5 takeaways from AP’s series on health disparities impacting Black Americans

2023/05/29 Leave a comment

Of note:

The Associated Press spent a year examining how racial health disparities have harmed generations of Black Americans. 

From birth to death, Black Americans fare worse in measures of health compared to their white counterparts. They have higher rates of infant and maternal mortality, higher incidence of asthma during childhood, more difficulty treating mental illness as teens, and higher rates of high blood pressure, Alzheimer’s disease and other illness as adults. 

Here are the key takeaways from each story:

WHY ARE BLACK BABIES AND MOTHERS MORE LIKELY TO DIE?

Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention. The 2021 rate was a significant increase from the prior year.

Black babies are also more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives. In 2020, there were 364,487 preterm births in the nation, about 1 in 10. Preterm birth rates were highest for Black infants, 14.2%, between 2018 and 2020. 

Multiple factors contribute to these disparities, according to the CDC and advocacy organizations, such as underlying health conditions. But more doctors and experts have pointed to the role of structural racism that has created inequitable access to health care, implicit bias and discriminatory care. Poor health care or outcomes for Black mothers in turn can create issues for their babies, putting them at risk for future health problems down the road.

WHY DO MORE BLACK KIDS HAVE ASTHMA?

Black children are more likely to have asthma and to be exposed to certain triggers, like mold and air pollution. Their asthma often is more severe and less likely to be controlled. About 4 million kids in the U.S. have asthma. The percentage of Black children with asthma is far higher than white kids; more than 12% of Black kids nationwide suffer from the disease, compared with 5% of white children. 

Some of the high rates of asthma among Black children are tied to genetics — family histories of allergies, and frequent respiratory infections. But much of the disparity lies in the same racist factors that afflict Black peoples’ health from birth to death.

With asthma, especially for kids, where you live makes all the difference. And where you live often depends on your race. Black Americans are more at risk of living in homes with asthma triggers, like cockroaches, dust mites, mold and rodents. Research also shows that air pollution can worsen asthma.

Across America, nearly 4 in 10 Black children live in areas with poor environmental and health conditions compared to 1 in 10 white children. Factories spew nitrogen oxide and particulate matter. Idling trucks and freeway traffic kick up noxious fumes and dust.

The disparities are built into a housing system shaped by the longstanding effects of slavery and Jim Crow-era laws. Many of the communities that have substandard housing today or are located near toxic sites are the same as those that were segregated and redlined decades ago.

HOW DOES RACISM AFFECT BLACK TEENS’ MENTAL HEALTH?

About 50% of Black youth experience moderate to severe symptoms of depression, and about 18% said they were exposed to racial trauma often or very often in their life.

The drivers of the mental health crisis for Black children begin early and persist through a lifetime. Black children’s first encounters with racism can start before they are even in school, and Black teenagers report experiencing an average of five instances of racial discrimination per day. Young Black students are often perceived as less innocent and older than their age, leading to disproportionately harsher discipline in schools.

Black adolescents are far less likely than their white peers to seek and find mental health care. In part, that’s because Black families often distrust the medical system after generations of mistreatment — from lack of access to care to being subjected to racist practices and experimentation. 

The country also has a shortage of providers who understand the roles that racial identity and racism play in shaping young Black people’s mental health. Research and health surveillance data point to a growing mental health crisis among Black youth over decades. Between 1991 and 2019, Black adolescents had the highest increase among any other group in prevalence of suicide attempts — a rise of nearly 80%.

WHAT ROLE HAS HIGH BLOOD PRESSURE PLAYED IN COVID DEATHS OF BLACK AMERICANS?

High blood pressure has played a major role in COVID deaths, and especially in the COVID deaths of Black people. Together, they have created a deadly combination: While it is listed as a contributing factor in 15.5% of the deaths of white COVID sufferers, the figure for Black victims is 21.4% — the highest of any racial group.

About 56% of Black adults have high blood pressure, compared to 48% of white people. Three in four African Americans are likely to develop the disorder by age 55.

While only 32% of white adults with high blood pressure have their condition under control with medication, the figure for Black Americans is even lower — 25%.

And it’s likely to get worse: By 2060, the number of Americans battling cardiovascular disease is expected to drastically increase. High blood pressure rates alone are projected to rise 27.2%, or from roughly 127.8 million to 162.5 million Americans.

Among white people, the prevalence of cardiovascular risk factors and disease is projected to decrease over time. Yet significant increases are projected among people of color, especially Black and Latino Americans.

Like many conditions, genetics do play a part. Experts also blame poor diets, high cholesterol, obesity and smoking — risk factors that often exist at higher rates in Black communities. Also, in recent years, more academics and doctors have called attention to structural inequities that have an outsized impact. Black neighborhoods are more likely to experience a lack of access to healthy foods or be inundated with fast food options.

WHY DO SO MANY BLACK PEOPLE DEVELOP ALZHEIMER’S DISEASE?

Black Americans are more likely than white people to develop Alzheimer’s. About 14% of Black Americans over the age of 65 have Alzheimer’s, compared with 10% of white Americans, according to the Centers for Disease Control and Prevention. Experts believe the rates could be even higher.

Health conditions like cardiovascular disease and diabetes experienced in earlier stages of life are known risk factors — both of which are more common among Black and Latino populations. Depression, high blood pressure, obesity and chronic stress are also risk factors. The CDC also acknowledges the impact of “higher rates of poverty, and greater exposure to adversity and discrimination” as risk factors.

Across the board, Black people are also unlikely to receive the health care that white people do — including necessary medication to treat Alzheimer’s and dementia-related disorders. A preliminary study released this year by Mount Sinai researchers found that Black people are less likely to receive dementia-related medications than white people.

Black and Latino populations are expected to rise in coming years, and so are the number of their cases of Alzheimer’s and related disorders. Cases among Black Americans are projected to increase four times over today’s estimates and Latino Americans could increase seven times, according to the CDC.

Some advocates estimate that by 2030, nearly 40% of all Americans living with Alzheimer’s could be Black or Latino. But the projected rise in cases isn’t just tied to population growth.

While evidence exists that certain genetic risk factors could differ by race and be a driver, the large disparities among racial groups can’t be explained just by genetics, experts say.

And the sheer trauma of experiencing racism is also believed to be a contributing factor.

