Recent reports around ethnicity and Covid-19 have surprised me. They have explained that black people are four times more likely to die of coronavirus than white people, and we don’t know all the reasons why.[1] But it wasn’t this fact that astonished me. The real shock was that this was actually a surprise to anyone. Health inequality between ethnic groups is old news. Just last year the BBC reported that black women are almost five times more likely to die in pregnancy and childbirth than white women.[2] A mirror has repeatedly been lifted up to these kinds of health inequalities in our society.
What we know
Perhaps we can’t rule out an unestablished minor genetic variation at play in either childbirth or Covid-19 infection.[3] But that should not detract from the indisputable major socio-economic variation that exists. As Ben Lindsay has recently reminded us, black people are more likely to be poorer than their white counterparts, and health is undoubtedly linked to wealth.[4] If you live in Kensington and Chelsea (21% black and Asian), women live on average to 86. If you live in Barking and Dagenham (42% black and Asian), you can knock eight years off that average life expectancy.[5][6] Yes we need further research to respond to this, and yet some significant and salient facts are already well established.
Of course, there is a degree of complexity in all of this. For example, Sadiq Khan highlighted recently that people of colour make up a much larger proportion of healthcare workers than the general population (40% of doctors and 20% of nurses).[7] In other words, one reason why black people are dying more often is that more of them are putting their lives on the line for the sake of our friends, family and community at large.
But the researchers at University College London, who did the original analysis, were clear about one major cause of the problem – social disadvantage: ‘actions that are likely to reduce these [differences] include ensuring adequate income protection (so that low-paid and zero-hours contract workers can afford to follow social distancing recommendations), reducing occupational risks (such as ensuring adequate personal protective equipment), reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.’[8]
Reality on the ground
Since people of colour make up a large number of front-line workers, they are more likely to be filling out our prescriptions, emptying our shopping baskets, sweeping our streets and driving our buses. In many cases, they have no choice but to put themselves at risk. A member of my church who works for a supermarket chain has to work from 5 a.m. to 10 a.m., then go home to homeschool her two children. Her company allowed some people to be furloughed on a first come, first served basis. By the time she’d recovered from her shift, her teaching and her sleeplessness, she found that she was one of the few left standing.
On top of this, the social circumstances that many find themselves in lend themselves to poorer health outcomes. I had to drop some food round to someone in an adjacent tower block in the council estate where I live. To do this meant pressing an external buzzer, entering into a crowded narrow foyer where people queued to get into the one working lift, then squeezing in to ascend to the twelfth floor. Everyday life for many people in poorer areas means that social distancing is either impractical at best or impossible at worst.
How we respond
There may be some who read this and think that the injustice that this represents is simply not a high priority. I beg to differ. London is moving towards being a ‘minority majority’ city. In other words, the majority of the population is increasingly being made up of what are sometimes called ‘minority’ groups. According to the last census, only 45% of the London population class themselves as white British.[9] This means that the plight of Londoners of colour fundamentally affects both the welfare of our city and the future health of our churches. It cannot be ignored.
Others will think that solving this should be the first priority of a Christian. I beg to differ. First and foremost, the gospel saves us from sin and eternal death, for eternal joy with God. It is only with the changed hearts that God grants by this gospel, that our actions become more than passing superficial assent but permanent sacrificial love. Highlighting the issues is essential, but it will take supernatural resources to enable the kinds of steps necessary to attend to this.
Mercy ministry
There is, though, a third option. When worship of and witness to Christ is our focus, we find that practical care of those both within our fellowships and outside of them comes as a package deal (Matthew 5:43–47; Galatians 6:10; 1 Thessalonians 5:15).
One way in which we as churches might, in part, seek to do this is by thinking through how to sustain ministries that have been put in place in the short term and help the poor. We can’t do everything, but it is likely that these will disproportionately benefit people of colour in our congregations and beyond.
Fostering agency
However, I want to highlight another key factor underlying health inequality that is often overlooked – something called agency. Agency is a sense that we can make purposeful choices. In other words, that we have some degree of control over our circumstances and situations. The less agency you have, the less well you are likely to be.[10] This is because agency ends up determining your levels of stress on the one hand, and your ability to access resources to promote and maintain health on the other.[11] When a pandemic hits, it would not be surprising that these effects get magnified.
