Intended for healthcare professionals

Opinion

As prime minister, Boris Johnson did not do enough to tackle racial inequalities

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1981 (Published 09 August 2022) Cite this as: BMJ 2022;378:o1981
  1. Zubaida Haque, member of Independent SAGE, former executive director of The Equality Trust
  1. Twitter @zubhaque

As Boris Johnson prepares to leave office, Zubaida Haque discusses why he failed to tackle racial inequalities during covid-19

Even before Boris Johnson became prime minister in July 2019, Black and ethnic minority ethnicity was a key factor in determining poorer life outcomes in Britain. The Windrush Lessons Learned Review concluded starkly that the UK government’s treatment of the Windrush generation, and its approach to immigration and citizenship more broadly, was caused by institutional failures to understand racial inequality and racism.1

But the covid-19 pandemic forcefully brought home the realisation that race isn’t just a risk factor in the UK and the US; it is the difference between life and death. The first 10 named doctors in the UK who died with covid-19 were all from Black and ethnic minority backgrounds; three out of the first six nurses to die with the virus were also from ethnic minority groups.2

Almost every trusted data source in the UK—Intensive Care National Audit and Research Centre, Office for National Statistics, Institute for Fiscal Studies, Public Health England among others—found that Black and ethnic minority people were over-represented in critical care hospital admissions and deaths compared with what we would have expected if the illness affected everyone in the same way.3 There was some variation with risks for different groups over time, but worryingly the higher death rates for some ethnic minority groups from covid-19 have persisted throughout the pandemic.4

The pandemic also amplified intersectional racial inequalities for some ethnic minority groups. A study in The BMJ in 2020 found that more than half of pregnant women admitted to hospital with covid-19 across the UK (between 1 March and 14 April) were from ethnic minority backgrounds.5 Black women were at particularly high risk, which was alarming given that pre-existing racial inequalities already showed that Black women were five times more likely to die in childbirth compared with White women in Britain.6

Researchers from race equality thinktanks and women’s third sector organisations found that Black and ethnic minority men and women were not just affected adversely, and disproportionately, by the pandemic in terms of health; they were also taking the brunt in terms of job losses, fewer hours of work, and pay cuts.78

It was therefore abundantly clear that Boris Johnson and his government needed to take action on several fronts to avoid widening racial inequalities. But, much like his approach to the pandemic, opportunities to address racial inequalities and systemic discrimination were squandered time and time again.

Following substantial public pressure, the government asked Public Health England to conduct a review into inequalities in covid-19 risks and outcomes.9 However, instead of a robust review addressing the causes of inequality of covid-19 outcomes (such as the experience of racism, discrimination, stigma, fear, and trust among Black and ethnic minority communities), the review was dogged with controversy about inappropriate appointments, superficial analysis confirming what we already knew, conflating racial inequality with other inequalities and “explaining away” systemic racial discrimination.10 Worse, recommendations to protect Black and ethnic minority communities from the pandemic were completely absent.

The prime minister undermined trust in the entire review by adding that his goal was to end “the sense of victimisation” among Black and ethnic minority communities and to “change the narrative” by focusing on the story of success among ethnic minority communities.11 More than two years into the pandemic, the tragedy is not just that Boris Johnson failed to address racial and socio-economic inequalities in the pandemic, but, by this failure, he has actually widened those inequalities. Before the pandemic, racial inequalities were stark, but at least overall mortality among ethnic minority groups was lower than that of White British and mixed groups. The latest Office for National Statistics analysis by ethnicity on deaths with coronavirus shows that this pattern has reversed for some ethnic minority groups.4

What is hard to come to terms with is that a large number of covid-19 deaths among Black and ethnic minority groups were avoidable given the overwhelming evidence of risks. These included lack of personal protective equipment for low paid frontline workers; inadequate financial support and separate accommodation for self isolation, and low uptake of vaccines in ethnic groups with the highest risk of severe illness. In each wave of the pandemic Boris Johnson took little action to mitigate the risks for Black and ethnic minority communities and other vulnerable groups. Even when there was recognition about the importance of a third vaccine dose in the face of the omicron variant, there was insufficient action, let alone a comprehensive national campaign to encourage or prioritise vaccine uptake among ethnic groups with the highest risks.

It is a tragedy that Boris Johnson was the prime minister overseeing an unprecedented public health crisis. Instead of leading a government that protected all groups with higher coronavirus risks, Johnson led a government that denied and obfuscated racial inequalities at every turn. His actions, or lack of actions, reinforced the devastating message that race wasn’t just a risk factor for Black and ethnic minority people; it was a matter of life and death.

Footnotes

  • Zubaida Haque is writing in the capacity as a member of Independent SAGE. She is former executive director of The Equality Trust

  • Provenance and peer review: Not commissioned, not peer reviewed.

References

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