Source: 5 takeaways from AP’s series on health disparities impacting Black Americans

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Lightman and Akbary: New data provide insight into pandemic inequalities

2023/04/03 Leave a comment

Insightful analysis, contrasting vaccination rates (relatively similar) and health outcomes (disparities):

Existing analyses of COVID-19 in Canada and internationally suggest infection rates were highly variable across populations, with researchers highlighting the disproportionate burdenexperienced by groups that are intersectionally disadvantaged.

Early in the pandemic, widespread evidence emerged of the unequal rates of infection experienced by residents and care workers in long-term care homes in Canada. Soon after, racialized populations and immigrants were also found to be especially hard-hit. The COVID-19 mortality rate was significantly higher for racialized populations.

Our new research finds that while these individuals had higher rates of COVID-19 infection, they were equally or more likely to get vaccinated than comparison groups. This has important policy implications. Rather than focusing on individual decision-making, the data suggest a need to prioritize protections and pay for workers in essential jobs that are unpredictable, dangerous, physically demanding and/or low wage.

Overwhelming evidence shows that vaccines are an effective protective measure, both in terms of reducing infection ratesand severity of illness. Using the 2022 Statistics Canada dataset “Impacts of COVID-19 on Canadians – Testing and Vaccination,” our analyses found that variable vaccination rates were not the reason behind differing rates of infection.

These data were collected as part of Statistics Canada’s crowdsourcing initiative which aimed to gather timely information on Canadians’ experiences of testing for COVID-19 and access to vaccination during the pandemic. Statistics Canada used open advertising to obtain participants who chose to self-select by completing an online questionnaire from February 21 to March 13, 2022.

For racialized minorities, 20 per cent tested positive, compared to 15 per cent for non-racialized minorities (outcomes were similar when comparing PCR to rapid test results). In particular, those who identified as Black and Filipino (populations that also have high rates of employment in care occupations and in service industries fared worst. Black populations experienced a one-third rate of positivity for rapid tests (see Figure 1).

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Citizenship was also an important factor. Those without Canadian citizenship status (including temporary foreign workers) fared worse for both types of testing (at an average of 22 per cent positivity), compared to those immigrants with citizenship status and the Canadian-born. The latter fared by far the best, at 14 per cent positivity via PCR tests, and 17 per cent positivity via rapid tests (see Figure 2).

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Women and men, interestingly, were found to have had similar rates of infection. However, those who identified as essential workers had higher rates of infection (see Figure 3), with women overrepresented among this population.

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Yet the data on rates of vaccination tell a different story. This suggests that variable infection rates were tied to specific jobs or to systemic inequalities, rather than a function of individual choice.

There was only a marginal difference in vaccination rates between essential workers and non-essential workers. Racialized people and immigrants had higher rates of vaccination than non-racialized people and non-immigrants (see Figure 4).

https://e.infogram.com/lightman-fig4-1h7g6k0gvyrgo2o?live?parent_url=https%3A%2F%2Fpolicyoptions.irpp.org%2Fmagazines%2Fmarch-2023%2Fnew-data-provide-insight-into-pandemic-inequalities%2F%3Futm_source%3DPolicy%2BOptions%2BNewsletter%26utm_campaign%3D18ca25504e-EMAIL_CAMPAIGN_2022_02_14_05_26_COPY_01%26utm_medium%3Demail%26utm_term%3D0_26f66e24ce-18ca25504e-104024581%26mc_cid%3D18ca25504e%26mc_eid%3D86cabdc518&src=embed#async_embed

Finally, the data reject explanations tied to access to health facilities. In the five cities in Canada with the highest rates of infection, residents had higher rates of access to at least one health facility and a pharmacy close to them (see Figure 5).

https://e.infogram.com/lightman-fig5-1hxr4zxr1nreo6y?live?parent_url=https%3A%2F%2Fpolicyoptions.irpp.org%2Fmagazines%2Fmarch-2023%2Fnew-data-provide-insight-into-pandemic-inequalities%2F%3Futm_source%3DPolicy%2BOptions%2BNewsletter%26utm_campaign%3D18ca25504e-EMAIL_CAMPAIGN_2022_02_14_05_26_COPY_01%26utm_medium%3Demail%26utm_term%3D0_26f66e24ce-18ca25504e-104024581%26mc_cid%3D18ca25504e%26mc_eid%3D86cabdc518&src=embed#async_embed

Together, this information suggests that COVID-19 infection rates were not related to personal decision-making or access to health services. Instead, it raises concerns about broader social responsibilities. Populations that are racialized and/or non-citizens and those doing essential jobs were infected at disproportionate rates, even as they took steps to get vaccinated.

Notably, the data do not provide information on time order, so it is plausible that those workers on the front lines reported positive cases prior to having access to the vaccine. This raises further questions about which occupations and which areas of each city were prioritized for personal protective equipment and early access to vaccination, while refuting suggestions of a lack of awareness or interest in vaccination by underserved communities.

As well, the data do not indicate the severity of illness. Thus, the analyses may tell a story of lives saved due to vaccination for populations that were at greater risk of infection due to their workplace conditions.

In terms of policy, this suggests that there is an urgent need to focus on improving working conditions for essential workers. This includes providing paid sick leave and job guarantees for those who take time off work to care for themselves or others. Staffing levels and accommodations to work from home for those who are sick (when possible) should be ensured. Accommodations to reduce workplace injuries and increase mental health supports must be made available. Providing safe transportation to and from work facilities as well as paid time to travel to get vaccinated should be a policy initiative. Finally, emergency housing for self-isolation when needed and access to child and elder care, as well as affordable housing for those with lower socioeconomic status, should also be top priority.

Perhaps most critically, wages must be raised for workers who are systematically at higher risk of infection due to the face-to-face nature of their employment (while also structuring workplaces to avoid dangerous work conditions where possible.) This would at least partially compensate for increased rates of infection within certain jobs and recognize the toll it takes on individuals, families and communities.

All this reinforces a structural rather than individual analysis of disease burdens and public health measures. Clearly, getting vaccinated is not the end of the story. Ongoing social responsibility is needed to protect vulnerable groups – whether this takes the form of masking, work-from-home measures, or other workplace accommodations.

The implications of the pandemic are nowhere near over. There must be a move beyond rhetoric of “gratitude” to essential workers; instead, governments and employers must implement better policies and pay. These policies must be evidence-based so Canadians have an accurate understanding about the pandemic and its effects.

Given the emerging information about the potentially long-term implications of COVID-19, these measures take on added urgency for groups such as children, people with disabilities and intersectionally disadvantaged populations.

