USA: Student loan debt is deepening the racial wealth divide

Of note. Anyone aware of comparable studies, even if Canadian tuition rates are more reasonable than in the US:

By design, economists’ reports are rather staid, which makes it all the more noticeable that in their 2016 report Black-White Disparity in Student Loan Debt more than Triples after Graduation, written for the New York-based Brookings Institution (BI), Professor Judith Scott-Clayton and Jing Li characterised the US$25,000 loan debt gap between whites and blacks in the United States a few years after graduation as “whopping”. 

At graduation, black students owed US$7,400 more than did their white peers (US$23,400 vs US$16,000). 

Since Scott-Clayton and Li’s paper, a series of other papers BI published have shown that the gap, if anything, has grown. 

Last June, a paper prepared for BI by Andre M Perry, Marshall Steinbaum and Carl Romer showed that in 2019, 75% of blacks who took out student loans to finance higher education owed more than they had borrowed as compared with 48% of whites.

“Black students finance their education through debt, and thus college degrees actually further contribute to the fragility of the upwardly mobile black middle class,” wrote Perry et al in Student Loans, the Racial Wealth Divide, and Why We Need Full Student Debt Cancellation.

“And because education does not achieve income parity for black workers, the disproportionate debt black students are taking to finance their education reinforces the racial wealth gap. Today the average white family has roughly 10 times the amount of wealth as the average black family, while white college graduates have over seven times more wealth than black college graduates.”

The debt differential begins as soon as the students write their first cheques. The financial crisis of many black families means that a much lower percentage are able to contribute to their sons’ and daughters’ higher education than is the case for white families. 

Some 72% of black students (as opposed to 34% of white students) qualify for Pell Grants. This federal programme provides the very poor with a maximum of US$6,495, roughly one-third of the cost of tuition, room and board at public universities and colleges, and a seventh of the average cost at private colleges and universities. 

In their study, Perry et al point out that the black student debt crisis is partially fuelled by the shift from “public funding to tuition-based business models in higher education – all financed with federal student loans”. 

According to figures from the American Association of University Professors, between 2009 and 2011 state governments cut their grant for full-time students at state universities and colleges from US$9,124 to US$7,364. 

Only in 2019-20 did the state grant equal what it was in 2009. The cumulative financial loss over this period for each full-time student is more than US$7,800. These figures show the reality behind Perry et al’s claim that “the balance (US$1.7 trillion) on the federal books represents the states’ disinvestment from higher education”.

Further adding to the aggregate black student debt is the fact that about 12% of black students enrol in for-profit colleges and universities, approximately twice the rate of whites. This sector has come under scrutiny for predatory practices that target, among others, economically disadvantaged populations such as blacks. 

“Despite enrolling only 11% of the higher education population, for-profit colleges and universities receive 25% of all federal student aid … Some of the largest for-profit colleges receive as much as 90% of their total funding from federal aid, incentivising schools to target low-income students and veterans who are eligible for large amounts of federal aid,” wrote William Roberts, managing director for democracy and government reform at American Progress, and Marissa Parker-Bair in an article published on the Center for American Progress’s website in July 2019.

According to Jon Boeckenstedt, vice provost for enrolment management at Oregon State University, “in addition to predatory practices, for-profit colleges and universities have very successfully lobbied the federal government to reduce oversight of their programmes”. 

“Further, for-profit colleges and universities tend to have lower graduation rates (26% v 60%) which means that students who took out loans to attend these institutions are unable to benefit from the increased salaries that are expected for college graduates. Historically, default rates for students who don’t finish the degree or programme they started are considerably higher than for graduates,” Boeckenstedt said.

Struggling to repay

The wage gap between blacks and whites is a significant factor in why black students – both those who drop out as well as those who graduate – struggle to repay their student loans. 

In 2019 the US Department of Education reported that one year out from graduation, blacks who hold bachelor degrees earn 10% less than their white counterparts (US$36,000 to US$40,000). In 2020 the New York City Department of Consumer and Worker Protection reported that, for whites and blacks who are further into their careers, the annual salary gap grows to US$21,900: US$64,700 to US$42,800. 

