‘Institutional racism’ led to lack of data on health inequalities pre-Covid

Institutional racism is to blame for a lack of funding to investigate ethnic disparities in healthcare in the decade before the pandemic, the Covid inquiry has heard.

That the UK had never collected any survey data specifically on older ethnic minority people was “particularly concerning”, said James Nazroo, professor of sociology at the University of Manchester.

The inquiry also heard how government decisions at the start of the pandemic “disregarded existing economic, social and health vulnerabilities experienced by ethnic minority groups”.

Government statistics have shown that Covid-19 mortality rates were higher for Black and South Asian people.

Nazroo, who was asked what material was available to the government at Covid’s outbreak, blamed “institutional racism in commissioning research” for a lack of information “that could be used to document the nature and patterning of ethnic inequalities in health”.

He told the inquiry that chronic underinvestment into ethnic inequalities had reduced government and decision makers’ ability to identify and manage pre-existing ethnic inequalities.

The last Health Survey for England to ‘oversample’ – a practice that allows researchers to study particular groups – people from ethnic minorities was in 2004. And funding for the Citizenship Survey for England and Wales – which over-sampled ethnic minority people and was once a key source of data – was scrapped by David Cameron’s government in 2011.

“So although there were reports, they were, at least by comparison to the post-pandemic position, fewer and further between, in part because of a lack of investment and funding,” said the lead counsel to the inquiry, Hugo Keith KC.

Keith did note that funding has become more available since the pandemic, explaining that it “has been provided by the National Institute for Health and Care Research (NIHR) and by government and therefore that in part is why there have been more surveys since the pandemic than there were before.”

The inquiry also heard that the government should have been more careful to take evidence of inequalities into account in its Covid responses.

An expert report for the Covid inquiry by Nazroo and his colleague professor Laia Bécares found there were “missed opportunities” by government and decision makers, who “disregarded existing economic, social and health vulnerabilities experienced by ethnic minority groups.”

Public Health England did publish a report in 2018 titled ‘Local action on health inequalities: Understanding and reducing ethnic inequalities and health’. Nazroo and Bécares said this paper “clearly stated the need to explicitly consider ethnicity within health inequalities work” and warned that “avoiding this could produce poor health outcomes and ineffective, or even harmful, interventions”.

Nazroo added that policy makers should have listened to the findings of the report to assess whether future engagement with ethnic minority communities may be negatively impacted.

“We highlight evidence on ethnic inequalities that should have been considered by decision-makers in their understanding of the unequal impacts of Covid-19 infection for ethnic minority groups, and of the unequal impacts of their interventions to control the pandemic,” his report read.