acism is a matter of life and death. Even before the coronavirus pandemic, racial inequalities in health, education, housing and employment have shaped the lives of BAME groups from cradle to grave. The pandemic is bringing the harsh realities of these longstanding inequalities into sharp focus, making it clear why race should be viewed as a “social determinant of health”. In this context, it is very welcome that the government has agreed to a review into why ethnic minorities are at greater risk of Covid-19, though they have yet to confirm the terms or membership of that review. The patterns we’re seeing – a disproportionately high number of BAME deaths from coronavirus – are not random, but instead track existing social determinants of health. In employment terms, ethnic minorities in Britain are already more likely to work in insecure, low-paid work, and more likely to be unemployed. In housing, they represent more than half of all overcrowded households, are less likely to own their home, and have up to 11 times less green space to access. In other words, their employment and housing circumstances mean they are more likely to be in contact with more people, and so are more at risk of getting Covid-19. Recent statistics suggesting that a third of people critically ill with coronavirus were from ethnic minorities have highlighted this greater risk. Some reports have picked up on the fact that ethnic minorities are more likely to live in London and Birmingham, where there have been more cases, and so perhaps the disproportionality is not so severe. Yet while it’s true that more people of colour live in the capital and more densely populated cities, they are also a much younger population, with relatively few older people due to the history of migration patterns to Britain. Age is the strongest predictor for risk of critical Covid-19 cases, yet only 2-3% of the over-85 population is BAME, while 35% of critical cases are BAME. And while 18% of the white population is over 65, only 5% of the BAME population falls into the same category. Even more striking than the disproportionality in critical cases is the fact that the first 10 doctors who died of Covid-19, and two-thirds of the first 100 health and social care workers, were from ethnic minorities. Although ethnic minorities are more likely to work in these sectors, the mortality figures far exceed their representation in health and social care. One likely reason is that ethnic minority staff are more likely to be on the frontline, and at greater risk of being exposed to the virus. We know that ethnic minorities are less likely to progress at work and more likely to be disciplined, affecting not just their pay, terms and conditions, but also the kind of tasks they are likely to perform, namely those that are less desirable or involve greater risks. Putting it bluntly, discrimination at work seems likely to be causing ethnic minorities to be at greater risk of getting seriously ill from Covid-19. It seems clear, then, that pre-existing ethnic inequalities have had an adverse impact on the number of BAME people affected by Covid-19. Unfortunately, however, there is limited understanding in Britain either of how racism is a structural, institutional issue, or how social determinants are the primary cause of health inequalities. Instead, we hear people offering cultural or even biological explanations for these inequalities. But “ethnicity” per se is not the cause or explanation for health or other social inequalities. Instead of suggesting individual or “cultural” explanations for these outcomes, the evidence shows that the social and economic inequalities faced by ethnic minorities lead to poor outcomes in health. Runnymede’s State of the Nation report, published last week, showed just how disadvantaged ethnic minorities were at the outset of the pandemic. In turn, these inequalities mean they are more likely to feel the consequences of the pandemic more in the months and years to come. After a decade in which policy has ignored racial inequalities, there are concerns that the government response to Covid-19 will again come up short. Ethnic minorities, after all, are disproportionately represented among some of the groups least likely to be helped – those in less secure employment, for example, or the self-employed. In fact, some of the new measures introduced as a result of the outbreak will worsen inequalities – including the increased state powers and reduction in people’s rights. Whenever the coercive power of the state is extended, those powers are most likely to be applied to ethnic minorities, and younger black men in particular. And if citizens feel empowered to report on each other, that too is likely to lead to unequal reporting of who is a threat, given existing public attitudes about race and criminality. Over the coming months we will see just how far existing social and economic inequalities affect ethnic minorities and other disadvantaged groups because of Covid-19. While the disease itself does not discriminate, our response to the pandemic is already seeing certain groups suffer worse outcomes from it. We cannot wait for the next pandemic to tackle racism and provide everyone in Britain with the life that they deserve.