Nor does higher education close the gap. A slightly higher percentage of blacks go on to graduate school than do whites (14% to 13%). Yet, wrote Scott-Clayton and Li, “blacks with graduate degrees still earn less on average than whites with only a bachelor degree.” 

Equally important for why blacks are less able to repay their college loans is the structure of the federal student loan programme. As soon as a student drops out of college or university, or graduates, the interest clock starts ticking. 

Graduate students are given a forbearance from repaying their undergraduate loans for the period of time they are enrolled in graduate school; however, the interest keeps accruing. 

The accrual of interest onto the principal debt, what economists call ‘negative amortisation’, is why nearly half of all blacks who took out student loans owe more on their loans than they did upon graduation.

A further factor mitigating against blacks repaying student loans is the direction of intergenerational transfer of wealth in black families. 

According to a 2017 study covering 23 years beginning in 1989 and conducted by the Economic Research unit of the Federal Reserve Bank of St Louis (FRBSL), after graduation white students benefit from their families transferring money to them to, for example, put a down payment on a house. By contrast, the FRBSL found that black graduates are much more likely to transfer money to their families to, for example, support their parents, thus leaving less money each month for loan repayment.

Neither the ability of well-off families, which are disproportionately white, to refinance student debt at favourable rates, nor what the income tax act allows former students to deduct from their income taxes, directly contribute to the debt crisis faced by blacks. 

They do, however, contribute to the wealth gap between the two groups and, thus, skew perceptions of the issue, leading some to argue that those who cannot repay their debts are the authors of their own misfortune.

Graduates from well-off families benefit from their history of positive credit scores. The interest rate on federal student loans is presently 6.8%. The most creditworthy customers, however, are able to refinance student debt for as low as 1.8%, says Carl Romer, Perry’s co-author. 

All former students can deduct US$2,500 of interest charges from their federal taxes. However, as Romer explained to me, the greater benefit goes to those who have borrowed less money. “If your loan is US$100,00 and you are paying 6% interest, then you are paying US$6,000 in interest. But you are still allowed to deduct only US$2,500 in interest. This penalises households with high amounts of student loans, which are disproportionately black households,” he told University World News.

The inequity is even more striking if we look at it over 20 years. Students who can refinance their debt at 1.8% repay the debt at the rate of US$496 a month and pay US$19,150 in total interest. Students whose debts are repaid at 6.8% interest pay US$763 per month and over 20 years pay US$83,000 in interest, or more than four times the amount their peers from well-off families pay.

Alleviating worst consequences

In their 2016 paper, among their proposals, Scott-Clayton and Li theorised that a ‘Revised Pay As You Earn’ (REPAYE) could alleviate the worst consequences of the racial debt disparities. 

Their caveats, including daunting paperwork and the fact that “too often students do not learn about the income-contingent options until after they are already in trouble – having missed payments, accumulated fees and damaged their credit” have proven all too prescient.

“Policy-makers as far back as the Clinton administration were very much influenced by the income-driven repayment plans in place in Australia and the UK,” Scott-Clayton says. 

“The difference in both of these cases, though, is that in those countries the plans work much more seamlessly with the treasury and payments are integrated into the tax system. So, this [the American system] is kind of trying to take that model and fit it into the very not automatic US system.”

REPAYE may look fair on paper, having, for example, former students pay 15% of their income towards their debt. Yet, Romer notes, because these households are in such straightened conditions, the presence of, in many cases, decades-old student debt on their credit report means “they are unable to access the type of credit that middle-class households need in order to thrive”.

“They are not able to get a credit card. They are not able to purchase a home. They are not able to do the types of things that would make their lives that much easier.”

Nor, Romer says, does the government’s logic make sense. For those who have been paying 15% for 20 or 25 years, the government cancels the debt.

“This is another reason why we say to cancel the debt instead of holding these households really hostage to their student debt for minimal levels of repayment, if any, it is better to just make their lives better by cancelling the debt.”

