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We should praise the heroic work of health workers battling COVID-19 but not assume they are immune from discrimination
Samrawit Gougsa is a global health advocate and communications officer at Minority Rights Group International.
At this moment, it seems almost sacrilegious and stupendously ungrateful to make any comment that is in any way critical of those working in Britain’s health services. To treat those with COVID-19 they are risking their lives, making huge personal sacrifices and keeping us all safe by doing so.
But difficult situations mean difficult questions.
One such question is: why have ethnic minority health workers died in such high numbers? Another is: why, even after controlling for socio-economic differences, do ethnic minority populations have a significantly higher likelihood of dying than their white counterparts in the UK? Is racism really still alive in our society (and in our health service)?
British lawmaker David Lammy in recent years has been carrying out a very impressive study of racism in the criminal justice system. Step by step, it unpacks the complex processes that lead to arrest, charge, conviction, sentencing and examines the impact of racial and religious discrimination at every step. The study is revealing, with clear patterns of differences of treatment in some stages and almost none at others. One result of the COVID-19 pattern of deaths for minority and majority populations must be the commissioning of a similar study in Britian’s National Health Service (NHS).
Those working in the health service are heroes, but they are working in a society in which discrimination of all types exist. Despite our respect for them and their courageous work throughout this pandemic, it is not right to assume that they are immune from discrimination. As products of the societies and families that raised them, albeit with training, the Hippocratic Oath and strong moral values moderating social attitudes and assumptions, they too are only human.
Research has shown that just being an ethnic minority can have an impact on one’s treatment. For example, a 2015 study found that in the United States, black and Hispanic patients received specific interventions for Atrial Fibrillation, a condition that causes an irregular and often fast heartbeat, less frequently. There was also a significant difference by sex, with “white patients and male patients receiving the most care.”
Another study in 2018 focused specifically on indigenous peoples in Canada and found that experiences of discrimination at the point of health care delivery is common. Patients stated that stereotyping, abusive treatment, and a lack of quality care are factors that discourage Indigenous people from accessing health care. Importantly, discriminatory attitudes in statements by health care workers were also documented, with one saying “People stereotype them. ‘Oh they are like this, they don’t take care of themselves’ is kind of the picture I get from other staff… I have seen that personally.”
The research shows that indigenous Canadians are routinely perceived as being responsible for their ill-health, assumed to have drug or alcohol problems and prescribed less pain relief than other Canadians. Basically, it highlights how the stereotypes that health care providers have about indigenous people can influence their clinical decision-making. It’s not just in Canada either, similar studies have found the same patterns in Australia, New Zealand and Guatemala as well.
We need a frank discussion about race, belonging, entitlement and treatment right now in the UK. Last week, Public Health England released the findings of a government-ordered inquiry into the disproportionate impact of coronavirus on ethnic minorities and confirmed that death rates from COVID-19 in England have been higher among people of black and Asian origin compared to any other ethnic group. We now need to go further and understand what is driving the disproportionate impacts in the first place.
Unfortunately, discriminatory attitudes may be one of these reasons. Talking about them is uncomfortable but sweeping the issue under the carpet means it will never be properly recognised nor addressed.
The many ethnic minority health workers who have lost their lives on the frontline of our battle against COVID-19 did not die from a lack of medical care or differences in treatment, but something deeper and more engrained in our society. We see correlations now, but we cannot firmly put our fingers on how discrimination, exclusion and behaviours interact to determine these outcomes until we conduct a thorough, extensive and nuanced study.
We should urge this to be done in the memory of those health workers we lost, and for the courage of many ethnic minority health workers that remain on the frontline, placing themselves in harm’s way to care for us and our loved ones.
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