A whitewash and another missed opportunity: the Consensus Statement from PHE, HSE and FOM on how best to mitigate risk of COVID 19 in occupational settings, with a focus on ethnic minority groups. *

* Detailed response from Doctors in Unite. A summary response can be found here.

With thanks to the TUC: Dying on the Job.  A report into Racism and Risk at Work

Doctors in Unite are disappointed with the recent consensus statement by Public Health England, the Health and Safety Executive and the Faculty of Occupational Medicine.  It is yet another missed opportunity to address the underlying causes of the high rates of infection and death from Covid-19 among ethnic minority workers in the UK.  The recommendations contained in the statement do not go anywhere near far enough to mitigate the risks they face from COVID 19 in the workplace.

The statement makes numerous self-evident statements like “existing workplace guidance and legislation should be reinforced across the whole workforce”, and “all individuals, including those from ethnic minority groups, should have the same approach to risk management in the workplace”, and “the approach to controlling risk should be equitable”.  While it says “employers have a legal duty to protect all workers from harm” it focusses almost entirely on individual responsibility and individual risk factors of workers, like age, sex, deprivation, obesity and diabetes.  Much of the statement concerns itself with “culturally competent” communication as though this were some new breakthrough in occupational risk mitigation, when it is simply the basic requirement to communicate clearly and respectfully with all people whatever their backgrounds.  The implication is that the disparities in infections and deaths of BME workers is down to their not understanding risks and risk mitigation, and better, “culturally competent” communication will solve the problem.

It is of course welcome to have culturally sensitive information in many languages to alert people of ethnic minorities to important measures that they can take themselves to mitigate their risk, but the consensus statement does not touch on the much greater impact that factors beyond the control of the individual has on their risk.

No mention of structural racism in society or racism in the workplace

The consensus statement opens by saying: “a wide range of research has explored the pathways that cause ethnic inequalities and have shown that this is a complex relationship, and the relative importance of different pathways in COVID-19 ethnic inequalities is not well understood”.  It references the paper by SAGE, Drivers of the higher COVID-19 incidence, morbidity and mortality among minority ethnic groups.

While the relative importance of different pathways or mechanisms may not yet be clear, the central theme of the SAGE paper is that structural racism determines these pathways, and their combined effect leads to the much greater impact of Covid-19 on BME people. (see diagram from the SAGE document in the appendix) The SAGE paper says, “All of these mechanisms arise from the wider social context that drive ethnic and other social inequalities, such as power relations and structural racism.”  Yet the consensus statement simply ignores this and does not mention the word “racism” once in the entire statement.  The consensus statement in fact misrepresents the SAGE paper in this regard, implying the usual “It’s very complicated and we need to do more research” response which is trotted out whenever action and real change is demanded over racial discrimination.  The statement is also extraordinarily myopic given the times we are living through, i.e. the Black Lives Matter movement, and the wider debate and reckoning with racism that BLM has engendered across UK society as a whole. 

The recent Channel 4 documentary “Is Covid-19 racist”, involved a number of high profile BME doctors, including Professor Tollulah Oni, Epidemiologist at the University of Cambridge, and member of Independent SAGE, and Dr Chand Nagpaul, Chair of the Council of the British Medical Association, who were unequivocal that discrimination at work was a direct contributor to the highly disproportionate deaths from Covid-19 suffered by ethnic minority doctors.

The consensus statement does mention “historically oppressed groups”, but only in relation to it explaining “understandable mistrust towards members of the majority culture in cross cultural interactions.”  Where is mention of current day racism and discrimination?

In an article in the New Statesman in 2018, Dr Zubaida Haque, also a member of Independent SAGE, and Deputy Director of the Runneymede Trust, wrote: “BME people are already affected by substantial structural inequalities: they are more likely to live in poorer households, more likely to face multiple disadvantages in the labour market (race, gender and religious discrimination) and more likely to have higher rates of child poverty in their households than white groups. Recent analysis by the Runnymede Trust and the Women’s Budget Group on the impact of budget and austerity cuts also shows that BME people, and BME women in particular, are the worse hit by the cuts.” 

