MINORITY AND INDIGENOUS TRENDS 2021 – Thematic chapter 1Recognizing the right to health for minorities and indigenous peoples: Transforming the global inequalities of the pandemic into health justice
The announcement by the World Health Organization (WHO) in January 2020 of a new and harmful infectious disease rightly raised the alarm among minorities and indigenous peoples around the world. Their concern, subsequently borne out by the disproportionate impact on these groups, was driven by a number of factors.
Alongside the endemic poor health these communities frequently face, they are also more exposed to harmful ‘risk factors’ (such as inadequate housing or hazardous employment) than the surrounding majority populations, further compounded by unemployment, discrimination and destitution. Besides often being more biologically susceptible to illness because of co-morbidities and poor health, they are also typically less able to access health care even in contexts where this is in principle universally available. At the same time, they are also overly represented in dangerous or insecure work that carries with it higher levels of personal risk, particularly during a pandemic, with many frontline jobs in areas such as nursing, delivery services and public transport occupied by members of non-majority populations. This complex range of factors meant that, long before the pandemic, health outcomes were significantly poorer for minorities and indigenous peoples – a reality that the pandemic has further reinforced.
Previous pandemics, most notably HIV/AIDS, have proved especially devastating to minorities, indigenous peoples and other socially-excluded groups. Notwithstanding the unprecedented scale of the current crisis, COVID-19 is only the latest in a long series of infectious epidemics and outbreaks, from tuberculosis and malaria to cholera and seasonal Lassa fever, that have been borne disproportionately by those on the margins of their societies. Even in wealthy countries where fatal infectious disease is rare, the impacts of the 2009 H1N1 pandemic on indigenous peoples in Canada and New Zealand, for example, revealed how the impacts of sudden health crises can be experienced very unevenly. In Canada, the division of roles and responsibilities between federal, provincial and territorial governments was not clear and produced jurisdictional disputes regarding funding as well as delays in decision-making for the provision of services. That Canadian experience shows how even the most well-resourced countries could be incapable or negligent in mounting a speedy, relevant and effective response to protect their minority and indigenous populations.
But the devastating impacts of epidemics for some minorities and indigenous peoples go back centuries, involving the intertwined spread of harmful viruses alongside colonial domination, land grabbing and, in some cases, acute depopulation and genocide. Based on this painful history, and more recent experiences of the SARS and H1N1 outbreaks, communities such as the Māori in New Zealand, the Cherokee Nation in the United States (US), and indigenous peoples in South America quickly took action and moved to protect their vulnerable. This also signalled to minorities and indigenous peoples elsewhere around the world the need to prepare. And, sadly, the fears of those who were raising the alarm early in 2020 have largely been borne out.
In many countries, minorities, indigenous peoples and other socially marginalized groups have been affected by higher levels of infection and mortality, from African Americans in the US to migrant workers in Southeast Asia. In the United Kingdom (UK), ‘while blacks are more than four times more likely to die from COVID-19, individuals of Bangladeshi, Pakistani, Chinese and mixed ethnic groups are about 1.8 times more likely to die from the pandemic’. At the same time, they are also facing greater barriers to accessing testing and care, a reality that is not adequately recognized when data is not disaggregated or is incomplete. Finally, as lockdown policies and other restrictions are often felt disproportionately by these communities, given their concentration in informal sector employment, the consequences can further deepen poverty and have negative health effects as a result of inadequate nutrition, evictions and other factors.
While the pandemic has brought greater attention to long-standing disparities, the needs and experiences of minorities, indigenous peoples and other disadvantaged communities are still not being given sufficient visibility. Complex social realities have often been overlooked or misrepresented by media and policy-makers, with communities often stigmatized for high infection rates without an understanding of the factors contributing to the prevalence of COVID-19. In the UK, for instance, some commentators have sought to blame the spread of the virus among minorities on ‘behavioural’ issues or an alleged failure to observe restrictions, rather than acknowledge the underlying social issues that have driven these spikes, from overcrowded, multigenerational households to their greater exposure to high-risk occupations. This lack of attention to diversity and inequalities among different social groups, both locally and globally, has contributed to the prescription of ‘one size fits all’ public health strategies that, in some cases, may be exacerbating the vulnerability of certain communities. For example, in countries where lockdowns are imposed without social support programmes, those already in economically precarious circumstances are more likely to take on potentially harmful work such as food processing, hospital cleaning, burials and cremations.
