Excess deaths and cases of Covid-19 have shone a light on the plight of migrants, ethnic and racial minorities throughout the world. The UK Race Disparity Unit based in the Cabinet Office recently published a report noting:“most of the increased risk of infection and death from Covid-19 among people from ethnic minorities is explained by factors such as occupation, where people live, their household composition, and pre-existing health conditions”. This report is now recommending mandatory recording of race or ethnicity in all death certification from now on.

Here in Ireland, excess cases and clusters have been documented in workplaces such as meat factories, food service and healthcare settings, where over 50% of the workforce are ex-pats or migrants. While the Central Statistics Office documents country of birth, language spoken and racial identity in its population statistics, as GPs in Ireland we are not yet identifying race-based health determinants in our own record-keeping or in shared national healthcare databases. 

Healthlink for example, records the ‘first language’ spoken by the patient during a Covid test referral, but not their race or ethnicity. Linguistic marginalisation or linguistic minoritisation is well-documented as a major barrier to accessing health services and information, but its independent contribution to health inequality where there are no other recognisable differences in health determinants such as educational attainment or race is not well researched.

Migrant workers are especially vulnerable because they are often placed in low-skilled, low-paid work and may live in unhealthy and overcrowded environments without access to healthcare in destination countries. They can be subject to the lack of collaboration between different jurisdictions on labour laws, a factor which can become highly relevant in a pandemic situation where workers regularly cross borders. Predicting health outcomes in migrant workers is difficult because they are not a homogenous group.

The focus of health assessment prior to migration and after arrival tends to be on health risks in the country of origin rather than health risks of the destination job. Migrant workers may, but do not necessarily bring their health risks of their country of origin with them. Occupational health assessments for migrant workers frequently focus on identifying or eliminating country-of-origin risks such as TB, HIV or hepatitis, which are not leading health indicators in the destination country, while at the same time failing to consider that migrants take up greater destination occupational health risks than non-migrant workers.

The housing of migrants who are asylum seekers in Ireland in institutional housing known as Direct Provision has been identified by the HSE and the UN as an independent and major risk factor for the spread of infectious disease such as Covid-19.