Policies to reduce mortality from Covid-19 among ethnic minorities in the UK should target reducing deprivation rather than biological factors, according to a new report that refutes the idea that genetic differences contribute to higher death rates from the virus.
The government report concludes that living in urban areas with high population density and in overcrowded households, as well as high-risk occupations and pre-existing health conditions are likely to be the main factors contributing to more severe Covid-19 outcomes for ethnic minorities.
“Deprivation is a good marker of many of these factors,” the report says.
Dr Raghib Ali, senior clinical research associate in epidemiology at the University of Cambridge, and newly appointed adviser to the government on Covid-19 and ethnicity said: “I don’t think structural racism is a reasonable explanation [for these disparities].”
He added that in designing policy to tackle disparities in outcomes, the government should “focus on key risk factors as opposed to ethnicity which is only a proxy”.
A growing body of evidence has shown that black and minority ethnic (Bame) groups are up to twice as likely to die than white people. Health experts have been searching for clues among the multiple medical, socio-economic, behavioural, cultural, environmental and biological factors that could be driving the association.
“It was reasonable to use ethnicity as a proxy at first, but going forward we need to extend risk assessments to all of the population,” Mr Ali said, adding that “we shouldn’t treat ethnic minorities as all the same”.
“I don’t think it’s equitable to exclude whites who are also at risk,” he added.
The report states that existing research suggests that biological factors such as genetics are unlikely to explain the different outcomes experienced by people from different ethnic groups suffering from Covid-19, while recent studies did not find any relationship between vitamin D levels and Covid-19 outcomes.
The report acknowledges that while most of the increased risk for ethnic minorities is “readily explained” by underlying factors related to deprivation, “it is not fully explained for some groups such as black men”.
Dr Ali noted that the difference in outcomes for black men might be explained by the prevalence of high-risk occupations and obesity, which existing studies do not adjust for.
Several public policy and health experts disagreed with Dr Ali’s assessment that the disparities in outcomes between minority ethnic groups are not caused by structural ethnic inequality.
“The government should be acting to address the underlying structures behind ethnic disparities,” said Dr Parth Patel, research fellow at the IPPR think-tank and an A&E doctor during the first wave of the pandemic. The IPPR has called on the government to take several urgent steps to address this inequality, including adding ethnicity as an independent risk factor alongside occupation and underlying health conditions when deciding priority for limited testing.