A note about methodology

Statistics Canada started the crowdsourcing initiative as part of a data collection series to address the informational needs of Canadians and enhance their understanding related to the impact of COVID-19. According to an evaluation report, Statistics Canada’s crowdsourcing products have proven to be useful for briefing purposes, policy research and analysis, program and service planning and decision-making, as well as knowledge-production and modeling. Statistics Canada uses a number of measures to ensure the quality of data collected through the crowdsourcing initiative. First, the questionnaires are designed based on Statistics Canada’s standard practices and wording used in a computer-assisted interviewing environment. During data collection, a computer application is used to automatically control the flow of questions, depending on participant responses, and to check for logical inconsistencies and errors in participant responses. The computer application used for these purposes is tested extensively. After data have been collected, Statistics Canada maximizes the quality of crowdsourced data through error detection of invalid or missing values for age, gender and postal code at micro levels. Furthermore, Statistics Canada compensates for overrepresentation and underrepresentation by calculating a benchmark factor for every participant based on demographic projections of the number of people by province and territory, sex and age group. As recommended by Statistics Canada, therefore, the authors of this article used the benchmark factor to produce their results in the same way that survey weights are used to produce estimates from non-crowdsourced data.

Source: Lightman and Akbary: New data provide insight into pandemic inequalities

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Conservative Policies Linked to Higher Death Rates for Americans, Study Finds

2022/10/28 Leave a comment

Not that surprising. Not exactly pro-life policies:

November’s midterms will serve as a political referendum on a number of issues, from gas prices to gun safety legislation and more. “At the end of the day, it’s just politics,” you might think. But according to new research, social and economic policies are life-or-death matters for working-age Americans. Changing state policies to become more liberal will save hundreds of thousands of lives while shifting to conservative policies will cost them, a study published Wednesday in PLoS ONE finds.

The new study is one of a recent spate to look at the link between policy and an unexpected increase in deaths among working-age Americans. Compared to European countries and other Western peers, the rise in deaths among this population in the U.S. has been “alarming,” Jennifer Karas Montez, a sociology researcher at Syracuse University and the first author of the new research, told The Daily Beast. She and her co-authors looked at mortality rates for the leading causes of death over a period of 20 years, at a time when “dramatic changes in state policies” were occuring.

The link between more conservative or liberal state policies and events like cardiovascular deaths or suicides are clearer for some policies, like regulations around tobacco. More liberal environmental policies are linked to lower levels of air pollution and decreased rates of asthma and other respiratory problems that can increase one’s chances of dying, Montez said. Liberal labor policies, like an increased minimum wage, may put more money in workers’ pockets that they can spend on healthier food or medical care.

“We often don’t talk about economic policies as if they’re health policies, but the reality is they are,” she said.

Some of these policies took a few years to immediately affect mortality rates. Criminal justice reform, for instance, took at least three years to have significant effects on rates of death—Montez said this may be due to the fact that these policies may have a downstream impact on people’s lives and livelihoods, and not one immediately felt. Liberal firearm safety laws, on the other hand, resulted in a near-immediate decrease in suicide deaths.

Of the policies studied, only more liberal marijuana policies were associated with a decrease in life expectancy. Even so, other studies on the overall health effects of marijuana policies have been inconclusive, identifying benefits such as treatment for chronic pain but an increased risk of motor vehicle accidents.

If states had adopted liberal policies across the board, Montez and her co-authors calculated that 171,030 lives would have been saved in 2019 alone; on the flip side, conservative policies in all states would have led to an additional 217,635 working-age deaths.

Americans should realize that the decisions being made in state houses are becoming increasingly important to their own lives, Montez said.

“We’ve pointed the finger at opioid manufacturers, we pointed the finger at multinational corporations, but state policymakers have been given a free pass, and that’s a really critical oversight,” she said. “We need to make sure that we’re holding them accountable for the decisions that they’re making that affect how healthy and long we live.”

Source: Conservative Policies Linked to Higher Death Rates for Americans, Study Finds

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Why Racial Inequities Still Persist in Health Care

2021/08/19 Leave a comment

Likely fewer disparities in Canada given medicare but some commonaliyies:

Two decades ago, only 9 percent of white Americans rated their health as fair or poor. But 14 percent of Hispanic Americans characterized their health in those terms, as did nearly 18 percent of Black Americans.

In recent years, access to care has improved in the wake of the Affordable Care Act, which reduced the number of uninsured Americans across all racial and ethnic groups. But the racial health gap has remained, according to a series of studies published on Tuesday in the journal JAMA.

A dismal picture of persistent health disparities in America was described in an issue devoted entirely to inequities in medicine. The wide-ranging issue included research on spending and patterns of care, comparative rates of gestational diabetes and the proportion of Black physicians at medical schools.

The journal’s editors committed to a sharper focus on racism in medicine after a controversy in June, in which a staff member seemed to suggest that racism was not a problem in health care. The ensuing criticism led to the resignation of the top editor and culminated with a pledge to increase staff diversity and publish a more inclusive array of papers.

“The topics of racial and ethnic disparities and inequities in medicine and health care are of critical importance,” Dr. Phil B. Fontanarosa, interim editor in chief of JAMA, said in a statement. He noted that JAMA has published more than 850 articles on racial and ethnic disparities and inequities in the past.

The new issue offers studies on disparities in the utilization of health care services and in overall health spending. Together, the findings paint a portrait of a nation still plagued by medical haves and have-nots whose ability to benefit from scientific advances varies by race and ethnicity, despite the fact that the A.C.A. greatly expanded insurance.

The racial health gap did not significantly narrow from 1999 to 2018, according to one study whose author said it was tantamount to “a comprehensive national report card.”

“We’re failing,” added Dr. Harlan Krumholz, the study’s senior author.

“If our national goals are to improve the population’s health and promote more health equity, then we have to admit that whatever we’re doing now is not doing the trick,” he said. “This should wake us up, and spark us to think of new and better approaches.”

Other studies in the journal teased apart factors that may be contributing to the gap, including different patterns of care-seeking. White Americans, for example, are more likely than members of minority groups to visit primary care physicians and specialists in the community, rather than a hospital or emergency room.

Source: Why Racial Inequities Still Persist in Health Care

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Canada needs a national database to track COVID-19 vaccination in real time

2021/01/06 Leave a comment

Good analysis on the need by Michael Wolfson, a former assistant chief statistician at Statistics Canada.

One of the frustrations I encountered with the non-resident birth data was that Quebec does not automatically include its health data as a matter of course in the Canadian Institute of Health Information, with Quebec refusing to provide me with the comparable data (given health provincial jurisdiction, point of principle over-riding common sense).

