8. Race, ethnicity, and the social determinants of health

The beginning of this section comes from: Coronavirus and the ‘social determinants’ of health inequalities: lessons from ‘Health in All Policies’ initiatives

A ‘social determinants’ focus shows that the most profound impacts on population health can come from (a) environments largely outside of an individual’s control (e.g. in relation to threats from others, such as pollution or violence), (b) access to high quality education and employment, and (c) economic inequality, influencing access to warm and safe housing, high quality water and nutrition, choices on transport, and access to safe and healthy environments.

In that context, the coronavirus also provides stark examples of major inequalities in relation to self-isolation and social distancing: some people have access to food, private spaces to self-isolate, and open places to exercise away from others; many people have insufficient access to food, no private space, and few places to go outside.

Corburn et al’s (2014) study of Richmond, California’s, focusing on ‘coproducing health equity in all policies’ highlights the strong connection between health and income and wealth, which differs markedly according to race and immigration status. It reports on a series of community discussions to identify key obstacles to health:

“emerging from the workshops and health equity discussions was that one of the underlying causes of the multiple stressors experienced in Richmond was structural racism. By structural racism we meant that seemingly neutral policies and practices can function in racist ways by disempowering communities of color and perpetuating unequal historic conditions” (2014: 627-8).

In the UK, there has been some political attention devoted on the impact of coronavirus according to race and ethnicity, albeit generally described with the problematic catch-all term BAME (Black, Asian, and minority ethnic) to refer to all non-white populations.

Most notably, the PHE report Disparities in the risk and outcomes of COVID-19 highlights the unequal impact of coronavirus, with an action plan delayed, but expected to follow.

This inequality is discussed somewhat in committee proceedings, including in relation to:

• Walton (1.5.20: q3) on concerns for BAME pregnant women and NHS staff
• Owen (5.5.20: q424) on the social determinants of health inequalities
• Owen (14.5.20: q95, q100) on the poor fit of PPE for women and BAME women
• Owatemi (14.5.20: q99):

‘In a survey of over 2,000 BAME NHS staff, 50% stated that there was a culture of discrimination within the NHS. They felt that they were unable to speak up due to the lack of BAME representation in leadership roles. Currently, only 6% of NHS leadership positions are BAME staff’

"Beyond the data" The government has now published the 70 page literature review and community engagement exercise that was part of the Public Health England review of ethnic disparities, a fortnight after publishing the first part of the reporthttps://t.co/mHeaDqKxcs

— Sunder Katwala (@sundersays) June 16, 2020

COVID-19 policy in the UK: oral evidence to the Health and Social Care Committee (5th March- 3rd June 2020)

1. The need to ramp up testing (for many purposes)
2. The inadequate supply of personal protective equipment (PPE)
3. Defining the policy problem: ‘herd immunity’, long term management, and the containability of COVID-19
4. Uncertainty and hesitancy during initial UK coronavirus responses
5. Confusion about the language of intervention and stages of intervention
6. The relationship between science, science advice, and policy
7. Lower profile changes to policy and practice
8. Race, ethnicity, and the social determinants of health