The impact of Covid-19 on black and ethnic minority groups across the UK

In Episode 5 of the Tea and Talk Podcast, meet Nasar Meer, Professor of Race, Identity and Citizenship in the School of Social and Political Sciences at the University of Edinburgh.

Nasar discusses the impact of COVID-19 on black and ethnic minority groups across Scotland and the UK.

Please note transcriptions are automatically generated so may feature errors.

Rebekah: [00:00:00] Hello, and welcome to the RSEs Tea & Talk podcast series. A programme inspired by the coffee houses of the 18th century, where great thinkers would come together to discuss ideas and matters of the day. I’m Rebekah Widdowfield and I’m Chief Executive of the RSE, which is the Royal Society of Edinburgh, and is Scotland’s National Academy.

Our mission is to advance learning and make knowledge useful. And as part of that, I’m having a series of conversations with some of Scotland’s leading authorities on a whole range of topics, starting with exploring different perspectives on the coronavirus pandemic. The conversations are all with fellows of the RSE who are keen to share their expertise and experience.

This week, I’m speaking about the impact of Covid-19 on ethnic minorities with professor Nasar Meer, professor of race, identity, and citizenship at the University of Edinburgh and a member of the RSEs Post-Covid Futures Commission. Nasar also sits on the Scottish government’s expert reference group on Covid-19 and ethnicity.

So we’re not in a coffee house. We both in our own homes, which explains the occasional dip in sound quality, but I’d encourage you to grab yourself a drink of something. Sit back and listen to one of Scotland’s leading experts talk about things that matter.

So Nasar, the COVID pandemic has affected everyone in some way, but I think there’s been increasing recognition recently that those impacts fall on equally across society and as reflected in different levels of vulnerability to the disease and indeed mortality rates. And I wonder if you can tell us about how COVID-19 has impacted on ethnic minorities across the UK.

Nasar: [00:01:37] Yeah. So we now have a pretty good evidence base to say the individuals in black, Asian, and minority ethnic groups are increased risk of mortality due to COVID-19. So they’re more likely to die. And those of black, African and black Caribbean descent appear to be of the greatest risk. Now, this has been confirmed in a number of different studies and sources, and most recently in a public health England inquiry, which to some extent, had to be cajoled from the health secretary to be released into the public domain.

What that showed and what it confirmed was that people of Chinese, Indian, Pakistani, Asian, other Caribbean, and other black ethnicities, which are the categories we use in the census had between 10 and 50% higher risk of death when compared to white bread. Now, this is a reversal of what was seen in previous years.

And level of mortality have actually been lower amongst these groups. And the disproportionate outcomes in terms of mortality and deaths, but also in terms of hospitalization and so on, it’s pretty consistent with what we’re seeing elsewhere in the world, in Sweden, in data coming from the U S and in Sweden as well.

Sorry, in Spain as well, to some extent it’s a reflection of geographic concentration in particular areas, you know? So in the UK, It’s especially been pronounced in places like London in the Midlands and Northwest as the concentration, black and ethnic minorities, but these risks over and beyond that as well, it’s not just about geography and it’s especially surprising because of everything else you know about.

COVID-19 where a younger age structure is meant to. Have some kind of protective effect and black and ethnic minority in the UK have a younger age structure. They’re a younger population and so on. So it’s quite a pronounced differential and it slightly varies according to sectors and occupations and so on.

So there’s one study by the health services journal, which showed some quite alarming cigarettes, which was of the deaths in healthcare workers around 63% were black and ethnic minority. About 36% ration. And about 27% were people of black ethnicities, which is consistent with an over-representation of these groups within what we call key worker populations, which means that they’re more likely to be exposed to COVID 19 than other sectors.

So we’re talking to him about healthcare workers, social care task force, where our workforce has cleaners people work in public transport, retail work, and so on. So there’s quite pronounced disparity.

Rebekah: [00:04:04] Yeah. So you mentioned the sort of differences according to people’s exposure and the sorts of occupations they’re doing.

Are there other things that you think underlie those differences or things that we know are there the causes of those differences?

Nasar: [00:04:18] Well, some people say not me, but some people say the most kind of proximal level. So centering on the body, the pronounced differences or something that the vulnerabilities of ethnic minority groups reflect greater levels of what you might call preexisting.

