Did institutional racism contribute to adverse COVID-19 clinical outcomes in ethnic minority healthcare staff? Systematic review

IntroductionOf the United Kingdom National Health Service (NHS) healthcare workers who died during the first wave of the pandemic, 63% belonged to an ethnic minority background, despite making up 21% of the NHS workforce. Previous research has considered biological and social causes such as obesity or overcrowded housing. This review aims to explore whether elements of institutional racism contributed to ethnic disparities in adverse COVID-19 clinical outcomes among healthcare staff. MethodEleven databases were searched including MEDLINE and the Cochrane Library. Eight healthcare organisations within the grey literature were also searched. A narrative synthesis was conducted. Results20 studies were included for review. There were ethnic disparities in the rate of COVID-19 infection, mortality and wellbeing. Three elements of institutional racism were identified associated with these adverse outcomes, namely, overrepresentation of ethnic minority staff in frontline roles, discriminatory redeployment and harassment and bullying. ConclusionThe pandemic exacerbated pre-existing racial inequalities within the UK healthcare workforce. Further research is required to clarify the definition of institutional racism and increase understanding of how this manifests in a healthcare setting and can be mitigated. Funding statementThe Wales COVID-19 Evidence Centre was funded for this work by Health and Care Research Wales on behalf of Welsh Government.