Racism and social inequality have contributed to the increased risk of black, Asian and minority ethnic communities (BAME) contracting and dying from Covid-19, according to a new study.

The report – from Public Health England (PHE) and based on stakeholder engagement with 4,000 people – found that historic racism may mean people are discriminated against when it comes to personal protective equipment (PPE) and may result in people from BAME backgrounds being less likely to seek care or demand better protection.

The report points to a raft of recommendations from stakeholders, including the need to develop “occupational risk assessment tools that can be employed in a variety of occupational settings and used to reduce the risk of employee’s exposure to and acquisition of Covid-19”.

Ethnic inequalities in health and wellbeing in the UK existed before Covid-19 and the pandemic has made these disparities more apparent and undoubtedly exacerbated them

This is especially true for BAME workers in health and social care and on the front line in occupations that put them at higher risk, it said.

The report added: “Ethnic inequalities in health and wellbeing in the UK existed before Covid-19 and the pandemic has made these disparities more apparent and undoubtedly exacerbated them.

“The unequal impact of Covid-19 on BAME communities may be explained by a number of factors ranging from social and economic inequalities, racism, discrimination and stigma, occupational risk, inequalities in the prevalence of conditions that increase the severity of disease including obesity, diabetes, cardiovascular disease and asthma.

“Unpacking the relative contributions made by different factors is challenging as they do not all act independently.

“The engagement sessions highlighted the BAME group’s deep concern and anxiety that, if lessons are not learnt from this initial phase of the epidemic, future waves of the disease could again have severe and disproportionate impacts.”

At the weekend, shadow justice secretary David Lammy said it was a “scandal” that the recommendations in the study had been “buried”.

It comes after the Government was accused of holding back this second PHE report when a first report on the issue was published at the start of June.

The first report looked at why people from BAME communities may be at higher risk from Covid-19 but made no recommendations and made no reference to the 17 sessions held with stakeholders.

The British Medical Association (BMA) sent a letter to Health Secretary Matt Hancock on Saturday asking why the pages with recommendations had been “omitted” from the first report.

The latest report says that stakeholders “expressed deep dismay, anger, loss and fear in their communities about the emerging data and realities of BAME groups being harder hit by the Covid-19.”

Stakeholders pointed to the racism and discrimination experienced by BAME key workers “as a root cause affecting health, and exposure risk and disease progression risk”.

The study said there are issues around stigma and BAME fears of being diagnosed with coronavirus.

It added: “For many BAME groups, lack of trust of NHS services and healthcare treatment resulted in their reluctance to seek care on a timely basis, and late presentation with disease.”

Stakeholders called for immediate action in areas such as housing to reduce inequalities, and “targeted messaging on smoking, obesity and improving management of common conditions including hypertension and diabetes”.

Other recommendations include:

– Better data collection about ethnicity and religion, including having this recorded on death certificates;

– Making it law for health risk assessments to be carried out for BAME workers;

– Culturally sensitive public health messaging so that people, particularly those who may not speak English as a first language, can follow advice on how to protect themselves from Covid-19.

The report did not look at whether genetics plays a role in BAME risk.

Commenting on the report, professor Andrew Goddard, president of the Royal College of Physicians, said: “The second part of PHE’s review once again shows how Covid-19 has disproportionately impacted those from BAME communities and widened health inequalities even further.

“It remains unclear to us why this element of the report did not accompany the earlier PHE review.

“Now that we have these recommendations, they must be placed at the core of both the NHS and the Government’s plans to restart services, as well as plans for further Covid-19 outbreaks.

“There is no time for complacency, and leaders at all levels should be made accountable for delivering these recommendations and regularly reporting on progress.”

Susan Masters, the Royal College of Nursing’s director of nursing, policy and practice, said: “If UK Governments had acted on the advice of previous reviews and reports, BAME nursing staff across the UK would have been better protected going into this pandemic.

“We’ve been calling on employers in all health care settings to take swift and comprehensive action to support and protect BAME staff through targeted risk assessments.

“These new recommendations show clearly why they must take place to avoid needless loss of life.”

A spokesman for the Government Equalities Office said: “This valuable insight will help inform the next stages of our work to tackle the disparities highlighted by the Public Health England review.

“This work will be led by the minister for equalities as we look to build on the good work that is already being done to protect our communities from the impact of the coronavirus.”