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I'm a public health expert. I know the hostile environment is making the coronavirus outbreak far worse

Like many unthinkable fiscal strategies brought forward by the chancellor in the past month, addressing structural inequities is now essential to fight this pandemic

Guppi Bola
Monday 13 April 2020 10:37 BST
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Chief nursing officer refuses to say how many NHS workers have died of coronavirus

The past week’s frightening number of black and ethnic minority (BAME) deaths from Covid-19 quickly disproved claims that the pandemic was a “great equaliser”.

Senior health figures and many of Labour’s new shadow cabinet have called for the UK government to investigate why more than one third of patients dying in ICU wards were from BAME communities. Any investigation relating to the disproportionate death rates will undoubtedly uncover more evidence on the complex yet striking relationship between health and inequality in Britain. UK BAME communities rank poorly in socio-economic indicators of poverty and deprivation; an outcome of long-standing institutional racism in government policies relating to immigration, housing, criminal justice and social welfare support.

A myth that many armchair pundits promote – and which needs debunking – is a naive explanation based on genetic differences between BAME and white people. While there may indeed be some factor of genetic vulnerability, the overwhelming determinants of health are socially created. Genetic risk factor debates have a long and notorious history; they are rooted in eugenics. Given the life or death implications of effective social distancing, examining the conditions in which people work and live is far more likely to help us determine who is most at risk of contracting and becoming severely unwell from Covid-19.

Take for example the fact that BAME families are more likely to live in low-income households and in overcrowded conditions. The IFS has already highlighted that lower-income families are more likely to be impacted in the medium and long term. Recent figures also reveal an overrepresentation of BAME communities in homelessness and those imprisoned – two groups that are significantly under-protected from the spread of the virus.

BAME workers too are already more reliant than white people on the gig-economy or zero hours contracts, often in high-exposure roles that lack social and economic safety nets. Ironically, much of the UK is currently relying on these very roles to make self-isolating more manageable, meaning that the racialised aspect of the crisis is further compounded. Government should ensure that private companies provide high exposure workers with Personal Protective Equipment (PPE) in just the same way that we prioritise healthcare professionals.

Policies designed to protect the most vulnerable and keep our communities safe are additionally layered with inequalities. The recent domestic violence bill, for example, ignores the reality of those BAME survivors who may be migrants and who are denied recourse to public funds, therefore leaving them unable to access safe refuge. BAME communities are also less able to access the appropriate information needed to stay safe, a vulnerability that has been exacerbated by cuts over the past decade for English language classes. Park closures during lockdown also disproportionately affect BAME citizens, who often lack adequate living space to exercise and attend to mental wellbeing.

Putting aside higher vulnerability, there are significant barriers to BAME communities accessing quality care in the NHS. This begins with experiences of discrimination within the healthcare system across all areas of expertise, and most notably in maternity, mental health and cancer care. Charging for overseas visitors to the NHS also plays a significant role in creating a hostile environment for BAME people trying to access care. Demanding a “proof of entitlement” for public service from the very communities that are already experiencing discrimination has eroded trust in the healthcare system.

During a public health crisis like the coronavirus outbreak, this is likely to have grave impacts on those already at risk. It is a drag on the urgent need to reduce infections.

Suspending NHS charges and associated data sharing with the Home Office ensures that right now, when people need to access healthcare, they know that they are welcome. Similarly, releasing those detained under immigration powers, supporting people housed in shared asylum accommodation and confirming no one will be made an “overstayer” because they have been self-isolating, are all strategies that will enable us to tackle the pandemic faster and safer.

Like many unthinkable fiscal strategies brought forward by the chancellor in the past month, addressing structural inequities now feel essential in order to address this pandemic. The government will need to adequately scrutinise their lockdown strategies and financial bail-outs, beginning with understanding racial disparities.

A starting point for this would be mandating Public Health England to monitor and release data based on ethnicity, BAME population density and associated risk factors of patients. Once this crisis passes, our focus should be on mitigating the worst effects of any future recession on existing racial inequalities. Calls for a minimum income are growing, but such ideas will only work if they embed an intersectional analysis. If we do this properly, we could finally begin to take seriously those long standing policies that drive racialised health inequalities in the UK.

Guppi Bola is a public health expert and the former interim director of Medact, the UK charity for global health

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