Letter to Jens Spahn


Dear Mr. Spahn,  

I am a German citizen from Munich, currently in my final year of studying Anthropology at the University College London (UCL). I am writing to you today to address an issue that has come to my attention recently: the disproportionate effect of Covid-19 on economically disadvantaged and minority ethnic people in Germany and particularly the lack of data-collection in those respects.  

The Süddeutsche Zeitung released an interview with Oliver Nachtwey, in which they discussed data collected by medical sociologist Nico Dragano, which revealed that unemployed recipients of social benefits (Hartz IV) were almost twice as likely to be hospitalized for Covid-19 as compared to the working population. They further discussed the lack of categories of class and race in the discourse around Covid incidence and mortality in Germany (Rühle, 2021). Through some further research I found that even British media outlets, such as The Guardian, are reporting on concerns from German doctors, that minorities are being heavily disproportionately affected by Covid-19 (Connolly, 2021). According to a widely circulated citation by Lothar Wieler, president of the Robert Koch Institute (RKI), Muslims make up “considerably more than half” of the patients receiving intensive care for Covid, even though they only comprise about 6% of the German population (Connolly, 2021). Being a second-generation immigrant of a minority ethnic background myself, this news was disquieting to me. Deeper research into the source of this statement revealed that Mr. Wieler’s words had been taken out of context by the media, so that these numbers were based on reports of physicians in three intensive care wards of three major German cities, and could therefore not be considered a reflection of the situation in the whole of Germany (Eckert, 2021). Regardless, these observations are distressing. Furthermore, this revealed a more longstanding issue: The fact that any form of identity information of Covid-Patients, beyond age and sex, are virtually unavailable across Germany.  

The news outlets NDRWDR and Süddeutsche Zeitung have requested the 16 ministries of health (administered by each of the 16 states of the federal republic) to provide information on the economic status, ethnicity or household size of Covid patients and found that 14 of them were unable to address any of those questions. The hospitals themselves as well as the Robert Koch Institute were equally unable to provide any of this data (Flade et. al, 2021; Rühle, 2021). This means that the data collected by Nico Dragano which encompassed around 1,3 million people insured with the AOK, is the most insight we have gotten in these regards (Rühle, 2021). While they only analysed correlations of Covid hospitalizations with employment status, a quick look at the 2020 statistics of the Federal Employment Agency (Bundesagentur für Arbeit (BA)) reveals that 75% of recipients of unemployment benefits actually have a migration background (BA, 2021). This suggests that the vulnerable group identified by Mr. Dragano is likely to consist to a large proportion of migrants as well. Further, it suggests that Mr. Wieler’s comment, that considerably more than 50% of hospitalized people are Muslim, could be widely applicable after all; considering that the predominant faith among Germans continues to be Christianity, with almost two thirds (62%) of Germans belonging to variations of this religion as of 2018 (European Commission, 2018).  

Health disparities are by no means exclusive to Germany; the United States as well as the United Kingdom have published reports revealing that ethnic and racial minorities have faced up to 5-times higher incidence rates and up to 7-times higher death rates as compared to the respective white population (PHE, 2020; CDC, 2021).  Only through this data has it been possible to identify who the vulnerable populations are and to subsequently analyse how they are being made vulnerable. This information is crucial for the design of effective interventions and is hardly provided through badly sourced newspaper articles and citations extracted from casual conversations. Solid statistical data is needed. 

I understand that Germany has a deeply burdensome history with categories of race and ethnicity. To this day, the German equivalent to race – Rasse – is heavily negatively connotated and vigorously avoided. Even I, who often and passionately speak about issues of race, find myself squirming at the word and reluctant to use it. This is why, in public discourse, we use language like Migrationshintergrund (migration background) or more rarely speak of “ethnic minorities”. In reality, however, these are euphemisms for race, because no one refers to a British, Austrian or Spanish person living in Germany as a person with a migration background or an ethnic minority, even though they technically are. The taboo of the word Rasse goes as far that the German Green party have pleaded for it to be banned from the constitution and replaced by ‘racist discrimination (“rassistische Diskriminierung”), while SPD-representatives suggested ‘ethnic descent’ as a substitution (Touré, 2020; von Bullion, 2020). Their argument is that, scientifically, race does not exist, and that this fact should be reflected in the constitution as a step towards the unlearning of racism (Welt, 2020). Their point, that race does not exist, is based on the important scientific findings that the majority of genetic variation is actually found within “racial” populations rather than between them. Therefore, race has no correlation with genetic variation, which is clinal, complex and everchanging. This makes the current mainstream understanding of the concept, which delineates fixed and distinct racial categories justified through biological differentiation based on phenotypical traits, not only harmful but also gravely inaccurate (Brown & Armelagos 2001).  However, the fact that categories of race have widely been de-naturalized and accepted as a social construct rather than biological fact, does not mean they are any less real (Goodman, 2016). In other words, the lived realities resulting from these categories continue to be maintained and perpetuated, regardless of their scientific grounding. Racialised people continue to be marginalised and discriminated against, with the result of adverse education, occupation and income opportunities. Further, as demonstrated by these health disparities, race, while not inherently biological (in a genetic sense), can have drastic biological (health) consequences. Gravlee (2009) has skilfully outlined how social (and particularly racial) inequality becomes embodied in the biological well-being of racialized groups.   

The sociologist Nachtwey pointed out in his interview that categories of class have similarly faced erasure from public discourse in Germany. He argues that in post-WWII-Germany, notions of class relations were incompatible with the myth of free market economy that was emerging and that tensions with the socialist DDR forced a narrative of a levelled middle-class society (Rühle, 2021). This language prevails into modern-day Germany, where we the lower class is rarely – if ever – referred to. Rather we euphemise it and speak of the ‘lower middle class’ and the ‘upper middle class’, while never actually using the word Klasse which has been replaced with Schicht, another euphemism. However, this shift in language did not in any way dissolve class relations.  

