As COVID-19 restrictions are loosened, Canada must do more to protect vulnerable groups, doctors say
Pandemic has 'ripped the curtain back' on poor health outcomes of racialized and other at-risk groups
A successful reopening of the economy following COVID-19 shutdowns must include confronting the inequality and systemic racism that puts people at risk, says one of Canada's leading medical experts on vulnerable populations.
As many Canadians rejoice in returning to some elements of life as they knew it before the pandemic — meeting on restaurant patios in B.C. or getting a haircut in Nova Scotia, for example — racialized, low-income, homeless and other at-risk groups will need more than face masks and physical distancing to keep well, said Dr. Andrew Boozary.
Boozary, executive director of health and social policy at Toronto's University Health Network, said reducing COVID-19 among those most vulnerable begins with addressing the social and economic inequities that made them more likely to fall ill from the virus or suffer other consequences during the crisis that contribute to poor health. Part of that work must include collecting race-based data, he said.
"The fact that it is patients and people living in low-income neighbourhoods or from racialized populations that have borne the brunt of the pandemic shouldn't be a surprise to anybody," Boozary told White Coat, Black Art host Dr. Brian Goldman.
"We have accepted the disparity in both life expectancy and disease burden in this country amongst Black, brown and Indigenous communities [and other] racialized communities. And really, I think it's important to state that our neglect has discriminated against people living in poverty and people from racialized communities for decades."
Although the Public Health Agency of Canada and its provincial counterparts do not collect race-based COVID-19 data — a fact that's brought much criticism throughout the crisis — CBC News conducted a data analysis, cross-referencing census data to case numbers for each borough or municipality released daily by Montreal's public health authority.
Of the 24 socio-economic factors tested by CBC News in Montreal, the strongest correlation in hard-hit areas was between COVID-19 cases and the percentage of Black residents.
Data collected in the U.S. and elsewhere has also shown that people of colour have been more likely to contract the virus.
The collection of race-based health equity data is a matter of life and death.- Dr. Andrew Boozary
In the 12 U.S. states reporting race and ethnicity data around COVID-19, Black residents were found to be 2.5 times more likely to die of the virus than the general population, according to the public policy research group APM Research Lab.
"I think it's been best said by leaders that really the collection of race-based health equity data is a matter of life and death," said Boozary, adding that Canada is far behind other jurisdictions on this front.
He said having that kind of data can help public health departments prioritize high-risk groups with targeted measures that take into account the social context that contributes to health risks both in a pandemic and in general.
He said COVID has also "ripped the curtain back on" things like how "we have accepted chronic homelessness in this country for decades."
"We know thousands of people in Toronto and across cities in this country experience homelessness day in, day out, and as a result have a life expectancy that's 20 to 30 years shorter than the general population… This isn't anything that COVID has necessarily affected or brought up, but it has put a mirror to the outcomes that we have neglected."
Policy initiatives like paid sick leave can help protect some of the most at-risk people, said Boozary.
"There are individuals who cannot afford to not go to work if feeling sick. We've known that before and COVID-19 has brought it up again in the cruelest of ways."
Measures that target personal support workers, migrant workers and those living in shelters or correctional facilities will also go a long way to prevent spread among some of those who might otherwise be particularly vulnerable to disease outbreak, he said.
Dr. Patricia Daly is vice-president of public health and chief medical health officer for Vancouver Coastal Health where COVID-19 is much more contained than it is in hard-hit Ontario and Quebec.
As a result of those lower numbers, B.C. is ahead of many provinces in terms of loosening restrictions and thinking about what the impact could be on all residents.
"We have a lot of people suffering, a lot of people who aren't working, people who have other health-care issues who haven't been able to get their treatment or see their physicians," Daly told Dr. Goldman.
"We have to think about populations living in poverty, those who may have lost their jobs, their homes," she said.
Like Dr. Boozary in Toronto, she's concerned about how to manage risks to people who are already facing obstacles to good health.
"Here in Vancouver we have a continued public health emergency due to opioid overdose deaths, and we saw a spike in overdose deaths since the pandemic started."
"We are quite anxious to ensure that as we open up we address some of those underlying consequences while of course continuing to monitor for any rise in COVID-19."
She said Vancouver Coastal Health has been "very focused on managing the outbreak, reviewing the number of cases we have every day, the contact tracing."
"But I want to not forget to think more broadly… to make sure that I am thinking about those vulnerable groups, those unintended consequences."
Written by Brandie Weikle. Produced by Jeff Goodes, Sujtata Berry, Arianne Robinson and Dawna Dingwall. With a file from Shanifa Nasser.