Looking beyond the immediate impacts of the pandemic, this chapter also explores what is needed for minorities and indigenous peoples to emerge from this pandemic and how progress towards realizing their equal right to health can be achieved. At a fundamental level, achieving meaningful progress towards this will require addressing long-standing issues of structural injustice. That is, aside from addressing the immediate concerns, such as access to basic preventative resources and vaccines, deeper systemic problems need to be confronted – the persistence of deep-seated inequalities that are a central cause of endemic ill-health among marginalized communities.
In the UK, ‘while blacks are more than four times more likely to die from COVID-19, individuals of Bangladeshi, Pakistani, Chinese and mixed ethnic groups are about 1.8 times more likely to die from the pandemic’.
Going beyond equity for minorities and indigenous peoples
One dominant public policy paradigm that continues to disadvantage minorities and indigenous peoples is the commonly accepted emphasis on utilitarian targets that aim to achieve ‘the greatest amount of good for the greatest number’ – a seemingly sensible proposition that can have the perverse effect of leaving the most excluded even further behind. For example, one of the identified failures of the United Nations (UN) Millennium Development Goals (MDG) agenda, running between 2000 and 2015, was that countries and international institutions focused exclusively on reaching the national targets while disregarding who, within a population, was experiencing or receiving the health and development benefits. It was the headline numbers that mattered most. Minorities and indigenous peoples, among the worst-off groups and individuals in many societies, were often neglected in the MDG efforts because it was easier and cheaper to reach larger numbers of better-off people and produce outcomes among them than among those who are marginalized – socially, physically or otherwise. The ethos of achieving targets in the face of global public scrutiny motivated a logic of maximizing efficiency over equity. As a result, social inequalities worsened in many places because those who were already somewhat well-off improved their health and lives even more. However, few would advocate for ‘equalizing down’ those with better outcomes, especially in terms of health. In contrast to maximizing cases, ‘equalizing up’ by giving priority to the worst off is a principle closely linked to improving the lives of minorities and indigenous peoples.
This was what the Sustainable Development Goals (SDG) agenda (2015–30) explicitly aimed to do and is reflected in the prominent tagline and ethical guiding principle of ‘Leave no one behind.’ While the SDG agenda is also structured towards achieving national and global targets, these must be achieved while also benefiting the worst off. However, in the first five years of the SDG era up to the beginning of the pandemic, in most countries little progress had been made. The pandemic and its multi-sectoral impacts are likely to put significant pressure on the ‘leave no one behind’ principle, if not render it meaningless. With national economies diminished and foreign assistance slashed, tentative successes in reducing extreme poverty in many countries have been erased, in the process reversing hard-won health achievements. It is unclear what will happen to the SDG agenda in the future, let alone the concern for equity and prioritizing those most behind. As pandemic recovery and rebuilding efforts intensify, governments and politicians will likely be aiming for as much economic growth as possible, even if it comes at the expense of environmental sustainability and social justice.
Yet this position is both unethical and counterproductive. On the one hand, the pandemic has made it harder than ever to ignore the structural violence and discrimination that have contributed, sometimes over hundreds of years, to the vulnerability of particular groups to ill-health and premature death. By extension, then, the societies that have created those harmful conditions now have a clear obligation to bring them to an end. At the same time, it has also brought to the forefront a realization that neglecting the health and well-being of one group exposes the rest of society, even the world, to the risk of a resurgence or a new threat taking hold. As the saying goes, ‘No one is safe until everyone is.’
Making the impact of COVID on minorities and indigenous peoples visible
As it stands, reliable data on infection rates, mortality levels and other indicators on COVID-19 are very difficult to achieve due to widespread under-reporting, lack of testing and other factors, including the reluctance of some governments to acknowledge the scale of their own problem. Though true across the world, this is particularly the case in countries where health systems and resources are already limited. In this context, it should not be surprising that, as with other health problems, data about the impact of COVID-19 on minorities and indigenous peoples is even patchier than what is currently available for the general populations. While in some richer countries such as the UK and the US, where health data is already disaggregated to some extent and communities have some protections in place, there is at least a partial picture of the impact on minorities and indigenous peoples. By contrast, in the Global South very little is known about how they are being affected. Nevertheless, extrapolating from the disparities where data is available, and widespread reports by human rights groups concerning lack of access to testing, health care or social welfare, it is likely that similar inequalities are at play. Indeed, in some countries there seems to be a clear practice of using the pandemic to scapegoat certain communities for the spread of infections. In India, for example, in the early weeks of the pandemic, Muslim individuals and groups were accused of spreading the virus.