Chronic health conditions. So things like cardiovascular disease, hypertension, diabetes, which are the most common illnesses are observed in COVID-19 fatalities. And that’s something which we know to be true from, you know, survey health surveys, gosh, diabetes survey shows that there’s disproportionate number of black and ethnic minorities with nasty, with elevated levels of diabetes.

And same is true for the health survey in England. Well, it starts to challenge that as an explanation for this on its own is the conditions are not only more prevalent in the UK is black and ethnic minority groups then than the white groups. But yeah, start to manifest at an earlier age. So one of the striking findings smell survey in England is the health of white English people aged about between 61 and 70 remarkably.

Is it comparable to that? People of Caribbean and Indian descent who are aged 46 to 50, and then Pakistani people that are aged 36 to 40, and then people of Bangladeshi background who are aged 26 to 30. So it’s true that ethnic minority populations are more susceptible to critical complications if they contract COVID-19 because of these underlying conditions.

But there’s a story behind these underlying conditions, which is why people like me and others who are working on this topic. Keep returned to this question of what we call the social determinants of health.

Rebekah: [00:05:53] It sounds like what you’re saying is that there are already pre-existing health inequalities for ethnic minorities that have in some way been, I guess, amplified and reinforced by COVID.

And you, you would just then beginning to talk about the story behind those differences and the social determinants. Could you tell us a little bit more about that? So, so what does social determinants mean?

Nasar: [00:06:12] Yeah, no, that’s, that’s precisely. Right. So in simple terms, what social determinants of health mean?

You don’t uncouple the susceptibility of illness in this case, this virus from their wider social exposures. Right? And so for example, we know that certainly economic status has been linked to the incidence and severity of viral pneumonia in recent years. And that’s, that’s a social gradient. So you can map the relationship between your social economic status and your likelihood to contract battle pneumonia in normal times, which is quite alarming, which is an exacerbated in the context of, of COVID 19.

We know, for example, the risks associated with COVID 19 transmission can be exacerbated by things like housing challenges faced by members of black and ethnic minority community. It’s, you know, overcrowding can lead to increased COVID 19 transmission. As individuals in households effectively are unable to self isolate properly.

We know that people from black and ethnic minorities are more likely to live in intergenerational housing, you know, from grandparents, parents, children, which then leads to a greater risk of transmission between younger children and older adults. And the reasons for that are not just cultural. It’s not the case.

Can actually minorities have a cultural tendency to live together in a big house. A lot of that has to do is socioeconomic status and what’s sometimes called housing precarity. So almost all ethnic groups as in minority groups in the UK, I’m more reliant on, on private rented housing than the white British majority.

And that’s something which is especially true for, for new migrants who are overwhelmingly reliant on private rented accommodation. So more at risk of being unable to have the capacity in their home, that the people who own their homes necessarily are able to have. So that’s one illustration of the way in which social determinants of health matter.

I mean, there’s other ways which people like me want to talk about, which is to say that whilst it’s undoubtedly true, that preexisting conditions are important in these groups. You know, we also need to ask why would we expect health outcomes for black and ethnic minorities to be different or better?

When they’re not better in other sectors, in the education system, in the criminal justice system, in child welfare. And I suppose that means we need to kind of get over our retinas of connecting some of the explanations we have for those. Differentials, you know, we know for example, that racial discrimination is a feature of those outcomes.

We know that racial discrimination is a feature, people having lower incomes, having low status occupations, having poor employment conditions, being worse off educationally. We know that racial discrimination contributes to people feeling like they live in hazardous environments. We know the rest of discrimination contributes to trauma.

We know that it means that people have very negative relationships to institutions, which are so important for health access. So there’s, there’s something which does the rounds in my field of work called weathering, which is about thinking. Of the experience of black and ethnic minorities of the life course.

So rather than it being one incident, thinking about things chipping away and taking their toll on people and groups cumulatively, rather than just on one moment, which is a way in which some clinical approaches thinking about the impact of COVID-19.

Rebekah: [00:09:30] So in terms of, you know, thinking about that experience of life course, I mean, it sounds from what you’re saying that there’s, you talked about the, the reticence maybe to talk about some of these issues, is that reticence a distinction between sort of policy and research, or is there a difference of a view of, in academia about sort of what underlies some of these differences?

