Immigrants. The working poor. Essential workers. Third doses lag in Toronto’s most vulnerable areas; Let’s celebrate Toronto’s vaccine success story

Not that surprising as they lagged with earlier doses as well.

Throughout the COVID-19 vaccine rollout, Torontonians have watched as neighbourhoods home to those experiencing some of the harshest outcomes of the pandemic have had among the lowest vaccination rates

Now, as public health and community organizations work on the ground to improve third-dose uptake, new data from the Gattuso Centre for Social Medicine at University Health Network lays bare the stark demographic differences between the Toronto neighbourhoods with the highest rates of third-dose vaccination and those with the lowest. 

What it shows in granular detail is that many of our most vulnerable citizens — immigrants, the working poor and essential workers in trades and manufacturing — live in areas where third-dose vaccinations just aren’t happening anywhere near the rates seen in some of Toronto’s richest and least-racialized neighbourhoods. 

For example, 71 per cent of the population is racialized in the bottom 20 per cent of Toronto neighbourhoods ranked by third-dose uptake. That compares to just 24 per cent in the top 20 per cent of neighbourhoods with the highest rates of third-dose vaccination. 

Similarly, the percentage of the population that meets low-income thresholds in the areas with the lowest third-dose vaccination rates is nearly double that in neighbourhoods with the most administered. 

“It doesn’t need to be this way. There was great success in narrowing the access gap for the rollout of Dose 1. It can be done again. We can’t afford not to,” said Dr. Andrew Boozary, executive director of the Gattuso Centre.

“If we don’t address the pathologies of poverty, if we don’t shift more public investment into these neglected neighbourhoods, we will continue to see worse health outcomes and wider health disparities than we’ve ever seen.”

The Gattuso Centre’s analysis also shows that neighbourhoods with the lowest third-dose uptake have higher proportions of essential workers in manufacturing, utilities, trades, transport and equipment operation — sectors that don’t conform to regular nine-to-five workdays and that are not conducive to allowing workers to take time off to get vaccinated during clinic hours.

Indeed, the percentage of the population working in manufacturing and utilities is 10 times higher in areas with the lowest rates of third-dose vaccination than in those with the highest rates. Likewise, the percentage of people employed in the trades, transport and equipment operation is more than four times higher in the bottom 20 per cent of Toronto neighbourhoods by third-dose vaccination than in the highest 20 per cent. 

“If racialized community members are getting their third doses at a third of the rate compared to non-racialized communities, we need to make specific, targeted interventions that are going to provide information in a culturally appropriate and safe way for these communities,” said Michelle Westin, senior analyst for planning, quality and risk at Black Creek Community Health Centre who has been leading mobile vaccination clinics in northwest Toronto.

“We need to be having ambassadors that are representative of these communities to help build that trust. We have to have vaccinators that are representative of these racialized communities. We need to make sure that vaccinations are accessible to people who are low income, so ensuring that they are in spaces that they can get to easily, assist with providing transportation if needed, ensuring that hours of the clinic work with folks that are having to work different hours of the day and multiple jobs,” she added.

The city of Toronto has been waging a three-pillared operation to get shots into arms in the neighbourhoods with the lowest uptakes. This includes hyperlocal clinics in malls, transit stations, workplaces and schools; outreach around these clinics through 155 community agencies and more than 400 neighbourhood vaccine ambassadors; and a get-out-the-vote style campaign, dubbed “VaxTO,” using text messages, phone calls, emails and town halls to get information out.

“We know that when we announced our target to reach 90 per cent of residents for their first dose, people told us it was impossible in a city as large and diverse as ours. We proved that it was possible when you commit to equity and you don’t stop,” said Coun. Joe Cressy, chair of the Toronto Board of Health. “You literally have to go door-to-door, building-by-building in every language with trusted local leaders. It’s not quick because tackling inequity is never quick. But it works.”

To date, 60 per cent of eligible residents in Toronto have received a third dose. 

But there is still a long way to go. The Gattuso Centre found that the gap between the neighbourhoods with the most and least third dose-uptake has widened substantially over the past seven weeks. In Kingsway South, for example, 68 per cent of eligible residents have received a third dose, compared to just 27 per cent in Mount Olive-Silverstone-Jamestown — a gap of 41 percentage points.

