differences in risk of severe COVID, but not all.  Some health factors also appear to be relevant.   More work is needed to better understand these factors but in the meantime, whether better culturally appropriate education on methods to lessen risks have any benefits in subsequent waves will be important to establish.”

Prof Trish Greenhalgh FMedSci, Professor of Primary Health Care Services, University of Oxford, said:

“A key section of this report is paragraph 27:

‘In summary, the evidence shows an increased risk for Black and South Asian ethnic groups. However, the relative risk of COVID-19 mortality is reduced when taking into account socioeconomic and geographical factors associated with different ethnic groups. Where people live, particularly in London and other cities, has had a large effect on the risk of individuals catching COVID-19. The current evidence clearly shows that a range of socioeconomic and geographical factors such as occupational exposure, population density, household composition and pre-existing health conditions may contribute to the higher infection and mortality rates for ethnic minority groups. Deprivation is a good marker of many of these factors.’

“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 (e.g more likely to have comorbidities such as diabetes) but also – and perhaps primarily – for reasons linked to poverty and social injustice.

“There is a large literature on the latter determinants – and indeed some studies have shown that if these structural causes are fully controlled for, ethnic and racial differences in Covid-19 almost disappear. Even in a country such as UK where healthcare is free to everyone at the point of need, there remain important barriers to access to care (for example, availability of GP appointments) for people living in more deprived areas. Policies on quarantining will interfere with people’s ability to work and hence to generate income for themselves and their dependents – and these policies, now that the furlough scheme has ended, will disproportionately affect those in certain types of job. Those in low-paid jobs, for example, also typically have lower job security, less flexibility in their roles, and less entitlement to sick pay and occupational health services. In other words, effectively reducing the inequalities of outcome in Black and South Asian groups will need a cross-government approach (both nationally and locally) to address these upstream structural inequalities.” 

‘Quarterly report on progress to address COVID-19 health inequalities’ produced by the Race Disparity Unit was published at 00:01am UK time on Thursday 22nd October.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Naveed Sattar: “No COI.”

Prof Trish Greenhalgh: “No COI.”

Dr Hajira Dambha-Miller: “No COI.”