COVID-19 guidance can be hard to follow, as it is constantly being updated according to the latest scientific findings. Now imagine having language as an extra barrier to your understanding of essential health advice.
2015 figures from the Office for National Statistics show that over four million people in England and Wales do not consider English to be their main language, and more than 860,000 of those people speak little or no English.
In July 2020, a joint letter to Health Secretary Matt Hancock and Communities Secretary Robert Jenrick voiced concerns about the government’s lack of translated public health information. Campaigners have said that even when translations are available, they are done in a ‘limited range of languages’ and take weeks to be revised after medical advice changes.
The government had originally provided guidance on social distancing in eleven languages, including Urdu, Bengali and Arabic. But at the start of May, when official guidance changed to new social distancing guidelines, ‘staying alert and safe’, it was not translated. Information on the use of face coverings and the NHS Test and Trace programme had also not been translated. Whilst information on face coverings has since been translated into nine other languages from English, official guidance on Test and Trace, and the latest lockdown guidelines remain available in English only on the GOV.UK website.
The organisation that co-ordinated the letter in July, ‘Doctors of the World’, has translated coronavirus advice into more than 60 languages to provide information for non-English speaking migrants and asylum seekers. These resources have been downloaded about 60,000 times in the UK so far. But, as the letter claimed, “it is not sustainable or practical for local authorities and civil society” to fill in the information gap for those groups already most vulnerable to the virus.
Migrant and ethnic minority communities are disproportionally exposed to COVID-19 health effects due to intergenerational living, pre-existing medical conditions, and persistent environmental injustice. Low-air quality near industrial sites, motorways and landfills has been pointed as a risk factor for lung-inflaming conditions such as Coronavirus. In the UK, of the first 2,249 patients with confirmed Covid-19, 35% were non-white, while only 14% of the population in England and Wales is non-White.
The lack of political will to provide these translations is tied to a wider issue of exclusionary health systems and resources. At the start of July, Medical Student Malone Mukwende gained visibility in the UK for producing a handbook called ‘Mind the Gap’, which shows how clinical signs appear on darker skin. “On arrival at medical school I noticed the lack of teaching in darker skin. We were often being taught to look for symptoms such as red rashes which I was aware would not appear as described in my own skin,” he told BME Medics. Mukwende hopes that this initiative will help make medical institutions, curricula, and professionals less biased and more inclusive.
His initiative and the creation of the Instagram page Brown Skin Matters by Ellen Margolis have led over 200,000 people to sign a petition calling for the General Medical Council (GMC), which oversees medical education and practice in the UK, to make teaching material more diverse. The GMC initially responded that they are working with medical schools in an effort to change the training of future doctors. In November 2020, a further response was added by the Medical Schools Council, stating that an Equality, Diversity and Inclusion Alliance had been created, with the first task to be an investigation into how best to diversify the medical curriculum. The NHS also acknowledged that its Health A-Z website should reflect “how different conditions can affect different people.”
In a similar effort, the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI) have funded six new research projects into the different effects of COVID-19 across ethnicities. Data suggests that minority ethnic individuals are twice as likely to die of COVID-19 than white people when taking into account other personal characteristics like age. One of the projects will develop a tool called ‘INCLUDE Ethnicity Framework’, which will enable the designers of clinical trials to analyse the factors that may reduce the inclusion of BAME participants, such as culture, treatment being tested, existing disease and trial information. Another will design and deliver culturally relevant health messages for Black and South Asian groups that have long been excluded from mainstream health services. Unfortunately, research focused on the particular health consequences of COVID-19 on ethnic minority groups is still the exception rather than the rule.
Behavioural scientist Dr. Pragya Agarwal warns that subversive racism and implicit bias in healthcare are also likely to be affecting minority ethnic communities during the pandemic. For instance, black patients may receive less pain relief than white patients due to a false belief about biological differences between black and white people. Inequality in health outcomes is often assumed to be the consequence of poor lifestyle choices or habits rather than a result of entrenched structural discrimination.
The pandemic is shining a light on inequalities in all areas of life and the healthcare system could not escape this scrutiny. From missing translations to the lack of medical education on symptoms in different skin tones there is a long way to go before BAMER people are completely integrated into British healthcare.
JAN Trust works to support women and young people from BAMER communities to overcome barriers to inclusion, by providing services such as ESOL-courses, mentoring, advice, guidance in issues of refuge/asylum, immigration, employment, housing and life in the UK. Many of our users are migrants or members of marginalised groups. While we deliver English skill courses, we will continue to advocate for wider inclusion of languages, cultural information and anti-racist practice in the UK’s health system.