“The gap is striking, especially given what we’ve learned throughout the pandemic. We’ve seen real success in earlier stages of the vaccine rollout when community leadership has been supported with the resources and focus to ensure there is true access. It obliterated many notions of vaccine hesitancy early on,” Boozary said.

“But if we stray from that, we will continue to see this widening of a gap and it will not be recoverable if we do not ensure that those same investments and resources and supports are there for everyone.”

Luwam Ogbaselassie, implementation lead with the Gattuso Centre who has been supporting the vaccination effort in the Humber River-Black Creek region, said the involvement of community leadership is key to narrowing the third-dose uptake gap. 

“Wherever there are resources being allocated towards vaccines, it should be guided by community leaders around how best to structure those clinics and how best to reach the people who have been the hardest to reach and continue to be the hardest to reach,” she said, noting that she has seen first-hand the meaningful impact of community ambassadors who live in the same buildings and in the same neighbourhoods as those who may harbour mistrust of the health care system. 

“I’ve always said as a hospital partner, we bring the vaccines, we bring the clinical teams, but we look to our community partners to guide us on how to set up the clinics, how to engage with people who live in the community.

“Community leadership makes all the difference.

Source: Immigrants. The working poor. Essential workers. Third doses lag in Toronto’s most vulnerable areas

On a more positive note:

It’s a snowy Thursday afternoon in Toronto and the vaccination clinic at the Woodbine Mall is getting ready to welcome its first visitors of the day. The news is full of the demonstrations in Ottawa against pandemic restrictions. Similar protests are about to come to Toronto. But at the clinic, the mood is purposeful, unruffled, even buoyant.

Nurses sit at tables filling syringes with vaccine and loading them into trays. Helpers lay out colouring sheets to amuse kids coming in for their jab. One greeter brandishes a little Canadian flag that she waves to show visitors when a booth is free.

As opening time approaches, operations manager Simone Richards gathers everyone for the daily huddle, a combination of pep talk, check-in session and revival meeting. Smiling behind her mask, she warns the group: “We are running low on teddy bears.” The local police station donated a pile of the toys to soothe nervous kids and there are only a few left.

After singing a rousing Happy Birthday for their clinical manager Arturo Villasan, staffers put their hands in, like athletes before a game, for a go-team cheer – except that, pandemic style, their hands don’t actually touch. Then they open the doors to let people through. They get hundreds a day, most of them happy to get the protection offered by the vaccines against COVID-19.

The scene at the Woodbine clinic tells a different story than you see in the headlines. In a week in which all the oxygen was consumed by noisy and sometimes obnoxious protesters, it is worthwhile to remember that most Canadians don’t feel their rights are being trampled by a despotic government. Most believe in vaccines and are eager to get jabbed. Most wear their masks and obey the rules on gathering and distancing. Though it will disappoint the Russell Brands of the world, Canada is not in revolt. Quietly, capably mustering all the available tools of technology, science and human collaboration, the country is getting on with the task of combating a deadly and insidious virus.

Toronto’s vaccination campaign, the biggest in its history, is an impressive success story. More than 6.5 million doses have been administered. Ninety per cent of residents 12 and older have one dose and 87 per cent two. Sixty percent of eligible residents have a booster, the result of a stepped-up Team Toronto drive to meet the threat from the Omicron variant. More than half of kids have one dose and a quarter have two.

To inoculate all those people in a city of 180 languages, dozens of cultural groups and scores of neighbourhoods has been a staggering task. To reach the hesitant, the disadvantaged and the disengaged, the city has hired hundreds of community ambassadors and translators to get the word out. It has dispatched mobile clinics from one end of the city to the other. It has bombarded residents with text messages, robocalls and flyers.

On the same afternoon that Ms. Richards and her team were greeting visitors to their big clinic in a Hudson’s Bay store at Woodbine, workers were going door to door in a Parkdale seniors’ building and soothing nervous kids at a Mount Olive school. At a small clinic in a mall at Jane and Finch streets, they don’t just wait for people to walk in. They recently persuaded the busy lady at the local roti joint to sit for a vaccination right in her shop. Every vaccination counts.

Leading me on a clinic tour, Joe Cressy, a city councillor who is chair of the city’s board of health, called it a brilliant example of breaking down silos and bringing everyone together in a common cause: pharmacies, hospitals, public-health workers; community and neighbourhood associations; cops and firefighters; care homes and schools.