Nasar: [00:09:50] Yeah, I’d say both. I’d say there are competing research perspective and some of this has to do with the proximity to what’s been studied. So it’s not unusual for people doing clinical work to focus in on the body. And then immediately around that in terms of the disease. And not necessarily to take the long view in terms of broad public health trends.

So that’s one thing, and that’s got a disciplinary cleavage to it for social scientists, even first-line studies, quantitative work, you know, we’ll, we’ll take a different view to people who necessarily do clinical work, but it’s also a reflection of the relationship between policymakers and researchers.

People like me sitting in universities who were able to do research can pretty much tell it as it is, or we find it. I think harder for legislators to accept that things like institutional racism may be part of a. Part of the menu of explanations for these differentials. And I think we kind of need to get beyond that.

I think that we were previously in a time when legislators and people who worked in the policy process would use terms like institutional racism and they understood that racism is a multiform concept. You know, it’s not just about somebody being called a name or, you know, somebody being unpleasant to somebody in the workplace actually, you know, it’s multifactorial, it spans labor markets, how I think criminal justice, health, and so on.

And we’ve moved away from that, which partly explains why I was describing at the outset, which was threatened for public health, England to report on the wider consultations they did, because those consultations largely confirmed the view amongst health practitioner of community advocates, stakeholders, that one of the biggest explanations for this disproportionality is black and ethnic minority experiences of race and discrimination.

Rebekah: [00:11:31] So, how do you think we can? Cause that’s a really important issue. And if we’re not sort of talking about these things or talking about them in the way they need to be talked about, obviously we’re not going to come up with the means of tackling them. I mean, have you got any thoughts on how we might be able to support a more open conversation that actually recognizes some of the complexities around what’s happening?

And she has a bit more of a candidate approach, I guess, all the things that are going on.

Nasar: [00:11:53] Well, one is just to recognize these concepts have some explanatory value and that they resonate community has other clients policy makers transfer, and then being vigilant and being proactive around that. So for example, one of the things that we encourage the Scottish government to do in taking a perhaps distinctive approach, certainly from the Westminster poets, you have to actively seek out.

Community-based organizations from ethnic minority groups, which will help them develop a fuller, more complete understanding of the dynamics of COVID 19 and its and its impact. And that includes things like thinking about not just the virus, but sick pay national insurance provisions, especially thinking about ways of covering people who, you know, for example, work in the gig economy who are disproportionately impact, black and ethnic minorities.

Thinking about things like universal credit, low pay, ensuring that universal credit doesn’t have that lengthy wait period, which then exacerbates the current inequalities of black and ethnic minority to find themselves then, and to think about how kind of historic racial inequalities dovetail in the present experience of COVID 19.

And, you know, one of the things that’s certainly focusing our minds is that there’s going to be a medium and longterm challenge. When, when we come out of this, you know, we anticipate that being quite a disproportionate economic impact from the lockdown on black and ethnic minorities, which heal wide and north inequalities.

Partly because of the nature of the occupations that have been predominantly held by black netting minorities. So what sometimes call the COVID-19 shut down will be, especially in sectors like transport in restaurant work, which is precisely where Bangladeshi groups, Pakistani groups predominantly are concentrated in levels of their work.

Rebekah: [00:13:43] So, I mean, nothing that interconnection with other inequalities is really interesting and really important. And actually looking at those inequalities through different lenses. I mean, this is obviously an area that you’ve worked on for a long amount of time. Is there anything that sort of surprised you in terms of the work you’ve been doing to look at the impact of COVID 19 on ethnic minorities?

Nasar: [00:14:02] So in a way. Yes and no. I mean, we should probably gonna be true of everybody who works in this field. Nothing has emerged the theoretically researchers wouldn’t have foreseen. And really, if anything is kind of being like a dark natural experiment, which if, you know, you’re with tracing agents through a system and it highlights all the weaknesses.

We knew the inequalities when tied to a single sector or a single sphere that there were, there were multifaceted. And we knew that where there wasn’t lots of evidence, the existing material confirmed the disproportionality was you Sal in people’s lives. Even if we didn’t have the quantitative data to recognize.

And COVID-19 teams really kind of illustrated that and illustrated it in a lethal way. And one of the outcomes of the challenges. So people in my field or people interested in looking at this from a social determinants of health perspective is to get policy makers, to think seriously about doing actions, which don’t necessarily have, you know, long dispute and on datasets to support.

