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Response to the ‘Disparities in the risk and outcomes of COVID-19’ report
in response to the publication of the first part of the Public Health England (PHE report, we co-wrote a letter with 30 other health and care organisations urging the government to publish, in full, the recommendations and findings from the community stakeholder engagements.
PHE submission on health inequalities in the Muslim community
BAME communities continue to experience a high burden of morbidity and mortality both in the community and on the frontline as a result of Covid-19. Compounding this is the increasing concern about the disproportionate impact that the pandemic has had on faith communities, especially the Muslim community, many of whom belong to high risk BAME groups.
Religion is a protected characteristic in the Equality Act and the lack of data available on faith communities is concerning. While the inquiry into BAME inequalities is encouraging, emerging data demonstrates that risks are not uniform across ethnic groups and current aggregated BAME categories fail to consider important in-group differences in ethnicity and faith, limiting the scope of understanding and relevant action. Faith-based organisations have been at the forefront of community efforts, providing mental health and spiritual support through helplines, virtual streaming of congregations and bereavement counselling. They have also been providing practical support by organising delivery of food, medicines and essential supplies to elderly, vulnerable and isolated households, offering guidance around issues such as end of life care and celebrating religious festivals as all as having to cope with excess burials and funerals in the community.
SOAS briefing on BAME Inequalities
It is clear that Black and Minority Ethnic (BAME) communities are disproportionately affected by Covid-19. A third of critically ill patients, 19% of deaths, and in some local authorities, more than 50% of deaths are among the BAME community, despite making up 15% of the population. The statistics for healthcare workers are even worse; 72% of all health and social care workers and 93% of doctors who have died have been from a BAME background, amplifying concerns of institutional racism and longstanding intersecting inequalities. It is well known that approximately 80% of health outcomes, and therefore inequalities, are socially determined.
The government’s announcement to conduct an enquiry into BAME deaths is welcome, and it must go further. In order to fully understand the drivers of the excess burden of morbidity and mortality on BAME communities from Covid-19, data must be collected and published on key determinants of health which includes protected characteristics as enshrined in the Equality Act 2010. This requires expansion of the current ethnicity grouping and inclusion of data on age, gender, religion, income, employment, education, immigration status, language, disability and co-morbidities as well as local authority, household structure, population density, pollution and social deprivation indices.
SOAS briefing on Faith
Covid-19 related morbidity and mortality has disproportionately impacted faith communities in the UK, which makes the lack of data available on faith particularly concerning. For many people in these groups, faith is a central part of their identity and way of life, impacting their health beliefs, and personal, household, and community practices. Religion is a legally protected characteristic in the Equality Act. Furthermore, members of minority religious groups are more likely to be from Black, Asian and Minority Ethnic (BAME) backgrounds, and experience multiple intersecting risk factors simultaneously.
More Muslim doctors have died from Covid-19 than all other religious groups combined, making up over 50% of medical worker deaths. BAME doctors, nurses and carers report that they find it difficult to raise concerns about inadequate access to personal protective equipment and testing or unfair redeployment as they feel pressurised and bullied at work. The government needs to urgently collect and publish data by faith and needs to consider a whole system intersectional approach to fully understand and contextualise risks.
Impact of COVID-19 on the Muslim Community
The Muslim Doctors Association submitted evidence to Public Health England's review on COVID-19 disparities on 21st May 2020.
In the submission we present a rapid review describing the excess burden of morbidity and mortality from COVID-19 experienced by members of the Muslim community and the multi-factorial risks involved. The submission outlines a framework to analyse and mitigates these risks to patients, communities and frontline workers covering
Recognising religion as a determinant of health
Assessing impact on Muslim communities based on published reports and our community outreach work
Understanding longstanding intersectional risks and institutional discrimination
Assessing impact on Muslim healthcare workers based on published reports and case studies submitted
Our recommendations include
Publication of outcomes by disaggregated data including religion
Addressing wider social and structural determinants of health including healthcare access and discrimination
Early multi-sectoral and multi-disciplinary stakeholder engagement to co-produce solutions
Faith and culturally sensitive health promotion strategies
Comprehensive occupational risk assessment and support for frontline workers
Ramadan in the Era of COVID-19
Since the outbreak of the COVID-19 pandemic, and in consultation with community organisations, health and medical experts, the BBSI has been providing ethico-religious guidance to the community. Muslim health workers and professionals, religious and community leaders, and institutions have been requesting the BBSI to communicate a comprehensive yet non-exhaustive guidance for the month of Ramadan and fasting. The BBSI is acutely aware that the Muslim community will likely not able to perform some of the communal activities due to the COVID-19 pandemic, such as attending the mosques and arranging large iftar (fast-breaking) gatherings with friends and family.
Given this, the BBSI and MDA would like to remind all Muslims that Allah – the All-Merciful and Generous – has promised that He will reward us for simply having the intention to do good, even if we are unable to perform what we intend due to forces beyond our control. We take solace from this and exert our efforts to fulfil our duties and responsibilities as best as we can. ‘Allah does not burden a soul beyond its capacity’. (Q, 2:286)
A Matter of Life and Death
This guidance by the BBSI and supported by MDA lays out an ethical framework, sourced from the Islamic tradition, which can guide Muslim stakeholders in their decision-making regarding resource allocation and end-of-life care. It addresses patient/family-level, clinician-level, and policy-maker level considerations, while recognising that every decision should be contextual and multi-faceted.
The Triple Penalty: Muslim Doctors in the NHS
In 2018 the Muslim Doctors Association (MDA) conducted a rapid review to explore religious discrimination in the NHS. This followed the initial GMC ruling on the Dr Hadiza Bawa-Garba case and access to GMC data which demonstrated higher complaints, fitness to practice investigations and more serious sanctions against BAME doctors. The MDA was also contacted by Muslim health professionals facing difficulties at work due to their faith.
The NHS Constitution embodies core values of respect, dignity, compassion and inclusion but recent evidence demonstrates that little progress has been made to address discrimination against groups with protected characteristics. The King’s Fund report in 2015 highlighted that people from all religions experience discrimination on the basis of their faith, but this is by far the highest amongst Muslims. International research on Muslim doctors working in Western countries has highlighted the multiple barriers and prejudices they face. However, research in the UK has focused almost exclusively on racial discrimination with limited information on doctors of faith.
The aims of the rapid review were to assess doctors' perceptions of the factors influencing the ruling on the Dr Hadiza Bawa-Garba, assess the prevalence of religious discrimination, and explore experiences of religious discrimination amongst female Muslim doctors working in the NHS.