Though we hear a lot these days about conflict and anger, what really stands out is the way all these groups are working arm in arm. As Mayor John Tory puts it, “the city has been united.”

Of course, it’s taking a while. It’s only natural that people are frustrated with the persistence of this virus and the annoying, limiting measures put in place to control it. If some believe that governments are to blame for much of the misery, they have a perfect right to say so, as long as they do it peacefully and lawfully. But while thousands are taking to the streets, hundreds of thousands of others are still lining up to get their shots and do their bit to quell the virus.

Ms. Richards and her Woodbine crew are standing ready to help them, with kindness, efficiency and good cheer. More teddy bears are coming.

Source: Let’s celebrate Toronto’s vaccine success story

A shot in the dark and 185 megabytes of data: How I investigated a system of bias in Canada’s prison system

Good account of Tom Cardoso’s data journalism and the processes involved in the Globe’s excellent analysis of racial disparities in incarceration (Bias behind bars: A Globe investigation finds a prison system stacked against Black and Indigenous inmates). Puts my small efforts in perspective:

A little over two years ago, I dropped a letter in the mail.

I had begun to wonder, after a series of high-profile criminal cases had ended in acquittals earlier that year – Gerald Stanley and Raymond Cormier’s trials, specifically – if I could collect any data on the racial composition of juries. I shot off a few e-mails to lawyers and activists, and quickly learned this data likely didn’t exist.

But, as part of my poking around, I realized I might be able to look at something else: sentencing. I figured sentences must be tracked in a structured way by correctional authorities; if not, they wouldn’t know when to release inmates. Given the overrepresentation of Indigenous people in the correctional system, it’d be worthwhile to examine sentencing data by race – so I pivoted, from jury composition to sentencing.

Though freedom of information requests are often a shot in the dark, I typed up a letter asking for 20 years of records from the Correctional Service of Canada’s (CSC) database, which I’d learned about by e-mailing yet another set of people. On Aug. 30, 2018, I mailed them my request, and then almost immediately forgot about it.

Weeks later, I heard back from the CSC’s freedom of information officers, and began a months-long negotiation for release of the data I’d requested. In April, 2019, I finally received a CD in the mail, and went to open the spreadsheet it contained.

Microsoft Excel booted up, and then immediately crashed. The spreadsheet the CSC had disclosed was 185 megabytes. In my hands, I realized, was an enormous data set unlike any I’d ever worked with, recording the lives of nearly 50,000 people in the CSC’s custody between 2012 and 2018. I used a statistical programming language called R to open the file, and began digging around.

It often takes me a while to become “comfortable” with new data, and it was especially true now given this file’s size. I had no idea what kinds of patterns it contained, or how best to summarize it. In my mind, I often picture this phase in any analysis as the point at which I “crawl inside” a data set.

To start, I blindly summarized it, curious to see what it’d tell me. I figured I needed a second opinion, so I sat down with Patrick White, a colleague who’d extensively covered the federal prison system, and showed him some of the charts I’d cooked up. “There’s almost too much interesting stuff in here,” I told him, “and I’m not sure where to start.”

After spending some time with the materials I’d pulled together, he asked simply: “What about these risk assessments?”

From there, exploring the data became easier, and I quickly uncovered some disturbing patterns. Indigenous and Black people seemed to be receiving worse scores across a range of assessments much more frequently than other groups. Two scores in particular, the “offender security level” and “reintegration potential” score, sounded especially important. But I had no idea what these scores were supposed to represent, how they were calculated or what impact they had on an inmate’s time in prison.

By now, it was December, 2019, and I began reaching out to anyone I knew who could tell me whether – and how – these scores mattered. At the end of each call, I’d ask them if there was anyone else they’d recommend I speak with. Over a period of 10 months, my network grew from a small handful to nearly 70 people.

With each conversation, I tightened my methodology and honed my analysis. Eventually, after being inspired by a U.S. news outlet’s investigation on risk assessments, I realized I needed to disambiguate the impact of race from everything else using statistical modelling. So once again I went back to my Rolodex, e-mailing academics, statisticians and data scientists who could help me. Over the winter, spring and summer, guided by their advice, I built the kinds of statistical models I’d need for the analysis.

