People from ethnic minority backgrounds constitute 14 per cent of the population but, according to a recent study, account for 34 per cent of critically ill Covid-19 patients and a similar percentage of all Covid-19 cases. These patterns are not unique to the UK – in Chicago, black people constitute 30 per cent of the population but account for 72 per cent of deaths from the virus.
Another analysis found that, of 119 NHS staff known to have died in the pandemic, 64 per cent were from an ethnic minority background (only 20 per cent of NHS staff are from an ethnic minority background). This disproportionate toll is shocking.
On 16 April the UK government announced a formal review, by Public Health England, into these higher death rates. We suggest that the review faces two key questions: why are people from ethnic minorities disproportionately affected by Covid-19 and what will we do about it? Our focus here will be on what must change in the cultures of NHS organisations. First, we consider why so many more staff from NHS minority groups are dying during this crisis.
We need to be careful about rushing to judgement before we have all the facts. We know that people from ethnic minority backgrounds tend to have higher co-morbidities. For example, those from BAME (black, Asian and minority ethnic) backgrounds have higher incidences of cardiovascular disorders and diabetes which can reduce people’s ability to recover from Covid-19. We also know that people from ethnic minority backgrounds constitute a disproportionately high number of key frontline workers – public transport drivers, cleaners, carers, Band 5 nurses, etc. In London, 67 per cent of the adult social care workforce are from minority ethnic group backgrounds. And those from ethnic minority groups are more likely to be concentrated in poorer areas, live in overcrowded housing and in inter-generational households.
In short, people from ethnic minorities are more likely to have underlying health conditions that make them more vulnerable to the virus, work in roles where they are exposed to it and live in conditions in which it is more likely to spread. As the Mayor of London, Sadiq Khan commented: ‘…the depth of inequalities is being laid bare in stark fashion’.
These inequalities are manifestations of the structural barriers and systemic discrimination faced by people from ethnic minority backgrounds. For health and care staff from minority ethnic groups, these barriers are also a daily work hazard. NHS staff from minority ethnic groups suffer discrimination and racism throughout their careers. For example, a survey of 487 doctors who became NHS consultants in 2017, showed that white doctors applied for fewer posts; were more likely to be shortlisted; and were more likely to be offered a job. On average, black doctors in the NHS earn £10,000 less and black nurses earn £2,700 less annually than white colleagues. Minority ethnic group staff are systematically over-represented at lower levels of the NHS grade hierarchy and under-represented in senior pay bands.
NHS staff are also subjected to racism by patients and other members of the public during their work with predictable consequences for their health and wellbeing. Staff survey data from the NHS shows that 29 per cent of ethnic minority staff have experienced bullying, harassment or abuse from other staff in the past 12 months, while the proportion experiencing discrimination at work from a manager, team leader or other colleague is more than twice as high as white staff. These trends are not diminishing.
Now, more than ever, it is essential to focus on addressing these inequalities and to value the diverse staff who make up the health and care workforce by developing and sustaining inclusive and compassionate workplaces.
What are we to do?
There is already good work under way focused on changing NHS structures and processes such as appointment and promotion processes, disciplinary procedures, and complaints handling (notably by the Workforce Race Equality team of NHS England and NHS Improvement). The greater challenge is to change cultures in which everyday discrimination goes unchallenged – for example, the leader who fails to see how their behaviour constitutes what Professor Alvin Alvarez of San Francisco State University has identified as everyday racism: ‘subtle, commonplace forms of discrimination, such as being ignored, ridiculed or treated differently’.
For those who think this couldn’t possibly be them or say this problem is too big to transform – yes, we can change. Look what we have accomplished nationally and as a health care system in the past eight weeks.
We don’t have all the answers (please share yours in the comments section below) but we have some suggestions.
First, we must recognise the role that white staff can and should play. It may be hard for white people to accept that we are all part of the problem. Almost all of us as individuals will say we are not – ‘it’s other white people’, but, in reality, we are all part of the problem and we should all be part of the solution. Research (yes, guided by the science www.workplaceedi.com) suggests how we might start.
We have focused here on what all of us working in health and social care can do, whatever the setting. Why? Because it’s right and because each one of us can take action to change, regardless of where we are in the hierarchy, whatever our role. If not now in this crisis, when? If not you, then who?
Honouring the contributions of ethnic minority staff and the sacrifices they have made demands that we each commit to this. This is how the light gets in.
Its time to move from 'Everyday Racism' to 'Everyday Activism'
All support from our Allys is greatly valued, & very much needed. We are definitely in this together.
This is a very good piece of work thank you. I appreciate the fact that individuals have to make positive changes in addition to system changes in the NHS. Disciplinary policies and capability policies should not only be strictly adhered to for junior staff but also for senior staff.
Thank you Suzie and Michael - I type with tears in my eyes
I remain hopeful of an NHS that stands out globally for Inclusive Practice
Thank you Suzie & Michael. I read this article with hope and anticipation for a better future for BAME staff in the NHS. Its the first time I have seen real practical suggestions that our white colleagues can implement as individuals to improve the health & wellbeing of BAME staff in the workplace. These should be written in the senior leaders competency based job description and form part of their work plan as accountability is the key. Where there is no accountability and demonstrable evidence of implementation demonstrated then no change will be manifested. I hope what is written here will be read by all who will make it their responsibility to share empathy, compassion and real care for what BAME staff go through on a daily basis.
One of the big challenges is reaching those who do not believe they are rascist because of the preconceived beliefs they hold about 'others' (that's every single one of us!). Trusts are starting to deal with unconscious bias, but there is a lot of work needed to convince people that there is a problem to overcome and to ensure that the training / awareness solutions are robust enough to be successful.
A very enlightened blog on a hugely important issue. But on the other side of the "what are we to do?" coin, we need to deploy the best epidemiology/big data and clinical science to understand the underlying pathobiology of the problem. Clearly aspects of deprivation are a major factor, but we still do not know why some populations are more predisposed to the infection, or do worse when infected. Until we have better mechanistic insights, some ethnic minority groups will continue to have an added disadvantage.
Worrying figures, disturbing facts. But it is hard to see that workers in health care can achieve much while racism is deeply rooted in the country's governing political party.
I agree with all that has been said - we need the public inquiry to inform us and equally need to act on the data that we do have and take steps now to protect BME staff. But whatever steps are taken, however well intentioned, we must take heed of the underlying causes of structural racism and inequalities. I am still astonished that the images from the outset of this crisis didn't include BME staff in senior leadership roles- it seems a very basic thing to get right -and the importance of valuing and including all staff in such comms cannot be underestimated if we are to have inclusive leadership and equality.
"And those from ethnic minority groups are more likely to be concentrated in poorer areas, live in overcrowded housing and in inter-generational households."
A missing factor is the phenomenon of 'chain migration' and the social clustering in communal organisations, restaurants etc, whether linguistic, ethnic or religious. The Covid-19 disparity is also seen in Britain's Jewish community, especially amongst the ultra-orthodox, as seen in New York and in Israel. The degree to which these minorities are closely knit socially facilitates the spread of any virus.
I am pleased with the research outcome, Iam typing with tears, I am going to Jamaica aftet Covid19 and I will read this findings sitting on my grandmother's grave. She worked in the NHS for over 35 years she was a windrush girl. She begged me not to peruse a career in the field of nursing I did not take her advice, the way am feeling now I wish I had listened. There seem to be light close to the end of the tunnel.