When the media have gone large on the conclusions of an overpoweringly tedious report, one of the biggest favours a columnist can do for a readership is to read the source. Friends, you owe me. I will expect flowers and chocolate. For I have located Public Health England’s ‘Beyond the Data: Understanding the impact of Covid-19 on BAME communities’ and ploughed through the whole bloody thing.
This is the report that produced headlines like the Guardian’s ‘Historical racism may be behind England’s higher BAME Covid-19 rate’. Channel 4 News hit the same black-and-brown-patients-are-dying-of-racism note, which conveniently chimes with the current hair-shirtery of Black Lives Matter. A bit too conveniently, I thought, which is why I tortured myself.
You’ll not be surprised that the report is numbingly redundant, with the same paragraphs cut and pasted multiple times throughout the document. You’ll not be surprised that the text is strewn with opaque jargon like ‘culturally competent’. You’ll not be surprised that I was bored witless.
Yet you may be surprised that this earth-shattering revelation of how ‘historical racism’ explains the disparity between white and non-white deaths from coronavirus is not supported by an iota of research. It is scientifically worthless. ‘Beyond the Data’ might better have been titled ‘Without the Data’.
The document that ruined my day comprises two tranches of information. Although PHE did none of its own homework, it did scrounge a fair bit of other people’s, assembling the results of several hospital studies in the UK and US. As the report concedes, the quality of these studies is ‘very low’, their conclusions inconsistent. Yet it’s not our purpose here to challenge the deduction that Covid death rates are higher among non-whites. What matters is why.
Other than collect available statistics, PHE essentially gathered a giant online focus group and invited participants to complain. Via platforms like Zoom, some 4,000 largely black and Asian Britons vented their hearts out. Recapitulation of their beefs constitutes the vast majority of this report. While few would contest that British minorities have legitimate gripes, this notion that higher Covid death rates are due to racism is merely a grassroots opinion. It’s what many of PHE’s ethnic minority ‘stakeholders’ want to believe. So the report’s verdict is merely an expression of kneejerk bias, with no basis in science. Indeed, the report itself attests: ‘No work was done to review the evidence base behind stakeholders’ comments.’
Being subject to ‘historical racism’ is medically meaningless. If one were to posit, as some have, that encounters with bigotry induce higher levels of stress hormones, which in turn might make patients more susceptible to Covid-19, we might like to see some clinical confirmation of that premise. Presumably, therefore, people of any race in high-stress professions — police, fire fighters, airline pilots — would also be more prone to dying from this disease. Is this the case? Let’s see some numbers.
Even the ‘income inequality’ PHE pinpoints would have to be broken down into medical factors that could influence ability to fight viral infection or it’s meaningless. After all, non-white NHS consultants have also been disproportionately felled by Covid, and these well-remunerated doctors would only have suffered ‘income inequality’ because their earnings are unusually high.
In the US, it’s credible that minorities on average are likely to have less access to good, affordable health care — if only because in the US there’s no such thing as affordable health care. Given the vaunted ‘free at the point of use’ NHS, one can’t argue that British minorities have poor access to health care, aside from in the present moment, when none of us have access to health care. Although ‘saved’, with a backlog of ten million cases, the NHS is still a train wreck.
While we’re at it, our ‘stakeholders’ are convinced that the NHS is a cesspit of prejudice, and the same staff (many themselves non-white) whom compatriots applauded every Thursday at 8 p.m. for months have been deliberately murdering black and Asian patients out of racial hatred. Hmm. Which is it: object of national worship, or institutional knuckle-dragger that needs to be ‘defunded’? I don’t think you can have it both ways.
If music to the ears of the oppressed, PHE’s pandering to ideological fashion is not in the interest of ethnic minorities’ health. Lazy finger-pointing at terrible racist Britain doesn’t help discover the underlying biological differences between ethnicities that make this pandemic more lethal for some than others.
Theories abound. Darker-skinned peoples absorb less vitamin D, deficiency in which correlates with severe reactions to the virus. Blood type A may also make one susceptible. Any epidemic spreads more quickly in high-density environments, and British minorities are concentrated in cities, while low incomes lead to domestic overcrowding. Asians’ frequently multi-generational households easily communicate infection to the at-risk elderly. Service occupations with high exposure to the public like bus and taxi driving could increase viral load. Perhaps some undiscovered genetic component could be in play.
Yet the most plausible explanation is comorbidities. Chronic underlying health conditions reduce one’s chances with this bug, especially diabetes, hypertension and cardiovascular disease, all common consequences of obesity. Much media coverage of this report scrupulously avoided the O-word, now cloaked coyly by the expression ‘health inequality’. ‘Beyond the Data’ didn’t examine the weight variable either, admitting that ‘when comorbidities are included, the difference in risk of death between ethnic groups among hospitalised patients is greatly reduced’. Exploring the puzzle of why certain western minorities run to fat would require another column.
As for ethnic variation in Covid fatalities, the answer to ‘why?’ remains ‘we don’t know’. Blaming ‘historical racism’ only discourages systematic medical research that might not obligingly generate more slogans for protest placards.
Lastly: isn’t it interesting nobody seems to give a toss that this virus is so much deadlier for men? Deadlier still for bald men. Let’s see PHE report on that conundrum, eh? Maybe the problem is hair-ism.
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