As I was doing that, I also began looking for inmates who could tell me about their experiences. Finding people who’d speak with me wasn’t easy, given I was looking at something as arcane and specific as risk assessments. I met Nick Nootchtai, for instance, after e-mailing a contact. They put me in touch with someone, who led me to someone else, who finally told me they knew of a person I might want to speak with. The first time I met Nick, at a Tim Horton’s in downtown Toronto, he handed me a plastic bag full of his correctional records, which shed light on the process and made it clear how critical these scores were.

My model’s findings were damning – so much so that I spent months trying to find an error in my code that could account for the discrepancies. When dealing with data-driven stories of this size, The Globe has a process for independently verifying findings. This meant handing over my entire analysis to a fellow data journalist, Chen Wang, and a Globe data scientist, Jeremy Gray. Our head of visuals, Matt Frehner, served as a sounding board for the investigation’s major findings.

I began to report the story in earnest in the spring, but the COVID-19 pandemic quickly became a priority. Months later, I was able to return to it, interviewing dozens of academics and experts in the field. Occasionally, I’d get a phone call from an unknown number – an inmate calling me from behind bars.

According to the CSC’s data, in 2018 an average of two inmates each day started serving a two-year sentence. That’s the threshold for sending them to federal prison, where risk assessments undoubtedly left their mark. The odds are good, then, that someone went to prison the same day I dropped my letter in the mail. Today, they are walking free.

Their experiences, along with those of so many others, are what you see today.

Source: https://www.theglobeandmail.com/canada/article-risk-backstory/

Coronavirus takes a toll in Sweden’s immigrant community

Like elsewhere:

The flight from Italy was one of the last arrivals that day at the Stockholm airport. A Swedish couple in their 50s walked up and loaded their skis into Razzak Khalaf’s taxi.

It was early March and concerns over the coronavirus were already present, but the couple, both coughing for the entire 45-minute journey, assured Khalaf they were healthy and just suffering from a change in the weather. Four days later, the Iraqi immigrant got seriously ill with COVID-19.

Still not able to return to work, Khalaf is part of the growing evidence that those in immigrant communities in the Nordic nations are being hit harder by the pandemic than the general population.

Sweden took a relatively soft approach to fighting the coronavirus, one that attracted international attention. Large gatherings were banned but restaurants and schools for younger children have stayed open. The government has urged social distancing, and Swedes have largely complied.

The country has paid a heavy price, with 2,769 fatalities from COVID-19. That’s more than 26 deaths per 100,000 population, compared with about 8 per 100,000 in neighboring Denmark, which imposed a strict lockdown early on that is only now being slowly lifted.

Inside Sweden’s immigrant communities, anecdotal evidence emerged early in the outbreak that suggested that some — particularly those from Somalia and Iraq — were hit harder than others. Last month, data from Sweden’s Public Health Agency confirmed that Somali Swedes made up almost 5 percent of the country’s COVID-19 cases, yet represented less than 1 percent of its 10 million people.

Many in these communities are more likely to live in crowded, multigeneration households and are unable to work remotely.

“No one cares for taxi drivers in Sweden,” said Khalaf, who tested positive and was admitted to a hospital when his condition deteriorated. Despite difficulties breathing, the 49-year-old says he was sent home after six hours and told his body was strong enough to “fight it off.”

In Finland, Helsinki authorities warned of a similar over-representation among Somali immigrants in the capital — some 200 cases, or about 14%, of all confirmed infections. In Norway, where immigrants make up nearly 15% of the general population, they represent about 25% of confirmed coronavirus cases.

“I think a pandemic like this one, or any crisis will hit the most vulnerable people in society the most wherever in the world, and we see this in many many countries,” said Isabella Lovin, Sweden’s deputy prime minister, in an interview with The Associated Press.

Noting that the virus was spreading faster in some crowded Stockholm suburbs, Lovin said said the city is providing short-term accommodation to some people whose relatives are vulnerable.

Sweden, Norway and Finland recognized early failings in community outreach in minority languages and are seeking to fix this. The town of Jarfalla, outside Stockholm, has had high school students hand out leaflets in Somali, Persian, French and other languages, urging people to wash their hands and stay home if sick.