Only last year the UN Special Rapporteur, Philip Aston said during a visit to the UK that: “Policies of austerity introduced in 2010 continue largely unabated, despite the tragic social consequences.”

To make matters worse people from ethnic minority backgrounds often live in overcrowded, multigenerational households meaning that spread of infection within communities is likely to be disproportionately high.

Where is the voice of BME workers?

The day-to-day experience, and the voice of BME workers is not reflected anywhere in the consensus statement.  There are countless reports documenting this, like the TUC’s report “Dying On The Job”, which has this to say:

“BME workers experience systemic inequalities across the labour market that mean they are overrepresented in lower paid, insecure jobs. These inequalities are compounded by the discrimination BME people face within workplaces. Our research carried out just before the outbreak of Covid-19 revealed that BME people’s experiences at work are blighted by discrimination: almost half of BME workers (45 per cent) have been given harder or more difficult tasks to do, over one third (36 per cent) had heard racist comments or jokes at work, around a quarter (24%) had been singled out for redundancy and one in seven (15%) of those that had been harassed said they left their job because of the racist treatment they received.

Yet very few had felt able to raise these issues.

As the disproportionate impact of Covid-19 on BME workers became clear, a range of individuals and organisations debated why this was the case, with a variety of explanations being put forward. Nowhere in these debates were the voices of BME workers heard. We set out to rectify this, launching a call for evidence to properly understand the issues workers were facing and what their preferred solutions were.

What people told us was shocking but not surprising as it directly reflected our research conducted before the pandemic and the experience of BME workers over the years. One in five of those who responded to our call for evidence said they had been treated unfairly because of their ethnicity at work during the pandemic and around one in six said they had been put at more risk at work because of their ethnicity. BME workers told us about being singled out for higher risk work, denied access to PPE and appropriate risk assessments, unfairly selected for redundancy and furlough and hostility from managers if they raised concerns. Workers repeatedly said that the fact that they were agency workers or did not have permanent contracts was exploited through threats to cancel work or reduce hours, both to silence them and force them to work in higher risk situations.”

Are these issues not relevant to the much greater rates of infections and deaths of BME workers?

Grossly inadequate health and safety monitoring and enforcement in the workplace

Employers cannot be trusted to be left to their own devices to ensure that workplaces are safe or to report occupational exposure to Covid-19.  For example, employers in the Leicester garment factories failed to protect Asian workers against Covid-19, while exploiting workers and paying illegal wages well below the minimum wage.  Widespread under-reporting of infections in the food processing industry goes on; one study found there were at least 30 times the number of cases as those reported by employers under the RIDOR regulations.  In the US an extreme example of employers acting with impunity over workers’ safety, occurred in one plant run by Tyson, the largest meat packing company in the US, when managers coerced staff to continue working when they were clearly symptomatic with COVID 19 and took bets on who would become unwell. Five of the staff died.

It is perhaps not surprising that practices like this occur, when the ability to regulate the workplace, the responsibility of HSE and Local Authorities, has been so severely weakened by cuts over the last decade, as well as a culture of “health and safety being a burden to business” encouraged by the government.  In 2015 the government issued a press release which said: “Boosting business by easing health and safety burden – 84% of rules scrapped or improved”.  The TUC estimates that in the past decade HSE inspections have fallen by 70%, and prosecutions for breaches by 82%.   The situation is so dire that statistically, each workplace can expect to be inspected by the HSE once every 275 years.  Local Authority enforcement of health and safety law and practices has been “eviscerated……Local authorities issued 80 per cent fewer health and safety enforcement notices in 2018-19 than they did in 2010-11.”  

Lack of regulation negatively impacts all workers, but more so BME workers as they are more likely to be in insecure work, and less likely to have the protection of trade unions

The impact on workers of a severely weakened regulatory framework is also not mentioned anywhere in the consensus statement.