After underscoring that 51% of the student debt is held by households with zero or negative net worth, and that black households at every income level and at every age are more likely to hold student debt than are non-black households, as had Scott-Clayton, Romer framed the question as a social justice issue.

Romer concluded, however, by speaking the language of political economy, saying that cancellation of student debt can help in the economic recovery from the COVID crisis. The FRBSL, he says, found that student debt slowed the recovery from the 2009 Recession. According to Romer, the Lee Institute based in Charlotte, North Carolina, reported that cancelling student debt would grow the economy by US$100 billion every year for the next 10 years. 

“They did this study five years ago. So, the amount of student debt has only grown since and it is pretty simple to infer their projection would have grown as well. As we recover from the pandemic-induced recession, it’s important to think about how previous economic studies on the macro-economic effects of student debt have shown that the answer is to cancel it in order to grow the economy,” says Romer.

Targeted or piecemeal approach?

A few days before I interviewed Scott-Clayton, the Biden administration cancelled the student debt of 323,000 people who together owed US$5.8 billion, which brought the number of former students whose debt the government had wiped out to 455,000 and the amount to US$8.7 billion. 

When I asked her about the government’s approach, given that the amount on the government’s books was US$1.7 trillion, Scott-Clayton said: “It is obvious that rather than pushing hard for some kind of blanket forgiveness, they’re trying to do a more targeted approach. And, to the extent that they are committed to that, they’ll keep identifying additional groups that are at high risk of delinquency and default.”

The problem with this piecemeal approach, she says, is that it “won’t reach all the borrowers who urgently need help”.


Immigration and natives’ exposure to COVID-related risks in the EU | VOX, CEPR Policy Portal

Interesting assessment that immigrant workers in EU countries helped non-migrants avoid COVID-related risks given that immigrant workers filled the more difficult and dangerous jobs and that native workers were more able to shift to jobs that could be filled from home:

In recent years, immigration policy has been at the forefront of political debates in high-income destination countries. The UK completed its withdrawal from the EU on 31 January 2020, due in part to the desire to have more control over its immigration policies and to limit migrant flows. Intense political debates and polarisation on immigration helped fuel the rise of right-wing parties in Europe and political controversies over the border wall and the Dream Act in the US.

Despite these high-profile examples of the popular and political backlash against immigration, the academic literature provides evidence that immigrant workers often fill difficult and dangerous jobs that locals are not willing to undertake (Orrenius and Zavodny 2009 and 2013, Sparber and Zavodny 2020).

The recent COVID-19 shock exerted unforeseen and sudden pressures on labour markets across the world. While the negative effects of the pandemic were widespread, some categories of workers were hit much harder than others due to their occupations (Adams-Prassl et al. 2020a and 2020b, Dingel and Neiman 2020, Garrote-Sanchez et al. 2020, Gottlieb et al. 2021). Migrant workers, in particular, have been more exposed to the negative impacts of COVID-19 (Basso et al. 2020, Borjas and Casidi 2020, Fasani and Mazza 2020 and 2021). Another strand of the migration literature shows that in response to immigration, native workers reallocate to different occupations in which they have a comparative advantage (Peri and Sparber 2009).

Against this backdrop, a question of interest is whether immigration contributed to reducing locals’ exposure to the COVID-19 pandemic. In a recent paper (Bossavie et al. 2020), we explore how the prevalence of immigration in a labour market affects different types of workers’ exposure to COVID-19 related risks. We provide evidence that not only were immigrant workers more exposed to the economic and health-related shocks of the pandemic; they also served as a protective shield for native workers. By selecting into higher-risk occupations prior to the pandemic, immigrants enabled native workers to move into jobs that could be undertaken from the safety of their homes or with lower face-to-face interaction with customers and co-workers during the pandemic.