Most of the research and reporting on the Global South has been about the population in general – how lockdown policies have impacted livelihoods, how infrastructure is being overwhelmed and the lack of vaccines – but with little discussion on the specific situation of minorities and indigenous peoples. There are some exceptions, however, that appear to highlight the disproportionate burden of the virus on these communities. For example, Brazilian researchers have reported that, while incidents among indigenous peoples are still under-reported, true mortality levels appear to be more than double those of non-indigenous Brazilians, with illegal mining, deforestation and land grabbing playing a key role in driving up infections. Other studies have identified lack of access to clean water or sanitation, communal living and proximity to urban centres as grave risk factors for indigenous peoples.
One dimension of the pandemic has been that the social distancing policies implemented to contain infections have been affecting minority and indigenous communities in very distinct ways. For a variety of reasons, many countries chose to respond to the pandemic by implementing radical physical distancing policies, such as nationwide stay-at-home orders. In richer countries, it was soon clear that in order for most people to be able to stay at home for extended periods of time, certain others would have to continue working outside their homes and provide a range of essential services – including health care, education, food, security, sanitation, transportation and other roles – to the rest of the population. A large proportion of those undertaking these vital but generally low-paid occupations were members of minority and indigenous communities, effectively risking their own health in order for the majority populations to be protected from the virus.
In the Global South, however, the standard lockdown approach had different dynamics. It was wholly implausible to expect millions living in urban settlements to practise social distancing and be able to work from home. It was similarly impractical to expect various pastoral or nomadic communities to comply with instructions meant for people with fixed and self-contained housing. Nevertheless, for these populations, failing to adhere to lockdown restrictions often meant being harassed or penalized for breaking the law. At the same time, those individuals who could not work from home and who were not regarded as essential workers – those paid hourly wages and working in entertainment, restaurants or street vending – had their livelihoods suddenly cut off. Again, workers in these kinds of insecure, low-paying jobs also belong disproportionately to marginalized groups and were also often unable to access welfare or support. The consequent negative impact on health and well-being, such as malnutrition and stunted growth, is only now being recognized. For example, in addition to the direct threat of COVID-19 itself, people living in refugee camps and migrant settlements worldwide, who are heavily dependent on international organizations and host governments for basic necessities, have faced increased hunger, intimate partner violence and morbidity as host and donor governments have chosen to focus on their own national populations instead.
The lack of internationally available and reliable information on the impact of COVID-19 on minorities and indigenous peoples is surely due in part to the wider absence of data collection facilities in the Global South. But it can also arise as a result of political indifference or a conscious desire to conceal. The problem of missing data does and will have enormous consequences for the future right to health and the health outcomes of minorities and indigenous peoples long after the pandemic has receded. In particular, the non-recognition or obfuscation of acute suffering and preventable deaths within these communities, through the absence or denial of official statistics, is one form of oppression. A remedy cannot be pursued if official or visible sources of data do not identify or recognize the problem. This is why calls for disaggregated data showing the specific outcomes for minorities, indigenous peoples and other disadvantaged social groups are so important. Given that the large majority of countries signed up to collect and publish disaggregated data when they signed on to the SDG agenda, this would simply require them to follow through on their commitments.
Impact reflects long-standing deprivations and relative inequalities
While large datasets or comprehensive evaluations may not be available, a growing variety of other sources document the experience of marginalized groups such as migrants and refugees as well as minorities and indigenous peoples. Drawing on disparate sources ranging from research publications and grey academic literature to news reports and social media, it is clear that protecting these communities from the health risks and associated social impacts of the pandemic requires some urgent interventions, whether it be access to information and personal protective equipment (PPE) to prevent infections or equitable provision of testing and vaccines.
But addressing the vulnerability of minorities and indigenous peoples to COVID-19 also requires addressing long-standing issues of discrimination. This means expanding our frameworks and reasoning beyond access to or redistribution of resources to tackle broader injustices, including structural racism. This matters very specifically in relation to the current pandemic, as well as poor health outcomes in general, because so often the solutions are framed in terms of access to goods and services such as health care or vaccines. To put it simply, securing access to vaccines and other resources is profoundly important for minorities and indigenous peoples, but the wider societal issues that have left them persistently vulnerable to acute health threats (HIV/AIDS, SARS, H1N1, Zika, COVID-19), as well as endemic levels of chronic diseases, injuries and impairments, must also be addressed. Improving health capabilities and building resilience among these marginalized communities to protect themselves and future generations from the next pandemic, as well as other diseases, require that underlying inequalities are effectively addressed.
