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Ethnic minority deaths and Covid-19: what are we to do?

Desperate times offer opportunities for the light to come streaming in. Currently, we are seeing that light in the outpouring of support and love for health and care staff across the world during this pandemic. In the UK, a large proportion of those staff come from ethnic minorities and some are dying at a much higher rate than white staff. The same is true in the general population.

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.

Of 119 NHS staff known to have died in the pandemic, 64 per cent were from an ethnic minority background.

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 London, 67 per cent of the adult social care workforce are from minority ethnic group backgrounds.

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.

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.

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 suggests how we might start.

Every white member of health and care staff can commit to:

  • treating those from different backgrounds with greater civility, respect, and compassion

  • ensuring co-workers feel the climate for inclusion has markedly improved within six months

  • learning about the research evidence on the impact of racism and discrimination on health, life chances and mortality

  • intervening when they observe discrimination, incivility or racism towards colleagues

  • becoming a champion of equality, positive diversity and inclusion and encouraging others to do the same

  • renewing these objectives every six months.

Every leader in the NHS (and politicians too) can commit to both those objectives and others by:

  • positively and overtly valuing equality, diversity and inclusion both for its own sake and for its impact on care quality and staff wellbeing

  • practising compassionate leadership – attending to those they lead, understanding their challenges, empathising and helping

  • providing stretching project and career opportunities for staff from minority ethnic groups while providing good support

  • learning about the research evidence on how diversity is associated with team and organisational effectiveness and innovation in health care

  • creating fair and just cultures in their teams and organisations

  • mentoring and coaching staff from minority ethnic groups and creating opportunities for reverse mentoring. For example, Sir Simon Stevens, Chief Executive of NHS England, has reverse mentoring from Habib Naqvi, Deputy Director of the WRES (Workforce Race Equality Standard) Programme

  • assessing their performance as inclusive leaders ensuring everyone they lead feels included by their leadership

  • ensuring all team members commit to the objectives above and receive regular supportive feedback.

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.

Leading through Covid-19

An online resource hub of quick-read practical guides and videos to provide support to leaders across health and care.

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