who is most at-risk for covid-19 in canada? it’s hard to know for sure — and even harder to know how to protect the most vulnerable.that’s why healthcare leaders are
calling on the ontario government to start collecting race and income-based data in relation to covid-19. without plans from the government to release data, researchers from western university have
combined existing data from the public health agency of canada and census data on race and socioeconomic composition of health regions. they found covid-19 infection rates are significantly higher in regions with a higher percentage of black residents.earlier reports from the u.s. show that
black populations make up one-third of hospitalizations for covid-19, despite only accounting for 18 per cent of the population in the areas studied.in chicago, black residents have accounted for
72 per cent of deaths from covid-19, despite making up only 30 per cent of the city’s population. in new york,
hispanic and black residents are facing twice the mortality rate of their white and asian counterparts. thousands of transit workers have fallen ill, a labour pool where ethnic minorities make up 70 per cent of the workforce.so where is canada’s data?on april 10, ontario’s chief medical officer dr. david williams said
race-based statistics are not being collected in canada “unless there are certain risk factors in groups or areas.” he added the world health organization (who) has not yet said race is a risk factor for covid-19.the u.s. shows canada that data collection infrastructure is not only possible, but can provide clarity, says sané dube, a policy and government relations lead at
alliance for healthier communities. dube created an
open letter calling on the ontario government to measure race and income-based data during the covid-19 pandemic. currently, data collection across canada is patchwork and not standardized.“people access healthcare in different ways,” says dube. “we can’t measure disparities and care inequalities if we don’t have data that shows the differential access that people have or the differential outcomes.”without the data on who is diagnosed with covid — and who is a disproportionately impacted — there’s no way that governments will be able to develop policies or a response as a province that takes into account those disparities, she says.
canada cannot extrapolate data from other countries
“ontario is such a diverse province, and canada’s most populous province. you cannot say that that diversity does not matter. we know that it matters,” says dube. “our context is not the same as china. the u.s. has the highest number of cases in the world, and they’re collecting data.
i don’t think that holds up to say ‘other people are not doing it.'”measuring race and income will give one part of the picture of which populations are being over-represented in covid hospitalizations. there are many other groups that live at that intersection. those experiencing homelessness, people with mental health issues and addictions, and indigenous communities are particularly vulnerable to covid-19.during the
media briefing, williams said the current main risk groups for covid-19 are the elderly, those with other co-morbidities, and other health conditions that reduce immune status. williams defended ontario’s lack of income and race-based data collection, saying, “regardless of race, ethnic or other backgrounds, they’re all equally important to us.”
dr. dexter voisin says, “yes, all groups should be equally valued, but we know from research that all groups are not equally impacted. covid impacts individuals based on income — which is highly correlated with race.”voisin, the dean of the factor-inwentash faculty of social work at the university of toronto, says, “in the ideal world it would not be necessary, but we know that we don’t live in the ideal world. public health issues impact folks differently based on their location, based on their social stratification within society, based on gender — and that’s not because of any kind of biological factor but it’s because of social factors.”co-morbid conditions, like heart diseases,
diabetes, and respiratory diseases, correlate with income and race. many black and indigenous communities are disproportionately impacted, which voisin says is, in part, because of where people live.“[williams] is on the right track but we need to move further along that line of inquiry. we need to pull this one step back and track vulnerability. we need to see that co-morbidity is based on income, based on place, and based on race,” says voisin.
knowledge gaps during h1n1
we’ve seen this before during the swine flu of 2009. first nations, inuit and métis peoples in canada were overrepresented during the h1n1 pandemic. although combined, these groups represented
4.3 per cent of the canadian population, this group represented 27.8 per cent of h1n1 cases.members of first nations were
6.5 times more likely to be admitted to an icu with h1n1 than non-first nations people. but the data gathered was inconsistent between provinces and the majority of literature focused on hospitalizations, icu admissions, and fatalities, leaving
gaps in knowledge of h1n1’s epidemiology in first nations, inuit, and métis populations.
‘crisis within a crisis’
“if you don’t address the crisis within the crisis, you don’t mitigate the larger crisis,” says voisin. “all of this is interconnected.”for instance, having a higher number of men from certain populations incarcerated means that having a higher number of women in single female-headed households raising children. this means having a higher disproportionate sample of the population living in poverty.living in poverty during a pandemic means not having the privilege to follow basic public health guidelines.“if you’re living in public housing, you don’t have the luxury of physical distancing,” says voisin. “if you’re living in poverty, you’re more inclined to be an essential worker working in fields where you have to go out to work — like being a bus driver or a home healthcare worker on the frontlines — and you’re less able to protect yourself. the social crisis and the public health crises are all of the same thread.”
this article was originally published on april 17, 2020 and updated on june 2, 2020.diana duong is a writer and editor at healthing. find her on twitter @dianaduo.dduong@postmedia.com
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