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58,000 more people would have died in first wave if white population faced same risk as black communities, paper finds

The sharply higher risk of death from Covid-19 among minority ethnic groups cannot be explained by differences in underlying health conditions and represents one of the starkest health inequalities of recent times, says a joint paper by two leading think tanks published today.

Calling for urgent action to better protect ethnic minority communities from the second wave of the virus, IPPR and the Runnymede Trust say the racial inequalities revealed by the pandemic’s vastly different impact are “a stain on our claim to be a civilised society”.

Among their recommendations is that ethnicity be considered as an independent risk factor, alongside age, gender, occupation and underlying health conditions, when deciding priority for limited Covid testing.

New analysis of health data by the CF healthcare consultancy for IPPR explored possible explanations for the higher risk of death among ethnic minority communities – where death rates are 3.3 times and 2.4 times higher respectively among black men and women than among their white peers. The research found:

After stripping out the effects of age and sex, at least 2,500 black and south Asian deaths could have been avoided during the first wave of the pandemic if those populations did not experience a higher risk of death from Covid-19.
If the white population faced the same risk as the black population, at least 58,000 more people in England and Wales would have died from the virus during the first wave; while 35,000 more would have died if the risk was the same as for the south Asian population.
The difference is not explained by variations in the prevalence of underlying conditions such as lung disease, obesity and diabetes across different ethnic communities. These account for only a very small part of their increased risk of dying from Covid-19 – just five percentage points for the black population.
Likewise higher deprivation, using the most commonly used statistical index of multiple deprivation, means black communities are 14 per cent and South Asian communities 9 per cent more likely to die from Covid-19 than white communities - again, insufficient to explain the far higher risk they face.
Since the wide genetic diversity within ethnic groups means genetics cannot explain why every minority group has a higher risk of death from Covid-19, the main factors are most likely to be unequal social conditions (such as occupation and housing), unequal access to healthcare, and the structural and institutional racism that underpins them.

Support for that stark conclusion comes from further key findings of the joint research paper:

Non-white patients with Covid-19 are more often acutely ill when first seen in accident and emergency departments (A&E), with black patients 55 per cent and south Asian patients 35 per cent more likely to need resuscitation or very urgent care than white patients. Black patients are also more than twice as likely to be admitted directly to a high dependency or intensive care unit directly from A&E.
Minority ethnic communities have suffered disproportionately from public health budget cuts in recent years, with the 10 most ethnically diverse local authorities suffering £15 million more in public health budget cuts compared to the 10 least ethnically diverse local authorities since 2014/15.

In addition, the Runnymede Trust found earlier this year that people from ethnic minority communities were 18 per cent less likely to be aware of the government’s “stay at home” message – suggesting a flaw in public health communications.

Meanwhile many find it harder to isolate because of their living and working conditions; nearly one third of Bangladeshi households and 15 per cent of black African households are classified as overcrowded, compared to only 2 per cent of white households, according to government figures.

IPPR and the Runnymede Trust call for government action to bring down the risk for people from minority ethnic communities – both from higher rates of infection and higher rate of death for those with Covid-19.

Among the urgent steps they ask the government to take are:

Include ethnicity as an independent risk factor alongside occupation and underlying health conditions when deciding priority for limited testing.
Offer temporary accommodation to all people who need to isolate but cannot do so due to their living conditions.
Ensure that isolation pay support, worth £500 to low-paid workers, is available to all, including people without immigration status and the 1.4 million whose visas currently allow them no recourse to public funds.
Stop charging patients to use the NHS during this crisis, under the ‘hostile environment’ aimed at deterring undocumented migrants, as this regime embeds racism and exclusion into public services and discourages a wider range of minority ethnic people from seeking timely medical help.
Send clearer and better targeted messaging to encourage all vulnerable populations to seek healthcare in a timely manner.
Introduce emergency health protection funding for local authorities this winter.

Parth Patel, IPPR Research Fellow and lead author of the report, said:

“We are now experiencing the second wave of this dangerous virus, and once again it is running along racist grooves.

“Our new research puts into context how stark the inequalities are. Addressing them is a matter of racial justice, but also a matter of public health – inequalities fuel pandemics.

