Over the past year, the Covid-19 pandemic has posed unprecedented challenges both for people and society. At the same time, it has thrust pre-existing health inequalities into sharp relief.
Research over the past year has consistently shown that minority ethnic communities are disproportionately bearing the brunt of the pandemic. During the first wave of the pandemic, a Public Health England report found that people from black and Asian ethnic groups were twice as likely to die from Covid-19 compared to white people. Led by public health regional director for London, Professor Kevin Fenton, the report noted that “stakeholders pointed to racism and discrimination experienced by communities and more specifically by BAME key workers as a root cause affecting health, exposure risk and disease progression.”
A review by Doreen Lawrence, meanwhile, concluded that structural racism led to the disproportionate impact of the pandemic on Black, Asian and minority ethnic communities. Entitled An Avoidable Crisis, the report notes: “This has been generations in the making. The impact of Covid is not random, but foreseeable and inevitable – the consequence of decades of structural injustice, inequality and discrimination that blights our society. We are in the middle of an avoidable crisis. And this report is a rallying cry to break that clear and tragic pattern.”
More recently, experts from UK and US universities has highlighted how systemic racism is driving health inequalities. Published in the BMJ, the report explores how racism is a significant cause of ill health and increased mortality rates from Covid-19. According to the authors, everyday discrimination, people’s implicit biases, and cultural and structural racism also lead to worse health outcomes.
Taking all the evidence into consideration, there is no denying the reality that inequality is rooted deeply in the UK healthcare system.
Building a fairer future
The theme for this year’s World Health Day is building a fairer, healthier world for everyone. In its campaign message, the World Health Organisation notes how the Covid-19 pandemic has highlighted how some people can have better access to health services and live healthier lives than others – and that this is not only unfair, but entirely preventable.
We agree. That’s why this World Health Day, we believe attention must be drawn to communities who have been adversely affected by the pandemic, and who are less likely to have access to quality health care services. But how do we actually go about improving health equity, especially for the most marginalised among us?
The WHO has proposed several steps towards achieving this goal, which include ensuring that communities are at the forefront in decision-making processes, and that everyone has living and working conditions that are conducive to good health. At the same time, they have called for leaders to monitor health inequities and ensure that all people are able to access quality health services depending on their needs and values within their communities.
Getting to the root cause
But we must go further, and acknowledging the existence of structural racism is paramount to bringing about change. It is a factor that puts ethnic minorities more at risk than their white counterparts. And while social determinants such as poverty, class and employment also play a part in health outcomes for minority ethnic communities, we cannot have conversations about progress without visibility of this issue.
As professor of epidemiology at University College London Michael Marmot notes in an analysis of Covid inequality, “Building a fairer society will entail addressing this fundamental cause of social injustice, in addition to the social and economic inequalities that are so pervasive.”
Moving out of the pandemic, the government must also ensure that healthcare is culturally inclusive to people from all communities. “At the heart of the Maya Centre is a renewed commitment to community development approaches which prioritise women’s holistic health & wellbeing – with a focus on diversity and inclusion of a range of voices,” says Emma Brech, CEO of The Maya Centre. Barriers to accessing health services and information must be also be removed, and data on health outcomes for ethnicity must be carefully recorded.
Some progress is already being made: since 8 March, the government have been recording women’s experiences of the health system as part of a new strategy to address the gender health gap. The call for evidence seeks to provide a comprehensive examination of the whole health and care system, and will take into account experiences of mental health and wellbeing; an issue which underpins our work at the Maya Centre, and that we have found to be intrinsically linked to physical health conditions.
As the World Health Organisation points out, it is not inevitable that some people should suffer unnecessary suffering, avoidable illness, and premature death. Everyone has the right to access services which help them maintain a decent quality of life; and nothing, not least ethnicity, should affect that.