'Structural racism' explanation masks risk factors responsible for Covid disparity in ethnic minorities, expert warns

  • ITV News speaks to Dr Raghib Ali

Structural racism is being too heavily relied upon as an explanation for the disparity in the impact of Covid on different ethnic minorities, a health expert has warned.

Dr Raghib Ali says ethnicity has become a proxy for other more significant risk factors that impact health outcomes among coronavirus patients - including underlying health conditions, occupational exposure and deprivation.

A senior clinical research associate at the University of Cambridge’s MRC epidemiology unit, Dr Ali has said he is not convinced structural racism played a role in the healthcare outcomes of different ethnic groups during the first wave of the Covid pandemic.

"If structural racism was an important problem, not saying it doesn’t exist, but if it was an important problem in healthcare outcomes, you’d expect it to be reflected not just in Covid but with other outcomes as well," he said.

A Covid alert level sign in Liverpool. Credit: PA

"But the truth, as we know from data, particularly from Scotland but also from England, is that most of ethnic minority groups actually have better overall health and lower rates of all-cause mortality than white groups."

The expert has called for "personalised risk assessment" to determine how critically ill an individual could become if they contracted Covid - rather than focusing too heavily on ethnicity as a potential risk factor.

Dr Ali - who was involved in the government’s first quarterly report on progress to address Covid-19 health inequalities - said the spotlight should refocus on risk factors such as obesity, age, population density, occupational exposure and overcrowded housing.

A Covid-19 sign in Manchester. Credit: PA

He said these factors should be assessed looking at the population as a whole rather than solely ethnic minority groups.

The most recent Office for National Statistics (ONS) data shows all ethnic minority groups other than Chinese had a higher Covid death rate than the white population across both genders, according to the latest data release.

It showed males of black African, black Caribbean and Bangladeshi ethnic backgrounds are dying at a "higher rate" of Covid than any other group.

There are concerns that as Covid cases rise again, the number of patients on waiting lists will go up too as operations are cancelled again. Credit: PA

Dr Ali said: "We have to adjust the risk factors rather than just saying it’s ethnicity, so the purpose of adjusting is to try to understand what’s causing that increased risk in blacks and south Asians.

"Of course, they still have an increased risk (that is) maybe two, three times (that of white people), depending on which papers you look at."

He added: "You have to target the risk factors because ethnicity is basically a proxy for those risk factors."

People wearing a face mask walk near a mural of a nurse in the Northern Quarter of Manchester Credit: Martin Rickett/PA

Dr Ali, who is set to become one of the the Government’s new expert advisers on Covid-19 and ethnicity, said that in the early stages of the pandemic, it was reasonable to use ethnicity as a proxy because there was not enough information about the disease.

But as new evidence comes to light, he said “it doesn’t make sense to put all minorities into the same basket".

He stressed not everyone from those communities is at higher risk of becoming critically ill or dying.

Dr Ali said that the problem with focusing on ethnicity means it "misses the very large number of non-ethnic minority groups and whites who also lived in deprived areas, who also live in overcrowded housing".

A stretcher which had been used recently to transport a body into a temporary morgue at a mosque in Birmingham. Credit: PA

Following Dr Ali's suggestions, Women and Equalities Minister Kemi Badenoch outlined plans and recommendations to tackle the health disparity. 

In a statement to the House of Commons on Thursday, she said the government should appoint two new Covid-19 and ethnicity experts and that ethnicity should be recorded on death certificates.

  • Women and Equalities Minister Kemi Badenoch gives a statement in the House of Commons

"This is the only way we will be able to establish a complete picture of the impact of the virus on ethnic minority groups,” she said.

She also announced a £25 million fund for “community champions” to help drive public health messages to groups hardest hit by Covid-19 and a “rapid light-touch review” of the approach taken by councils.

“I want us to capture the good work being done by local authorities and directors of public health so we can learn the lessons of what works at the local level,” Ms Badenoch said.

The government’s Covid-19 health inequalities report looks at the effectiveness and impact of the current actions being undertaken to lessen disparities in infection and death rates of Covid-19.

It found evidence shows an increased risk for black and south Asian ethnic groups but the relative risk of Covid-19 mortality is reduced when taking into account socioeconomic and geographical factors associated with different ethnic groups.

The report comes after the IPPR and the Runnymede Trust recently estimated almost 60,000 more deaths involving coronavirus could have occurred in England and Wales if white people faced the same risk as black communities.

It found 35,000 more white people could have died if the risk was the same as for the south Asian population.