With Sweden’s relatively low-key approach to fighting the virus that relies mainly on voluntary social distancing, there are concerns the message has not reached everyone in immigrant neighborhoods.

“It’s important that everyone living here who has a different mother tongue gets the right information,” said Warda Addallah, a 17-year-old Somali Swede.

Anders Wallensten, Sweden’s deputy state epidemiologist, said officials have worked harder on communicating with such groups “to make sure they have the knowledge to protect themselves and avoid spreading the disease to others.”

But teacher and community activist Rashid Musa says the problem runs much deeper.

“I wish it were that easy — that you needed to just translate a few papers,” he said. “We need to look at the more fundamental issue, which is class, which is racism, which is social status, which is income.”

“The rich have the opportunity to put themselves into quarantine, they can go to their summer houses,” Musa said.

A key government recommendation for individuals to work from home if possible is harder in marginalized areas where many have jobs in the service sector.

“How can a bus driver or a taxi driver work from home?” Musa asked.

Evidence of this disparity can be found in anonymous data aggregated by mobile phone operator Telia, which has given the Swedish Health Authority information about population mobility. By comparing the number of people in an area early in the morning with those who traveled to another area for at least an hour later in the day, Telia estimates how many go to work and how many stay home.

“We do see certain areas that are maybe more affluent with a bigger number of people working from home,” said Kristofer Agren, the head of data insights for Telia. Data shows a 12 percentage point difference between Danderyd, one of Stockholm’s most affluent suburbs, and Botkryka, one with the highest percentage of first- and second-generation immigrants.

“Many of our members have contracted the coronavirus,” said Akil Zahiri, who helps administer the mosque on the outskirts of Stockholm. “But you do the best you can.”

Zahiri spoke to the AP as he sat alone in Sweden’s largest Shiite mosque coordinating a video call with the congregation to pray for a member who died of COVID-19. The sound of prayer crackled through the computer, breaking the silence in the empty hall.

During Ramadan, the month when Muslims fast during the day, the mosque canceled all public events. Zahiri reminded the congregation to take part in social distancing, urging them to stay home for the Iftar, the daily breaking of the fast after sunset, and to avoid sharing food with friends.

Source: Coronavirus takes a toll in Sweden’s immigrant community

Addiction Kills More Blacks, But Treatment Is Prescribed Mostly To Whites

Yet another study on the disparities in healthcare:

White drug users addicted to heroin, fentanyl and other opioids have had near exclusive access to buprenorphine, a drug that curbs the craving for opioids and reduces the chance of a fatal overdose. That’s according to a study out Wednesday from the University of Michigan. It appears in JAMA Psychiatry.

Researchers reviewed two national surveys of physician-reported prescriptions. Between 2012 and 2015, as overdose deaths surged in many states, so did the number of visits during which a doctor or nurse practitioner prescribed buprenorphine, often referred to by its brand name, Suboxone. The researchers assessed 13.4 million medical encounters involving the drug but found no increase in prescriptions written for African Americans and other minorities.

“White populations are almost 35 times as likely to have a buprenorphine-related visit than black Americans,” says Dr. Pooja Lagisetty, an assistant professor of medicine at the University of Michigan Medical School and the study’s corresponding author.

The dominant use of buprenorphine to treat whites occurred at the same time opioid overdose deaths were rising faster for blacks than for whites.

“This epidemic over the last few years has been framed by many as largely a white epidemic, but we know now that’s not true,” Lagisetty says.

What is true, Lagisetty added, is that most of the white patients either paid cash (40%) or relied on private insurance (35%) to fund their buprenorphine treatment. The fact that just 25% of the visits were paid for through Medicaid and Medicare “does highlight that many of these visits could be very costly for persons of low income,” Lagisetty says.

Doctors and nurse practitioners can demand cash payments because there’s a shortage of clinicians who can prescribe buprenorphine, according to Dr. Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University. Only about 5% of physicians have taken the special training required to prescribe buprenorphine.

“The few that are doing it are really able to name their price, and that’s what we’re seeing here and that’s the reason why individuals with more resources — who are more likely to be white — are more likely to access treatment with buprenorphine,” says Kolodny, who was not involved in the study.

Kolodny wants the federal government to eliminate the required special training for buprenorphine and a related cap on the number of patients a doctor can manage on the drug.

