The race for recognition: lessons from the pandemic for race equality.
Every day, sombre announcements from NHS Trusts have told a story of service and sacrifice. How they mourned Dr Amged El-Hawrani in Burton and nurse Areema Nasreen in Walsall; how they remembered Dr Habib Zaidi in Southend and nurse John Alagos in Watford; how they cried for nurse Donna Campbell in Cardiff, Dr Muhanad Eltayib in Belfast, and porter Elbert Rico in Oxford. How grieving colleagues lined the street in St Helens outside the hospital to applaud the coffin of Dr Sadeq Elhoswh.
Over 150 health and social care staff have died during the pandemic. Over two-thirds of them have been from ethnic minority backgrounds, among them those whose families had come to this country from Pakistan and India, from Sudan and Egypt, from the Philippines.
And there is strong early evidence of a disproportionate coronavirus death rate among ethnic minority patients too. A Times analysis of the first 12,600 patients to die in hospital saw 6.4% of deaths among black people, compared to 3.2% of the population, and 8% of deaths among Asian people, who make up 7% of the population. There were 70 deaths per 100,000 people among those of black Caribbean ethnic origin, compared to a mortality rate of 23 deaths per 100,000 people among the white British.
Comparing death statistics to census statistics on the size of each minority group is too simplistic, however. Age matters too, given nine-tenths of deaths have been among the over-60s. A quarter of the white British are aged over 60, compared to 17% of black Caribbean residents, 12% of British Indians, and just 6% of those of Pakistani origin. If other things were equal, age demographics would be a reason to expect ethnic minorities to be less vulnerable but an Office of National Statistics analysis calculating age-standardised mortality rates sees disproportionate impacts on all minority groups.
The impacts on ethnic minority groups are unlikely to be even – and the reasons for differential impacts may differ significantly across different groups, as Lucinda Platt and Ross Warwick’s study for the Institute of Fiscal Studies emphasises.
The ethnic disparities will have complex causes. How deep-rooted social, economic and health inequalities interact; the composition and contribution of the NHS workforce and other public services; patterns of travel to work, of household formation and inter-generational contact; and brute bad luck from the geographic path that the pandemic took are all likely to contribute. Their relative weight will be a core question for the public health inquiry.
Why ethnic data matters
UK policymakers have been pushed to respond quickly to this emerging evidence. The British Medical Association has pushed for an inquiry into the pattern among NHS staff – and Public Health England has committed to investigate the public picture.
These are appropriate, important responses to what the data has shown – and they illustrate, too, the importance of having data to act upon. Yet only Britain and Ireland, among OECD members in western Europe, routinely collect ethnicity data, reflecting the outdated allergy across much of European public policy to ethnicity and race.
While race inequality enjoys relatively high salience among policymakers and politicians, civil society, academia and the media, this will not be universally acclaimed. In the darker corners of the internet, extreme groups seek to fan minority-blaming conspiracy theories, such as claiming Muslims have created the virus. Public communication about the causes and consequences of ethnic disparities should look for strategies that can delegitimise the efforts of extremists, without amplifying them with undue oxygen.
How to talk about race: avoiding the “them and us” trap
“So you clap for me now?” was the theme of a video poem about the contribution of migrant and ethnic minority workers to the NHS. Its author, Darren Smith, said it aimed to foster empathy and bridge divides. The film seemed a missed opportunity to do that. That was partly about tone of voice: the message appeared to be less “look what we can be at our best”, but a more resentful, “remember, when you clap, that you are worse than this”.
The aim of the film was consciously to subvert a “them and us” narrative but a broad public audience would not recognise themselves in this picture of resenting and fearing all migrants, before flipping overnight from blanket hostility to universal gratitude. Awareness of the ethnic minority and migrant contributions to the NHS has been reinforced in this crisis, not invented by it.
Online reactions were polarised. The already converted, celebrating the video’s viral potential, clashed with those who were angry and unpersuadable. Yet the film seemed to me to misfire not just for the audience it was ostensibly addressing, but to also miss the mark for perhaps a significant number of those of us it hoped to speak for as well. I found it jarring that the poem talked about “your food” and “propping up your hospitals”. Why not “our hospitals?”.
There is a persistent weakness in some pro-diversity arguments that are commonly used to try to counter “them and us” narratives which paint difference as a threat. However benignly intended, accounts of how migrants make a net fiscal contribution to the Exchequer and how cultural diversity makes the food better are “they are good for us” stories. That is still a “them and us” account. To transcend that, we need a broader story of the bigger “us” – about who we are and what we share.
From that perspective, the idea of society now owing a greater “national debt” to ethnic minorities may not prove an especially helpful frame. After all, Britain’s ethnic minorities certainly did not make any collective decision to make some kind of “blood sacrifice” to the common good.
