The Public Health England review of Covid-19 and the disproportionate impact on people from Black, Asian and Minority Ethnic (BAME) backgrounds should be a 'a wake-up call' for the government to make population health an urgent priority. 

In a statement, the King's Fund said the coronavirus pandemic had exposed the stark inequalities that exist throughout our society. People who have been worst affected by the virus are generally those who had worse health outcomes before the pandemic, including people working in lower-paid professions, those from ethnic minority backgrounds and people living in poorer areas. 

The review Disparities in the risk and outcomes of COVID-19 confirmed that the impact of Covid-19 has replicated existing health inequalities and, in some cases, exacerbated them further, particularly for BAME groups. 

The British Medical Association called the report a missed opportunity as it is a statistical analysis and did not highlight the action needed to avoid harm to BAME communities. It added that practical guidance was needed, particularly in relation to how healthcare workers and others working in public-facing roles will be protected.

Pandemic shines a light on entrenched health inequalities

It report found that the largest disparity was by age. Among people already diagnosed with Covid-19, people who were 80 or older were 70 times more likely to die than those under 40. Risk of dying among those diagnosed with Covid-19 was also higher in males than females; higher in those living in the more deprived areas than those living in the least deprived; and higher in those in BAME groups than in white ethnic groups.

An analysis of survival among confirmed Covid-19 cases and using more detailed ethnic groups, shows that after accounting for the effect of sex, age, deprivation and region, people of Bangladeshi ethnicity had around twice the risk of death than 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.

Sally Warren, Director of Policy at The King’s Fund, said: "We’ve known for many years that these groups typically have worse health outcomes, but there has been disappointingly little effort over the past decade to address inequalities and improve people’s health. The scandal is not that the virus has disproportionately affected certain groups, but that it has taken a global pandemic to shine a light on deeply entrenched health inequalities.

"Public health is about much more than infection control, and healthier populations will be more resilient to new threats. Preventable conditions including obesity and diabetes are major risk factors for Covid-19.

"This should be a wake-up call for the government to make population health an urgent priority. We need ambitious and binding national goals to drive progress, a cross-government strategy to reduce health inequalities and increased investment in prevention and public health."

Race is clearly a significant factor in Covid-19 effects

The NHS Confederation, which represents organisations across the healthcare sector, is hosting the NHS Race and Health Observatory, which will identify and help to tackle the disproportionate effects that race can have on patients, communities, and staff.

Niall Dickson, chief executive “There is much we still do not know, and these figures do not take account of comorbidities which may well explain some of the differences.  Working age men are twice as likely to die than working age women, while by far the biggest differential factor is age - those who are in their 80s are 70 times more likely to die than those under 40.

“But race is clearly a significant factor even if we cannot explain all the reasons why this may be the case. It is striking that people of Bangladeshi background had twice the risk of death than white people.

“The usual cry of ‘more research’ usually elicits groans but it is the right response here and reflects that everyone is trying to understand the impact of a new virus on some known inequalities. We also do need to know more about the larger number of deaths among a range of lower paid caring occupations including social care, nursing auxiliaries and assistants."