So not sure how realistic Wolfson’s proposal is but better and consistent data helps all:

With Canada in the midst of rolling out the vaccines, the importance of effectively monitoring the immunization campaign is coming to the fore. The federal government has recognized the importance of monitoring data, at least within federal jurisdiction, and the prime minister himself recently emphasized the federal government will “be a partner with the provinces  … [for] better co-ordination of data.”

The government response nicely recognizes the lead role of the provinces in setting priorities for vaccination. And the federal government appears sanguine about the existing jumble of layers of vaccine-monitoring data systems, including for adverse reactions.

This co-operative federalism is wonderful—when it works. However, for anyone with experience in software, databases and statistical analysis, the vaccination monitoring described sounds like a dog’s breakfast. That’s not good enough when lives are on the line.

Standard adverse-event reporting systems in the U.S. and Canada missed the scandalous connection between Vioxx and heart attacks. Something more reliable is essential for COVID-19 vaccinations, not only for safety but to avoid misinformation from anti-vaxxers.

Canada has world-class potential for statistical surveillance of adverse health events in the electronic health databases housed in each province. But these data often reside in multiple impenetrable silos within each province.

The COVID-19 pandemic has dramatically increased the urgency of breaking down these data silos. One of the most important blockages has been provincial insistence that health care is their show; the only role for the federal government is to hand them more money, no strings attached.

This has to stop.

Specifically, for a vaccine registry and monitoring, the obvious solution is a single standardized system, mandated by the federal government using its constitutional jurisdiction for statistics. The federal government could commission an organization—Statistics Canada is an obvious choice—to immediately develop a secure, real-time data-collection portal or site for critical information on every person who is vaccinated for COVID-19.

This software system would be used in clinics, doctors’ offices, and drugstores. The nurses and other health professionals giving the vaccination would enter information, exactly as done for flu vaccinations. But now, some of the information would be federally mandated, over and above anything recorded for patients’ medical records and provincial billing purposes.

Decades of experience have shown that rhetoric about federal-provincial co-operation has continually failed, resulting in the patchwork of incoherent and incomplete data that have been limiting too much of the science for managing Canada’s pandemic, and the health-care sector more generally.

The federal government was successful in eliminating doctors’ extra billing by holding back transfers to the provinces. But with no strings attached, a number of provinces have been shamefully clawing back some of the COVID-19 cash payments the federal government has sent to the neediest Canadians by reducing or cancelling their social assistance. To ensure effective implementation of this monitoring solution, strong fiscal sanctions should be included if provinces do not co-operate.

Real-time, federally mandated vaccine monitoring will provide crucial information on vaccination uptake not only by province, but also by neighbourhood, type of vaccine, race/ethnicity and occupation —enabling provincial and local public-health authorities to target vaccinations to the vulnerable. This is not federal intrusion into provincial jurisdiction; it is simply the most efficient constitutionally enabled way to provide critical information.

There is no reason that this kind of software could not be adapted and made available across the country for vaccinations in a matter of weeks, along with speedy agreements on data standardization.

While confidential personal data are involved, Statistics Canada has, for decades, collected exactly such data in the monthly labour-force survey (recently doing so online), with exceptionally strong safeguards for security and confidentiality.

There are obvious privacy concerns. However, we must be careful not to allow them to overshadow the potentially huge benefits. The framers of Canada’s constitution, over a century and a half ago, recognized the fundamental importance of critical statistical information that is national in scope.

While the proposed data flows may raise concerns among provinces and territories regarding ownership, these can be ameliorated with clear ground rules on how they can access these data.

Privacy commissioners across Canada have adopted the principles of necessity and proportionality as the central criteria for data collections that raise privacy concerns. For pandemic vaccination, with the deaths of potentially thousands of Canadians in the balance, these criteria would clearly be met.

Now, more than ever, Canada needs a strong national approach for monitoring data to ensure vaccination proceeds effectively, fairly and safely.

Michael Wolfson is a former assistant chief statistician at Statistics Canada and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.

Source: Canada needs a national database to track COVID-19 vaccination in real time

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Study: Structural racism has material impact on health of ethnic minorities, immigrants

2020/12/16 Leave a comment

Medical study:

Structural racism can lead to discrimination in many aspects of life including criminal justice, employment, housing, health care, political power, and education. A new study published in the American Journal of Preventive Medicine examines the impact of structural racism on health and confirms that chronic exposure to stressors leads to a marked erosion of health that is particularly severe among foreign-born Blacks and Latinx. Investigators say largescale structural policies that address structural racism are needed.

Structural racism is defined as laws, rules, or official policies in a society that result in a continued unfair advantage to some people and unfair or harmful treatment of others based on race.

There is evidence that structural racism has a material impact on the health of racial/ethnic minorities and immigrants. Comparing allostatic load–a multidimensional measure of the body’s response to stressors experienced throughout the life course–between immigrants and non-immigrants of different racial/ethnic backgrounds can help shed light on the magnitude of health differences between groups.”

Brent A. Langellier, PhD, Lead Investigator, Department of Health Management and Policy, Dornsife School of Public Health, Drexel University

Investigators examined patterns in allostatic load among US- and foreign-born Whites, Blacks, and Latinx. Using data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES), they collected data on a 10-item measure of cardiovascular, metabolic, and immunologic risk.

Measures of cardiovascular risk included systolic blood pressure, diastolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol. Metabolic risk indicators included body mass index (BMI), blood sugar (HbA1c), urinary albumin, and creatinine clearance. Immunologic measures were white blood cell count and current or previous asthma diagnosis.

Based on the literature suggesting that, for many outcomes, immigrants have paradoxically good health that declines with time in the US, investigators examined aging gradients in allostatic load for each group. They also assessed whether allostatic load in each group changed across NHANES survey cycles. Their analyses were conducted in March 2020.

Results showed that allostatic load increased with age among all groups, but the increases were much steeper among foreign-born Blacks of both genders and foreign-born Latina women. The difference between the first and last survey cycle was most pronounced among US-born Black women (from 2.74 in 2005-2006 to 3.02 in 2017-2018), US-born Latino men (from 2.69 to 3.09), and foreign-born Latino men (from 2.58 to 2.87).

Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women, and flattest among US-born and foreign-born Whites. Notably, foreign-born Latina women had among the lowest allostatic load at the youngest ages but among the highest at the upper end of the age distribution.