BME workers face greater workplace exposure to Covid-19

A disproportionate number of people from ethnic minority backgrounds are employed in low paid sectors such as cleaning and caring roles, where they cannot work from home. They are often in public facing roles and often have inadequate PPE.  Earlier this month the High Court found the UK has failed to grant workers in the gig economy the rights they are entitled to under EU Health and Safety law. This includes the right to be provided with Personal Protective Equipment (PPE) by the business they are working for, and the right to stop work in response to serious and imminent danger.  The case was brought by the International Workers of Great Britain (IWGB) a union representing mostly Black, Asian and Latino workers, who are twice as likely to be on these zero-hour contracts compared to their white peers.

A study at the University Hospital Birmingham showed that cleaners in the hospital were more likely to catch COVID 19 at work as front-line medical staff who work with COVID patients.  ICU and theatre staff had less than half the seropositivity rates, and they have greatly superior PPE.  The study also showed that BME health care workers had twice the seropositivity rate of their white colleagues, and that this difference persisted after the results were corrected for deprivation, indicating that greater workplace exposure was the reason.

The TUC report “Dying on the job” spells out how racism in the workplace results in this greater exposure.  Where are any of these practices mentioned in the consensus statement or any recommendations made how to tackle them?

Inadequacies in existing workplace guidance also not addressed

The consensus statement also does not mention the importance of indoor airborne spread in the transmission of COVID 19 in the workplace, and the necessity of proper ventilation.  Existing government guidance was until recently very poor on this issue (it essentially said “open windows and doors where possible”); it now refers to the newly updated HSE guidance on ventilation, which is much better. However, without additional resources to improve ventilation and without a regulator to monitor and enforce the new ventilation guidance, it is difficult to see how things will improve for many workers currently working in risky environments. Workplace guidance has also not caught up with the scientific evidence on aerosol transmission in other respects, even though official PHE guidance recognised this 2 months ago.  The fact of aerosol spread makes a mockery of the “1m plus rule”, i.e. workers should wear a mask or increase ventilation only if they cannot socially distance by 2m.  The consensus statement simply endorses existing guidance; indeed it says it should be reinforced.  We would ask, why do there continue to be hundreds of workplace acute respiratory infection  incidents of Covid-19 every week if the current guidance is effective? 

Large outbreaks of Covid-19 have occurred in workplaces, many involving large numbers of BME workers, where inadequate ventilation is thought to play an important role.  A detailed study of the outbreak in the Tönnies meat packing plant in Germany in June showed the importance of ventilation in such plants, and demonstrated it was factory working conditions and not individual worker behaviour which was responsible for this large superspreading event.

It is the responsibility of employers to address issues like ventilation in the workplace, and to provide all workers with face coverings of appropriate specification to reduce risk of spread.  The consensus statement says nothing of these issues either, and while employers continue not to implement them, further outbreaks will continue to occur to the detriment of all workers.

Conclusion

The consensus statement offers nothing new and in fact is retrogressive.  None of the major determinants of occupational risk are discussed and the emphasis is focused on health education messages which put the onus on the individual to avoid catching COVID 19, and any individual risk factors workers may have.  Workplace guidance is seriously flawed in important respects, and the regulatory framework is barely functional.  Hundreds of Covid-19 infection incidents occur each week in the workplace.  All workers suffer the consequences.  There is also studious avoidance of the issues of racism both in the workplace and structural racism in society at large.  The voice of BME workers is yet again not heard.  The statement can safely be called a whitewash; it does nothing to draw attention to these issues or the failure of employers to ensure a safe working environment, or the failure of Government to tackle the long recognised social determinants of health which lead to stark health inequalities.

29 November 2020

Appendix

Structural racism in ethnic minority Covid-19 infection and mortality

If image is indistinct please see page 4 here.

From: Drivers of the higher COVID-19 incidence, morbidity and mortality among minority ethnic groups, 23 September 2020.  Paper by the ethnicity sub-group of the Scientific Advisory Group for Emergencies (SAGE).

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