To assess the exposure of immigrant and native workers to the economic and health risks posed by the pandemic, we construct various measures of vulnerability. We look at three main dimensions of occupational vulnerability in the context of COVID-19: whether an occupation can be carried out from home, whether it has been categorised as essential by governments in the context of COVID-19, and whether it is exposed to COVID-19 health risks. In general, lower-skilled occupations such as machine operators, waiters, and day laborers tend to be less amenable to work from home than professional and managerial occupations. Essential jobs are concentrated in key sectors such as healthcare or agriculture. The higher health risks are found in essential occupations that require intensive face-to-face interactions such as doctors, personal care workers, or bus drivers.

We focus on destination countries in Western Europe, including the 15 countries that were the initial members of the EU (prior to the 2004 enlargement), Norway, and Switzerland. This region is the destination for an estimated 60 million of some 272 million immigrants worldwide. The analysis is based on a harmonised labour force dataset (EU Labor Force Survey) that contains detailed information on personal characteristics (such as age, education, occupation, and sector) of native workers and labour migrants in hundreds of local labour markets in subregions within European countries.1 The distribution of occupations by type of exposure to COVID-19 and by migrant status in the EU is reported in Figure 1.

Figure 1 Relative size of telework, essential, and non-face-to-face jobs in the EU

Source: Own calculation based on EU-LFS 2018 data, following EC directive (2020) and Fasani and Mazza (2020).

We first find that immigrants are generally employed in occupations that are more vulnerable to COVID-19-related risks (Fasani and Mazza 2021 report similar findings). Our estimates show that only 27% of employed migrants in the EU15 have a job amenable to telework, compared to 41% of native workers (Figure 2). On the other hand, migrants are slightly more likely to be in essential occupations. Combining those two categorisations of job vulnerabilities, migrants are more than 10% less likely than natives to hold jobs that are shielded from negative income shocks associated with the COVID-19 pandemic. Furthermore, migrants are also more likely to have jobs that are exposed to health risks, though we report significant heterogeneity in exposure among immigrant groups. The higher vulnerability of migrants is common across skill levels but varies depending on country of origin, with Eastern European migrants being the most exposed to income risks while migrants from Western Europe or North America have a similar risk profile to natives. Recent Eurostat statistics show that the higher vulnerability of migrants to the COVID-19 shock in Western Europe resulted in higher employment losses in 2020 (4% drop vis-à-vis 2019, compared to 0.8% fall for natives during the same period).

Figure 2 Share of workers by region of origin and risk type

Source: Own calculation based on EU-LFS 2018 data, following EC directive (2020) and Fasani and Mazza (2020).

We then examine whether the presence of immigrants in local labour markets has a causal impact on the vulnerability of native workers in the same geographic areas. Our empirical analysis is motivated by a general equilibrium model of comparative advantages in task performance between immigrant and native workers (Peri and Sparber 2009). In the model, native workers reallocate to other occupations in response to an influx of immigrant workers. In the empirical analysis, we use an instrumental variable approach to account for the non-random location choices of migrant responses to local job opportunities, which is based on past migration presence in the same region. Because of information, networks, and preferences, there is a strong positive association between current and past immigrant presence across European regions, as immigrants tend to move to the same locations where previous immigrants from the same country already live.

We find that native-born workers in those European subregions with a higher share of immigrants are significantly less likely to be exposed to various dimensions of occupational vulnerability associated with COVID-19. This association is especially strong when looking at the likelihood of being employed in teleworkable occupations (Figure 3), and the results get stronger once the endogeneity of immigrants’ location choices is taken into account. Immigration thus had a causal impact in reducing the exposure of native workers to some labour markets risks associated with the COVID-19 pandemic.

Figure 3 The relationship between share of immigrants in the working-age population and share of natives employed in jobs amenable to work from home in European regions

Source: Authors’ calculations using the EU Labor Force Survey 2018.
Note: The sample includes NUTS-2 regions from the EU-15 as well as Switzerland and Norway.