“Our findings add to the evidence that structural racism has a material impact on the health of racial/ethnic minorities and immigrants – and that this effect accumulates throughout the life course,” noted Dr. Langellier. “They further suggest that the disadvantage experienced by racial/ethnic minorities is compounded among minorities who are also immigrants, which erodes the health advantage that many immigrants have at early ages.”

These findings highlight the magnitude of the disparities in health that are produced by inequities in exposure to these risk and protective factors. “Collectively, our findings and evidence in the broader literature suggest that reducing these disparities will require big, structural policies that address structural racism, including inequities in upstream social determinants of health,” concluded Dr. Langellier.

Source: Study: Structural racism has material impact on health of ethnic minorities, immigrants

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Inequities in COVID-19 Health Outcomes: The Need for Race- and Ethnicity-Based Data (Library of Parliament Research)

2020/12/11 Leave a comment

Good background note:

For Indigenous peoples, Black Canadians and other racialized groups, race and racism are important social determinants of health.

Social determinants of health may contribute to negative health outcomes or health inequities, which are differences in health outcomes that could reasonably be avoided among groups, such as racial or ethnic groups. Addressing inequities through inclusive policies and legislation relies on the collection and availability of data disaggregated by various identity factors, such as ethnicity. However, collecting race-based health data remains a challenge in Canada.

Canadian health care stakeholders have identified racism as a public health emergency and emphasized its profound negative effects on Indigenous peoples and racialized groups. The Chief Public Health Officer of Canada’s Report, released in October 2020, asserts that COVID-19 has not affected people in Canada equally. The report recognizes Canada’s history of systemic racism and colonization and the role of social determinants of health in existing health inequities among Canadians.

This HillNote examines the role of race and ethnicity in COVID-19 health outcomes in the United States (U.S.) and the United Kingdom (U.K.), countries that systematically collect race-based health data, as well as initiatives to collect these data in Canada.

Health Inequities and COVID-19 in the United States and United Kingdom

Certain health data disaggregated by ethnic group or race have been collected in the U.S. and U.K. for years. Research in the U.S. indicates that, compared to white Americans, racialized groups tend to face disproportionately elevated risks of COVID-19 diagnosis, hospitalization and death. According to age-adjusted data, Indigenous, Black, Latino, Pacific Islander and Asian Americans face elevated risks of COVID-19 death compared to white Americans.

Number of COVID-19 Deaths per 100,000 population in the United States, adjusted for age by Racial or Ethnic Group, 10 November 2020

The bar graph shows the number of COVID-19 deaths per 100,00 deaths in the United States, adjusted for age, by racial or ethnic group. The various racial and ethnic groups are arranged along the vertical axis in order to highest number of deaths to lowest. Indigenous Americans have the highest number of deaths, at 164.7 per 100,000, closely followed by Black Americans with 153.2 deaths per 100,00. White Americans show the lowest number of deaths, with 50.9 deaths per 100,00.

Source: Figure prepared by author using data from APM Research Lab, “The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S.,” 10 November 2020.

Similar trends have been identified in the UK. For example, data from the first wave of COVID-19 show that members of ethnic minority groups in England died at higher rates than expected, based on their demographics, in contrast to the white population.

Excess Deaths (%) during the pandemic in England by Ethnic Group, 28 April 2020

The bar graph shows the percentage of excess deaths based on expected number of deaths and actual number of deaths based on population structure of racial and ethnic groups. Black, Asian, and Minority Ethnic (BAME) population groups all show a positive excess death percentage, with Black background showing 341% excess deaths. The white population group shows a negative excess death percentage, at -13% excess deaths. The graph concludes that the Black background group is dying at higher rates than the white background group.

Source: Figure prepared by author using data from Abdual Razaq, Dominic Harrison, Sakthi Karunanithi et. al,“BAME COVID-19 Deaths – What do we know? Rapid Data & Evidence Review,” Centre for Evidence-Based Medicine University of Oxford, 5 May 2020.
Note: Excess deaths represents the difference in “Observed deaths” and “Expected deaths” for different population groups, based on the size, age and structure of the population.

A study analyzing the results of 50 studies published between December 2019 and August 2020 from the U.S. and U.K. exploring the relationship between ethnicity and clinical outcomes in COVID-19 concluded that individuals from Black, Asian and Hispanic ethnic backgrounds had a higher risk of SARS-CoV-2 infection compared to white individuals. The study highlights underlying inequities that may contribute to the elevated risks for some groups, including structural racism, barriers accessing health care, potential for increased transmission in overcrowded housing, and overrepresentation in essential occupations.

Health Inequities and COVID-19 in Canada

In Canada, COVID-19 data disaggregated by race have not been systematically collected. However, certain provinces, such as Ontario and Manitoba have begun collecting data on race, ethnicity, and in some cases Indigenous identity, for COVID-19 cases. In addition, some municipal public health agencies, such as Toronto, Ottawa and Montreal, have begun collecting and analyzing similar data.

Preliminary data show that in Toronto, while 52% of the population identifies as belonging to a racialized group, as of September 2020, 82% of COVID-19 cases and 71% of hospitalizations were among people belonging to racialized groups. Similarly, data from Ottawa show that members of racialized populations, particularly those who identify as Black, are overrepresented among individuals diagnosed with COVID-19.

Furthermore, during the first wave of the pandemic, Statistics Canada indicated that COVID-19 mortality rates were higher in Canadian neighbourhoods with higher proportions of population groups designated as visible minorities. These analyses suggest that factors such as overcrowded households, “less favourable living conditions,” employment in essential or frontline work, and barriers or discrimination in accessing services, such as those related to health and education, may contribute to the elevated risk for individuals belonging to racialized groups.

Collection of Race, Ethnicity and Indigenous Identity Health Data in Canada

According to health experts, policymakers need disaggregated data to properly understand and meet the needs of specific groups of people. The collection of Canadian health data is a shared responsibility between federal, provincial and territorial governments. Provincial and territorial public health authorities are responsible for reporting data, including COVID-19 case-related data, to the federal government.

At the federal level, the Canadian Institute for Health Information (CIHI) and the Public Health Agency of Canada are responsible for collecting and reporting nationally on health data that have been voluntarily provided by the provinces and territories. Statistics Canada collects various types of socioeconomic survey data that could be used to understand the indirect impacts of COVID-19.

The collection of national race-based health data in Canada is fragmented, with no national approach to date. COVID-19 has reinforced calls for the collection of such data. Some organizations, such as the Canadian Human Rights Commission, have called for a national strategy to improve the collection of Indigeneity and race-based data.

