250 public health professionals condemn ‘dangerous’ race report for ignoring inequalities

Letter says report draws from flawed methodologies and contradicts decades of academic research

Paramedics wheel a patient from an ambulance into the Royal London Hospital (AFP via Getty Images)

Some 250 public health professionals have written a letter condemning the government’s recent report on race and ethnic disparities, saying its “dangerous” denial of structural racism distorts the key causes of health inequalities in the UK.

The letter, shared with The Independent and The Guardian, says the report draws from flawed methodologies and contradicts decades of academic research.

It accuses the Commission on Race and Ethnic Disparities, which conducted the review on behalf of Downing Street, of omitting evidence from the government’s Scientific Advisory Group for Emergencies on how structural racism shapes Covid outcomes.

Dr Ahimza Thirunavukarasu, a co-author of the letter, said there had been “a lot of dismay” among her colleagues following the publication of the report, which has been widely criticised for concluding that the UK is not an institutionally racist country.

In many aspects of health, those from ethnic minority backgrounds suffer worse outcomes than white people.

Read more:

• Racism in healthcare is real and it matters
• Institutional racism exists in UK and healthcare, says head of NHS race body
• Government’s race report branded an ‘insult’ which ‘glorifies slave trade’

Black babies in the UK have over twice the risk of being stillborn and black mothers have four times the risk of death in childbirth, the letter says. At the end of life, black Caribbean, Pakistani and Bangladeshi people live up to nine years fewer in full health, it adds.

When it comes to Covid-19, Black men are still more likely to die from the virus then white men, once socioeconomic factors are accounted for. And Bangladeshi and Pakistani people continue to experience a considerably higher risk of death compared to white people, research has shown.

Downing Street’s report cited multiple reasons for disparities in health between ethnic minorities, such as deprivation, geography and other socio-economic factors, but downplayed the role played by structural racism on these differences.

“The report talks a lot about how overt racism doesn't exist and therefore concludes that structural racism doesn't exist, which is missing the point of the definition,” Dr Thirunavukarasu told The Independent.

“With Covid, risk of exposure is used to explain why outcomes are different in groups. But the question is why is there that difference in the first place?

“Why are ethnic minorities more likely to be working in professions where they aren't receiving the right PPE, or they're in more public-facing roles where they have that risk of exposure, or why are they living in overcrowded accommodation? It's all those underlying factors where structural racism plays a role.”

The letter, co-authored by a number of public health doctors, including Dr Chetna Sharma and Dr Emma Sherwood, says that “structural racism has long been recognised as a significant driver” of health inequalities in Britain.

It highlights the omission of “inconvenient” evidence from the government’s race report regarding the ways in which structural racism have exacerbated Covid-19 outcomes among people of colour.

According to Sage research, some ethnic minorities who are hospitalised with the disease may experience poorer outcomes, including critical care admission and death.

The group also said there was some evidence to suggests ethnic minorities working in the same occupation as white ethnic groups experience greater Covid-19 risk. Difficulty in accessing personal protective equipment was posited as one reason for this in healthcare workers.

Dr Thirunavukarasu also noted that the report “repeatedly cherry picks” data, such as the fact that almost half of doctors are from an ethnic minority background, to fit its preferred conclusions on the state of diversity and racial equality in the NHS.

She highlighted how the review fails to take into consideration the lived experiences of many ethnic minority staff working within the healthcare system, who are more likely to be disciplined, more likely to be referred to their professional regulator and less likely to be shortlisted for jobs than their white counterparts, according to research.

The independent NHS Race and Health Observatory said last week that institutional racism exists both in the UK and within the NHS.

The group was set up in response to widespread concerns over the disproportionate impact of coronavirus on ethnic minorities.

Dr Thirunavukarasu expressed concern about how the findings of the government’s race report would be used to shape and drive healthcare policies in the years to come.

“The report is so worrying as it's such a high level report that can be used to form policy,” she said.

“It’s also concerning that people who don’t agree with the importance of structural racism throughout society could use this as evidence to back unwanted policies. There is a lot of work going on in this area and we need more acceptance of the issues at hand here.”