Covid19 – Why inclusion is a verb.

C19 ethnicityNorthwood in North West London, is in my opinion very beautiful, leafy, green and with an abundance of magnificent and very large detached houses, many on plots of upwards ½ an acre. It came to me on one of my early morning walks as I ventured past some of these houses, that we are genuinely not all in this covid19 situation together. Let’s be honest, surviving lockdown in a one bedroomed flat, in a tower block, as a single parent with 2 children under 5 is a very different proposition to being in lockdown and living in one of the houses I walked past in Northwood.

We are now well into the third week of lockdown and what is becoming clearer is that some people are more at risk of getting the virus than others and indeed some people are more likely to die. Sobering and very scary thoughts. The current evidence shows that older people and men are more likely to succumb to the virus and black and minority ethnic (BME) people are also at higher risk.

Last week was an extremely difficult week for many of us, we began to hear of the deaths of our medical, nursing and social care colleagues, horrible at the best of times, made worse by knowing they died because they contracted the virus. I was particularly struck by the deaths of some of our black and minority ethnic (BME) colleagues, at the end of last week we had lost 5 BME doctors and several nurses, a midwife and care worker, today less than a week later we have lost a total of 10 doctors from BME backgrounds. This is a shocking and unprecedented figure. My thoughts and condolences are with their families and all families that have lost loved ones.

Over the weekend, the intensive care national audit and research centre (ICNARC) published some data from critical care units participating in the Case Mix Programme (all NHS adult, general intensive care and combined intensive care/high dependency units in England, Wales and Northern Ireland, plus some specialist and non-NHS critical care units) The report contained data on all confirmed COVID-19 cases reported to ICNARC up to midday on 03 April 2020. I was astonished to read that even though BME people only make up approximately 13% of the total population in the UK 2011 census 35% had contracted the virus and had ended up in intensive care.

C19 ethnicity

I did what I always do when I am unsure and worried about what data pertaining to race actually means, I contacted my friend and world expert on health and race Dr David R. Williams of Harvard University and as always, David was willing to give up his precious time to talk to me about these truly troubling statistics.

He said that the data was not surprising and that in the US and UK the patterns were strikingly similar. He shared a lot of information, research and findings with me, which only served to confirm my fears. He said that people from BME backgrounds acquiring the virus, becoming sick and dying at a higher rate than their white counterparts was as a consequence of the lives that many BME people live.

The facts are that BME people globally are more likely to acquire diseases and when they do they are more likely to die from them. Numerous studies have been done to try to understand this phenomenon, the most well known of these is the work done by Arline Geronimous on Biological Weathering. In short, she describes that age not only captures the time you have been alive but the experiences you’ve had in that time. Bad experiences, for example being discriminated against and having to live in a hostile environment for long periods of time impact on an individual’s psychological and physiological health, meaning they are more compromised and likely to become ill and even die at a younger age than their white counterparts. What I found particularly fascinating about her work was the fact that class, wealth and fame do not insulate BME people from being weathered and that middle class, well paid, professional people, like many of our doctors were just as likely to experience the outcomes of being weathered as poorer people.

When I give talks on race equality I try to ensure my audience understand what the consequences of living in a society that doesn’t always consider your needs does to individuals from BME groups and how inclusive behaviour helps to mitigate some of the risks associated with exclusion like stress, depression, low self-esteem and a lack of confidence.

In the UK people from BME backgrounds are more likely to be in lower paid jobs, so called gig economy work, live in poorer housing and have less access to open spaces and healthy lifestyles, the social distancing that is required at this time can be problematic for people that live in multiple occupancy buildings with high numbers of people living together.

About a month ago Sir Michael Marmot published a report about Life expectancy in the UK he stated that many people that were in poverty would have shorter life expectancies, he went on say, Some ethnic groups face much higher rates of poverty than others, particularly those from Black, Bangladeshi and Pakistani backgrounds where rates of poverty after housing costs are taken into consideration are as high as 50 percent”.

Together the findings from Sir Michael Marmots report, Dr Williams work on race and health and Arline Geronious’ work on biological weathering, tell us something about why people from BME backgrounds are possibly more susceptible to Covid19.

This evidence gives lie to the statement that we are all in this together, we certainly are not. It would seem that even though the virus does not discriminate, our Prime Minister, Matt Hancock and Prince Charles are testament to that, as consequence of the pervasiveness of discrimination across the globe, with some groups being ‘othered’ for centuries, their ability to respond strongly to a crisis such as the one we are currently going through is severely compromised.

Thankfully, the issue is beginning to be highlighted and discussed by people across the country and an article was written about it in The Guardian newspaper further illustrated and highlighted the situation. Inequality and particularly health inequality is an important issue and for those of us from BME backgrounds, a life or death one.

Covid19 highlights the importance of inclusion and compassion in our country. Many people that are on the front line are from BME backgrounds, doctors, nurses, bus drivers, cleaners, shop assistants, these people are in essential jobs and play key roles in keeping the country going. It is true that they are being valued and appreciated for their contributions to society at this time. However, we should value, respect and appreciate the contributions of these people in good times as well as bad. During this unprecedented time, it is an opportunity for all of us to reflect on what is of value and what is not. We should consider that everyone regardless of background deserves the opportunity to thrive, not just survive. I am told that I am unrealistic, idealistic even and the world which I describe and aspire to couldn’t exist and is called utopia, well maybe, but I believe the consequences of the health and social inequalities that human beings have created across the globe can be seen glaringly and most obviously during times of crisis like this and they are much too serious, damaging and devastating for us all to ignore for a minute longer.

For all the fallen heroes and heroines of the NHS that have given their lives in service of other people and the country. Forever in our memories.

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