A new report by Public Health England (PHE) has found that the coronavirus pandemic exposed and exacerbated longstanding inequalities affecting black, Asian and minority ethnic (BAME) communities in the UK.

In the report, Beyond the data: understanding the impact of COVID-19 on BAME groups, PHE engaged more than 4,000 people who represent the views of BAME communities, to gather insights into factors that may be influencing the impact of Covid-19 on these groups and to find potential solutions.

The report highlighted BAME groups deep concern and anxiety that if lessons are not learnt from this initial phase of the epidemic, future waves of the disease could again have severe and disproportionate impacts.

In April, the Chief Medical Officer asked PHE to investigate disparities in risk and outcomes of Covid-19. This rapid review, Disparities in the risk and outcomes of COVID-19found that the highest age standardised diagnosis rates of Covid-19 per 100,000 population were in people of Black ethnic groups (486 in females and 649 in males) and the lowest were in people of White ethnic groups (220 in females and 224 in males).

An analysis of survival among confirmed Covid-19 cases showed that, after accounting for the effect of sex, age, deprivation and region, people of Bangladeshi ethnicity had around twice the risk of death when compared to people of White British ethnicity. People of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity had between 10 and 50% higher risk of death when compared to White British.

This work also included a rapid literature review conducted with the National Institute for Health Research (NIHR). 

In a letter to the Equalities Minister, PHE said that the clear message from stakeholders was the requirement for tangible actions, provided at scale and pace, with a commitment to address the underlying factors of inequality.

Recommendations from the BAME report

The insights from stakeholders have been used to shape the recommendations in the report, which are:

  1. Mandate comprehensive and quality ethnicity data collection and recording as part of routine NHS and social care data collection systems.
  2. Support community participatory research, in which researchers and community stakeholders engage as equal partners in all steps of the research process, to understand the social, cultural, structural, economic, religious, and commercial determinants of Covid-19 in BAME communities.
  3. Improve access, experiences and outcomes of NHS, local government and Integrated Care Systems commissioned services by BAME communities.
  4. Accelerate the development of culturally competent occupational risk assessment tools that can be employed in a variety of occupational settings.
  5. Fund, develop and implement culturally competent Covid-19 education and prevention campaigns, working in partnership with local BAME and faith communities to reinforce individual and household risk reduction strategies.
  6. Accelerate efforts to target culturally competent health promotion and disease prevention programmes for non-communicable diseases promoting healthy weight, physical activity, smoking cessation, mental wellbeing and effective management of chronic conditions including diabetes, hypertension and asthma.
  7. Ensure that Covid-19 recovery strategies actively reduce inequalities caused by the wider determinants of health to create long term sustainable change. 

The report concluded that the unequal impact of Covid-19 on BAME communities may be explained by a number of factors ranging from social and economic inequalities, racism, discrimination and stigma, occupational risk, inequalities in the prevalence of conditions that increase the severity of disease including obesity, diabetes, CVD and asthma.

It added that unpacking the relative contributions made by different factors is challenging as they do not all act independently, but urgent, collaborative and decisive action is required to avoid a repeat of this in the future.