So what we might “owe” ethnic minorities is simply a full and equal share of voice in our collective recognition of what this moment means, how we respond to it together, and what that means for a vision of a shared future. That would involve both symbolism and substance.
What next?
(1) Shape the coronavirus inquiry:
The urgent first step is to ensure that the initial inquiry into the causes and consequences of ethnic disparities is rapid, rigorous and practical. Attention has now shifted from hospitalised deaths to those in care homes too, but not yet to deaths at home, and in the community, which is where most excess deaths among ethnic minorities are taking place. The pandemic may be past its peak, but significant risks to health and life remain during the long tail of the months ahead. To talk only of deeper social inequalities may prove too fatalistic about interventions that could begin to stem disparities now.
So the Spring 2020 challenge for policymakers is to identify any responses in diagnosis, treatment and public communication which could help to mitigate the immediate risks without losing sight of longer-term structural causes.
Public Health England should seek to structure an inquiry process and outputs that avoids a sharp trade-off between those goals and timelines – so that immediate policy advice can broaden out to institutionalise a deeper, sustained commitment to addressing the broader social determinants of ethnic health inequalities that this pandemic has brought into sharp focus.
(2) Invent new rituals of remembrance
How should we mourn those who have been lost in this pandemic? Many people have lost relatives and friends without the usual rituals of saying goodbye. Local faith-based and secular services should be offered to those bereaved in strange times, perhaps drawing on the new models of local community group cooperation Dan Corry lays out in his essay. A significant moment of national mourning will be needed too, alongside the creation of new rituals in schools, hospitals and workplaces. To reflect on our losses, we need a shared moment about what we have been through together, and who we are today, to which ethnic minorities would be naturally integral.
(3) Embed race equality in the NHS
We often talk about the NHS as a symbol of migrant contribution. We should perhaps say more about how the NHS best champions what true integration really means in our multi-ethnic society, as those of every ethnic and faith background contribute to something that benefits us all.
Nationally and locally, NHS trusts should honour the staff lost in this crisis. The post-pandemic era will be an important moment for the NHS to recommit to acting on race equality. Ethnic minority NHS staff make up a fifth of the workforce – and 44% of the clinical staff. Scrutinising perceptions of equal opportunity and voice at every level should include setting out a road-map over this decade for how NHS leadership can fully reflect the NHS workforce’s diversity.
(4) Renew the race audit as an action plan
The story of race, opportunity and disadvantage in Britain has never been more complex. There are persistently stubborn traditional inequalities in crime and justice; unemployment, mental health and life expectancy. There is a fast-shifting pattern of outcomes in education and work, where ethnic minority Britons are now more likely to have a degree than the white British, yet still face ethnic penalties on entry to and progression in the workplace.
The debate about the future of work, as laid out in the essay by Andrew Pakes, will be much enriched by stronger data, given this ever-more complex story of progress and barriers – across gender, geography and between generations.
Yet this remains under-valued, on both the left and right of British politics.
The left often claims that it already knows what that evidence will show, lapsing into a fatalistic narrative that nothing much ever changes on race. There is more work to be done, but the cultural left can sound strangely determined to insist, against the evidence, that all of the energy it invested into anti-racism over the last half century has achieved little or nothing.
The British right is happier to celebrate signs of progress – but struggles to acknowledge when its vision of meritocracy requires further action to break down barriers. Without this it may struggle to bridge both the persistent ethnic vote gap and the increasing generational gulf in its own political support.
The evidence from the crisis confirms the importance of the Race Disparity Audit, a pioneering public policy initiative that has lacked a public story – or a forward agenda to act upon it. Before this pandemic, it risked becoming an abandoned orphan child of the Theresa May administration. Both major parties talk about “levelling up” but neither has yet fully taken on the task of showing how to integrate a practical policy agenda for fair chances and no unfair barriers, regardless of class, race, gender or hometown.
5) Race equality is not a matter for government alone
Britain’s public conversation on race can be remarkably narrow. It is curious how often it returns to focus on three issues on which there has been welcome progress – overt racism in football, ethnic minority representation in parliament, and now the ethnic minority contribution in the NHS – yet rarely looks more broadly beyond them.
Now is the time to ask more from other institutions. For instance, when will any newsroom in London be able to match the ethnic diversity of the House of Commons? No FTSE 100 company has ever yet appointed a British-born ethnic minority Chief Executive, yet we have had two Asian Chancellors in a row. 37% of FTSE100 companies still have all-white boards and leading charities are even further behind.
Beyond the pandemic, auditing the race for opportunity in this decade needs to stretch beyond government policy to the responsibilities within every sphere of economic, cultural and political power to demonstrate their practical commitment to fair chances for talent from every part of the increasingly multi-ethnic society we now are.