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. 2021 Oct;75(10):970-974.
doi: 10.1136/jech-2020-216061. Epub 2021 Apr 21.

Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities

Srinivasa Vittal Katikireddi  1 , Sham Lal  2 , Enitan D Carrol  3 , Claire L Niedzwiedz  4 , Kamlesh Khunti  5 , Ruth Dundas  6 , Finn Diderichsen  7 , Ben Barr  8
Affiliations

Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities

Srinivasa Vittal Katikireddi et al. J Epidemiol Community Health. 2021 Oct.

Abstract

Minority ethnic groups have been disproportionately affected by the COVID-19 pandemic. While the exact reasons for this remain unclear, they are likely due to a complex interplay of factors rather than a single cause. Reducing these inequalities requires a greater understanding of the causes. Research to date, however, has been hampered by a lack of theoretical understanding of the meaning of 'ethnicity' (or race) and the potential pathways leading to inequalities. In particular, quantitative analyses have often adjusted away the pathways through which inequalities actually arise (ie, mediators for the effect of interest), leading to the effects of social processes, and particularly structural racism, becoming hidden. In this paper, we describe a framework for understanding the pathways that have generated ethnic (and racial) inequalities in COVID-19. We suggest that differences in health outcomes due to the pandemic could arise through six pathways: (1) differential exposure to the virus; (2) differential vulnerability to infection/disease; (3) differential health consequences of the disease; (4) differential social consequences of the disease; (5) differential effectiveness of pandemic control measures and (6) differential adverse consequences of control measures. Current research provides only a partial understanding of some of these pathways. Future research and action will require a clearer understanding of the multiple dimensions of ethnicity and an appreciation of the complex interplay of social and biological pathways through which ethnic inequalities arise. Our framework highlights the gaps in the current evidence and pathways that need further investigation in research that aims to address these inequalities.

Keywords: COVID-19; ethnicity; health inequalities; social epidemiology.

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Conflict of interest statement

Competing interests: SVK, SL, EDC, KK and BB are members of the UK Government’s Scientific Advisory Group on Emergencies (SAGE) subgroup on ethnicity and COVID-19. SVK is co-chair of the Scottish Government’s Expert Reference Group on ethnicity and COVID-19. SL is currently seconded to the UK’s Government Office of Science. KK is Director for the University of Leicester Centre for BME Health, Trustee of the South Asian Health Foundation, national NIHR ARC lead for Ethnicity and Diversity and a member of Independent SAGE. All authors write in an independent capacity and the views expressed do not necessarily represent any government or funding organisation.

Figures

Figure 1
Figure 1
A framework for understanding pathways underpinning ethnic inequalities in COVID-19 and potential targets for policy.
See this image and copyright information in PMC

References

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