We also find heterogeneous effects depending on the characteristics of native workers. The effects of immigration on job safety are stronger for highly (i.e. tertiary) educated native workers, who benefit from the presence of both high-skilled and low-skilled migrants. By contrast, the effects are smaller and statistically insignificant for less (i.e. non-tertiary) educated native workers. We also assess whether these compositional effects on employment of certain types of native workers are accompanied by overall changes in total employment and wages. We find no evidence of wage or employment impacts among native workers, suggesting that the increase in job safety among native workers is driven purely by their reallocation from vulnerable jobs to safer jobs.

In short, we find that immigration to Western Europe reduced the economic exposure of natives to COVID-19 related labour market shocks by pushing them towards occupations that are more amenable to work from home. Our paper thus provides another example of immigrant workers in effect ‘protecting’ native workers by taking on the riskiest jobs during the pandemic.

Source: Immigration and natives’ exposure to COVID-related risks in the EU | VOX, CEPR Policy Portal

The Black Mortality Gap, and a Document Written in 1910

Important history:

Black Americans die at higher rates than white Americans at nearly every age.

In 2019, the most recent year with available mortality data, there were about 62,000 such earlier deaths — or one out of every five African American deaths.

The age group most affected by the inequality was infants. Black babies were more than twice as likely as white babies to die before their first birthday.

The overall mortality disparity has existed for centuries. Racism drives some of the key social determinants of health, like lower levels of income and generational wealth; less access to healthy food, water and public spaces; environmental damage; overpolicing and disproportionate incarceration; and the stresses of prolonged discrimination.

But the health care system also plays a part in this disparity.

Research shows Black Americans receive less and lower-quality care for conditions like cancer, heart problems, pneumonia, pain management, prenatal and maternal health, and overall preventive health. During the pandemic, this racial longevity gap seemed to grow again after narrowing in recent years.

Some clues to why health care is failing African Americans can be found in a document written over 100 years ago: the Flexner Report.

In the early 1900s, the U.S. medical field was in disarray. Churning students through short academic terms with inadequate clinical facilities, medical schools were flooding the field with unqualified doctors — and pocketing the tuition fees. Dangerous quacks and con artists flourished.

Physicians led by the American Medical Association (A.M.A.) were pushing for reform. Abraham Flexner, an educator, was chosen to perform a nationwide survey of the state of medical schools.

He did not like what he saw.

Published in 1910, the Flexner Report blasted the unregulated state of medical education, urging professional standards to produce a force of “fewer and better doctors.”

Flexner recommended raising students’ pre-medical entry requirements and academic terms. Medical schools should partner with hospitals, invest more in faculty and facilities, and adopt Northern city training models. States should bolster regulation. Specialties should expand. Medicine should be based on science.

Source: The Black Mortality Gap, and a Document Written in 1910

Why Racial Inequities Still Persist in Health Care

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

Why doctors want Canada to collect better data on Black maternal health

Need this for many groups:

A growing body of data about the heightened risks faced by Black women in the U.K. and U.S. during pregnancy has highlighted the failings of Canada’s colour-blind approach to health care, according to Black health professionals and patients.

Black women in the U.K. and U.S. are four times more likely to die in pregnancy or childbirth than white women, according to official data. A recent U.K. study published in The Lancet found that Black women’s risk of miscarriage is 40 per cent higher than white women’s. In Canada, that level of demographic tracking isn’t available.

“For our country, we don’t have that data. So it’s difficult to know exactly what we’re dealing with,” said Dr. Modupe Tunde-Byass, a Toronto obstetrician-gynecologist, and president of Black Physicians of Canada. “We can only extrapolate from other countries.”

Source: Why doctors want Canada to collect better data on Black maternal health

New data provides a rare glimpse at ‘substantial’ Black overrepresentation in Ontario’s jails

Of interest:

Nearly one out of every 15 young Black men in Ontario experienced jail time, compared to one out of about every 70 young white men, and incarcerated Black people were more likely to live in low-income neighbourhoods, a new study of hard to come by race-based inmate data shows.

