On Friday, 26 June, rs21 East London held an online meeting to explore the relationship between state racism and the healthcare system during the COVID-19 crisis. Rose Whitehorn writes about some of the key issues discussed.
In light of the recent murder of George Floyd, by a group of Minneapolis police officers in the US and the subsequent reinvigoration of the global Black Lives Matter movement, the fact that black people and people of other ethnic minorities are dying at a higher rate from COVID-19 affirms the need for action in tackling racial inequalities. For example, official reports show that people from BAME groups are twice as likely to contract COVID-19 and up to four times more likely to die from the disease, compared to the white population in the UK. However, this issue and the causes behind these deaths are not getting adequate attention from the government. We have seen many articles in the media trying to make links between these deaths and biological factors or congenital anomalies. These views are scientifically unfounded. Many people would like to paint this as coincidental or push the blame back onto the BAME community based on racialised perceptions and biases about their behaviour and lifestyle choices, rather than recognizing the true reasons behind these deaths. All the evidence shows that this is a systemic racist issue and that racial inequality is an insidious problem throughout society, which continues to grow under the current government.
To explore these issues, we were joined by M.G., a doctor, health campaigner and activist with the Sudanese Doctor’s Union, and S.W., a junior doctor and activist with Docs Not Cops, a group that campaigns against immigration controls in the NHS. Both speakers offered significant insight on this topic, touching on a broad range of themes.
The inequities that we see today amongst BAME communities are fundamentally shaped by the legacy of colonialism, racism and capitalism. People from BAME groups are disproportionately more likely to be on a low income, which can shape all aspects of an individual’s life including housing insecurity, food poverty and health. Each of these factors has a knock-on effect; economic disparities often lead to health problems, with wealthy people living longer and healthier lives, while poor people tend to have health that degrades more rapidly. As our speaker, S.W. said it is important to note that ‘COVID-19 did not create the inequality but rather, it did expose and exacerbate it’. This problem has been accelerated by the fact that millions of people in the UK have lost their jobs and income altogether due to the COVID-19 pandemic, increasing financial vulnerability and inequality.
In addition, the housing challenges faced by members of BAME groups have served to increase the risks of spreading COVID-19. Poor housing conditions and homelessness have a detrimental impact on health, with a direct effect on cardiovascular and respiratory diseases. Combined with COVID-19, these pre-existing conditions create a higher risk of death. Many people on low incomes in the BAME community live in overcrowded conditions, which has made it difficult for individuals to self-isolate during lockdown.
BAME people make up a disproportionately large share of key worker roles in the UK, including roles in the health services, food and retail, care work, sanitation and public transport. These key worker roles are deemed most necessary to the continued functioning of society during the lockdown. As a result, they hold the highest risk of COVID-19 exposure. Despite this, they are some of the most poorly paid jobs in the country. It should also be noted that many BAME key workers have no choice but to use public transport in travelling to their jobs, leading to additional risks of contracting COVID-19. The death of rail worker Belly Mujinga on the 5 April 2020 from COVID-19, highlights the need for further protection for key workers. Her contraction of the disease was linked to a brutal and cruel racist attack when she was spat at by a 57-year-old white male whilst working at Victoria train station. Though there is no certain evidence that she contracted COVID-19 from the attack, there is no doubt that risks involved in her role may have increased her chances of falling ill. Stemming from this, key workers have been demanding sufficient PPE and testing since the beginning of the lockdown, yet levels of PPE have been wholly inadequate throughout the pandemic.
Decades of funding cuts to the NHS and local authorities have also increased structural issues and limited access to health care in vulnerable and low-income areas, putting BAME communities at greater risk and leading to fears that support systems will be overwhelmed and unable to cope after the pandemic.
The hostile environment
There is no doubt that the hostile environment originally created by the Immigration Act 2014 — which was later tightened and expanded under the Immigration Act 2016 — has had a devastating impact on migrants living the UK. We can see this in regards to their treatment in the NHS and beyond, leading to fatal consequences for many migrants during the COVID-19 pandemic. The hostile environment includes measures to limit access to work, housing, health care, bank accounts and more. Healthcare providers are effectively required to act as border guards in their role, resulting in migrants either being denied medical care or being forced to pay huge charges for access to healthcare. On the 25 March, Boris Johnson promised that charges for migrants would be stopped and that asylum seekers would receive the funding that they need during this pandemic, however there has been no evidence of this and an article in The Guardian revealed that that NHS charges for migrants are still happening. There have also been accounts of non-British key workers, who work within the NHS, having to pay for access to healthcare. This hostile environment not only stops and delays migrants from receiving the necessary treatment but also deters them from seeking medical attention for fear of being charged or even detained, which has likely contributed to the spread and mortality rate of COVID-19 within the BAME community. Healthcare workers are organising through such groups as Docs Not Cops and Medact to actively fight against the hostile environment in the NHS. Their joint campaign, ‘Patients Not Passports’, is calling for an end to the charges and an end to patient immigration policing.
Thousands of migrants and asylum seekers are still imprisoned in detention centres across the UK, in overcrowded and inhumane conditions. This poses a serious threat to their safety during the COVID-19 pandemic. The organisation ‘Detention Action’ has taken the government to court over their failure to safeguard those held in immigration removal centres from COVID-19, they are also calling for the immediate release of all those still detained.