And let’s see this difference here between, you know, clear lack of evidence and a lack of clear evidence. And I think we’ve probably had a lack of clear evidence around some of these issues, but enough to appetite. Whereas I think sometimes policymakers have thought that that’s the same as a clear lack of evidence.

Rebekah: [00:15:23] I mean, certainly one of the things I’ve seen in the public health, England recent report was there were a number of recommendations around the need for better data and more research. But it sounds like what you’re saying is not saying we don’t need that, but actually we’ve also got an awful lot that we already know that we could use to guide decisions.

I mean, in that context, are there any particular interventions you think government wherever Scottish government or the UK government should be taking now to address some of the issues that COVID 19 has shown a spotlight

Nasar: [00:15:50] on. Yeah, well, I mean, I don’t want to roll back from the need to generate more data.

I think that’s really important. I think rather than just generating new data, the challenge is often being data linkage between different sectors. So tying up census data to NHS data, to local authority data, and then as I’ve indicated, you know, marrying that to things like educational outcomes to lake lip, market participation to criminal justice experiences.

And to be fair to the last UK administration from 2015, the cabinet office embarked on what it called was the race disparity order and generated some really useful portals though. You know, it confirmed kind of what we already knew, but it was just good to have that, to be able to utilize that Scotland didn’t join that up in the same way.

So that’s certainly something that Scotland can do in terms of generating the data. But you’re right. In terms of your second part of your question, there is enough information to be making interventions. You know, we know that housing, we know that labor market access, or as well come out of the lockdown, the disproportionate impact of those kind of risks, I think economists will have a profound impact on health.

And, you know, there should be targeted interventions trying to address that. And those things are something that the government can can do tomorrow. I’ll certainly set out a strategy to try to do. I think that the way in which sometimes governments administration. So I don’t think this is to the Scottish administration at the moment.

I think they’re genuinely interested in trying to make sense of what’s going on and to try to marshal the best evidence to make interventions meaningful. But I’m a little, I’m a little bit more.  the way in which the UK government is trying to approach this at the moment. I think that there’s enough data for them to be able to make meaningful interventions.

And this is part of the paradox, you know, they’re really good data and there has been for awhile now, whereas that’s not necessarily the case of Scotland, Scotland does need to generate more data sets to be able to make interventions that reach the parts of the system that he wants to reach. So yes, more data, but also a lot of data out there which could be utilized to make interventions, which will have a meaningful impact.

And I

Rebekah: [00:17:56] guess the data to look at those impacts as well, and look at how effective those interventions are. I mean, when you’re talking there about things that will impinge disproportionately on ethnic minorities, or that there’ll be affected more, for example, issues like housing and access to the labor market.

But in terms of sort of an intervention around that, how far should it be about addressing the challenges that everyone faces for example, or will face around the labor market or on housing? Or how far do you think there should be interventions that are maybe more targeted to ethnic minorities?

Nasar: [00:18:24] I think, I mean both, but I think there needs to be targeted interventions.

So, I mean, any sophisticated understanding of policy will understand that it’s received and it lands in context, which aren’t equal. And, you know, we’ve seen this in terms of trying to address health inequalities in the past, governments will offer increasingly lifestyle approaches, you know, a healthier eating, doing more exercise and so on.

Because it’s cheap, you know, you don’t need to change stuff necessarily to send those messages out. And then people take up of messages and lo and behold, the health Nicole’s is wide. And because the middle-class says, well, eat healthier and do more exercise. Whereas what was needed was targeted interventions to make sure that the people in lower socioeconomic groups had better housing.

I mean, damp for example, is a really good predictor of health inequality. Those kinds of interventions, can’t just be generic into, they need to be done to, to the groups that are most susceptible to those kinds of risks. And that’s what I mean about kind of intelligent policy design, which then goes back to the point.

I was making earlier about connecting with groups with stakeholder groups, community groups, with users, and to some extent, reverse engineering policy. On the basis of the intelligence you’re getting back. And, you know, there’s times at which governments do that well, you know, to kind of devolve some of this thinking and then to report back, but it requires strategy.