In the US, data released by the CDC showed that between February and July 2020, 78 per cent of COVID-19 deaths of people under 21 years of age were of minorities or indigenous peoples.
Structural racism and public health – minorities, indigenous peoples and COVID-19
There is very little debate or controversy so far about which countries have been most severely affected by the pandemic in terms of deaths. It is also not controversial that the impacts of both the virus itself and policy responses are not randomly or evenly affecting all individuals or groups in societies. It is also accepted that in severely affected countries, minorities and indigenous peoples have been disproportionately affected compared to majority populations. For example, ‘Black and Latinx people and Indigenous Americans are roughly three times as likely to be hospitalized and twice as likely to die from COVID-19 as are white, non-Hispanic people in the United States.’ There is, however, much debate about why these groups have been so adversely affected.
One way to understand the controversy is to recognize that there are two competing kinds of explanations. Some professions seek to explain why more members of minorities and indigenous peoples are getting sick and dying by examining biological causes, particularly genetic traits specific to minority and indigenous populations. Because COVID-19 is a disease and biological functioning is a natural process, they seek a natural science explanation about why biology is functioning poorly or fails. In contrast, others seek to explain disproportionate exposure to the virus, as well as pre-existing biological vulnerabilities, in terms of the effects of social conditions certain communities experience daily and how they accumulate over the life course.
Those looking beyond biomedical causes have been able to show how minorities and indigenous peoples are being disproportionately affected by COVID-19 deaths and disease in Canada, the UK, the US and some other wealthy economies. For example, in the US, data released by the Centers for Disease Control and Prevention (CDC) showed that between February and July 2020, 78 per cent of COVID-19 deaths of people under 21 years of age were of minorities or indigenous peoples. Meanwhile, researchers in the UK observed that ‘deaths from COVID-19 among people from ethnic minorities are two to four times higher than in the white majority population’ – disparities they attributed in part to ‘comorbidities, overcrowded housing, income inequality and occupational risk’.
While racism has always underscored health inequalities in societies, contemporary activist movements, particularly the social protest movement of Black Lives Matter and related campaigns to decolonize global health, aim to show that the health inequalities that have become visible during the pandemic are not accidental or in some way natural events, but rather the reflection of persistent and pervasive efforts of domination and exclusion. The importance of this wider awareness is that previously the emphasis has been on the material deprivation associated with the status of belonging to a minority or indigenous community as the key factor determining poor health. Now structural racism is being identified, not only as a primary cause of deep-seated material deprivation, but also as an independent cause of vulnerability and harm. There seems to be a growing public understanding that institutions worldwide have, through structural racism, perpetrated violence against minorities and indigenous peoples – including through national public health systems. These are long-standing global problems that are evident at a global level between richer and poorer countries, but also evident within countries between the dominant and the marginalized.
Beyond the science – designing accessible and appropriate responses
In light of the disparate impacts of the pandemic on different social groups, some governments, organizations and social movements are seeing the current crisis as an opportunity to address long-standing structural injustices. These efforts have often been led by minorities and indigenous peoples as they have mobilized in response to the disproportionate impacts of the pandemic among their populations. However, despite being among the worst affected, they have frequently been disregarded by policies and programmes that are designed first and foremost with majority populations in mind.
Lockdown rules, welfare support programmes, new public health legislation, testing facilities and other services are all modelled on a particular vision of a citizen or subject. For example, a drive-through testing facility may be accessible to large numbers of people in a city, but inaccessible to those who do not have cars. Preventing any further erosion of health outcomes and capabilities among minorities and indigenous peoples in light of the pandemic will require concerted and specifically designed efforts. It cannot be expected that the acute vulnerability or harms that certain communities face will be adequately improved through yet more generalized approaches to recovery and rebuilding. The recent history of the MDG era demonstrates that minorities, indigenous peoples and other groups can continue to be excluded even when the majority populations are faring well.
Many governments have sought to justify their policies as ‘following the science’. But such an evidence-based approach would mean following epidemiological analyses which show the prevalence of risk and disease is higher among minorities and indigenous peoples. Given that this is an infectious disease epidemic, this should mean that efforts are targeted to reduce the risk of the most vulnerable and mitigate the further spread of the virus within these communities. Instead, public acknowledgement of the acute impacts on certain population groups, particularly minorities and indigenous peoples, has been minimal.
