Figures from the Office of National Statistics (ONS) showing that Black people are four times more likely to die than White people are very concerning. There is an urgent need to understand the reasons for this and for action to be taken. There are four questions that any review needs to answer urgently: 1. How has structural discrimination contributed to health inequalities experienced by People of Colour?
During a conversation about the horrific disparities in Covid-19 deaths a friend told me that the reason why Black and Asian people were disproportionately dying was “because of lifestyle choices". I think I did well to restrain my anger. Unfortunately, I see very little debate in the media about how social inequalities and racism have led to poorer health outcomes in our country. “Nobody chooses to have poor health” I said to my friend. I would be interested in what a review would conclude the health impact has been of years of high unemployment, low pay, shift work, poor housing, food insecurity, high stress levels, and discrimination.
2. Are People of Colour disproportionately affected by clinical decisions on how to treat people with underlying health problems in our hospitals?
At the beginning of March, it became clear that the virus was disproportionately affecting Black Americans. At the same time there were concerns that hospitals in the US would be unable to provide care to all critically ill patents and that doctors would have to make difficult decisions about who would receive medical care amid shortages. A debate raged, “What if there were two patients, both in need of a ventilator, but there is only one ventilator available, who gets the ventilator?” an American news reporter asked. “One of the patients is obese, has diabetes, and high blood pressure...in that scenario the clinical decision would almost certainly be to not to give the limited resource to the person with underlying health problems. Many Black activist were rightly pointing out that such clinical decisions would overwhelmingly impact on people of colour. There were calls for a lottery system to be implemented in such a dreadful context. There is already evidence that Black people experience different outcomes from UK hospitals, for example, the fact that Black women have significantly worse health outcomes than White women in childbirth.
3. Has the lack of PPE disproportionately affected frontline workers of colour - bus drivers, agency nursing staff etc?
Four months ago, I could not have told you the difference between an FFP3 mask and a surgical mask. But for the last four months I have been listening to health professionals from the NHS on an almost daily basis sharing their concerns about Personal Protective Equipment (PPE). But what we don't often hear is the army of key workers behind the scenes. Their voices have only come to the fore because of the tragically high numbers of transport workers who have died from the virus and the epidemic that has spiralled out of control in our care homes. Front line, public facing and low paid jobs such as care workers, supermarket and transport workers are exposed to the virus with little protection or support. Further, some types of PPE don’t work properly for people with beards (which will disproportionately affect Muslim and Sikh men), and there is nothing in official guidance about infection control for predominantly Black women hair extensions or weaves. I recently listened to a social media post from a Black agency nurse, who spoke about how he believed that agency staff were not being provided with full PPE when working on Covid-19 wards. He also had concerns that many agency workers were not members of a Union and were not in a position to refuse work. I want to know why agency workers like him are only issued surgical masks and flimsy aprons? I want to know why transport workers and care workers are not issued with PPE?
4. Are people with darker skin tones more at risk due to a lack of vitamin D?
The ONS data shows that once social and economic or factors are considered Black people are still twice as likely to die than White people. There are some voices that suggest that looking at anything other than social reasons would be to underplay the significant role that structural discrimination has played in health inequalities. However, it is vital that we are open to all reasons if we are to save lives. Vitamin D is key to boosting the immune system. Darker skin tones produce vitamin D more slowly and current government advice (although not widely known) is that people of African, Caribbean and Asian heritage should take a supplement all year round – White people are only advised to take a supplement in the winter months. This needs to be looked into urgently, and advice to communities of colour needs to be issued rapidly
Some people are now calling for an independent inquiry – given the scale of the tragedy I would add my voice to such demands. However, we need an interim review that is focused on saving lives now.
