Using intersectionality in policymaking and analysis: summary findings

Spotlight example of how the concept of intersectionality has been used to identify and understand structural inequality in Scotland

An intersectional approach can cast light on the lived experiences of people with intersecting identities, and can be used to develop policies and services that tackle structural inequality. One example of where an intersectional approach has been used to identify and understand structural inequality is provided here. See the main report for more examples.

Spotlight Example: Understanding racial inequalities during COVID-19

Research looking at the impact of COVID-19 has found that minority ethnic people are more likely to contract and experience serious outcomes from COVID-19. During the first six months of the pandemic, people from minority ethnic groups in England were almost three times as likely to contract COVID-19 and five times more likely to experience serious health outcomes.^[12] In Scotland, National Records of Scotland (NRS) found that between 12th March 2020 and 30th September 2021 deaths amongst people with Pakistani ethnicity were 3.7 times as likely to involve COVID-19 as people with White Scottish ethnicity. Deaths amongst people with Chinese ethnicity (1.7 times as likely), Indian ethnicity (1.7 times as likely) and Other Asian^[13] ethnicity (3.0 times as likely) were more likely to involve COVID-19 than people with White Scottish ethnicity.^[14]

Taking account of a range of factors demonstrates that the link between being a member of a minority ethnic group and a heightened risk of contracting and experiencing serious outcomes from COVID-19 is not direct. Looking across evidence from Scotland, England and across the UK, a number of mediating factors were identified, including:

• Socio-economic circumstance – As in the rest of the UK, minority ethnic people remain more likely to be in poverty than the majority White Scottish population^{[15] [16]}. Data from the ONS and the PHE analysis confirmed the strong association between economic disadvantage and COVID-19 diagnoses, incidence and severe disease.^[17]
• Research suggests that individuals from minority ethnic groups are more likely to have had to work outside of their home during the national lockdown, and are more likely to work in occupations with a higher risk of COVID-19 exposure, such as health and social care.^{[18],[19],[20]}
• COVID-19 disparities between different minority ethnic groups may be due to reduced access to healthcare. Analyses by the Institute for Public Policy Research indicate that in England the ten most deprived authorities have experienced 15% of all public health budget cuts in the past 5 years. According to Census data, many of these areas are more ethnically diverse than the population average.^[21]
• Effects of lockdown - according to The Runnymede Trust, people from Bangladeshi (43%) and Black African^[22] groups (38%) were most likely to report loss of income since COVID-19, compared with 22% of White people. Those from Black and minority ethnic groups were also more likely to have used savings for day-to-day spending (14%) compared with those from White British backgrounds (8%).^[23],[24]

In addition, Keys and colleagues highlighted that, when considering health inequalities and potential ethnicity-related vulnerabilities to COVID-19 in the UK, it is important to understand the historical context.^[25] This is a key tenet of intersectionality. Previous global influenza pandemics and infectious diseases epidemics have clearly shown a clear association between poverty and increased transmission of infectious diseases. ^[26],[27]

The context of racism and discrimination experienced by minority ethnic communities, particularly minority ethnic key workers, is vital to understanding health risks, exposure risk and disease progression risk. Issues of stigma with COVID-19 were identified as negatively impacting health seeking behaviours. Fear of diagnosis and death from COVID-19 was identified as negatively impacting how minority ethnic groups took up opportunities to get tested and their likelihood of presenting early for treatment and care. For many minority ethnic groups, lack of trust in NHS services and health care treatment resulted in their reluctance to seek care on a timely basis, and late presentation with disease.^[28]

The Scottish Government established an Expert Reference Group on COVID-19 and Ethnicity (ERG) in response to reports that some minority ethnic groups are at risk of experiencing disproportionate effects of COVID-19. In September 2020, the ERG published advice and recommendations to the Scottish Government in relation to data, evidence, risk and systemic issues.^[29] This highlighted that "vulnerabilities to COVID-19 are consistent with an established pattern in which 'intersections between socioeconomic status, ethnicity and racism intensify inequalities in health for ethnic groups"^[30], and suggested a range of institutional and systemic factors that could be driving this increased vulnerability among minority ethnic groups including:

• Differential exposures to COVID-19, due to occupation exposure, income and housing issues faced by those seeking asylum, living conditions, poverty, racism and discrimination, and a lack of understanding of Scotland's ethnic diversity.
• Differential vulnerabilities due to health inequalities.
• Differential access to treatment and other forms of support, including a greater risk to adverse outcomes even after hospitalisation, barriers to accessing NHS services among migrants, and experiences of discrimination when accessing health services.^[31]