Some physicians who have studied racial disparities in addiction treatment say the root causes go back to 2000, when buprenorphine was approved. At that time, proponents argued that buprenorphine was needed to help treat suburban youth, says Dr. Helena Hansen at New York University. Those young patients didn’t see themselves as addicted to heroin in the same way as hard-core urban heroin users who went to methadone clinics for treatment, she says.

“Buprenorphine was introduced as private office treatment, for a private market, with the means to pay,” says Hansen, an associate professor of psychiatry and anthropology. “So the unequal dissemination of buprenorphine for opioid dependence is not accidental.”

Hansen added that the fix must include universal access to treatment in a primary care setting, an end to the criminalization of opioid dependence (which puts more blacks in prison for drug use than whites), and more federal funding to expand access to buprenorphine for all patients.

Several leaders in the fight to reduce opioid overdose deaths say the study results are disturbing.

“It really demands for us to be looking at equitable treatment for addiction for African Americans as we do for white Americans,” says Michael Botticelli, director of the Grayken Center for Addiction at Boston Medical Center and the former director of the Office of National Drug Control Policy.

Botticelli identified some key issues that may be contributing to the racial treatment gap that deserve further investigation. For example, he wants to know whether Medicaid reimbursement rates are simply too low to entice more doctors to work with low-income patients, or there are too few inner-city doctors prescribing buprenorphine, or African Americans themselves are somehow reluctant to seek this form of treatment.

Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, called the findings surprising and disturbing. Surprising because the disparity is so large, and disturbing because her agency has prioritized educating doctors about the value of prescribing buprenorphine.

Volkow also expressed disappointment that federal parity laws, which are supposed to guarantee equal access to all types of medications, don’t seem to be working for buprenorphine. “We need to ensure that we have capacity to provide these treatments,” Volkow says. “Because if you say you have to pay for them, but there are no services that can provide the treatments, then the issue of paying for them is secondary.”

Volkow has noted that fewer than half of Americans with an opioid use disorder have access to buprenorphine or the two other medications used to treat opioid addiction: methadone and naltrexone. Volkow said she is glad that the use of buprenorphine is on the rise, but the U.S. needs to understand why this lifesaving treatment isn’t benefiting all patients who need it.

Source: Addiction Kills More Blacks, But Treatment Is Prescribed Mostly To Whites

Huge Racial Disparities Found in Deaths Linked to Pregnancy

Yet another example of racial disparities. Have not seen and comparative Canadian studies and grateful if any readers can direct me accordingly:

African-American, Native American and Alaska Native women die of pregnancy-related causes at a rate about three times higher than those of white women, the Centers for Disease Control and Prevention reported on Tuesday.

The racial disparity has persisted, even grown, for years despite frequent calls to improve access to medical care for women of color. Sixty percent of all pregnancy-related deaths can be prevented with better health care, communication and support, as well as access to stable housing and transportation, the researchers concluded.

“The bottom line is that too many women are dying largely preventable deaths associated with their pregnancy,” said Dr. Anne Schuchat, principal deputy director of the C.D.C.

“We have the means to identify and close gaps in the care they receive,” she added. While not all of the deaths can be prevented, “we can and should do more.”

Maternal health among black women already has emerged as an issue in the 2020 presidential campaign. Senator Kamala Harris, Democrat of California, and Senator Elizabeth Warren, Democrat of Massachusetts, have both raised the glaring racial discrepancies in maternal outcomes on the campaign trail.

“Everyone should be outraged this is happening in America,” Ms. Harris recently said on Twitter. She blamed the deaths on racial bias in the health system.

The American College of Obstetricians and Gynecologists, which was not involved in the C.D.C. report, recently acknowledged that racial bias within the health care system is contributing to the disproportionate number of pregnancy-related deaths among minority women.

“We are missing opportunities to identify risk factors prior to pregnancy, and there are often delays in recognizing symptoms during pregnancy and postpartum, particularly for black women,” Dr. Lisa Hollier, immediate past president of the American College of Obstetricians and Gynecologists, said in a statement.

The United States has an abysmal record on maternal health, compared with other high-income countries. Even as maternal death rates fell by more than one-third from 2000 to 2015 across the world, outcomes for American mothers worsened, according to Unicef.

The C.D.C. examined pregnancy-related deaths in the United States from 2011 to 2015, and also reviewed more detailed data from 2013 to 2017 provided by maternal mortality review committees in 13 states.

