5 Years on: COVID-19's Impact on Ethnic Minorities, from Crisis to Change

The long memorial wall skirting the south bank of the River Thames, decorated with over 240,000 hand-painted red hearts commemorating lives lost during the COVID-19 pandemic, was a poignant backdrop to Sunday 9th of March’s five-year national Day of Reflection.

The virus's widespread impact expanded beyond mortality. COVID-19 was devastating to the populations’ health and well-being, with severe infections leading to hospitalisations and death, while some survivors continue to experience multiple facets of long COVID.

These impacts were inconsistent across the UK, both socio-economically and ethnically.  Those from ethnic minority backgrounds in the UK faced higher infection, hospitalisation and death rates, with the risk of severe illness exacerbated by pre-existing conditions. Individual risks were compounded by endemic structural and historical inequities, with multiple social determinants of health impacting exposure to the virus and its knock-on effects.

• • Increased exposure arose partly from the greater presence of ethnic minorities in “essential jobs” (healthcare, transportation and food supplies), who had less ability to work from home—and which many middle-class families benefited from—from crowded living conditions in multi-generational households that made social distancing difficult, and increased likelihood of living in urban rather than rural areas. 

  • A greater predisposition to the risk of severe illness from pre-existing conditions (diabetes, hypertension and obesity) compared to those from White communities.

  • Vaccine hesitancy, resulting from past negative experiences of statutory services, including the police, education, social care and healthcare services, resulting in lower uptake of vaccines. 

  • The secondary impact of COVID-19, for example, on school closures, affected ethnic minority children disproportionately for those with less access to digital learning resources. 

In short, beyond the disproportionate health impact of the disease, COVID-19 not only exposed ethnic-based inequities in British society, it compounded them.

What lessons do we take away from the COVID-19 experience for ethnic minority populations?

1. Health equity: Improving healthcare access, investing in appropriate preventive care services that target the disenfranchised (regular healthcare check-ups) is needed.

2. Building trust: Health equity can only be achieved by building trust in the healthcare system through culturally competent care and, critically, engaging meaningfully with communities at the local level and in creative ways over the long term (e.g., using health roadshows in known community settings, or mobile clinics).

There was a perception amongst some ethnic minority groups that services where only interested in vaccine hesitancy in minority communities because of the infectious impact COVID-19 had on the White community. In contrast, diseases that primarily impact the Black community (such as Sickle Cell Disease) continue to receive low levels of investment compared to similar diseases primarily impacting the White UK community.

Healthcare services at a senior level need to look like, sound like and understand the communities they serve more. In urban areas, it is not uncommon for healthcare services to have 50% or more ethnic minority staff, but they are generally at the lower levels of the pay structure.  The situation is even more stark if you remove medical doctors from the equation, given this profession is well represented particularly by the South Asian community.

3. Strengthening communities: Grassroots organisations were key during the pandemic in supporting ethnic communities with food, health resources and vaccine outreach.  Money should be invested in these Third Sector agencies, which are much more lithe, adaptive and responsive than statutory services and are more widely accessible. The hyperlocal approach adopted in the pandemic in many areas, aimed at reducing vaccine hesitancy, needs to be maintained and developed further to engage communities in public health programmes, generally.

4. Engaging in advocacy: Advocacy networks should push for policy changes that address ethnic disparities in healthcare, education and employment at the local level.

5. Working with trusted community leaders: Working with such leaders to disseminate and promote reliable health information.

6. Addressing social discrimination: Strong anti-racism policies and awareness are needed.  This could be incorporated into education and public health systems to tackle racism systematically and holistically.

7. Preparing for the future: More money should be invested in community-based healthcare centres and mental health services.  At the national level, there should be increased representation of ethnic minority populations in policymaking to ensure voices are heard and can shape future responses to health crises.

Five years after the first wave of COVID-19 spread across the UK, it is easy to forget the devastating short- and longer-term impact.  Equally, it is easy to forget the virus’s disproportionate impact on those from ethnic minority backgrounds at the individual and societal levels.  These impacts were exacerbated by known structural inequalities within British society.  

We must seek changes to address these inequalities and collectively create a more equitable society.