26th August 2020   •   opinion
Doctors and public health professionals from the UK and US: we need more systematic reform in our societies

We are doctors and public health professionals from the UK and US who formed an online group during the pandemic to discuss why Black and Ethnic minorities are at higher risk of dying from Covid-19.

This is despite the fact the UK has the NHS - something that has been proposed as a solution to racism in the US healthcare system.

In the US, Black people are more than twice likely to die from Covid19 and in the UK, Muslim majority Pakistani and Bangladeshi populations also carry double the risk.

Many of the issues faced in the UK are exactly the same as those faced in the US.

In both countries we have seen the vilification of Black and Ethnic minority communities in the US and UK respectively, blaming congregations and faith practices for spreading disease and reinforcing racist stereotypes of uncivilised and dangerous populations posing public health security threats.

A shared concern and struggle for social justice has been highlighted by the group. Covid-19 has reinforced what we already knew through research.

Racial segregation (i.e. the physical separation of racial subgroups in space) matters and reflects widespread institutional discrimination that in turn impacts social, economic and health-related well-being of a number of racial/ethnic minority groups.

The comparison of “Two different healthcare systems, one outcome” has shown us the sheer impact that systemic racism plays in the healthcare arena. We already have awareness of the disparities; but it is troubling to see how little progress has been made.

We have yet to have accountability. We bring forward our collective insights, whether from working with individual ethnic patients or populations. The collective voice requests to bring positive change to ethnic minority communities that we serve.

Signed (from left to right, top to bottom)
Dr Balsam Ahmad
Dr Bushera Choudry
Dr Enam Haque
Dr Taison Bell
Dr Utibe R. Essien
Dr Rageshri Dhairyawan
Dr Ebony Jade Hilton
Dr Hina J Shahid


We recommend:

  1. We must name racism as a cause for the structural inequalities that racialised minorities face. By not naming it, we do our patients a disservice & perpetuate institutional racism.

  2. We must challenge the misuse of race as a biological category in clinical practice and research, as it can further embed racial inequalities.

  3. Better diversity training for medical students and doctors, that goes beyond the token gesture of unconscious bias training. This aligns to the BMA racial harassment charter, and the GMC are considering firmer guidance on diversity as well. This should extend to inclusion with influence at senior levels and in decision making processes that moves beyond representational politics.

  4. Better engagement with minority communities to enable them to have more influence on how their health is improved. This would be through funding of grassroots organizations involved in improving health in minority communities. This aligns to NICE guidance: Promoting health and preventing premature mortality in black, Asian and other minority ethnic groups.

  5. Better understanding of the social determinants of health, at both undergraduate and postgraduate level. Need this incorporated into the curriculum better and considered in assessment. This moves to address the misunderstanding that Covid-19 is worse in BAME communities due to ethnicity, rather than racial disadvantage and racism.

  6. Challenge the negative stereotypes of communities that have been disenfranchised and marginalised for long, including many black and minority ethnic communities and use the Covid19 pandemic as a teachable moment to raise awareness of the societal and health inequalities and to galvanise public support for their reduction.

  7. Move policy narratives and actions from a focus on vulnerability to that of promoting community resilience and building on community assets by engaging with “lay knowledge” in a way that can challenge or complement other dominant forms of knowledge.

  8. “Place” matters in understanding cumulative vulnerability and the lived experiences of black and ethnic minority communities. Hence there is a need to understand better how “vulnerability is distributed across & clustered” in different communities and places. (See this paper)

  9. Need to challenge government policies on austerity, immigration, citizenship and security that disproportionately impact ethnic minority communities creating social and structural exclusion and barriers to accessing health care.

  10. Interventions should be community led that move towards empowerment models enabling control and self-determination of solutions that matter most to communities.

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Mita is a newspaper columnist, Mindfulness Based Cognitive Therapist, Acupuncturist and expert in other healing techniques.
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