In addition to bypassing Michael Marmot’s reports on structural racism in health inequalities (The Sewell report cited my work – just not the parts highlighting structural racism, 7 April), the Sewell report also ignored one by the Scientific Advisory Group for Emergencies last September on the reasons for the disproportionate deaths among black and Asian people. This paper found: “All of these mechanisms [leading to racial disparities] arise from the wider social context that drive ethnic and other social inequalities, such as power relations and structural racism.”
The report is on the government’s website with the words: “the paper was the best assessment of the evidence at the time of writing”. The Sewell report is patently unable to withstand scrutiny, so why has the government not repudiated it?
Dr Jonathan Fluxman
GP, London
• Someone’s health displays the accumulation of influences across their lifespan. Prof Marmot hits the mark when he says “inequalities in health tell us about inequalities in society”. In 2000, he introduced me to the Camden and Islington health action zone in central London. These zones were selected because their residents were sicker than the average population. The Camden and Islington zone contained shocking inequalities in wellbeing and survival. It was also a complex mosaic of ethnicities, and greater illness stalked some groups from infancy. Heroic efforts were made to involve people from the most vulnerable groups and develop new services aligned with them.
Sadly, such zones were short-lived. The government developed a blindness to inequalities unless they related to “levelling up” the time to travel between Leeds and London. Compared with the British white population, Covid-19 was more deadly among middle-aged men with African or Asian heritage. That was not just about their experience of 2020, it was about lifetimes of disadvantage and social exclusion.
Woody Caan
Retired professor of public health, Duxford, Cambridgeshire
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