Conversations about the disproportionate impact of COVID-19 felt by racially minoritised communities in the UK have also highlighted the pervasive and longstanding health inequalities they experience. Reports on COVID-19 by Public Health England and Independent SAGE highlight increased risk of exposure and acquisition, worse outcomes due to barriers in accessing timely care and increased co-morbidities associated with deprivation (such as hypertension and diabetes), and the significance of structural racism and discrimination. Despite this, other causes for racialised COVID-19 health inequalities continue to be discussed in political and scientific spheres and the media. The persistence of these views that are not grounded in scientific data, may contribute to immediate and longer-term harms to the very communities most impacted by COVID-19.
One of the first suggested causes was that racially minoritised people had a genetic or biological susceptibility to COVID-19; that there was something innately different about their bodies that made them more likely to suffer poor health outcomes from COVID-19, as well as many other diseases. Knowledge of the historical origins of racism and racialisation helps discredit this theory, although this history has rarely been taught in medical school curricula. During the period of European colonial expansion, people were ascribed different intellectual and behavioural traits and crucially, different value, based on their appearance and skin colour, to justify racist practices including the subjugation, enslavement and genocide of peoples claimed to be of lower human worth than Europeans. However, the Human Genome Project demonstrated no genetic basis to “races”, showing more genetic diversity within them, than between them. “Race” and “ethnicity” are social categories. Attributing racialised health inequalities to genetic or biological differences suggests that these categories are innate, and risks inaction on the social roots of these inequalities, diverting resources to research looking for genetic or biological causes. And yet this theory of innate susceptibility is still in popular use, as referenced recently by Home Secretary Priti Patel.
Other conversations have focused on stereotypes about the culture and behaviour of racially minoritised communities. Last summer, areas in northern and central England with large Asian populations reported a spike in cases. Craig Whittaker, MP for the Calder Valley said on the radio that Muslims and Black and minority ethnic (BME) groups were not “taking COVID seriously enough”, blaming them for increased rates. Discussion also focused on how Asians had a cultural preference for living in multigenerational households, which put them at higher risk of acquisition. However, whilst 24% of Bangladeshi and 18% of Pakistani households experience overcrowding compared to 2% of white British households, they also have the highest rates of child poverty in England, suggesting that living in crowded multigenerational households may not be explained by just a cultural preference, but enforced by poverty. Reports also emerged that (mainly Asian) workers at clothes-making factories in Leicester were forced to work by employers in unsafe environments during lockdown, contributing to transmission. Stereotypes and assumptions of behaviour can also lead to over-policing. The National Police Chiefs’ Council analysed data on fixed-penalty notices issued under coronavirus regulations and found that people from racially minoritised communities were 1.6 times more likely to be fined than white people, with young men from these communities being 2 times more likely than their white counterparts. Attributing racialised health inequalities to cultural stereotypes and assumed behaviour makes racially minoritised communities culpable for circumstances that are not of their making. This shares some of the characteristics of victim blaming.
Genetic explanations of racialised health inequalities suggest that racially minoritised people’s bodies are innately weaker. Explanations that attempt to ascribe behaviour to culture, suggest that it is the cultures of racially minoritised people that are deficient. There is nothing new about this; the earliest racial taxonomies offered by European scientists such as Carl Linnaeus posited that non-European people’s bodies, cultures and brains were inferior. Current genetic and cultural explanations suggest that racially minoritised communities are responsible for their excess morbidity and mortality. In so doing, they draw attention away from the urgent need to make structural changes to support them, such as offering financial support to self-isolate if symptoms of COVID-19, or addressing policies that may act as barriers to accessing health services, such as migrant charging.
Of course many healthcare professionals will reject un-evidenced explanations however popular they are in the public discourse, but nevertheless we need to recognise that people from racially minoritised communities may reasonably conclude that healthcare professionals may share these views. This may deter them from accessing and engaging in healthcare. How we choose to frame conversations about racialised health inequalities is crucial to ensure that historically underserved communities are not further disadvantaged. This is of particular importance with regards to COVID-19 vaccination. Whilst data on vaccine uptake by ethnicity is vital to address emerging inequalities quickly, we must be alert for how it may be used to blame and shame communities who have low uptake rates, risking discouraging them further. To improve uptake, it is vital that we build trust; trust that has been damaged by blaming communities and viewing them as deficient. Recognising that some reasons for mistrust are well-founded can help healthcare professionals productively engage with these communities’ concerns, so that they can provide reassurance and accessible, transparent information about the vaccine.
About the authors: Dr Rageshri Dhairyawan is a Consultant in Sexual Health and HIV Medicine at Barts Health NHS Trust and an Honorary Senior Lecturer at Queen Mary University London. Her research and advocacy focus on reducing health inequalities (@crageshri)
Darren Chetty is a lecturer and doctoral candidate at University College London and co-author (with Dr Adam Ferner) of How to Disagree: Negotiate Difference in a Divided World (Quarto). His research examines racism and education (@rapclassroom)