In July 2020, CIHI stated “[t]he lack of race-based data in the health sector in Canada makes it difficult to measure health inequalities and to identify inequities that may stem from racism and discrimination.” In response to the “urgent” need to understand the impact of COVID-19 on racialized communities in Canada, CIHI proposed a pan-Canadian standard in July 2020.

CIHI’s proposed standard, adapted from the Ontario Anti-Racism Directorate’s standards, defines race and ethnicity, and asserts that First Nation, Métis and Inuit people in Canada “have a constitutionally recognized status that is unique” and that Indigenous identity data “merit distinct considerations.” CIHI is currently seeking feedback regarding best practices and approaches to implementing these standards and collecting race-based data.

Racism and discrimination have been identified as significant determinants of health outcomes for racialized groups in general and during the pandemic. The Black Lives Matter movement has drawn global attention to the devastating effects of racism and racial inequality prior to, and during, the pandemic. Experts assert that the collection of race-based health data is integral to the recovery from the COVID-19 pandemic and that this data collection must be followed by action.

Source: https://hillnotes.ca/2020/12/08/inequities-in-covid-19-health-outcomes-the-need-for-race-and-ethnicity-based-data/

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How A Minneapolis Clinic Is Narrowing Racial Gaps In Health

2020/11/12 Leave a comment

Of interest:

North Minneapolis, one of the most racially diverse neighborhoods in Minnesota, was already dealing with high coronavirus infection and death rates when George Floyd was killed by police outside a corner store just 3 miles away.

His death on May 25 sparked deeper conversations all across the U.S. about the ways racial inequality plays out, including when it comes to health. Nationally, Black people are at least twice as likely to die from heart disease, from COVID-19 or in childbirth, compared with white people, and north Minneapolis mirrors those trends. Nearly two-thirds of Latinos in the area who get tested for the coronavirus test positive — that’s a rate nearly 10 times higher than the state’s rate overall.

“We were not surprised, because we serve a community that has health disparities,” says Stella Whitney-West, CEO of NorthPoint Health & Wellness Center, a community health and dental clinic and social services agency located in the heart of north Minneapolis.

Stella Whitney-West has been CEO of NorthPoint Health & Wellness Center for the last 16 years. “Our staff is reflective of our community that we serve,” she says.

But NorthPoint also has a five-decade history of addressing public health through the lens of race. It was founded with a mission to increase access to health care and social services in a community that today is 90% Black, Latino or Asian.

Central to its approach is tackling the social problems that contribute to illness — in order to better prevent and treat disease. Over the years, the center has made strides in public health: increasing the rates for child vaccinations and screenings for things like cancer, depression and dental care needs.

Of course the coronavirus pandemic has also added weight to many existing social burdens that contribute to poor health: loss of employment and insurance, poverty and food scarcity, stress and anxiety. Whitney-West says the racial strife layered on top of that also feels like a step backward.

“It’s been hard — not only for the community but patients, clients and our staff,” says Whitney-West. “Our staff is reflective of our community that we serve. Civil unrest — the riots in the aftermath of George Floyd’s death — brings us back to the history of how NorthPoint was started.”

The NorthPoint center began during a time eerily reminiscent of today.

NorthPoint is located at a corner of Plymouth Avenue that burned down during protests and rioting in 1967, when long-standing grievances in the Black community over lack of access to adequate housing, education and health care turned violent.

“I was 10 years old at the time, but it was very traumatizing to see all these Black people getting beat up by police and the fires right on our block,” says Gary Cunningham, who lived on Plymouth Avenue and watched it burn that night.

Inadequate access to medical care was a major issue that shaped life for Cunningham and his neighbors.

“There was an issue with ambulance service,” Cunningham says. “The ambulance wouldn’t serve the Black community there,” so he and his mother would take the bus across town when they needed care. “Most Blacks went to Dr. Brown — his office would be like 200 people in the waiting room because he was one of the few Black physicians.”

The federal government tried to increase access to health care for minorities. Among other efforts, President Lyndon B. Johnson’s War on Poverty established pilot programs in 14 cities to offer health and social services.

North Minneapolis got one of those programs. Months after the 1967 riots, Pilot City — which later became NorthPoint — opened in an old synagogue on Plymouth Avenue.

“I just remember it being a place where community gathered. The health center and social service center at that time were one place,” Cunningham recalls.

Nearly four decades later, Cunningham took over as the clinic’s CEO.

By then, Pilot City had fallen into disarray — its public image was that of an impoverished clinic of last resort. By 2002, when Cunningham took over, he says, it was running a $2 million annual deficit, and few patients were getting regular vaccinations or mammogram screenings.

So Cunningham refocused on Pilot City’s original mission: to increase access to health care by also identifying and enhancing social services to support that goal.

Cunningham’s team developed some innovative solutions to bring more patients in, including providing bus tokens to patients who couldn’t otherwise afford transportation. NorthPoint’s new approach reached a growing Somali and Hmong population in the area through hosting lunch events with religious leaders and featuring food from those communities. Over the last 15 years, vaccination and health screening rates more than doubled, to close to 80%.

That has meant more prevention of disease and lower costs for treatment and care.

Diabetes, lead poisoning and depression are also big problems in the community. So NorthPoint lobbied local agencies to get lead paint safely removed from homes. The center stocks a free-food shelf with healthy, culturally relevant food. All patients — regardless of what health problem they come in for — are now automatically screened for depression and dental care needs and are told to bring their family members in as well.

Enlarge this image

NorthPoint’s founding mission was to increase access to health care and social services. Over the years, this approach helped the clinic increase the neighborhood’s rates of child vaccinations and screenings for things like cancer, depression and dental care needs.

These measures have increased NorthPoint’s reach into a diverse community — something many other medical centers facing similar dynamics are struggling with today.

Rashida Jackson first came to NorthPoint as a patient in childhood, and is now community board member. The clinic, she says, is a beloved part of the community.

As a child, Rashida Jackson, 52, came to NorthPoint for health care, and now her mother, children and all her grandchildren see their doctors there.

Jackson is now on NorthPoint’s board of directors, which draws a majority of its seats from patients like her, who are members of the community.

“This is one of those powerful institutions that developed out of a lot of civil unrest and pain,” says Jackson, “and it’s a thing of pride to see this small community health clinic explode and grow. Whatever social service support you need, they have.”

That’s why the center is so beloved by the community, she says: “We own it, it’s family — it’s almost a living, walking, breathing thing.”

