How is COVID-19 affecting children and young people in BAME communities?
Black, Asian and Minority Ethnic (BAME) communities are overrepresented in cases of coronavirus based on what we would expect from UK population demographics. This has prompted investigations into the reasons why, and deeper discussions on how the pandemic is affecting BAME communities.
Despite the fact that younger people are a low risk group for the virus itself, BAME children and young people, specifically, are experiencing the pandemic differently from their peers — as a consequence of the disproportionate social, economic, and psychological impacts on their communities.
“School closures have had a big impact on BAME children,” says Dr Zubaida Haque, Interim Director at the Runnymede Trust, the race equality thinktank. “These children are disproportionately from lower socioeconomic backgrounds, and overcrowded and multigenerational homes.
“They are suffering the most while being least able to socially distance, and it’s taking a psychological toll. Pakistani, Bangladeshi and Black children, in particular, are more likely to lose a loved one and less likely to have proper access to online learning.”
Zubaida says that, broadly, we can use the terms “BAME” and “poor” interchangeably. This is not to say that there are no white children in lower socioeconomic groups. Rather, it is to say that when we are discussing inequality, we are disproportionately referring to children from BAME communities.
The inequalities witnessed before COVID-19 will be exacerbated in the wake of the crisis — a widening gap along lines of class and race.
The Runnymede Trust wrote an open letter expressing concerns about using predicted grades in place of exams cancelled due to COVID-19. The Trust says that students from lower socioeconomic groups are more likely to have grades under-predicted than those from more advantaged backgrounds.
The letter is co-signed by Professor David Gillborn at the University of Birmingham, whose research on race inequalities in education suggests that “teachers’ expectations of Black students and their working class peers tend to be systematically lower than warranted by their performance in class”.
If some students’ grades are under-predicted, there are implications for those about to start A-Levels and university. Ultimately, the Trust is concerned that the inequalities witnessed before COVID-19 will be exacerbated in the wake of the crisis — a widening gap along lines of class and race.
Black life matters: inequality, race, and worse health outcomes
Dr Andrea Barry is a Senior Analyst at the Joseph Rowntree Foundation, where she conducts research aimed at addressing poverty: “I ran a seminar last October during Black History Month. In the US, where I’m from, we talk more bluntly about our past — but the UK doesn’t have that sort of conversation, yet.”
Andrea says that there is a lack of historical understanding when it comes to race in the UK, even more so than in the US. The core curriculum doesn’t currently cover Black British history, although social enterprises like Black Curriculum are working to address this gap. There have also been calls to make lessons on empire a compulsory part of secondary school teaching.
In the US, researchers are aiming to understand the consequences of the past on contemporary experience. Professor David Williams at Harvard suggests that small, seemingly inconsequential acts of “everyday discrimination” can stack and lead to worse health outcomes, including mortality.
Notably, biological responses to adverse childhood experiences, such as inflammation, can persist well into adult life. And some effects can persist whether or not a person actually experiences an instance of everyday discrimination — even the expectation, the so-called threat of exposure, is enough.
Recognising the profound role of a person’s internal beliefs and perceptions presents a challenge to researchers. Untangling genuine acts of discrimination from perceived mistreatment is tricky and compounds the problem of quantifying acts of discrimination.
Biological responses to adverse childhood experiences, such as inflammation, can persist well into adult life.
“There are many tangible ways in which race and health are linked — racial differences in health outcomes are glaring,” says Andrea. “We also know that police are more likely to stop and fine BAME people for violating lockdown rules during the pandemic, including teenagers in those communities.”
The Joseph Rowntree Foundation’s UK Poverty 2018 report found that around 120,000 more Black, African, Caribbean, and Black British people were in poverty than five years earlier. Andrea says that such data on inequality shows how the differences in health outcomes are shocking but not surprising.
Dr Omowunmi (Mo) Akindolie is a Consultant at King’s College Hospital: “Conversations about race can be uncomfortable, but they allow us to confront truths about our society. And once we’ve fully acknowledged that a problem exists — we can talk about what to do about it.”
