Doctors raised an alarm in March: Somalis in Sweden are heavily over-represented among those who die from COVID-19. Other ethnic groups, such as African Americans in some US states, have subsequently also been recognised as over-represented. And the question immediately arose why this is the case.
The availability of information in various languages was considered to be one cause, and Swedish official agencies introduced information campaigns. Other social and cultural factors have also been brought up in the public debate: cramped housing, difficulties in working from home, and a tradition in certain cultures to remain close to sick relatives and friends to care for them.
“It’s my perception that the official agencies have focussed on classic social causes such as cramped housing and the fact that many have a type of work that does not allow them to work from home. These aspects are extremely important”, says Anna Bredström.
A public debate focussed on culture
She is, however, at the same time sceptical that the focus is often placed on culture. Anna Bredström’s research concerns how ethnicity and migration shape health, healthcare and the production of biomedical knowledge. She considers that the over-representation of certain groups raises a larger question about health equality.
She points out that she has not systematically studied the particular debate about the corona crisis and migration, but she does recognise the arguments from other contexts in which questions of migrant health are discussed.
“Culture and cultural differences are often brought up as an important aspect, and it may be this idea that I am most sceptical about. It’s not the case that culture is not important. Culture plays a role in how we experience and interpret symptoms. It also affects the way in which we seek medical care”, says Anna Bredström.
But she believes that we must consider the concept of culture in the right way. It is easy to simplify this, and create stereotypes instead of understanding. This contributes to a form of cultural racism in which the cultures of certain groups are seen as problematic.
Anna Bredström points out that what is seldom discussed in the public debate is how ethnic discrimination influences the healthcare system. She has previously studied how different groups are met by such bodies as local healthcare centres, youth clinics, and maternity care.
“Health and healthcare are, unfortunately, not equal. Some groups hesitate in seeking care as a result of previous experience of negative encounters. Further, the way in which the healthcare system is organised makes it rather inaccessible for many groups.”
Ethnicity and genetic differences
Another topic that the media has mentioned, although not to any great extent, is whether genetic factors play a role in vulnerability to the coronavirus. This is a further aspect in which Anna Bredström is interested, and her research will follow this during the pandemic. Together with her colleague Shai Mulinari at Lund University, she is studying how ethnicity is used in population genetics.
“The aim of the genetic research is to bring more accurate diagnoses and develop tailored treatments. We are studying genetics from the perspective of the social sciences, and investigating the consequences of an interest in genetic variation within and between different groups. Will studies in genetics lead us to consider ethnicity as a biological property, and if so, what effect will this have on questions of racism and equal health?”
An interest in genetic variation has led to an increased focus on both race and ethnicity in medical research, principally in the US.
“A critical debate is under way about the with danger of focussing on ethnicity and race,” says Anna Bredström, “but this debate also deals with questions relating to justice and such questions as which groups are represented in clinical trials of various drugs.”
“It will be interesting to see the extent to which this is picked up in research into the novel coronavirus, and what effects it will have. Will genetic differences be studied as a possible cause for the over-representation of certain ethnic groups in the statistics? And if so, will the explanation based on genetic differences win territory from other explanations such as social background and culture?”
Can the pandemic stimulate measures to increase health equality?
The public debate has discussed the fact that certain ethnic groups have been hit hard by the coronavirus, and the question has arisen why this is the case. Anna Bredström believes that this is a step in the right direction. But much depends on the measures that politicians choose to adopt.
“Of course, there’s a risk that the image presented by the media will reinforce stereotypes and racism, but even so I believe that it’s positive that the differences in vulnerability are highlighted. It has generated some initiatives that may lead to improvements. But if the changes are to be permanent, we must understand what has to be done and we have to take it seriously. Otherwise, there’s big a risk that after a year or so we will just continue as usual. The issue of equality is truly a question for our politicians.”
Translated by George Farrants.