Using a snapshot of every Ontario inmate released in 2010, self-reported race data, home address data and 2006 census demographics, researchers from the University of Toronto, Ryerson University, McMaster University, St. Michael’s Hospital and ICES, a non-profit clinical research institute, have provided a rare glimpse at “substantial” Black overrepresentation in jails.

“The key thing here is really just the extent to which young Black men experience incarceration in Ontario,” said lead author Akwasi Owusu-Bempah. “It’s hugely troubling, especially in light of what we know about the consequences of criminalization, of incarceration for their futures and the futures of their families and their communities. We know what it does. Incarceration derails lives.”

The jail data, provided by the Ontario Ministry of the Solicitor General, held details of 45,956 men and 6,357 women who were released from provincial correctional facilities, which house accused awaiting bail or trial, and offenders sentenced to less than two years.

Overall, 12.8 per cent of men identified as Black and had an incarceration rate of 4,109 per 100,000; 58.3 per cent identified as white, for an incarceration rate of 771 per 100,000, and 28.9 per cent as “other,” for a rate of 1,507 per 100,000.

“Other” includes Indigenous, another group vastly overrepresented in jails and federal prisons but not the focus of this study.

For women, the rates were much smaller for all groups but, overall, Black women were incarcerated at a rate of 259 per 100,000, white women had a rate of 96 per 100,000 and the rate for “other” was 248 per 100,000.

Young men between the ages of 18 and 34 had the highest rates of incarceration in all groups, but young Black men had rates ranging around 7,000 per 100,000, compared to about 1,400 per 100,000 for younger white men.

Neighbourhood demographic data gleaned from the forward sortation area of postal codes showed Black men and women were more likely to come from low-income areas of the province. Black men spent more days incarcerated than white men and had higher rates of being transferred to a federal prison.

“This study demonstrates that incarceration is heavily concentrated among young Black men who come from economically marginalized neighbourhoods,” concluded Owusu-Bempah, an assistant sociology professor at U of T, and co-authors Maria Jung, an assistant criminology professor at Ryerson, Firdaous Sbai, a doctoral sociology student at U of T, Andrew S. Wilton, an ICES researcher, and Fiona Kouyoumdjian, an assistant professor in McMaster’s department of family medicine.

At the root of the higher rates are “historical and contemporary social circumstances of Black people in Canada,” note the researchers. These include 200-plus years of slavery and anti-Black racism, and disparities in many systems, including education, employment, child protection and justice.

Black people experience higher rates of child apprehensions and school suspensions and expulsions, and are more heavily policed, the authors said in highlighting disparities found in numerous studies, and also groundbreaking reporting done by the Star around Toronto police arrest and charging patterns and carding, when police stop, question and document citizens in non-criminal encounters.

Lower incomes for Black people have resulted in Black families living in areas that are “underserved by transit, libraries, schools and hospitals,” and those neighbourhoods tend to have higher levels of crime and crime victims, and concentrated law enforcement, the paper notes, citing academic work done by David Hulchanski on Toronto.

In the United States, the “American experience” with race and incarceration “shows us that concentrated incarceration has negative consequences at the individual, family and community levels, including social problems relating to poverty, mental health, education, employment and civic involvement,” the researchers wrote.

That ends up distorting “social norms, leads to the breakdown of informal social control, and undermines the building blocks of social order which are essential for community safety,” the paper concludes.

The often claimed but false trope that Canada is better on race and racism than the United States is also examined at the outset of the paper, which is published in the journal Race and Justice.

While not directly comparable, the authors later note that 2016 data from the U.S. Bureau of Justice Statistics showed Black men were jailed in state and federal institutions each day at a rate of 2,417 per 100,000. In the Ontario study, the annual incarceration rate in 2010 for Black men was 4,109 per 100,000.

That, the authors wrote, helps to “contextualize the extent of Black over-incarceration in Ontario.”

Owusu-Bempah, in an interview, said that “when we think about mass incarceration and we think about this kind of concentrated incarceration as an American phenomenon, I think we can see very clearly here that the levels of overrepresentation that we see in the United States is here in Canada.”