Mo says that the pandemic has magnified the extent of the problem — 94% of the UK doctors who have died from COVID-19 are of BAME heritage. And before COVID-19, the MBRRACE-UK report found that Black and Asian women are at increased risk of dying during pregnancy versus white women.
Mo says that it is not much of a leap to translate these health outcomes into corresponding outcomes for the children and young people in those communities. These are just some of the inequalities that impact them more than their peers — and inequalities for which we have available data.
The great lack: abridged reports and data thwarts
A recent report from Public Health England, the disparities review, stated that although death rates are higher among people of BAME heritage, such differences in death can be mostly explained by “the effect of occupation, comorbidities or obesity”.
The report did not, however, include these variables in its analysis. It is also not possible to combine data points to look at children and young people in BAME communities, specifically. Limited ethnicity data is something that we also noted for many health indicators in our 2020 State of Child Health report.
Where quantitative data were not available, qualitative alternatives were offered to inform the disparities review. Several BAME organisations who consulted with Public Health England say that this “lived experience” was not included in the report. And they wrote a letter calling for its publication.
“Valuable information was gathered and not included in the disparities review,” says Mo. “In other words, we weren’t reading the full report. Many important voices from BAME communities had effectively been removed from the conversation.”
The implication is that we cannot fully understand the impact of COVID-19 on BAME children and young people without knowing how it affects their communities. Ultimately, there is a challenge in deciding the relative value placed on subjective experience and objective data.
“We need to be clear that BAME children and young people are diverse and can’t be bundled together when it comes to developing solutions.” — Dr Mo Akindolie, King’s College Hospital
Reports including community voices were later released in both England and Wales. In addition to structural factors, both cite socioeconomic inequality, increased risk of exposure at work, and cultural factors linked to comorbidities as some of the challenges influencing outcomes in BAME communities.
An additional challenge stems from the use of BAME as a catch-all term when discussing children and young people in these communities. Although it originated as a means to unite different minority groups, BAME can also serve to obscure important distinctions between the communities it includes.
“We need to be clear that BAME children and young people are diverse and can’t be bundled together when it comes to developing solutions,” says Mo. “Cultural norms are radically different between, say, Hong Kong and Côte d’Ivoire.”
“We need to untangle the term because the experiences within those communities are so different,” says Andrea. “Home ownership, for example, is high in Asian communities but very low in Black communities — we need to be able to see these distinctions.”
The historian David Olusoga, on the other hand, notes that while the term may be limited in some respects, it continues to serve as a useful umbrella — under which communities with what he calls “a shared colonial experience” can work together in creating a path forward.
Getting out: moving beyond the sunken place
While the disparities review did not include recommendations, the follow-up reports include “tangible actions” from some of the BAME organisations who consulted on the review. These recommendations seek to support BAME communities, including children and young people, and include a call for better data collection, involving communities in research, and addressing discrimination.
“We have also been pushing for more resources for summer schools,” says Zubaida. “These are as important for education as they are for their social, psychological, and pastoral benefits. Getting children into school or summer programs will be of huge benefit to children and their families.”
A related campaign supported by the College, meanwhile, called for the government to extend the provision of free school meals through the summer. In response, the government has announced a COVID summer food fund for children and young people.
“The last few months have shown us just how different life can be for people within our societies… These are all problems that can be fixed — if we work together to solve them.” — Dr Andrea Barry, the Joseph Rowntree Foundation
“BAME children and young people have faced disproportionate economic impacts, mental health challenges, and disrupted education — so many consequences of lockdown restrictions,” says Mo. “Going forward, we need to adopt a culturally sensitive approach to serving them.”
“The last few months have shown us just how different life can be for people within our societies,” says Andrea. “We need to make sure that this doesn’t happen again. These are all problems that can be fixed — if we work together to solve them.”
The College recently published our own response to Public Health England’s disparities review, as well as a statement of solidarity and support for our BAME colleagues and communities. We have stated our commitment to taking further actions to understand the risks faced by BAME communities.
This, in turn, will allow us to call policymakers to account so that there are improved outcomes for children and young people in BAME communities. The inequalities they experience, along with their working class peers, must be urgently addressed.
Originally published at https://www.rcpch.ac.uk on June 24, 2020.