Yet when communities have been allowed to play a central role through meaningful engagement, outcomes have often been greatly improved, as demonstrated by community-led health strategies employed by indigenous peoples in Australia and Canada. Such examples show how appropriately implemented community participation can jointly achieve epidemiological goals and realize human rights principles. Such efforts also move away from viewing these communities as passive subjects with acute vulnerability to being active agents protecting and expanding their capabilities to be healthy over the longer term.
The pandemic has made it glaringly obvious that to be healthy and stay healthy is not just a matter of having access to health care when you fall ill. Good health requires a whole range of physical, social, economic and other conditions at the household and community levels, as well as nationally and globally. In richer countries in particular, it was soon clear that protecting oneself and loved ones from potentially fatal infections required being able to stay at home for long periods of time. This, in turn, required a large number of further capabilities: having sufficient public health information about the risks in a language that is comprehensible; a safe home with sufficient space to be indoors for days and weeks; associated equipment such as a computer, internet and phone; and access to cash or credit to buy groceries. From this perspective, it is evident that COVID-19 deaths and disease follow the patterns of how health capabilities are usually distributed in a society. The situation of minorities and indigenous peoples can also be understood in terms of health capabilities, rather than just in terms of access to health care. Previously, high levels of poor health and co-morbidities made them more biologically vulnerable to infections. The surrounding conditions further constrained their abilities to protect themselves: for example, communities may not speak the dominant language in which public health information is provided, or lack ID cards to access public facilities.
Policies therefore need to go beyond health care or public health. However, addressing the deeply entrenched social dynamics and relations that help perpetuate domination and marginalization requires a wide range of different efforts, including rights-based advocacy and collective action, particularly within and across communities, to address structural injustice. This means mobilizing for the protection of not only the human right to health but all human rights of minorities and indigenous peoples. Where societies protect all the human rights of all individuals and communities, especially those who are most vulnerable to ill-health, all individuals and communities will enjoy better health outcomes and be more resilient against threats such as pandemics.
Preventing the next pandemic?
While some may be focused on recovery and rebuilding from the current pandemic, there is an understandable interest in preventing the next pandemic or other health emergency. The next major infectious disease outbreak or pandemic will be different in some ways. But it will not be surprising when it happens as the WHO and other organizations are constantly identifying and monitoring outbreaks that they consider could be sources of future epidemics. Indeed, many of those potentially dangerous viruses arise from situations where there is a human role. Massive deforestation exposes new organisms to humans, poor human–animal interactions can produce new organisms, rising temperatures may expand zones of existing epidemics, and so forth. Addressing the potential sources of new and resurgent epidemic threats will require a range of cooperative actions from the local to the global. World leaders have recently called for an international pandemic treaty in order to better alert countries, create better systems for data collection and distribution of relevant goods, and, importantly, address the sources of global health threats.
However, it remains to be seen whether global efforts to avert the next major health crisis will focus on the crucial role of structural racism towards minorities, indigenous peoples and other marginalized communities. Just as national policies have focused on policies for the general public, international agreements will likely focus on institutions with various functions. But while we know that access to goods such as masks or hand sanitizers, and health care, including testing, are all important, they too are only partial components of health resilience. The scope of pandemic prevention must be human focused, and help individuals promote their abilities to prevent infections in themselves, their families and communities. And, importantly, preventing future epidemics means promoting health now, so that populations are as healthy as they can be when a new health threat emerges.
Failing to recognize the crucial role that social exclusion and discrimination play in pandemics and other health emergencies, as well as the everyday functioning of health systems, means that next time infections will once again spread among the most disadvantaged communities. There is a real possibility that without sufficient supply and distribution of vaccines in the Global South, COVID-19 could persist indefinitely, potentially enabling the emergence of more harmful variants of the virus and then a resurgence in infections across the entire global population. All of this is to say that addressing the underlying drivers of poor health for minorities, indigenous peoples and other marginalized groups is crucial to addressing the entire human population’s vulnerability to the next global health threat.
The principles that underpin the right to health and other human rights more generally for minorities and indigenous peoples continue to have salience during the pandemic and are crucial for recovery. First, the right to health encompasses more than health care, and includes supportive conditions that protect and expand the capabilities of individuals and communities to be healthy over the long term. Second, minorities and indigenous peoples have a right to non-discrimination in accessing and experiencing health care, as well as public health policies. And, third, the right to participate in health-related decision-making at the personal and policy level must be respected and realized. Fourth, the right to protection of identity must be respected, because many communities have beliefs and practices related to health and well-being that are central to their personal and group identities. Addressing the acute vulnerabilities of minorities and indigenous peoples is a prerequisite for ending this pandemic for all, as well as for protecting the health of all societies in the future.