“Yet many months after the unequal impacts first began to emerge, little or nothing is being done to address them. We cannot eliminate all the effects of structural and institutional racism overnight. But we can and should take practical steps now to better protect minority ethnic communities, to support people to self-isolate and to ensure healthcare access is less unequal in the dangerous winter months that lie ahead.”

Dr Halima Begum, Director of the Runnymede Trust, said:

“I am repeatedly asked if Covid-19 is a ‘racist disease’. It is not. But it prevails in a society that is riddled with structural inequalities whose roots are firmly entrenched in race and ethnicity.

“This report offers yet more evidence that race acts as a determinant of public health. Our findings illustrate the devastating impact that social deprivation and structural racism continue to have on minority ethnic communities confronted by Covid-19.

“There can be no justification for the finding that 58,000 more people would have died in England and Wales if the white population had faced the same underlying risks as black communities. If that figure does not give the government cause to sit up, listen and take action, I don’t know what will.

“Urgent action must be taken to address these injustices and inequalities. This means including ethnicity as a risk factor in prioritising Covid-19 testing, and providing temporary isolation and pay support so that, on testing positive, people can at a bare minimum self-isolate safely and effectively.

“Covid-19 has amplified and exacerbated pre-existing racial inequalities in our society. As we head into what promises to be a long, challenging winter, we cannot ignore these inequalities any longer. For the government to do so would be to condemn thousands more black and ethnic minority people to a needless death.”

ENDS

Dr Parth Patel, IPPR Research Fellow and lead author of the paper, who is also an A&E doctor, is available for interview

Dr Halima Begum, Runnymede Trust Director, and Alba Kapoor, Policy Officer and a co-author of the paper, are also available for interview

CONTACT FOR ALL INTERVIEW AND OTHER REQUESTS

David Wastell, IPPR Head of News and Communications: 07921 403651 d.wastell@ippr.org
Robin Harvey, Digital and Media Officer: 07779 204798 r.harvey@ippr.org

NOTES TO EDITORS

The joint IPPR and Runnymede Trust paper, Ethnic inequalities in Covid-19 are playing out again – how can we stop them? by Parth Patel, Alba Kapoor and Nick Treloar is available at: https://www.ippr.org/blog/ethnic-inequalities-in-covid-19-are-playing-out-again-how-can-we-stop-them and on the Runnymede Trust website
Advance copies of the paper are available under embargo on request
We defined black ethnicity as Black African, Black Caribbean and Other Black, and south Asian as Indian, Pakistani and Bangladeshi. There are important variations within and between these groups and we disaggregated analyses where data made this possible. We defined deprivation using the index of multiple deprivation, using the Ministry of Housing, Communities and Local Government data on distribution of deprivation by ethnicity. The underlying diseases we looked at were diabetes, obesity, stroke, cancer, dementia, kidney disease, chronic obstructive pulmonary disease and hypertension. Risk of death from Covid-19 associated to deprivation level and underlying disease were harvested from the openSAFELY study published by Williamson et al. in Nature July 2020. We defined death from Covid-19 as death within 28 days of a Covid-19 positive swab test, in line with Public Health England. We analysed data up to 15 May 2020, before when 98 per cent of recorded Covid-19 deaths in the UK (first wave) had occurred. All analyses refer to England and Wales.
Estimates for additional and avoidable deaths to convey risk disparity were derived using indirect standardisation of mortality rates by age and sex, based on ONS data of Covid-19 deaths by ethnicity and the 2011 census. We applied hazard ratios (using multivariate Cox proportional hazard model from openSAFELY) to the prevalence of underlying diseases and deprivation by ethnicity to estimate the role these play in driving inequalities between ethnic groups. Differences on presentation to emergency services were an analysis of the NHS Emergency Care Dataset for records where ethnicity data was available. These analyses were all performed by CF healthcare consultancy. Public health budget cuts were a like-for-like analysis adjusting for inflation of local authority public health budget changes between 2014/15 and 2019/20.
Runnymede Trust is the UK's leading independent race equality think tank www.runnymedetrust.org
IPPR (the Institute for Public Policy Research) is the UK’s pre-eminent progressive think tank. With more than 40 staff in offices in London, Manchester, Newcastle and Edinburgh, IPPR is Britain’s only national think tank with a truly national presence. www.ippr.org