The agency found that black women were 3.3 times more likely than white women to suffer a pregnancy-related death; Native American and Alaska Native women were 2.5 times more likely to die than white women.

[The topics new parents are talking about. Evidence-based guidance. Personal stories that matter. Sign up now to get NYT Parenting in your inbox every week.]

Obstetric emergencies involving complications like severe bleeding caused most of the deaths at delivery. Disorders related to high blood pressure accounted for most deaths from the day of delivery through the sixth day postpartum.

A leading cause of pregnancy-related deaths was cardiovascular disease, which is not typically associated with young pregnant women.

Heart disease and strokes caused more than one-third of pregnancy-related deaths, the C.D.C. found. Cerebrovascular events, such as strokes, were the most common cause of death during the first 42 days after the delivery.

Cardiac disease, which disproportionately affects black women, may be present in a woman before pregnancy, but it also may appear during pregnancy. If heart disease goes undetected, it may become acute after the baby is born.

Toronto is segregated by race and income. And the numbers are ugly

More good detailed analysis at the census tract level by David Hulchanski that highlights the disparities that more aggregated analysis misses.


My analysis, focussing on outcomes of second generation visible minorities 25-34 years old shows largely comparable outcomes for most groups, with the exception of Blacks, Latin Americans, Arabs and West Asians. Discrimination certainly plays a part in these disparities but other factors (e.g., time in Canada, area of study etc) also play a part:

In Toronto, the colour of money is mainly white.

New demographic charts show a strikingly segregated city, with visible minorities concentrated in low-income neighbourhoods and white residents dominating affluent areas in numbers far higher than their share of the population.

The new charts come from University of Toronto Prof. David Hulchanski and his research team, known for using census data to illustrate growing income inequality in the city. Their latest effort flags the role of discrimination in that inequality, with lopsided racial breakdowns that surprised the researchers.

“It’s starker than we would expect,” Hulchanski said in an interview.

Hulchanski revealed the new charts last week in the Netherlands at a conference called “Urban poverty and segregation in a globalized world.”

Using the 2016 census, his team calculated that 48 per cent of Toronto’s census tracts are low-income neighbourhoods, where the average individual income is $32,000 before taxes.Fully 68 per cent of residents in these neighbourhoods are visible minorities while 31 per cent are white. (Whites make up 49 per cent of Toronto’s population.)

The main ethno-cultural communities in these low-income neighbourhoods are all overrepresented compared to their share of the city’s population. Black residents, for example, are 9 per cent of the population but make up 13 per cent of residents of low-income neighbourhoods.

High-income neighbourhoods are almost a reverse image. They make up 23 per cent of Toronto’s census tracts, with average individual incomes of $102,000 before tax. Fully 73 per cent of residents in these neighbourhoods are white, far higher than their share of the city’s population. The rest are visible minorities, of whom only 3 per cent are Black.

Whites are also overrepresented in middle-income neighbourhoods, where the average income is $49,000.

“Money buys choice. And people with the most choice are choosing to live in certain areas,” Hulchanski says, explaining the disproportionately high concentration of white residents in high- and middle-income communities.

Choice also partly explains the makeup of low-income neighbourhoods. Some members of ethnic groups prefer to live where their communities are most numerous, giving them easy access to the shops and cultural or religious services that facilitate integration or simply make life more enjoyable.

York University Prof. Carl James, who reviewed Hulchanski’s charts, questions how free the choice actually is for visible minorities.

“We have to think about how the system might have enabled and co-operated in making it possible for some people to access high income neighbourhoods and to stay in those neighbourhoods, or operated to keep others out of those neighbourhoods. It’s not just individual choice. Many other structural things work in relation to choice.”

Studies indicate that discriminatory barriers to good jobs and housing play a determining role.

“Discrimination is not at the same level as in the United States,” Hulchanski says, “but that doesn’t make it any better for those who face that problem here.”

The researchers split the city into high-. and low-income categories by comparing neighbourhoods that were 20 per cent above or below the Toronto Census Metropolitan Area average. Middle-income was within 20 per cent. The team then used census data to see the makeup of those communities.