And today, NorthPoint is once again being held up as a model.

This past summer, in the wake of George Floyd’s death, Minneapolis and the Hennepin County Board of Commissioners declared racism a public health crisis.

Irene Fernando, one of the co-authors of the county’s declaration, says just as NorthPoint has done in the health realm, the county wants other government agencies to rethink policy — by looking at how race affects outcomes in education, employment and criminal justice.

“NorthPoint listens to the community,” says Fernando, who also serves on NorthPoint’s board. “Earlier than other entities, NorthPoint was reporting on race; earlier than other entities, NorthPoint was willing to do free testing for COVID.” So thinking about improving access to health care “is in how NorthPoint operates,” she says.

One reason its approach differs from those of other health centers is that it is a community health clinic, not a hospital, says Ed Ehlinger, former Minnesota health commissioner, who has written about racism in health.

That means, he says, its mandate is to improve public health in the community; it’s not under the same commercial pressures many private hospitals are up against.

Ehlinger compares NorthPoint to medical centers in countries that have universal public health care. “They focus on community-oriented primary care and have much better outcomes and lower health care costs,” he says. “So even though there aren’t as many of those neighborhood health centers left, I see them as the model that we should look to replicate, in moving forward.”

At a time when few patients trust their health care providers, NorthPoint has bucked that trend.

LaVonne Moore, a midwife and lactation consultant with the center, says that’s in part because NorthPoint recruits its leaders and doctors from the community it serves.

Moore, who lives nearby, says that interconnection between residents and staff fosters enduring, trusted relationships with patients and a level of care that is highly unusual today.

“I’m a provider,” she says. “I have dropped medicines for COVID-19 patients at their door: I just leave it at the door, go back in the car, make sure they know what’s out there, and they come to the door and pick it up.”

That trust is critical, especially given the gravity of problems that north Minneapolis faces these days: Nearly two-thirds of Latino patients who test for the coronavirus at NorthPoint are testing positive. While that’s an alarmingly high rate, CEO Whitney-West says it’s also a positive sign. A significant number of those patients are undocumented immigrants, she notes, and the findings suggest they trust NorthPoint enough to get tested at the center.

And from a public health standpoint, that’s a win, she says, because you need to know where the virus is in order to stop its spread.

Source: How A Minneapolis Clinic Is Narrowing Racial Gaps In Health

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Opinion: Diversity of thought needed in our pandemic response

2020/11/07 Leave a comment

Good, thoughtful commentary that applies more broadly than to the pandemic, and the risks of simplistic thinking and solutions:

Over the past nine months, we have seen an incredible change in the way we live, work and interact. The world is clearly different now. Our lives are intertwined with the evolving COVID-19 pandemic, and many look to experts from a variety of fields for guidance. Medical, public health and scientific leaders have become sources of insight and direction. Many may think there is only one “scientific truth,” and therefore every expert should be of the same opinion. But science, particularly when dealing with a novel threat, comes with many uncertainties.

As with any important issue, personal values influence how people interpret the science. We all have biases, which are influenced by our life experiences, cultures, emotions and personal beliefs, and experts are susceptible to these factors, as well.

This matters because diversity of thought, spurring civil debate, can help us collectively think through complex issues such as our pandemic response. Disagreement among experts is a normal and essential part of scientific discourse, as data continues to accumulate over time. However, one’s inherent beliefs and biases may play a significant role in the interpretation of the evidence at hand, and the messaging that follows.

Some may be motivated by their fear of infection, some by an urgent desire to return to a sense of normalcy and others by political or ideological beliefs, or even a need for notoriety. Some of the more polarizing views are what sow division among the population.

Oftentimes, the loudest voices espousing simplistic answers are not the correct ones, yet they may garnish the most attention and support in the media and online. The public — not aware of all the nuances — may lose trust in science after being bombarded with polarized, and often incorrect, views that are given as much, or more, attention than those that follow fundamental scientific principles and are transparent about their level of uncertainty. This eroding trust in the scientific community further splits populations.

Due to the emotions at play and the public-facing nature of the discussion, scientific discourse risks becoming politicized and devolving into a polarized conflict.

On the one extreme, discussion is interpreted as fear-mongering by people who think the potential harms of COVID-19 have been greatly exaggerated and that the harms of certain interventions have been underestimated. On the other extreme, the idea of personal freedoms are elevated over disease control and the focus becomes primarily on the harms of lockdown. Both of these positions have a nugget of truth in them, but the dogmatism may preclude any meaningful discussion that could lead to an evidence-based consensus.

Moderate voices that try to find a balance between the two more extreme views matter in this pandemic. It is important to listen to arguments from across the spectrum and try to interpret the data in as nuanced and unbiased a manner as possible. This is a tall order, as the moderate view often carries with it significant uncertainty, and pivots as available evidence evolves.

Recognizing the nuances and complexity of disease is crucial to forming a more complete understanding. Moderate voices may not make headlines or get clicks because the answers to simple questions are long and complex, but they are important to listen to. The moderate voice is not one single voice: opinions vary between the two extremes and the answers are often complex.

In contrast, the more extreme viewpoints have a tendency to be amplified to a great degree within their own echo chambers, which can then be prone to politicization. This drives false dichotomies, and polarized discussions — such as masks versus no masks, aerosols versus droplets, lockdowns versus personal freedoms — where in reality, the answer often lies in between.

People with extreme views often choose to compare countries to prove their point, celebrating certain jurisdictions while condemning the approach of others, but give no consideration to the complex demographic, social, political and geographic factors that lead to particular situations, as well as the changes that occur over time.

Who can be trusted given all the conflicting information? First of all, diversity of thought is crucial. And second, it is important to recognize our own biases and how they influence our perceptions and how we interpret evidence. People who are adaptable to messaging and acknowledge uncertainty as the evidence evolves are key, given that the scientific method is meant to gain more precision over time. Dogmatic stances are best avoided.

We are moving into the future with an evolving roadmap for how to deal with COVID-19 — one that’s guided by lessons learned from our collective global experience. Different perspectives offer valuable insights in this pandemic and together they can offer a clearer picture of the truth. That said, the “infodemic” will continue with the pandemic, and it is important to try to put information into context, recognize our own biases and be willing to revise our positions in the face of new evidence.

We require a diverse group of voices at the table, but must continue to make an effort to foster healthy public discourse that’s free of politicization, by appreciating and considering the input of experts from all walks of life. The general population is as diverse as their experts in their values and opinions, and public policy should try to find the middle ground. Therefore, moving forward, now more than ever, a balanced, pragmatic and evidence-driven approach to the interpretation and messaging of the COVID-19 pandemic is needed.