People can feel a lack of agency because of their previous experience of oppression, present socio-economic conditions or ongoing prejudice. But whatever the reason, this is something that we can all play a part in restoring.
Acts 6:1–7 gives us one model for what this looks like within our fellowships. Hellenistic Jews were being overlooked in the daily distribution of food. The solution did not leave the disadvantaged ethnic groups as helpless victims but empowered participants in putting things right. In the process of ensuring representation and restoring agency, great leaders emerged and the missional movement flourished.
Representation versus agency
What steps can be taken to give people of colour in our congregations agency? The default answer is to ensure that you have representation. It is true that ‘it is hard to be what you cannot see’. Lay leaders may be reticent to step forward, staff may be harder to recruit and vocations more difficult to release if people of colour are not visibly present. We need to think creatively about how they might be invited into meetings that they would normally feel ineligible for. We should consider if creating bespoke programmes to nurture talent might help.
However, it is important to stress that this is not necessarily limited to establishing formal positions. In fact, formal positions can be a way of avoiding thinking hard about this. Agency is about being able to genuinely influence how things happen.
Are people of colour in our congregations not only visible, or even listened to, but aware that their voice makes a difference? What evidence would they see of that? When have they been given responsibility on the basis of their character and coached towards competence? This begins when white majority cultures resolve to meaningfully relate to and invest in people of colour.
Leading by example
Significant change always starts with the leadership. Their actions – spoken and unspoken, whether at the microphone, in meetings or at mealtimes – set the tone for what is really endorsed and what isn’t.
I need to stress too that none of this needs to be seen as a threat to a white majority culture. It is not that some people need to be ‘pushed off the table’ to make way for others. There is simply more space left to fill. The vision we work towards is all peoples, tongues and nations worshipping the Lamb. We are all bereft if any are missing, excluded or sidelined.
Becoming an advocate
Let me finish with a concrete way for each of us, within our contexts, to begin addressing one of the underlying factors behind ethnic health disparities. This is your call to action. Become an advocate for a person of colour.
I’ve heard many stories of people finding themselves participating in conversations, with significant contributions to make, only to find that their opinion was either not sought or simply drowned out. Many of us will have experienced something like this at one time or another. But when you have experienced this enough times, in enough different contexts, you begin to believe that what you have to say simply doesn’t count. You believe your role is merely to survive, rather than to shape the institution. And that is the experience of many people of colour.
However, I am blessed to have had many advocates along the way who decided to seek my voice, and even stifle others long enough, so that it could be heard – and, perhaps as importantly, actually engaged with. Many are not so fortunate. None of us can do everything. But is there someone – perhaps one person in your circle of influence – with whom you could make a start? They may be in the pew. They may even be in a position of leadership. But do their judgements ever affect change? It matters, for the sake of our churches and for the flourishing of our city.
Rev. Dr Jason Roach is Vicar of The Bridge Battersea and Board Member, The Co-Mission Initiative
[1] https://www.theguardian.com/world/2020/may/07/black-people-four-times-more-likely-to-die-from-covid-19-ons-finds
[2] https://www.bbc.co.uk/news/uk-england-47115305
[3] The range of possible causes with respect to Covid-19 data are well described in The British Medical Journal (https://www.bmj.com/content/369/bmj.m1548)
[4] https://www.premierchristianity.com/Blog/Covid-19-has-revealed-racial-inequalities.-Here-are-3-ways-the-Church-must-respond; for the data see: Guy Palmer and Peter Kenway, ‘Poverty Among Ethnic Groups; How and Why does It Differ?’ (Joseph Rowntree Foundation, 2007), page 5.
[5] https://www.standard.co.uk/news/london/revealed-the-london-boroughs-with-the-longest-and-shortest-life-expectancy-a3618471.html
[6] https://data.london.gov.uk/dataset/ethnic-groups-borough
[7] https://www.theguardian.com/commentisfree/2020/apr/19/bame-dying-coronavirus-sadiq-khan
[8] https://wellcomeopenresearch.org/articles/5-88
[9] https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/regional-ethnic-diversity/latest#main-facts-and-figures
[10] Tamber and Kelly, ‘Fostering Agency to Improve Health’ (Bridging Health and Community, 2017), page 17.
[11] Whitehead et al, ‘How could differences in “control over destiny” lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment’ (Health and Place, 2016), pages 51–61.
