disparate impact of Covid-19: death rates

On 2 June 2020 Public Health England released its report COVID-19: review of disparities in risks and outcomes. The report confirmed that BAME people are dying disproportionately (people of Bangladeshi origin who contract the disease being up to twice as likely as, and people from other BAME groups being up to 50% more likely than, white Britons to die), but neglected to suggest the reasons for the disparity or to make any proposals to deal with it. It has been widely criticised for this failure. The Guardian reported in June that the BMA had called two months previously for an inquiry into the high death rate among BAME healthcare workers, but to no avail. BMA Council Chair Dr Chaand Nagpaul complained that the PHE report “fails to mention the staggering higher proportion of BAME healthcare workers who have tragically died from Covid-19 – with more than 90% of doctors being from BAME backgrounds,” and failed properly to consider the “occupations of BAME victims, exposure to the virus and availability of personal protective equipment (PPE) as risk factors”.

According to a report in the Health Service Journal, “[a]n earlier draft of the review which was circulated within government last week contained a section which included responses from the 1,000-plus organisations and individuals who supplied evidence to the review. Many of these suggested that discrimination and poorer life chances were playing a part in the increased risk of covid-19 to those with BAME backgrounds… One source with knowledge of the review said the section ‘did not survive contact with Matt Hancock’s office” over the weekend’”.

The Times reported on 12 June 2020 that the published version of the PHE report had also excluded recommendations on how to protect BAME people from Covid-19. According to The Times “a 69-page document … sent to the government at the end of May” included seven PHE recommendations, “including targeted health advice and risk assessments for Bame staff working in hospitals”. The failure to publish this was, the Times reported “because of ‘current global events’ including the wave of anti-racism protests”.

The disproportionate racial impact of Covid-19 is not restricted to the UK. On 5 June 2020 an article in US Medical News Today (Racial inequalities in COVID-19 — the impact on black communities) reported that the limited available statistics indicated that the death rate for Black Americans was up to three times as high, and that for Latinx people almost twice as high, as that for white Americans. In some states Black and/or Latinx death rates were as much as 5 or 10 times higher than white death rates.

The Medical News Today article links disparate death rates in the US to significant and enduring economic disadvantage, the income of Black and Latinx households in 2015 having been 59% and 79% respectively of that of white households (the first of these figures unchanged from 1978). The figures for household wealth are considerably worse, Black and Latinx households having had 10% and 12% as much wealth as white households in 2016. Black and Latinx Americans disproportionately work in food-related and caring roles regarded as ‘essential’ during the Covid-19 crisis and Black and Latinx Americans suffer from significantly higher rates of hypertension, heart disease, and diabetes, conditions which are themselves linked with stress, including the stress of race discrimination. Black and other minority ethnic Americans also receive significantly worse health care than other Americans.

In the UK, too, poverty, unemployment and inadequate housing are unevenly distributed. In 2018, the EHRC reported that BAME people were twice as likely as white people to be unemployed, that significant race-pay gaps existed between Black and white workers with similar levels of qualifications; that Pakistani or Bangladeshi and Black adults are more likely to live in substandard accommodation than white people with 30.9% of Pakistani or Bangladeshi, 26.8% of Black and 8.3% of white people living in overcrowded accommodation; that 35.7% BAME and 17.2% white people live in poverty and that the mortality rate for Black African women in the UK was four times that for white women. There is also concern that disproportionate BAME death rates among NHS workers may result from race discrimination; ITV News reported in May 2020, at a time when 7 times as many BAME as white NHS staff had died, that 50% of 2000 BAME NHS workers surveyed felt that discriminatory behaviour had contributed to this death toll, with 20% claiming to have been the victims of discrimination.

According to ITCV’s report, one respondent had stated that “All BAME nurses [have been] allocated to red wards and my white colleagues [are] constantly in green wards” and that another said that “Only BAME doctors from the department have been put forward for deployment”. A British consultant cardiologist of Pakistani origin was quoted as saying that “Many of the white doctors are in management positions leaving more BAME on the coal face” while a doctor working in A&E told ITV that “colleagues, ‘particularly’ non-BAME staff, ‘literally avoid going to covid areas pushing me and my junior colleagues there even when we have patients, we [are] already seeing’. Of those surveyed who had been redeployed to meet the needs of the coronavirus outbreak, more than half said they did not feel comfortable raising their concerns about the move”. BMA Council Chair Dr Chaand Nagpaul “told ITV News: ‘Our own BMA surveys of the past have shown bullying and harassment of doctors and ethnic minority doctors to be much greater than white doctors'”.

The PSED requires public authorities, including ministers, to pay due regard to the need to eliminate unlawful discrimination and to promote equality in their decision-making. Whatever the exact causes of the disproportionate racial impact of Covid-19 in the UK, public authorities are required to pay due regard to the fact of it. They may also find themselves being held responsible in due course for substantive breaches of the Equality Act 2010 as well as of Articles 2 and 3 of the European Convention on Human Rights.