Zain Chagla is an infectious diseases physician and an associate professor at McMaster University. Sumon Chakrabarti is an infectious disease physician with Trillium Health Partners Mississauga and a lecturer at the University of Toronto. Isaac Bogoch is an infectious disease physician at Toronto General Hospital and an associate professor at U of T. Dominik Mertz is an infectious disease physician and an associate professor at McMaster.

Source: https://ottawacitizen.com/opinion/opinion-diversity-of-thought-needed-in-our-pandemic-response/wcm/c064636f-583e-41e0-8c8f-3b65a3b14e8b

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Health Minister orders review of pandemic warning system, concerns raised by scientists

2020/09/09 Leave a comment

Really hope the review will be truly independent, review all appropriate documentation, analysis and memos and identify what level and persons were responsible for the decision (i.e., was the decision made at the bureaucratic or political level):

Canada’s Health Minister has ordered an independent review of the country’s pandemic early warning system, after The Globe and Mail reported that the respected surveillance and research unit was silenced last year, several months before the COVID-19 outbreak hit.

Health Minister Patty Hajdu said the federal review will probe the shutdown of the system, as well as allegations from scientists inside the Public Health Agency of Canada that their voices were marginalized within the department, preventing key messages from making it up the chain of command.

“My hope is that we can get the review off the ground as soon as possible,” Ms. Hajdu said in an interview. “The independence of this review is critically important.”

A Globe investigation in late July detailed how the unit, known as the Global Public Health Intelligence Network, or GPHIN, was effectively silenced in May, 2019. The team of analysts – including doctors and epidemiologists specially trained to scour the world for health threats – were reassigned to other tasks within the government amid shifting department priorities.

Though GPHIN had garnered a stellar reputation internationally, and was dubbed a “cornerstone” of global pandemic preparedness by the World Health Organization, officials within Public Health decided in late 2018 and early 2019 that the operation was too internationally focused and could be put to better use working on domestic projects. The new work did not involve pandemic preparedness.

Those changes led to the shutdown of a special surveillance and alert system that helped Canada and the WHO gather intelligence on potentially threatening outbreaks, particularly in situations where foreign governments were trying to hide or play down the event.

Current and former scientists and doctors at Public Health also said they began to fear that their messages were not being heard, or understood, by layers of department officials who lacked a sufficient background in science. That made it difficult to convey urgent and complex information up the chain of command.

Responding to those concerns, Ms. Hajdu said her office has spent the past month looking into the problems at the departmental level, which led her to order the review.

“I’m concerned when there is an accusation that scientists are not being fully empowered, or in some way feel their voices are being blunted or muted,” Ms. Hajdu said in an interview.

“I can listen to those kinds of worries and do the kinds of things that I’m prepared to do, which is to order a review of the program and to determine whether or not the changes are actually resulting in the kind of information that Canada needs.”

Ms. Hajdu said she has asked that the review be done expeditiously, so that fixes can be identified and the recommendations implemented as soon as possible. She said that could mean having the recommendations back in six months.

“We’re working on [appointing] some professionals that would have the experience and the expertise to be able to do this review thoroughly, but also expeditiously … I don’t want this to be a two-year review,” the Health Minister said. The people leading the review are expected to be named in the coming weeks and will be independent of Public Health Canada.

Created as an experiment in the 1990s, GPHIN became a key part of Canada’s pandemic preparedness capacity after the deadly 2003 SARS outbreak, and was seen as a way to collect intelligence on global outbreaks. The point was not merely to identify the threat early, but also to monitor crucial developments and clues about the spread, often before official announcements were made by foreign governments, to speed up government decision-making.

With a team of roughly a dozen highly specialized analysts working in multiple languages, GPHIN was globally renowned for its ability to collect and disseminate credible information. It scoured more than 7,000 data points a day, including medical data, news reports, scraps of information on social media, and details on internet blogs to gather intelligence on outbreaks.

GPHIN had been credited with detecting some of the most important signals from the 2009 H1N1 outbreak in Mexico, outbreaks of Zika in West Africa, and a potentially catastrophic 2005 bird flu outbreak that the Iranian government tried to hide. As recently as two years ago, the WHO credited the Canadian unit for supplying 20 per cent of its “epidemiological intelligence.”

However, department changes effectively shuttered the operation, and limited the power of scientists inside the agency. The Globe obtained 10 years of internal GPHIN records which showed the system, which had issued more than 1,500 intelligence alerts about potential health threats over that time, went silent on May 24 last year. That coincided with a department edict that all such alerts had to be approved by senior managers inside Public Health. GPHIN analysts were shifted to domestic projects, such as tracking the effects of vaping in Canada, which effectively curtailed Canada’s surveillance of international health threats.

Past and present employees told The Globe that the system was designed to provide information to speed up Canada’s response to a dangerous outbreak such as COVID-19, including measures such as shutting down the border, quarantining travellers, enforcing physical distancing, and locking down long-term care homes.

“A lot of the work that we’ve done [over the past month] is to try to dig a little bit deeper into how this is working and why were these changes made,” Ms. Hajdu said.

GPHIN “has the potential to be a very valuable asset for Canada. It can’t be wasted,” the Health Minister said.

“The intent when there is an emerging pathogen is to close it off, to try and contain it as best as possible – at its source. So that you don’t end up in a pandemic like this again.”

The independent review follows a pair of other developments in recent weeks. Last month, the Auditor-General of Canada launched an investigation into the shutdown of the pandemic surveillance unit. And Public Health officials have restarted the GPHIN alert system.

COVID-19 has been a reckoning for governments around the world, exposing weaknesses in pandemic readiness and responsiveness. Ms. Hajdu said countries must now take stock of what needs to be done to implement stronger measures, including early warning and surveillance capacity, that will remain effective and not be eroded over time, when the memories of the crisis fade.

The federal review will look at “governance and what works best” for GPHIN, Ms. Hajdu said, adding that the messages raised by scientists inside Public Health, who took risks by speaking out publicly, resonated with her.

“In [The Globe’s] reporting, the plea from the scientists and the researchers that work in that team were particularly profound,” Ms. Hajdu said.

“There is still enough there to save, and to boost, and I think this independent review is going to be very helpful,” she said. “Obviously there is a lot of work to do.”

Source: Health Minister orders review of pandemic warning system, concerns raised by scientists

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