A delayed report into the reasons why black, Asian and minority ethnic people (BAME) are disproportionately contracting and dying from Covid-19 has increased pressure on the government to act immediately to address the problem. The Public Health England (PHE) review, based on stakeholder engagement with more than 4,000 people, says historical racism may make BAME individuals less likely to seek care when needed or, as NHS staff, to speak up when they have concerns about personal protective equipment (PPE) or increased risk. Dr Jennifer Dixon, the chief executive of the Health Foundation, said: “Black and minority ethnic communities speak loudly in this report and say discrimination is among the fundamental causes of ill health. They should be listened to. “We have seen many commissions make recommendations on racial equality in the past. Now is the time for further concrete action, beginning with government.” PHE’s work on disparities in the effects of Covid-19 on BAME communities has been dogged by controversy since it published its first report two weeks ago, which found that BAME Britons were up to twice as likely as white Britons to die if they contracted coronavirus, but it failed to examine why or propose solutions. Additionally, it was reportedly censored by the government before publication to remove any references to the impact of structural racism, and last week it emerged that there was an entirely separate 69-page document, which was leaked to Sky News. This document, finally published on Tuesday, contains recommendations including the mandatory collection of ethnicity data at death certification, good representation of BAME staff at all levels in NHS and care services, and “fully funded, sustained and meaningful approaches to tackling ethnic inequalities”. However, it still attracted criticism for being too vague. Dave Prentis, the general secretary of the Unison union, said: “The government must act now. Words and promises to do something in the future won’t cut it any longer. “The government’s failure to release the PHE data and recommendations together was a huge mistake. It’s caused further mistrust and damage to the black community at a time when people need reassurance, not dither, delay and excuses.” Kamlesh Khunti, a professor of primary care diabetes and vascular medicine at the University of Leicester, said: “The report makes seven recommendations, many of which seem obvious, but does not give a huge amount of detail on how these can be implemented and over what timeframe.” The Royal College of Nursing said the report supported its calls to protect BAME staff through targeted risk assessments “to avoid needless loss of life”. Criticism of the government for failing to take action to protect BAME people from the disproportionate risk posed by Covid-19 has come as tens of thousands of people in the UK have taken to the streets to protest against racial injustice. It emerged on Tuesday that the government’s scientific advisers had raised the prospect of protests or unrest due to racial inequality and economic hardship being exacerbated by the virus. In a paper published in late May on the Covid-19 risks from public protest in the event that lockdown is eased, the Sage/SPI-B security and policing sub-group cautioned: “Inequality and grievance in the UK ought not to be seen in isolation. Although a sense of common purpose does not yet exist, there are some signs that it is emerging, for example, in comparisons of the differential impact on certain ethnic communities. This is already a cause célèbre for organisations such as Black Lives Matter, which has a global network. “Economic hardship and a sense of hopelessness among young people may also be channeled in ways reminiscent of protests in France, specifically emulating them.” Additional reporting by Russell Scott