Covid-19 and ethnic minority communities—we need better data to protect marginalised groups

A recent ONS report on religious groups has shown that Muslims have the highest age standardised mortality rate. The disproportionate impact of covid-19 on ethnic minority communities in the UK is also well documented. There are various complex reasons for the disproportionate risk, which is also affecting older people and populations living in more deprived areas. A number of factors have been explored such as social deprivation and underlying health issues. However, some ethnic minority communities are still inexplicably faced with greater odds of dying from covid-19. Within the Asian community it has been observed that Muslim-majority ethnic groups such as Pakistani and Bangladeshi communities are more likely to die than those from Indian ethnic backgrounds. Multiple other Muslim-majority ethnic communities have reported similar concerns. The ONS report noted the close correlation between religion, ethnicity, and social deprivation

Religious identity is particularly significant for minority populations, and this intersects with their diasporic ethno-cultural identities. The values and customs of faith communities promote health behaviours and beliefs linked with a range of positive health outcomes and sense of wellbeing. However, Muslim communities are among the most disadvantaged and discriminated groups in the UK; over half of Muslim households live in poverty, are more likely to experience job, housing, and income insecurity and live in overcrowded households. They are less likely to experience progression in education and the labour market. These factors contribute to some British Muslims internalising a socially devalued and stigmatised identity, further amplified by divisive media and political narratives.

This social and structural exclusion and stigma may contribute to mistrust of mainstream health advice, impede access to healthcare services, and thereby increase the likelihood of having underlying health conditions linked with poorer outcomes from covid-19. Additionally, religious and cultural concepts of fatalism, congregational practices, and preference for alternative faith-based healers can increase risks. Excess deaths from covid-19 have been reported by Muslim funeral services and the restriction on communal cultural practices has negatively impacted mental health

The strong affiliation with religion seen among minority groups can be explained by the phenomenon of “reactive religiosity”; a protective response to prejudice and politicisation of their identities and provides a platform for socioeconomic mobility.  Religion and ethnicity are both legally protected characteristics, and their combination makes people much more vulnerable in society. Hate crimes against Muslims continue to increase year on year and have increased further during the pandemic. This may contribute to poorer health outcomes, as seen in covid-19, if people are reluctant to access healthcare, resulting in delayed presentation with more advanced disease. Of concern, over 50% of doctors who have died in the UK have been Muslim, despite constituting 9.1% of the medical workforce. This must be understood against a backdrop of Muslims being the most discriminated religious group in the NHS and the excess deaths raise concerns about the role that systemic factors may have played. 

During the pandemic, faith-based organisations have been at the forefront of community efforts, filling a void left empty by a lack of effective government response. These organisations have produced multi-lingual and contextualised infographics; communicating public health campaigns through faith and ethnic media channels; offering mental health support; and providing guidance about hospital visits  and end of life care. Faith-based organisations play a vital role in health promotion through health messaging that is accessible and relevant and encourages people to seek and access healthcare.  However, these grassroots volunteer-led efforts have received no government support, despite lobbying, which is limiting their effectiveness and sustainability.

The government has promised a next phase in its response. Co-production of multi-level interventions built on community insights will be vital to that. As highlighted in multiple policy briefings and government submissions, there is an urgent need to improve data on protected characteristics such as religion, disaggregated ethnic groups, and disability in order to protect marginalised groups.

However, we need to go beyond numbers and biology to understand the intersectional and systemically embedded disadvantage and discrimination that ethnic minority communities embody every day. This starts with us, as clinicians, scientists, healthcare professionals and policymakers. We must legitimise research and support efforts to reduce health disparities.

Hina J Shahid is a portfolio GP in London and an Honorary Clinical Tutor at Imperial College School of Medicine. She is the Chair of the Muslim Doctors Association and sits on the GMC BME Forum and the NHS Religion Equality Advisory Group. Twitter handle @hinajshahid

Salman Waqar is a portfolio GP and an academic researcher at the University of Oxford. He is the General Secretary for the British Islamic Medical Association, and sits on the NHS Religion Equality Advisory Group and the GMC BME Doctors Forum. @salmanWaqar 

Competing interests: HS is chairperson of the Muslim Doctors Association and co-founder of of NHS Religion Equality Advisory Group. SW is the general secretary of the British Islamic Medical Association, a member of NHS Religion Equality Advisory Group, Member of GMC doctors forum.