The age of the Ontario data — now over a decade old — speaks to how rare it is to come across race-based Canadian data, the researchers noted in an emailed response to Star questions.

“While these data are from 10 years ago, our ongoing involvement in the criminal justice system indicates that the overrepresentation of Black people persists today,” said the research team. “We think that monitoring and publicly reporting on the overrepresentation of Black people on an ongoing basis is important.”

In order to examine Ontario jail demographics, the researchers used gender and birthdates to link the provincial jail data to health administrative data held by ICES that was used in a 2018 study that looked at use of health care during incarceration and following release from jail. That study found the access rates of all types of health care were significantly higher for incarcerated people.

There is also a huge financial cost involved in jailing people. The Star has twice used inmate postal code data, length of incarceration data and daily cost of housing an inmate to show that in some Toronto city blocks, tens of millions of dollars are being spent to jail their citizens.

Preventing and reducing incarceration could free up money that could be reinvested in those neighbourhoods.

The authors of this report are part of a growing chorus of researchers, academics and advocates calling for more racially disaggregated justice data in Canada, which lags behind the U.S. and U.K.

More data around Canadian incarceration populations in provincial and territorial jails that identifies areas and groups experiencing high levels of incarceration, the paper concludes, “will help inform targeted initiatives to prevent criminal justice involvement” and “mitigate” the impacts on people and communities.

Source: New data provides a rare glimpse at ‘substantial’ Black overrepresentation in Ontario’s jails

They’ve been called hot spots. It’s actually ‘code’ for social inequity

More analysis confirming COVID-related racial and other disparities:

People who live in Toronto and Peel COVID-19 hot spots are on average nearly twice as likely to be racialized and about four times more likely to be employed in manufacturing and utilities compared to those in the regions’ other neighbourhoods, a new analysis shows. 

New research from the Gattuso Centre for Social Medicine at University Health Network also highlights how residents of these hot-spot areas are, on average, more than twice as likely to work in trades, transportation and equipment operation and also more likely to meet low-income thresholds.

While the public has heard over the past year that racialized people, those with lower-income status and essential workers are bearing a disproportionate burden of the COVID-19 pandemic in Ontario, the analysis from the Gattuso Centre highlights at a granular level who actually lives in the neighbourhoods hardest hit by the virus, how much money they make, and what they do for a living. 

“When we talk about ‘hot spot’ postal codes, what we’re really talking about is the structural determinants of health. Social inequities and the pathologies of poverty have been driving this pandemic,” said Dr. Andrew Boozary, executive director of the Gattuso Centre. “This is further evidence that life-saving measures need to get to neighbourhoods with the highest structural risks –– this at the very least means community leadership driving vaccine rollouts and better safety measures at workplaces.”

Using Census data, the social medicine team looked at demographics in Toronto’s 13 “sprint” strategy communities deemed most at-risk and compared it with the rest of Toronto’s forward sortation areas (the first three characters in postal codes). They also compared hot spots in Toronto and Peel with the remainder of neighbourhoods in those regions, and did a similar comparison of all of Ontario’s 114 hot spots with postal codes in the rest of the province.

In virtually every case, the most at-risk neighbourhoods had, on average, higher proportions of racialized individuals, those who meet low-income measures, people who work in manufacturing and utilities, and those employed in trades, transportation and equipment operation. 

For example, M3N, which includes Jane and Finch and Black Creek, has the most manufacturing and utilities employment, the sixth-highest proportion of people who meet low-income thresholds, the eighth highest employment in trades, transportation and equipment operation, and is the 10th most racialized community out of all postal codes in Toronto and Peel.

Similarly, L6R, in northern Brampton, has the most trades, transportation and equipment-operation employment, the fourth-most manufacturing and utilities employment and is the third-most racialized postal code out of all Toronto and Peel neighbourhoods. 

The only exception the researchers found was in the Ontario-wide hot-spot comparison, in which the percentage of people who work in trades, transportation and equipment operation in hot spots was slightly lower than non-hot-spot neighbourhoods.