Similarly, banning the word Rasse from the constitution, would not cause the existing inequalities to disappear, rather it would rob us of the vocabulary to address them. These conversations, although uncomfortable, need to be held in order to effect change. Banning certain words, or certain statistical data are counterproductive and shallow attempts that avoid commitment to tackling the structural violence and the systems of housing, education, employment, earnings, health care, and criminal justice which perpetuate unequal distribution of resources and health outcomes (Bailey et. al, 2017).  

The ongoing marginalisation is also deeply entangled with why people from a migratory background might be over-represented on Covid wards. Lothar Wieler has suggested that this over-representation is due to culturally conditioned behavioural differences between the Muslim population and the remaining German population. He has claimed that they comprise a “parallel-society” who are suffering because of a strong “barrier of communication” (TAZ, 2021). However, this harmful and inaccurate narrative further facilitates the othering of a population that should long have been accepted as part of the German society. In fact, research from the US has shown, that behavioural differences are inadequate for explaining racial health disparities (Kuzawa & Gravlee, 2016). Rather, as research on Covid in the UK has confirmed, it is more sensible to look at systemic causes which lead minority ethnic people to have higher exposure to the virus. For example, correlations with occupations, population density, use of public transport, household composition and housing conditions are more likely to be the causes for these disparities (PHE, 2020). Statistics from the German Centre for Integration and Migration Research have shown that here in Germany migrants comprise 35,5% of the workforce in essential occupations such as care, cleaning and post. This is considerably higher than the 22,9% that they comprise of the complete employment market, suggesting higher risk of exposure (Flade et. al, 2021). Again, it becomes clear that the issue of inequality is a structural one, existing regardless of linguistic discourse around it.  

The whole idea of not having categories of race or ethnicity rests on a premise of preventing discrimination. This, however, as I have demonstrated is a false premise. Discrimination does not emerge through the acknowledgement of race or ethnicity and it does not disappear once it stops being addressed. In fact, a refusal to acknowledge race/ethnicity creates further harm as it denies the lived experiences of racialised people and it deprives us of the vocabulary to discuss and tackle these inequalities. Therefore, I plea for a break in this comfortable silence and for a commitment to addressing and tackling these systemic issues. As, for health equity and an effective protection of vulnerable populations, it is imperative to stop ignoring inequalities and to understand the underlying structures perpetuating them. For this, the relevant vocabulary, statistical categories and data are necessary so that constructive conversations can be held, and adequate interventions can be designed and employed. 


BROWN, R. & ARMELAGOS, G. (2001) Apportionment of racial diversity: a review. Evolutionary Anthropology10, 34–40.  

BUNDESAGENTUR FÜR ARBEIT (2021, February 09). Migrationshintergrund nach §281 Abs. 4 SGB III, Berichtsmonat: September 2020. Retrieved from:  

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), United States of America. (2021). Hospitalization and Death by Race/Ethnicity. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html#print (Accessed: 03 March 2021) 

CONNOLLY, K. (2021, March 03) “German doctors broach ‘taboo’ subject of Covid toll on minority groups”. The Guardian. Retreived from: https://www.theguardian.com/world/2021/mar/03/german-doctors-broach-taboo-subject-of-covid-toll-on-minority-groups 

ECKERT, T. (2012, March 04) “Herkunft von Covid-Patienten wird in Deutschland nicht erfasst – „Bild“ reißt laut RKI und Bethanien-Klinik Aussagen aus dem Kontext” Correktiv.Faktencheck. Retrieved from:  

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FLADE, F., GHASSIM, A., GRILL, M., SCHREIJAEG, J., REISIN, A. NDR/WDR (2021, March 4) “Die Ahnungslosigkeit der Politik”. Tagesschau. Retrieved from:  

GOODMAN, A. (2016) Chapter 4: Disease and dying while black: how racism, not race, gets under the skin. In M. K. Zuckerman & D. L. Martin (eds.) New Directions in Biocultural Anthropology, pp. 69-87. John Wiley & Sons, Inc. 

GRAVLEE, C. C. (2009) How Race Becomes Biology; Embodiment of Social Inequality. American Journal Of Physical Anthropology 139:47–57 

KUZAVA, C. W. & GRAVLEE, C. C. (2016) Chapter 5: Beyond genetic race: biocultural insights into the causes of racial health disparities. In: M. K. Zuckerman & D. L. Martin (Eds.) New Directions in Biocultural Anthropology (pp. 89-105) John Wiley & Sons, Inc. 

PUBLIC HEALTH ENGLAND (PHE). (2020)1 Disparities in the risk and outcomes of COVID-19. Retrieved from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdf 

(Accessed: 03 March 2021) 

RÜHLE, A. (2021, March 10) “Die Risiken sind dramatisch ungleich verteilt”. Süddeutsche Zeitung p.9  

TAZ (2021, March 06) “RKI-Chef Wieler zu Corona und Migration: Ungleichheit macht krank” Retrieved from: https://taz.de/RKI-Chef-Wieler-zu-Corona-und-Migration/!5756163/ 

TORÉ, A. (2020, August 28) “Rasse im Grundgesetz Ersetzen” Fraktion SH  

Retrieved from: https://sh-gruene-fraktion.de/pressemitteilung/rasse-im-grundgesetz-ersetzen 

WELT (2020, June 11) “Grüne wollen „Rasse“ aus dem Grundgesetz streichen, Regierung skeptisch” Retrieved from: 

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