Covid-19 response

Scotland can’t be complacent about Covid’s impact on ethnic minorities

Can the ethnic inequalities in English Covid-19 mortality act as a warning for Scotland?

Doctors wearing scrubs and protective facial masks, looking down at something below them

by Professor Nasar Meer and Dr Kaveri Qureshi

Published 12 June 2020

The UK’s public health response to Covid-19 has varied across its home nations, with the Scottish Government and the Welsh Assembly maintaining the lockdown, pursuing testing and insisting on social distancing in ways that depart from a unified approach.

Given it is more than 20 years since health was entirely devolved to Scotland, some divergence was inevitable (and indeed was already evident).

One question this raises is whether policy difference is also reflected in health outcomes and, in particular, whether Scotland too has seen the big differences in Covid-19 deaths among ethnic minority groups documented in England.

As the First Minister recognised in Parliament on Wednesday, the data is currently very limited but, relying on the National Records of Scotland and partial information from Public Health Scotland, the dramatic ethnic inequalities in English Covid-19 mortality are not presently being seen in Scotland. There are reasons, however, to be extremely worried, and which should guard against any sense of complacency.

Disproportionate chronic illness

One reason is that certain ethnic minority groups in Scotland have disproportionate underlying profiles of chronic ill health. In particular, South Asian groups are especially affected by diabetes and cardio-vascular disease, while heart disease has been one of the most common pre-existing conditions observed in Covid-19 fatalities in Scotland. Equally, the data shows that people in the most deprived areas of Scotland were more than twice as likely to die with Covid-19 than those living in the least deprived areas. This is hugely relevant for Scotland’s ethnic minorities, who remain more likely to be in poverty than the majority white population, and especially those members of ethnic minority groups who are new migrants.

Greater vigilance is also necessary because ethnic minority populations are more susceptible to critical complications if they contract Covid-19, not because ethnic and racial categories are themselves a causal factor, but because they amplify underlying social determinants which generate these pre-existing health conditions.

Poor language provision

Someone holding the paperwork and leaflets that are regarding the Coronavirus pandemic

In spite of these vulnerabilities, Scotland’s public health messages concerning Covid-19 prevention and social distancing have not always been made available for anyone with a minority language as their mother tongue. This is an error because we know that poor language provision in healthcare settings has been identified as a strong barrier to healthcare.

Racial discrimination

Add to this our findings from three surveys of Scottish ethnic minorities which showed that from 2015 to 2019 between 18 and 20 per cent of respondents said they experienced racial discrimination in using health services.

Frontline workers

View of a man through a window driving the bus, the bus is red and you can see a high-visibility vest on his seat

What should really be focusing our minds is that the same factors which make ethnic minorities vulnerable to pre-existing health conditions also make it harder for them to protect themselves from the virus through social distancing. One example is keyworker occupations: in Scotland healthcare and social work make up 28 per cent of working people in the African ethnic group, and 22 per cent of those in the Caribbean or black group. Similarly, 21 per cent of working people in the Asian groups work in retail and the Indian and Pakistani groups are over-represented in transport, where they have been required to work during the lockdown, risking exposure to the virus.

Another example is overcrowded accommodation, which particularly affects Pakistani and Bangladeshi households in Scotland and will also mitigate against effective social distancing.

Living in poverty

A family of a mother and a small boy and girl, hanging out a window and smiling.

All of this is made worse by uneven engagement in paid work that is reflected in 20 per cent of people from ethnic minority groups living in relative poverty compared with 14 per cent of white British people in Scotland.

After taking account of housing costs, the situation is even starker, with 36 per cent of ethnic minority people in poverty compared with 17 per cent of the white British group. Add to this that ethnic minorities in Scotland are concentrated in the lowest-paid occupations and in shutdown industries (for example, 50 per cent of Pakistani and 30 per cent of Indian people in Scotland work in hotels and restaurants).

We fully anticipate disproportionate economic impacts from the lockdown will further amplify socio-economic inequalities between ethnic groups, and give rise to further risks. It is a classic downward spiral where those ethnic inequalities in health that are driven by social and economic disadvantage become even greater.

Tackle these underlying issues alongside healthcare

For these reasons we need to be much more vigilant and proactive in encouraging the Scottish Government to actively seek out community-based organisations from ethnic minority groups, and to develop a fuller and more complete understanding of the dynamics of Covid-19 in the populations they serve.

Public Health England and the UK Government has lacked the courage to acknowledge underlying inequalities, Public Health Scotland and the Scottish Government must be better and certainly not take anything for granted.

This requires policy-makers, public agencies and advocates to maintain a broad focus on the underlying determinants of susceptibility to the virus and not allow the physiological risks to be separated from their social exposures.

Only by doing so will Scotland mitigate the worst of the disproportionalities seen elsewhere.

About the authors

Nasar Meer is Professor of Race, Identity and Citizenship and a commissioner on the Post-Covid-19 Futures Commission convented by the Royal Society of Edinburgh (RSE), and Dr Kaveri Qureshi is a lecturer in Global Heath Equity.

This article was first published in The Scotsman on 4 June 2020: Scotland can’t be complacent about Covid’s impact on ethnic minorities.

All images via Getty Images