It requires a degree of longterm planning, which might be longer than the life course of one administration. But the thing, so Scotland has kind of tried to do a, you know, it’s a waste of quality framework strategy document, for example, it’s a 16 year plan. Which if implemented and, you know, we’re kind of three or four years into that if implemented could make a profound change, but you see implementations to find out, which is important too.

So intelligence consultation, targeted interventions, and also implementation.

Rebekah: [00:20:15] And how far are these sort of issues being addressed by some of the groups are being set up? Cause I mean, that’s often a sort of government reaction to an issue is set up a group to look at it in more detail. I mean, there’s obviously the equality and human rights commission has just recently announced an inquiry about this as the expert reference group that you were on that Scottish government is set up to look at ethnic minorities or these groups thinking about those questions or what questions should they be thinking about?

Nasar: [00:20:38] Yeah, you’re right. To say that there’s been a plethora of groups set up to look further into these kinds of disparities. They’re all doing the different things is my understanding. Some groups are more focused on generating data. Some special groups are convened more to think about policy interventions.

I think there’s a broad axes here between groups set up, which are committed to taking both a long than a broad view and groups, which are set up to look at specific interventions and. I circled back to the things that I’ve said in the early part of the conversation. I think that any kind of inquiry or any kind of group, which wants to look a COVID 19 blackness in minority disproportionality and a local clinical way.

Well, the entirely valid, but I think it’ll just be short term, unless it’s also able to connect it to wider inequalities in terms of the things that we’ve discussed. And which have been long recognized. So, you know, there’s a series of new groups set up as you’ve identified, but actually when you look at things like the Marmot reports or even the HSN report at the turn of the century, which it’s the last, you know, I think that was 99 or 2000, which was the last time ethnic disparities and health inequalities was properly investigated.

There’s nothing that looking at the present outcomes, that would be a surprise to, to HSN. And in fact did not surprise to Michael Marmot either. He wrote the other day in a commentary that, you know, there’s a precise, systemic inequality is identified, you know, way back when, and now they’re being played out.

So the groups that are able to generate more data and especially in Scotland, you know, the special reference group is. It’s particularly interested in trying to connect up different forms of data sets, which paint a much more holistic picture. I think this is really important, but it can’t just be that it has to be about more long-term targeted interventions, which tie health disparities, inequalities to wider socioeconomic determinants, the social determinants of health.

Rebekah: [00:22:42] So I think it sort of takes us back to sort of one of the earlier points about actually there’s a lot that we already know. And as you said, we’ve actually known about these systemic inequalities for, for decades now. And, and getting on foot for more than that. I mean, obviously the black lives matters movement and some of the protests and increased focus has been on inequalities and racism on the back of George Flores.

DAF has brought a new look at this, I guess, and a new visibility or an increased visibility. What connections, if any, would you draw to some of the issues that the black lives movement is looking at and what ethnic minorities are experiencing in terms of COVID-19.

Nasar: [00:23:18] It’s it feels like a really important moment to be discussing these issues in lives of these mobilizations.

So the first thing that I would say about the black lives matter movement in relation to COVID-19 is the BLM movements are specifically about wanting to elevate a recognition of the experience of people, of African descent. Oh go the meaning of the black in that, I mean, I think it has brought a resonance for all racial minorities, but there is a particular view that historically across a number of sectors, people of black African descent have been disproportionately targeted in terms of policing practices, but also overlooked in terms of things like meaningful health interventions.

So in that respect, I think that’s really important. So elevating the experience of black populations, you know, within the NHS and, and more broadly outside of just clinical encounters with health services, you know, public health, more broadly conceived, which has implications from under things and not just, you know, COVID-19 for mental health, for stress, for anxiety.

Even things like hypertension are often, you know, associated with perceived stress, a societal level rather than, you know, an individual level. So once we start to ask those questions, then it really kind of reverses the telescope and asks not all for the experiences of black groups, but there the experiences of white majorities.

Well a white majority is doing and a society in which to be white carries with it, a certain kind of currency, a capital, which isn’t named as such. It’s just there it’s unspoken. It’s the Archimedean norm to be white is to be normal, to be something different is not. And I think that’s an interesting challenge.

I think for people in the health community and beyond to try to wrap their heads around and not see disproportionality in terms of health outcomes as being matter of disease or viral conditions, but actually about a latent configuration or fabric of society at large. So that’s kind of the, the subtle and the nuanced point.

