We must act now

As the initially censored Public Health England report makes clear, Covid-19 has exposed the lethal structures of systemic racism in our society. Artwork and text by Katherine Hearst.

‘We can’t breathe’ were the last words of Nadia Choucair, who lived on the 22nd floor of the Grenfell Tower. Much like George Floyd’s final gasps for help, the majority Black and Asian tenants’ concerns about the safety of the tower block fell on deaf ears.

In response to the Black Lives Matter (BLM) protests sparked by Floyd’s murder, Matt Hancock was quick to deflect their relevance to systemic racism in the UK, ‘I think, thankfully, this is all based in response to events in America rather than here.’

However, the protests coincided with the attempted censorship of a section of a government commissioned report by Public Health England (PHE) into disproportionate deaths of ethnic minorities from Covid-19, which cited systemic racism as the main predictor. When the latter was finally released it argued:

Differences in cultural factors may play a role in disease risk, but it is more likely that the decreases in life expectancy and health outcomes are due to social, economic, and structural determinants of health.

It concluded unequivocally, the government has a ‘legal and moral duty to act’. As one contributor put it:

We must act now – COVID-19 did not create inequalities, these have been with us for a long time, we don’t need more data or research to act. We must prevent any more harm being done. 

Covid-19 has traced a thread of violence and exclusion that runs through our institutions and services and exposed more insidious forms of state violence: the flammable cladding wrapped around Grenfell that incinerated the majority BAME residents of the tower block, the disproportionate numbers of workers from BAME backgrounds impoverished by zero hour contracts, hostile environment policies that have stripped many key workers of access to public funds.

Together, these present an incriminating vision of an economic system that relies on the expendability of Black and Brown bodies. The Labour Party leadership’s dismissal of BLM’s calls to move funding away from the police and into mental health services and youth work as ‘nonsense’ demonstrates a failure to recognise these connections. When the UK’s criminal justice budget outstrips the amount spent on primary education, housing, and social care, Starmer’s response betrays a basic misunderstanding of the conclusions of the structural systems of oppression outlined in the PHE report.

The report traces a stark connection between entrenched racial inequalities and material deprivation. ‘The fact that we can map death rates from Covid-19 on to almost all other negative societal outcomes is all the evidence we need to know the main problem is with structural racism,’ said Winston Morgan, a toxicologist and clinical biochemist at the University of East London.

The cluster of 34 deaths at the Church street estate in Brent, one of the most racially diverse boroughs in the country, is testament to this. A poverty commission set up by Brent council in February found that a third of employees in the borough earned below living wage, a third of households claim housing benefit and one in six are in fuel poverty.


The PHE report cites the concentration of BAME communities in poor quality housing as a major contributing factor, increasing ‘the risk of cardiovascular disease, respiratory disease, depression and anxiety, as well as lack of sleep and restricted physical activity.’ Additionally, overcrowding, which disproportionately affects BAME households, makes social distancing impossible. According to an English Housing Survey conducted between 2014-19, Bangladeshi families were 15 times more likely to experience overcrowding than white households.

‘If I was to have one takeaway so far, it is that the expenditure on housing is impoverishing the people of Brent,’ said Richard Best, who led the Brent Poverty Commission. The shortage of social housing in Brent means vulnerable renters will be at risk of homelessness with the lifting of the eviction ban in late August.

The Grenfell tower fire is the starkest recent example of how racial discrimination in housing allocation has fatal implications for black and brown tenants. Of the 72 victims, 34 were from ethnic minority backgrounds. The calls to include racial discrimination in the terms of the public inquiry highlight the role of structural racism which meant the concerns raised by the majority BAME tenants were ignored.

The report omits to mention air pollution as a factor in the disproportionate death toll in the BAME community. Rosamund Kissi-Deborah, World Health Organisation advocate for health and air quality whose daughter Ella died in 2013 from an asthma attack linked to toxic air described the omission as ‘astonishing‘:

…air pollution in itself is racism because, yet again, it disproportionately affects black people – Covid-19 has just made it more obvious.  

This oversight is particularly remiss in light of the debate about a ‘green recovery’ in the aftermath of the pandemic.


The PHE report cites inequalities in employment as another contributing factor: BAME workers are more likely to be employed on casual contracts in industries impacted by lockdown. According to the Race Inequality in the Workforce Report, workers from ethnic minority backgrounds are 47% more likely to be on zero hour contracts.

Redundancies are hitting casualised workers the hardest. The shock of coronavirus has unveiled an already precarious economy propped up on the expendability of workers on zero hour contracts- many of them from ethnic minorities.

The concentration of workers from BAME backgrounds in ‘front line’ jobs is also identified by PHE as a major contributor to the high mortality rate. It cites the health and care workforce as being significantly overrepresented by workers from BAME groups, constituting 40% of doctors, 20% of nurses, and 17% of social care workforce.

The ‘ethnic wage gap’ is reflected in the structure of the NHS workforce. A 2014 investigation into discrimination within the NHS revealed  a high concentration of workers from BAME backgrounds in the lower levels of the workforce, in contrast to the ‘snowy white peaks’ of management: ‘By every measure, London’s black and minority NHS staff fare less well than their white counterparts.’

The results of an ITV news survey outlined how the disparity between the ‘snowy white peaks’ and the majority BAME workers on the front lines of the crisis is responsible for their disproportionate death toll. The majority of respondents cited unfair deployment of BAME staff in front line roles: one respondent attested that ‘All BAME nurses [have been] allocated to red wards and my white colleagues [are] constantly in green wards.’

Hostile environment

Hostile environment policies have bred mistrust and confusion in BAME communities, deterring them from seeking timely medical care. Fears about data sharing with the home office and resultant deportations have obstructed healthcare access for many undocumented migrants. Doctors of the World reported:

Most of them are well informed about entitlements but it’s the fear that GP registration means they have to share their information and this could be sent to the Home Office. They are also often refused GP registration as they do not have ID or proof of address.

The Patients Not Passport report Migrants’ Access to Healthcare During the Coronavirus Crisis conducted by Medact, the New Economics Foundation, Migrants Organise found that digital exclusion and language barriers prevented an effective public health campaign.

The suppressed section of the PHE report traced the seemingly intangible connections that bind together structural inequalities in the UK. It has shown that this system has a body count: while it may kill more slowly and quietly than police brutality, it kills all the same. As Gary Younge put in the New Statesman:

In the slogan ‘I can’t breathe’ – among George Floyd’s last words as the police officer knelt on his neck – there is the connective tissue between the most brazen forms of state violence and the more banal tribulations of the ailing pandemic patient.

We need to resist calls from senior politicians to view the resurgence of Black Lives Matter protests as a ‘moment.’ We do that by identifying the connective tissue that links our homes, our jobs, our health, and the air we breathe.


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