Resources - National

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Ecuador

Leticia Cuéllar, Irene Torres, Ethan Romero-Severson, Riya Mahesh, Nathaniel Ortega, Sarah Pungitore, Nicolas Hengartner,
and Ruian Ke

This important preprint paper shows  the huge  increase of excess deaths in Ecuador in March to May 2020. Most if not all were due to COVID-19. Analysis by ethnicity showed that the highest rates of excess deaths were among Indigenous groups. When analysed by age and sex, young Indigenous women were at much higher risk than women in other groups.

Germany

Marie Tallarek, Kayvan Bozorgmehr and Jacob Spallek (BMJ Global Health)

This article argues that pre-existing discrimination against asylum seekers and refugees has been exacerbated by COVID-19. "Inclusionary and diversity-sensitive approaches to public health  not only serve human rights but also contribute to better health for everyone."

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Ghana

Jessica Michgelsen, Daniel Boateng, Karlijn A.C. Meeks, Erik Beune, Juliet Addo, Silver Bahendeka, Karien Stronks and Charles Agyemang (Int. J. Environ. Res. Public Health 2021, 18, 2451)

This study concluded that Christian religious Ghanaian men living in Europe seem to have lower CVD risk compared with their non-religious counterparts, while Christian religious women in Ghana appear to have increased CVD risk..

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Italy

Gianfrancesco Fiorini and eight colleagues, Journal of Public Health Research

This article argues that pre-existing discrimination against asylum seekers and refugees has been exacerbated by COVID-19. "Inclusionary and diversity-sensitive approaches to public health  not only serve human rights but also contribute to better health for everyone."

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Nordic Countries

This report compares policies on education, health and the labour market and their impact on young migrants in Denmark, Norway, Sweden and Finland. It also includes a comparative study of unaccompanied refugee minors in Norway and Sweden. 

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United Kingdom

Mathur R et al, Lancet

This large study found that some minority ethnic populations in England have excess risks of testing positive for SARS-CoV-2 and of adverse COVID-19 outcomes compared with the White population, even after accounting for differences in sociodemographic, clinical, and household characteristics. Causes are likely to be multifactorial, and delineating the exact mechanisms is crucial. Tackling ethnic inequalities will require action across many fronts, including reducing structural inequalities, addressing barriers to equitable care, and improving uptake of testing and vaccination.

Raghib Ali, Avirup Chowdhury, Nita Forouhi, Nick Wareham. MRC Epidemiology Unit, University of Cambridge.

This report provides much of the detail that contributed to the Health Chapter of the Commission report. It draws heavily on work carried out by the Office of National Statistics (ONS) and the Scottish Health and Ethnicity Linkage Study. It examines the relationships between health, ethnicity and socio-economic circumstances, and demonstrates that, as the analysis by ethnic group and by disease or health condition becomes more detailed e.g. from South Asian to Indian, Pakistani and Bangladeshi or from overall mortality to heart disease and cancer types, so a more complex picture of advantage and disadvantage emerges. 

This wide-ranging report from 10 Government-appointed commissioners, all but one of whom has an ethnic minority background, has generated huge controversy. While acknowledging that racism and ethnic inequalities persist, it argues that considerable progress has been made in recent decades. In particular, it demonstrates the complexity of the variations in health, with some ethnic minorities faring better than the White majority in overall life-expectancy and pointing out, for example, that the White majority has the highest death rates due to 9 of the 11 most common forms of cancer.

Razai M, Kankam HKN, Majeed A, Esmail A, Williams D. ,British Medical Journal

The authors argue that although socioeconomic status partly explains ethnic disparities seen with covid-19, cultural and structural racism also adversely affect health.

Laurence Gruer and 10 colleagues, Journal of Public Health

This is the last analysis from Phase 4 of the Scottish Health and Ethnicity Linkage Study (SHELS). It examines rates of hospitalisations and deaths related to all infections and 15 different infection categories. It also looks at ethnic differences for serological diagnoses of HIV, HBV and HBC. The study demonstrates very varied, and sometimes enormous, ethnic differences, pointing to a complex mix of causative factors. The paper also provides a useful context for the recent findings of  higher rates of morbidity and mortality due to COVID-19 among some ethnic minorities in the UK.

Emma M. Davidson, Anne Douglas, Nazmy Villarroel, Katy Dimmock, Dermot Gorman, Raj S. Bhopal.

Journal of Public Health

This article describes how the National Health Service in Lothian (the region in Scotland, UK, that includes Edinburgh) succeeded in increasing the recording of the ethnicity of patients attending hospital from 3% to 90% in three years. The focus is on attendances for Accidents and Emergencies.  This is an impressive achievement. However, another recent article from Scotland (below December 2019) shows that even if ethnicity recording rates are relatively high, they may not be enough to enable reliable comparisons between ethnic groups to be made.

S. Knox, RS. Bhopal, CS. Thomson, A. Millard, A. Fraser, L. Gruer, D. Buchanan

Journal of Public Health

This article analyses in-patient rates by ethnicity in Scottish Hospitals in 2013.  It reports that the completeness of ethnicity coding on hospital admission records was 76%, a marked improvement since 2010. However, the validity of admission rates based on these data was variable across ethnic groups and further improvements are required to support monitoring of inequality.

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United States of America

This is a  complex, well-organised  website providing a wealth of quantitative data from twelve of  largest US cities, comparing cities, ethnic/racial groups within cities, neighbourhoods etc. Inequities abound in every dimension, showing in particular the way in which African American and Latinx/Hispanic communities have faired least well in the pandemic, but to a varying extent in different cities.

This is a collaboration between the Covid Tracking Project and the Boston University Center for Antiracism Research. It provides constantly updated data on Covid-19 cases and deaths by race and ethnicity in most US states and territories. 

This web encyclopaedia offers numerous articles about racism and health in the United States. It has a section devoted to Covid-19, including a link to the Covid Racial Data Tracker.

This report by the American Medical Association focuses on Latinx/Hispanic communities, who make up 18% of the US population but have had 33% of Covid-19 cases. It draws on information provided by 30-45 minute interviews with 16 people with knowledge and experience of how pre-existing circumstances have combined with the pandemic to impact on  Latinx communities. While arguably from too narrow a range of  spokespersons to give a complete picture, nevertheless the report achieves its aim of  providing "guidance in identifying and understanding the vulnerabilities, needs and opportunities present in the Latinx community in order to allow physicians, essential health care workers and health care organizations to serve this community in a more equitable manner."

Dolores Acevedo-Garcia and nine colleagues, Health Affairs

This study uses a composite metric to assess the neighbourhood conditions that children experience today across the US. Overall, the Child Opportunity Score for White children (73) was much higher than for Black (24) and Hispanic (33) children.  The authors conclude that to improve children’s health and well-being, the health sector must move beyond a focus on treating disease or modifying individual behaviour to a broader focus on neighbourhood conditions.