I think that they’re much harder point is that, I guess it sources the question of black African disproportionality, further up the policy discussion. When I was looking at some of the figures of the numbers of black doctors and nurses and care workers who have contracted COVID-19, it’s remarkable.

It’s, you know, it’s really, really high. And the reasons for that aren’t necessarily reflected in the quantitative data. They’re partly reflected in the fact that these people have worked in institutions, which perhaps haven’t taken their wellbeing. Seriously enough. And I, you know, I have family and friends who work in primary care and I cannot tell you in all honesty that I have every confidence that their employer will look after that as well, as well as it might look as two white coworkers.

And do I say that? Not because I’m paranoid or I say that based purely upon the evidence and that’s, and if black lives matter gets us to think in health sectors seriously about that. And that’s a really, really important advance that can be made, but it’s not going to happen overnight. And it would require more.

More reflection, I think, on, on, on why brokers, people empower people in the policy process, healthcare professionals as much as anything that’s asking something as, as people of black or African descent.

Rebekah: [00:26:35] One thing COVID does seem to have done is actually increased the focus on inequalities within society and particularly in the media.

So as you say, not that these inequalities haven’t already been preexisting, but actually has brought them maybe more to the surface and particularly around health inequalities. There’s obviously been quite a lot of talk as well, without wishing to downplay a tool, the tragic consequences of COVID, but also thinking about actually, well, how can we use this as a way to think about what a fairer society looks like?

Do you feel that’s within reach a fair society and, you know, in terms of ethnic minorities, how might we get there? If you were sitting in a, in the cabinet at the moment at wherever at a UK level or Scottish level, you know, what would be the one or two things you’d be absolutely pushing for.

Nasar: [00:27:18] That’s a really good question.

So on the first part of it, is there an opportunity to refocus or readable letters on inequality? Yes, it certainly S brings with it more challenges. It’s not an opportunity which is without cost. You know, we’re coming up to the lockdown, which we’ve already talked about. Well, exacerbate inequalities. And so we’re kind of already two steps behind where we were before we went in.

Well, some of the things that we’ve talked about already in the discussion has been making sure that things like universal credit housing benefits and so on, are accessible for the people don’t find themselves in a, in a period of lag, which then for example, contributes to things like homelessness.

There’s just, there’s just kind of basics that I think coming up lock down the governments need to do to ensure that purely surviving the pandemic of one, leave people in a much worse position. I think there’s been something in the recognition, the contribution of key workers and the way in which before the pandemic and the lockdown, you know, these are people who are car tries just low skilled.

You remember that phrase, low skills workers, and it was being tied to migration points criteria. And the home secretary in particular was taking great joy in coming up with a, a program which would prevent people on low incomes entering the country. And this effectively core kind of entreaty NHS staff cleaners, Sally ruled out social co-workers and spawn.

I think that’s been turned on its head, quite frankly. And I think enough people have realized that those people who calls low skilled are actually actually the workforce that need to be valued the most. And some of that’s been reflected in, you know, clapping for the NHS and so on. And people have different views on that.

Some people think it is kind of instrumental and other people think it’s been appropriated or whatever else, but. It certainly strikes our recognition that you have a relatively low paid multi-ethnic multi-racial workforce has kept the country going. And that comes with a need to recognize that when we come out with a pandemic, so better pay for people in the front line, better pay for key workers and more secure employment.

All that stuff I think is up for conversation. But as I said, you know, this requires political will as much as intelligent policy design. And, you know, there’s a question as to how much desire there is for this presently, the UK level, maybe Scotland can strike out and do things differently. There appears to be some kind of ambition for that, but it’s as much as up to researchers and I suppose, kind of commentators journalists and so on to try to get governments to honor honor that direction of travel.

Rebekah: [00:29:54] And I think organizations like the Royal site of Edinburgh, Scotland, national academy as well, to make sure that we actually keep supporting and stimulating debate and drawing in informed evidence and expertise to help shape what happens, you know, societal level. And indeed, in terms of intelligent policymaking to use your phrase.

Professor Nasar Meer. Thank you so much for talking to us today and sharing your expertise and experience and knowledge around the impact of COVID-19 on ethnic minorities. Thank you.

Nasar: [00:30:23] Thanks so much.