Racialized Class Inequality is a Death Sentence: An Analysis of the COVID-19 Pandemic in the UK

The COVID-19 era has laid bare the extent of racial inequality in the UK. From diagnosis rates to death rates, it is non-white sections of the population that are most likely to be affected. Illustrating this is the fact that, despite forming just 14% of the UK population, non-white ethnic groups have accounted for around a third of all Intensive Care Unit (ICU) admissions.^[1]  Although the exact nature of the situation will become clearer as more data becomes available, the overarching role played by social exclusion is already plain to see. Non-white groups are left dangerously exposed to the pandemic by deeply-ingrained, longstanding inequalities.

Overcrowded Housing

The question of overcrowded housing is demonstrative. Even after controlling for region of residence, non-white groups are statistically more likely to live in overcrowded accommodation than the white British majority. Taking the Bangladeshi ethnic group as an example, just short of 30% of households have more residents than rooms. For white British households, this figure stands at just 2%.

Living in overcrowded accommodation maximises the chances of COVID-19 transmission and makes adhering to self-isolation guidelines essentially impossible. In certain ethnic groups, high rates of overcrowding can be explained in part by the cultural tradition of multigenerational households, yet the issue can be seen more broadly as a manifestation of poverty and low income. As the UK poverty rate for non-white groups is twice that of white groups, racialized class inequality is to blame for increased levels of exposure to the virus.

Overcrowding can also lead to health problems such as respiratory disease and depression, both of which have been mentioned as factors increasing the risk of contacting COVID-19.^[2] Overcrowding therefore not only increases the risk of COVID-19 transmission, but causes some of the illnesses thought to worsen the impact of the virus.

Health

With non-white groups experiencing high rates of poverty, and with poverty known to cause ill-health, it is unsurprising that certain non-white groups suffer disproportionately from other underlying health conditions deemed ‘high risk’ in conjunction with COVID-19 as well.

Black and south Asian groups, for example, have been found to have much higher rates of diabetes than the population as a whole, a disease that leaves a person ‘clinically vulnerable’ to COVID-19.^[3] In addition, older Pakistani men have been found to have particularly high levels of cardiovascular disease (CVD), a set of disorders described by Public Health England^[4] as ‘key risk factors for poor outcomes’.

Just as respiratory disease and depression are linked to living in overcrowded accommodation, diabetes and CVD are linked to other manifestations of poverty. Honing in specifically on diabetes, this year’s Marmot Report found the disease to be closely associated with both Adverse Childhood Experiences (ACEs) and food insecurity.^[2] With regard to CVD, the same report discusses its intrinsic link with food poverty and poor housing conditions.

Taking this into account, the high incidences of these conditions within non-white groups is no coincidence. Rather, it is a direct consequence of systemic and far-reaching social inequality. To make matters worse, vital healthcare is often out of reach. Historic racism, including past experiences of poor care and treatment at health care institutions have been found to dissuade non-white groups from seeking much-needed medical assistance.^[4]

Occupational Risks

A person’s occupation has a major bearing on their level of exposure to COVID-19. Those employed in dangerous “key worker” roles have no other choice than to risk coming into close contact with the virus, increasing their chances of infection.

A number of non-white ethnic groups are over-represented within these “essential worker” roles. Taking the black African group as an example, almost a third of the working-age population are employed as “essential workers”, with approximately one fifth employed in health and social care specifically.^[3] These statistics have likely contributed towards the high diagnosis rates within this group.

Low-paid roles tend to be dangerous, and low pay is far more commonplace within non-white groups.The three-way intersection of race, pay bracket and occupational exposure is a plausible explanation for the disproportionate numbers of non-white deaths within the NHS workforce. Despite only 20% of NHS nurses coming from a non-white background, they have accounted for 64% of all deaths within this staff group.

Similarly, non-white individuals account for 44% of NHS medical staff, yet have accounted for a staggering 95% of all medical staff deaths.  Given that these roles are high-risk by their very nature, the disparity likely stems from high concentrations of non-white workers in low-paid roles that necessitate coming into close contact with the virus. Systemic racialized class inequality once again presents itself as the overarching cause of why those outside the white majority are at an increased risk of being adversely affected.

Certain observers have attempted to attribute these ethnic disparities to genetic differences, however there is no scientific basis upon which to make this lazy and racist case.  Instead, the situation must be seen as rooted firmly in the racial inequality that pervades so many aspects of life in the UK. From housing to healthcare to employment, those outside dominant whiteness are left behind. And now, they are directly exposed to the worst public health crisis that has been seen in peacetime.