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.
I really enjoyed reading this article, especially getting clarity about ways to commitment to anti-racism as a lead.
Such an eye opener!
I’ve been a band 2 for 6 years with no hope of progressing I’m working directly with patients whilst heavily Pregnant and asthmatic There’s been no protection or shielding offered to me now as I approach 28 weeks gestation Yet my colleagues who fall into other high risk sectors have been working from home or shielding One if which was pregnant and white Yet when I asked about shielding at 28 weeks conveniently I was told the guidelines have Changed
The NHS does not care to include BAME staff in its protection plans I do not feel my life holds the same value as other colleagues even though it’s clear people of ethnic minority are more likely to die
I’m scared for my unborn child
I have antibodies but do not want to contract it again whilst in my last trimester The after effects have made me breathless
Why was no widespread protection given to BAME staff after evidence showed that 75% of front line deaths are BAME Institutional racism that’s why
May I, gently, ask about two things:
1. The validity of the "population" comparison. If looking at "black" NHS staff deaths as proportion of a population, is it reasonable to use the population of employees at the individual hospital (including linked workers like ambulance staff), the population of the local community in which the hospital is placed (e.g. the part of London; or London as a whole), the region (e.g. London as a whole, or "the North West") or the country as a whole (e.g. England). As will be recognised, the proportion of visibly "black" people in the UK is far far smaller than in London; smaller in London than in Haringey. Not all areas of the UK have been affected by Covid-19 in the same way.
2. Since pay-discrimination and difficult living conditions are not a uniquely black experience, and immigration from Eastern Europe since 2003 has been significant, would you agree it worthwhile to seek data for Slavs?
Despite a converted effort and the social movement around Race Equality, there are still structural barriers and institutional/organisational culture issues holding back the progress around the Race Equality agenda. This is a great publication to call for action and call out institutes and organisations that merely play lip service to such fundamental movements. We are the change that we seek.... Keep driving that change.
I understand what you are trying to convey. However please don't confuse ethnicity with religion.
As the research indicates that in London, 67% of social care workers are BAME, (and I dare to add, almost all of them in front line roles).
It would really help, if some research would further look at the reasons behind that staggering number and the possible remedies!!
I am following this subject very seriously, and am pleased to have found this site. I am white British and a fierce opponent of discrimination of all kinds. Many years of working in a Government department brought to my attention that discrimination is commonplace, and usually perpetrated in “grade order” on a downward trajectory. People who acquire positions of authority are often not qualified on a job-knowledge basis, nor a people oriented attitude. This, plus a virtually non-existent system of accountability, (which no doubt departments would deny) provides a continual enablement of the practice of discrimination in job acquisition, promotion within the structure, and career progress, as well as too often a safe environment for bullying by those with under-developed personalities so inclined towards its usage. I am obviously not saying that all, or even the majority of people in positions of authority fall into the category that I have described, but the structural failure provides situations that are more rife than is acceptable, particularly for unfortunate individuals on the end of it.
It is not remotely difficult for me to imagine that BAME employees at all levels of the NHS face the distinct possibility of running into this iniquitous phenomenon, and my heart bleeds for any, possibly even the many, who have done so. The number of deaths for BAME people in the NHS is appalling. I am also wary of what seems to me to be something of a watering-down by the media by spreading their concern about BAME deaths in the community, even though I find that question just as devastating, of course, but my current and immediate attention Is drawn to the situation of BAME people in the NHS, and possibly their supporters from any racial group who must feel just as helpless.
Finally, for the time being, (!) I watched the Bishop of Dover on the Sophie Ridge programme this morning, and her insight, perception, humanity, and indeed Christianity moved me to tears. She should surely be in a leading position amongst whatever group of people are formed to investigate the racial discrimination that unfortunately shames our nation in this era, but, again, I do believe that we need a thorough enquiry into overall workplace structure and culture, with particular attention to the qualities required for the selection of people into positions of authority, and proper systems of accountability for actions and decisions made within those positions.
It is important to understand this problem correctly. The piece correctly identifies a number of factors - type of job- housing- co morbidities . etc. Until the real reasons for disproportionate deaths is known it would be dangerous to leap to the wrong conclusion.
If you take two people who work in the same job , live in similar housing, share the same co moralities- one Black one White -does the incidence of death actually differ ? And it is hard to get that level of comparable exactitude. But seize on race alone in the absence of hard fact and we could be inadvertently causing death by being unscientific.
The Vit D deficiencies are an interesting fact. My research interests are in the haemoglobin disorders like sickle cell disease and thalassemia. I am interested in these disorders contributing to the co-morbidities these patients and the link with the increase in death rates from Covid-19. This is an area for statistical research too. Another vulnerable group that needs recognition.
I'm not a clinician, just a simple man. It appears that men of all ethnicity are twice as likely to die from Covid 19 than women. Is this not worthy or investigation? Have 70 so called celebrities demanded an independent investigation into this factor? I think ALL lives matter.