I find it quite depressing to read so much biological racist thinking to explain current racial inequalities in #Covid19 mortality & morbidity rates. In the general population & in healthcare staff.

Depressing but typical, we need to continue to push back & ask for solid evidence...& become more research literate. When well documented social & structural determinants are put aside in preference for some speculative genetic explanations...I worry.

This urge to seek genetic explanations in vulnerability or outcomes for all racial differences is the height of scientific racism but it is so ingrained in our culture, so ingrained...despite having so little empirical basis.

Anyway I wanted to remind us all that heathcare institutions are structurally racist. Like all structures in society. This is not a matter of agreement or disagreement, it is just a fact.

That in the absence of any solid empirical finding regarding genetic vulnerability, our attention ought to be on reducing the inequalities which reproduce differing health outcomes across racial lines (amongst others).

We could never cover all manifestation of structural racism in health in a single thread or article or book. But I do want to share a few just so we remember that racism is a structural reality so some of us can get real.

So here we go...1) black (and brown) medics in NHS are paid thousands less than white medics, they face unacceptable barriers and discrimination... https://www.theguardian.com/society/2018/sep/27/black-medics-in-nhs-paid-thousands-less-than-white-medics

2) Black and brown medics, are more likely to be complained about, disciplined & be investigated by the GMC
https://www.ouh.nhs.uk/education-centres/training/documents/fair-to-refer.pdf

3) BAME doctors & healthcare staff are more likely to face harassment ‘ bullying in the NHS. https://www.independent.co.uk/news/health/nhs-staff-racism-bme-ethnic-england-data-a9340601.html

4) BAME patients consistently report poorer experience & pooer care when interacting with heath systems.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213375/BME-report-June-09-FINAL3.pdf

As a reminder those inequalities are accounted for by systemic AND individual bias. That is bias at macro/meso levels and bias as micro level.

I like to speak of the lived experience of one of my research participants for my doctoral thesis, with full their consent...to break away from stats & make these numbers speak more personally.

This is the story of a non-binary Black person who was hospitalised unable to walk & with visions difficulties. They noted very quickly they were treated differently. Took them being much more vocal than other patients to obtain pain medication...

Their body was handled roughly, they noted how other patients on the ward would be greeted warmly, they were hardly ever greeted, they were given medication without explanation (thus without consent)...they were distressed made a race complaint which was of course discounted...

Were discounted in their physical experience too. Got discharged deteriorated to the point of urinating blood. Did not seek help for a long while...because distrusted their own experience & believed they would not be taken seriously. And would be problematised again.

Racial bias & prejudice influence pain management (who gets pain killers for example), communication and Interactions with colleagues & patients (eg. micro-communication such as eye rolls, interruptions, trust/distrust).

The stuff that made the experience of my participant hellish & frankly traumatising, but returning to #Covid19 why think about structural racism & institutional bias...?

To elucidate vulnerability. For example, if is being hypothesised that diabetes & high blood pressure may account, if only partly for* the unequal outcomes & vulnerability to #COVID19 we’re seeing in black & brown patients.

WE DO NOT KNOW FOR SURE. There has not been no systemic data collection and analysis yet, but...we do know that theses conditions make the management of infections more complex. So it is likely part of the puzzle.

HOWEVER, these conditions are also socially determined and therefore surprise, surprise! Influenced by racism.

Studies have found high blood pressure to be linked to racism even after controlling for age, education, income, BMI, smoking ect...

So what we’re saying is racism is an INDEPENDENT risk factor.

https://professional.diabetes.org/abstract/relationship-between-exposure-racism-and-blood-pressure-african-american-women-diabetes

Similarly...exposure to racism alone has been to predict diabetes risks in Black groups.

https://professional.diabetes.org/abstract/relationship-between-exposure-racism-and-blood-pressure-african-american-women-diabetes

Finally I will no go into differencual mortality rates, again LOADS out there, see for example deaths in black expectant mothers, black infant mortality rates, or again breast cancer survival rates across race.

So what I am saying is this; it is completely outrageous to reach for genetic hypothesis on the mist of all this empirical evidence. Let’s start with the obvious which is also the most discomforting social inequalities & racism.

Racism makes us multiply vulnerable because it operates at multiple levels. It likely increase our vulnerability to #COVID2019 by* damaging our body & mind, then reduces our ability to get timely & appropriate medical support...

Then when in hospital or when we get the support, we may not be treated with the same level of urgency, attention or care and/or compassion...

When or if we return home, we will be disadvantaged by the level of support available to us & will continue to face discrimination from other domains. This is what we’re dealing. The complexity & chronicity of racism. You don’t like it?

Great, do something about it.