Even if not detained, asylum seekers have been left extremely financially vulnerable by the government. People in this group are 74% below the poverty line, as a result of work restrictions from working and only receiving £5.66 a day. This amount is not enough to survive on, with many people having to choose between basic necessities such as food or medicine, let alone allow them to afford face masks or sanitation products as protection from COVID-19.
The UK Home Office is so adamant in pursuing its own vicious policies and goals that it shows a complete disregard for the human lives that are at stake.
Many black people and other people of colour have described having negative experiences with health care providers, where they felt racially discriminated against. Many BAME people have voiced concerns that they often do not feel listened to or believed in medical environments and as a result, do not receive the best care. Many also feel that they have to push their case much harder, in order to be taken seriously. Reports have found evidence that stereotyping and biases on the part of healthcare providers can all contribute to unequal treatment, which supports these claims. It is possible that white clinicians who don’t believe they are racist might typically demonstrate unconscious implicit negative racial bias and stereotypes. We can see evidence of this racial bias not just in relation to the COVID-19 pandemic but across all areas of medicine. A recent enquiry into maternal deaths found that black women are 5 times more likely to die in childbirth than white women. This problem is nothing new but black people are now receiving the data that confirm what they already knew. Due to this unfair treatment, it is highly probable that members of the BAME community are less likely to seek help when they are ill, possibly contributing to the higher number of COVID-19 deaths.
S.W. brought up the point that medicine, like many other professions, is affected by the class system, which means it is easily susceptible to the same hierarchies of race and power. The profession has been dominated by white men for a long time; most BAME healthcare workers are usually in lower-paid junior positions or A&E roles, which are usually public-facing. There has been some speculation that BAME health workers have unwittingly been assigned to more dangerous tasks, due to the unconscious (or conscious) racial bias of superiors. M.G. confirmed that it is harder to get into a higher paid role as a POC, especially if you are an immigrant and do not hold a British degree, since some foreign degrees are not regarded in the same esteem even if they are just as thorough. For these reasons, BAME health workers have reported that they feel afraid to speak out about inadequate PPE or risks to health, since they feel it might affect them adversely in their professional lives, which significantly increase the risk of these workers contracting COVID-19.
When discussing racism of the state in relation to the medical world it would be short-sighted to not mention the history of racialised scientism and eugenics. Both have had a lasting and detrimental effect on society and the problems of racism that we see today. Race categorization was a system created by colonial scientists and leaders in the 17th century during the rise of the transatlantic slave-trade in order to justify the horrific and violent atrocities inflicted upon the people of Africa and other areas of the world that were colonised by the British. It was noted by S.W. that genomic and genetic research receives the majority of funding for medical research. This is partially why we should be very wary of any public figure or media outlet trying to make links between the BAME COVID-19 deaths and genetic variation. There has been no such scientific evidence that proves this link. The general public are conditioned to search for singular biological reasons rather than looking at the web of inequalities and disparities between races and classes. Blind reverence for science, in this particular situation, obscures real social problems. One member questioned if this occurrence might have had an ‘othering’ effect, causing white people to feel a false sense of safety, as they might feel they are not at as high a risk of contracting or dying from the disease. This could lead to some white people to be less vigilant with the lockdown rules, which in turn could cause further spread of COVID-19.
Policing and fines
Since the lockdown started in the UK on the 23 March, there has been a heavy police presence in public areas, with fines issued to those deemed to be breaking the social distancing rules. However, the guidelines were vaguely applied, with police often accosting households of people who had ventured outside together as breaking rules around social distancing. Moreover, these fines were much more likely to affect working-class people from low-income areas, since they are likely to live in overcrowded housing, often without access to a garden. Reports have shown that the police are two times more likely to issue fines to BAME people, and tend to arrest a disproportionate number of BAME people compared to the UK’s white population. There is speculation that the police are specifically targeting BAME people; it is well known that BAME communities and low-income areas are usually more heavily policed. This is reminiscent of the racist stop and search policy that has also specifically targeted BAME communities and resulted in disproportionate numbers of BAME people being imprisoned for minor offences. Our speaker, M.G., pointed out that these policies only work to further entrench inequalities and create lasting damage in people’s lives.
Moving forward and solidarity
We have the reports and evidence to show that systemic racism is occurring, but these will not create change in and of itself. How can we turn this information into anti-racist action to fight state violence against the BAME community? We must demand change. We need to put pressure on unions and the government for safeguarding in every form, be it access to healthcare for all, adequate PPE, fair pay, access to food, safe affordable housing and an end to the hostile environment. The ‘Patients Not Passports’ campaign is making great headway in the fight to scrap the NHS charges for migrants and is open for anyone to get involved; one member pointed out the crossover with other oppressed groups, such as the working class, the transgender community, people with disabilities and the elderly, all of whom have also faced discrimination in the health system both during and outside of the COVID-19 pandemic. We should not lose sight of marginalized groups. A third of all of the UK’s deaths from COVID-19 have taken place in care homes, where there has been a serious lack of adequate PPE. We should never forget that many elderly and disabled people were pressured into signing DNR forms by their healthcare providers back in May, when the government suddenly panicked over the number of hospital beds available in the NHS, literally signing away their lives and chances of living if they contracted COVID-19. There is an opportunity for true solidarity and to build unity between these groups. If we are going to have any chance at ending this systemic inequality and state racism, then we must do so together, as a collective front.