By Pranathi Yannamani
Unless you have been in hibernation for the past 3 months, you are probably aware of the global Coronavirus pandemic we are in the midst of, and its high death rate, which has surpassed 28,000 in the UK[1]. What you might not know is that black, Asian and minority ethnic groups (BAME) are greatly over-represented in the death tolls, compared with the proportion they make up of the general population. While in the UK, 87% of people are white, and 13% are BAME[2], they make up 18% of coronavirus deaths[3].
This is worrying, because although most COVID-related deaths are in older people, the BAME population in the UK tends to be younger than the white population. We would therefore expect the death rate to be lower in the BAME community.
It is not currently known why this imbalance exists, but it has been suggested that it is because there are higher rates of underlying health conditions such as diabetes, high blood pressure, and cardiovascular disease in BAME individuals. It has also been mentioned that BAME communities live in large families with ‘grandchildren, parents and children – all living the one household’. I find this broad generalisation to be deeply concerning; there is an implication of culpability in sentiments such as these, and this echoes age-old attitudes propounding the inferiority of non-Caucasian individuals. While deprivation is an acknowledged indicator for mortality, not all BAME communities have high levels of deprivation. For example, while 8.3% of people living in the most deprived areas are Indian, 8.6% are white British: there is a higher proportion of white British people living in deprived areas that Indian people. Additionally, 30.9% of those living in the most deprived neighbourhoods of the UK are Pakistani[4], which is almost four times as many as the proportion of Indian people, so how can we treat them as one group? Do the umbrella terms ‘South Asian’ or ‘BAME’ really do this diversity justice?
I take issue with the fundamental homogenisation of the BAME group. Why is it that in this country, you are either white, or other? The BAME population is formed of many individuals from tens of countries, so to treat them as one group feels dismissive, as though we should be grateful to be acknowledged at all.
Furthermore, if the high death rates seen in BAME individuals are related to deprivation, then how can the disproportionately high death tolls in BAME healthcare workers be explained? BAME individuals make up 44% of UK doctors, but 91% of doctors who have died due to coronavirus were BAME. In the nurse and midwife workforce, 20% of the workforce are BAME, but 72% of those who died were BAME workers[5]. This is a hugely significant inequality and cannot be ignored. Due to the patient-facing nature of the work these deceased individuals undertook, and the fact that most of them were working over the pandemic period, it is likely that they contracted COVID while they were working. Not whilst living in their supposedly overcrowded houses in deprived neighbourhoods as some ‘experts’ would suggest.
Some argue that genetic differences are the cause of the increased death rate in BAME individuals, but this argument simply does not stand because the BAME community is made up of individuals of different races. It simply does not make sense that all non-Caucasian races have a mysterious genetic predisposition that makes them more susceptible to death by coronavirus.
We need to accept that there might be flaws in the system. There are health inequalities in the NHS that present barriers to people of colour accessing services.
The Chair of the BMA, Dr Chaand Nagpaul, remarked that these inequalities have always been in existence – it is the severity of the pandemic that has brought them to light in such a shocking way.
What can we do to help bridge this gap? The government has made a start by proposing to launch an investigation into how the inequalities came about, but the head of the enquiry is Trevor Philips, a former Labour politician who was suspended from the party following accusations of Islamophobia. This is hardly reassuring. Public Health England has defended his appointment despite calls from a number of medical associations for him to be removed from the enquiry. This enquiry seems to be less an interrogation into discrimination in the NHS than a political move to appease.
As a medical student volunteering to work in a hospital, whose ward has been scarred first-hand by the death of a BAME team-member, I am worried. Superimposed upon my concern about the lack of adequate PPE for NHS workers (our eye protection was made for us and donated by a DT class in a local secondary school), is a genuine fear for the welfare of my BAME colleagues and family who work in health and social care settings- who will be there to pick up the pieces when all this is over?
[1] https://www.google.com/search?q=covid+death+rate+uk&oq=covid+death+rate+uk&aqs=chrome..69i57j0l4.4394j0j1&sourceid=chrome&ie=UTF-8
[3] https://www.nuffieldtrust.org.uk/news-item/are-more-black-asian-and-minority-ethnic-people-dying-with-covid-19-than-might-be-expected