What Public Health England’s report on BAME deaths says – and what it doesn’t

Disproportionate death rates among people from ethnic minority backgrounds were confirmed, but the reasons have been left unexplored.

By Samir Jeraj

A woman in Muslim dress waits for a bus in London (Photo By Getty Images)

Public Health England has published its report on Covid-19 infections and deaths among people from Black, Asian and Minority Ethnic (BAME) groups.

Here are its main findings, and the questions left unanswered:

BAME people are more likely to contract Covid-19

The report lists a number of factors that make it more likely that BAME people contract coronavirus, including living in urban areas, deprived areas, and overcrowded housing, as well as working in high-risk jobs such as healthcare and transport.

These were all issues that race equality organisations were raising as concerns to the NHS before the disparities in deaths became apparent.

People born outside of the UK and Ireland also had greater risk, particularly people born in Central and West Africa. The report attributes this to problems accessing healthcare like language needs and “cultural” differences, but there is no explicit mention of the coalition’s hostile environment immigration policy and its legacy.

Black and Asian people are more likely to die from Covid-19

The pattern of “all cause” mortality (deaths by any cause) has reversed the pre-pandemic pattern, with a four times higher-than-expected death rate among black men, three times for Asian men, and twice as high for white men.

Bangladeshi people are twice as likely to die compared to white British people, when factors like age, sex, deprivation and geography are taken into account. Chinese, Indian, Pakistani, other Asian, Caribbean and other black groups had between 10 per cent and 50 per cent greater risk of death compared with white British groups.

For some communities, however, the data will not explain anything. The 16 ethnic groups covered in the analysis do not include communities such as Cypriots or Somalis.

Part of the disparity will be down to a higher level of pre-existing health conditions in BAME communities

The researchers were not able to control for pre-existing conditions, such as diabetes and blood pressure, but it is clear they had a big impact. While diabetes is mentioned on 21 per cent of death certificates for Covid-19, that figure goes up to 43 per cent for Asian people and 45 per cent for black people. The proportions are similar for hypertension, according the report.

People from BAME groups in general are at greater risk of developing diabetes and hypertension, with black men being most at risk of the latter and Asians of the former. The extent to which these differences themselves are due to broader inequality and social causes is a whole other issue that is not addressed by the report, just as the reasons why BAME people are more likely to live in overcrowded homes or deprived areas go unexplored.

Nurses from Asian and “other ethnic” backgrounds are nearly twice as likely to die as their white colleagues

Occupation is another factor that the researchers were not able to control for when looking at deaths overall. They used all-cause deaths to look at the differences in deaths by job compared to last year and found a significant rise for people working in caring personal services (including nursing), elementary security occupations, and road transport drivers. For example, people working as security guards were dying 2.3 times more than a year ago.

The section on nurses shed light on some of the tragic and disturbing stories coming out of the NHS. The data shows 3.9 per cent of Asian nurses and 3.1 per cent from “other ethnic” groups have died from Covid-19, compared with 1.7 per cent of white nurses and 1.5 per cent of black nurses.

This could be the result of other factors, as these statistics are not controlled for age, location, and the type of role they had as a nurse.

There are undoubtedly further questions to answer from employers and government. Academic Roger Kline has written extensively about how workplaces should have carried out better risk assessments and equality impact assessments for key workers.

Fringe theories, such as genetics or vitamin D prevalence, remain just that

As the rising number of deaths among BAME people started to be noticed, various fringe explanations were touted as being the cause, ranging from vitamin D deficiency to some mysterious genetic factor. A common theme among these theories was a diminishment of structural inequality and discrimination as factors. The report quickly brackets off genetics along with household composition as possibly explaining “some of the findings”. Vitamin D does not receive a single mention.

A public inquiry is still required

Calls for a public inquiry from the race equality sector, Labour and others, are still valid. The report does not look at why BAME communities were in a more vulnerable position, nor the impact of decisions made by government and its agencies. The risk factors, both medical (higher rates of diabetes and hypertension) and socio-economic were well-known even before the Cabinet Office’s Race Disparity Audit was published in 2017. The question now, as then, is whether government is committed to race equality or merely quantifying racial inequality.