Evidence of discrimination is reinforced by another chart produced by Hulchanski’s team, showing relatively high levels of education in low-income neighbourhoods. Half of all residents in those areas have a post-secondary degree: 25 per cent from a university and 25 per cent from a community college.

Hulchanski questioned why half the city has average gross incomes of only $32,000 when so many people in those low-income neighbourhoods have relatively high levels of education. “That doesn’t make sense, except for discrimination,” he said.

Another worrying sign for Hulchanski is that 57 per cent of residents in Toronto’s low-income neighbourhoods are immigrants, including established ones who arrived before 2006. Only 31 per cent of residents in high-income areas are immigrants, including 23 per cent who arrived prior to 2006.

The racial segregation of Toronto neighbourhoods is in the context of research, also from Hulchanski’s team, illustrating the growth of low- and high-income neighbourhoods in Toronto, while middle ones steadily disappear.

The polarized income trend dates back to the 1990s, caused by federal and provincial cuts in transfer payments and social assistance, along with tax cuts, rising housing costs and the disappearance of well-paid manufacturing jobs, Hulchanski says.

Government policies caused the income polarization, and only government policies can reverse it, he argues. Hulchanski warns that in Europe, where the trend is less severe, income polarization and ethnic segregation has contributed to the rise of far-right populist movements and outbreaks of violence.

“How long can this continue?” Hulchanski asks. “There is no sign of the trend reversing yet.

“Will there be riots in Toronto? Who knows?”

Source: Toronto is segregated by race and income. And the numbers are ugly

Doctor Tells A Personal Tale Of Racial Disparity In Organ Transplants : Shots – Health News : NPR

Yet another example of biases at work:

While she was a primary care doctor in Oakland, Calif., Dr. Vanessa Grubbsfell in love with a man who had been living with kidney disease since he was a teenager.

Their relationship brought Grubbs face to face with the dilemmas of kidney transplantation — and the racial biases she found to be embedded in the way donated kidneys are allocated. Robert Phillips, who eventually became her husband, had waited years for a transplant; Grubbs ended up donating one of her own kidneys to him. And along the way she found a new calling as a nephrologist — a kidney doctor.

Her candid new memoir, Hundreds of Interlaced Fingers: A Kidney Doctor’s Search for the Perfect Match, explores her personal story and some troubling statistics. Roughly 1 in 3 of the candidates awaiting kidney transplants are African American, Grubbs learned, but they receive only about 1 in 5 of all donated kidneys. White people account for about a third of the candidates awaiting kidney transplants, but they receive every other donated kidney.

Grubbs writes of accompanying Phillips in 2004 to meet with members of the transplantation team — including a doctor, a nurse and a financial counselor — for a routine evaluation and update. After being on the waiting list for a kidney for five years, he had neared the top of the list.

“We sat in a clinic exam room listening to a series of people whose job it seemed was to talk Robert out of even wanting a transplant,” Grubbs writes. Such meetings may be meant to make sure patients understand the difficult realities of organ transplantation, she says, but, “… the message we took away was, ‘The kidney transplant system doesn’t like black people.’ ”

Grubbs, now a nephrologist at the Zuckerberg San Francisco General Hospital, and assistant professor at the University of California, San Francisco, recently sat down to talk about her experience with NPR.


Interview Highlights

One of the things you write about in the book is that your colleagues did not appreciate that you published a piece in a health policy magazine — Health Affairs — [detailing the inequities in transplantation]. It was called “Good for Harvest, Bad for Planting.” In fact, you got a lot of blowback that you were not expecting.

You know, I’m from a tiny little town in North Carolina, so maybe I was a bit naïve. Because I honestly thought that people would read this piece from a doctor being surprised at how the system was set up, and that they would take a look at it and be reflective and think about what they might be able to do to make the system at least seem more equitable to people on the outside. But clearly that was a naïve thought, because what ended up happening was that people who were very close to the issue became very angry, and they took it personally.

Why do you think that was?

Many doctors can acknowledge that there are race disparities in health care, that people of color do worse across many areas than white people. But I think most of us tend to think that somebody else is responsible for it. So for them, it meant that I was pointing the finger at them. And I think the unfortunate thing that we tend to do is, when we are associated with a bad thing, we spend our time trying to disassociate ourselves from that bad thing, rather than spending our energy in acknowledging that this is a bad thing and we should all work together to try to make it better.