- Refocus data collection and disaggregation efforts to ensure the situations of the most excluded are not concealed or overlooked: In line with the promise of the SDGs to ‘leave no one behind’, it is vital that the specific outcomes of minorities and indigenous peoples are adequately captured in official data and targets. These systems, while urgently needed during the pandemic, should be maintained after recovery to assess and respond to the incidence of other health inequalities among communities.
- Ensure that public health strategies reflect the specific social realities of minorities and indigenous peoples, with measures in place to ensure their rights are protected: The ‘one size fits all’ approach to managing the pandemic has in some cases placed marginalized communities at greater risk by failing to recognize the precarious nature of their livelihoods and the lack of an economic support net to weather the crisis. However, the imposition of standardized medical policies predates COVID-19 and is likely to continue without sustained efforts to design policies that are accessible and appropriate.
- Involve minorities and indigenous peoples in the design of public health responses to ensure their relevance and effectiveness: Human rights-based approaches to public health require meaningful participation by community representatives in the design and implementation of any strategies directed towards those communities. This includes groups that may be marginalized within minority and indigenous communities, including women, persons with disabilities, older persons and LGBTQ+ persons.
- Address the fundamental role of structural racism in perpetuating health inequalities: While disparities in outcomes have often been framed in material terms, acknowledging the association with higher poverty levels among some communities, there has been less recognition of the roles that racism and discrimination have played in determining these gaps. Public health should therefore embrace an approach grounded in principles of social justice and anti-racism that includes a wide range of human rights.
- Promote a rights-based pandemic recovery that addresses not only inequities around COVID-19, but also other health challenges: The disproportionate burden borne by minorities and indigenous peoples during the current crisis illustrates historic, longstanding inequities that will remain in place long after the end of the pandemic. These must be addressed to ensure lasting equity and resilience not only for these communities but also for societies as a whole.
 Richardson, K.L., Driedger, M.S., Pizzi, N.J., Wu, J. and Moghadas, S.M., ‘Indigenous populations health protection: a Canadian perspective’, BMC Public Health, vol. 12, 2012, p. 1098.
 Yaya, S., Yeboah, H., Charles, C.H., Otu, A. and Labonte, R., ‘Ethnic and racial disparities in COVID-19-related deaths: counting the trees, hiding the forest’, BMJ Global Health, 5, 2020.
 Stuart, E., ‘Why leaving no one behind matters’, in Development Co-operation Report 2018, Paris, OECD, 2018.
 Nature, ‘Time to revise the Sustainable Development Goals’, Editorial, 14 July 2020.
 Fellows, M., Paye, V., Alencar, A., Nicácio, M., Castro, I., Coelho, M.E., Silva, C.V.J., Bandeira, M., Lourival, R., Basta, P.C., ‘Under-reporting of COVID-19 cases among indigenous peoples in Brazil: a new expression of old inequalities’, Frontiers in Psychiatry, 12 April 2021.
 Simionatto, S., Barbosa, M. and Marchioro, S.B., ‘COVID-19 in Brazilian indigenous people: a new threat to old problems’, Revista da Sociedade Brasileira de Medicina Tropical, 53, 2020, e20200476; Cupertino, G.A., Cupertino, M.D.C., Gomes, A.P., Braga, L.M. and Siqueira-Batista, R., ’COVID-19 and Brazilian indigenous populations’, American Journal of Tropical Medicine and Hygiene, vol. 103, 2020, pp. 609–12.
 Maxmen, A., ‘Inequality’s deadly toll’, Nature, 28 April 2020.
 Stafford, M., Boolaky, U., Elwell-Sutton, T., Asaria, M. and Nazroo, J., ‘How to interpret research on ethnicity and COVID-19 risk and outcomes: five key questions’, The Health Foundation, 27 August 2020.
 Khunti, K., Platt, L., Routen, A. and Abbasi, K., ‘COVID-19 and ethnic minorities: an urgent agenda for overdue action’, British Medical Journal, 369, 2020, m2503.
 Razai, M.S., Kankam, H.K.N., Majeed, A., Esmail, A. and Williams, D.R., ‘Mitigating ethnic disparities in COVID-19 and beyond’, British Medical Journal, 372, 2021, m4921.
Photo: Indigenous Muruwari elder Rita Wright, a member of the ‘Stolen Generations’, is seen at home with her son Dean Wright, who is ill with kidney failure, in Sydney, Australia, January 19, 2021. Picture taken January 19, 2021. Credit: REUTERS/Alamy.