“That’s the thing with this data, it also really shows the disparity. It really shows that no, we haven’t all been through the same experience with COVID,” said Sané Dube, Manager, Community and Policy with Social Medicine at UHN, using the example of someone who makes over $100,000 annually, lives in downtown Toronto and can pay for their groceries to be delivered.

“That is very different from the experience from the person who is making $30,000 in a grocery store, has continued to work the whole pandemic and lives in a certain part of the neighbourhood. There’s this idea that we’ve all had the same experience in this pandemic. We haven’t. This really brings that home.”

Laura Rosella, scientific director of the Population Health Analytics Lab at the Dalla Lana School of Public Health and a collaborator on the analysis, notes that hot spots are vulnerable for different reasons, which is why connections between policy-makers and the communities are so important.

“The data kind of gives you that first layer, saying we need to pay attention here. Then it’s the conversations with the community that will tell you what the solutions are,” Rosella said. “The data alone won’t tell you what the solutions are. The community will.”

Michelle Dagnino, executive director of the Jane/Finch Community and Family Centre, says that while she is not surprised by the data, many people, including many who work in social services, did not realize just how many people in vulnerable areas have continued to go to work throughout the pandemic. 

“I think there was a sense that there were going to be more workplace shutdowns than there ever actually ended up being. The definition of ‘essential’ just ended up being so broad in terms of these workplaces,” she said. 

“Effectively, all of our factory workers, whether they’re manufacturing glass panes or producing clothing or whether they’re delivering factory-made goods through Amazon distribution centres, they have been open the whole time. And the consequences of that in this third wave have led us to a situation where we have seen racialized, low-income workers dying because they’ve had to continue to go to work.”



Even in hot spots, newcomers to Canada are missing out on COVID-19 vaccines

Good detailed analysis:

Refugees, immigrants and other recent newcomers to Ontario are being vaccinated for COVID-19 at much lower rates than Canadian-born or long-term residents, new data shows.

And even with the provincial government’s revised vaccination rollout plan prioritizing hot spots, newcomers living in neighbourhoods most at risk for transmission continue to experience the lowest rates of vaccination compared to those who were born in Canada or who have lived here for more than 35 years, according to a new report by the non-profit ICES, formerly the Institute for Clinical Evaluative Sciences.

The report acknowledges that the province’s decision to target hot spots and expand age eligibility in early April has resulted in an overall increase in vaccinations in these neighbourhoods, but finds that vaccine coverage continues to lag in immigrants, refugees and recent OHIP registrants, including older adults. 

“There’s age risk and there’s transmission risk, and we know that immigrants and refugees are overrepresented in essential workers, and we know that many immigrant communities live multi-generationally,” said Dr. Astrid Guttmann, chief science officer of ICES and lead author of the report. “So the risk of transmission is higher and they’re less vaccinated. We need it to be the other way around.”

In the province as a whole, Guttmann and her team found that, as of April 26, vaccine coverage in Canadian-born and long-term residents 16 years of age and older was 38 per cent, compared to 28 per cent in immigrants, 22 per cent in refugees and 12 per cent in recent OHIP registrants. 

The report notes that large percentages of Canadian-born and long-term residents aged 70 and over have been vaccinated, between 71 and 86 per cent. But in the same age cohort among immigrants, refugees and recent OHIP registrants (with the exception of recent OHIP registrants in the lowest-risk neighbourhoods), vaccine coverage has ranged between 47 and 65 per cent. 

“We’ve seen within a hot spot, not everyone is feeling the heat equally,” said Dr. Andrew Boozary, executive director of social medicine at University Health Network. “And that is where we need to continue to be more data driven, being led by communities as to how to best reach the most disadvantaged populations, even within a postal code.”

He noted that the provincial government’s announcement Thursday that it will shift 50 per cent of Ontario’s COVID-19 vaccine supply to the 114 hardest hit neighbourhoods for two weeks starting next week was “definitely welcome” but that not doing so earlier “has come with very real costs.”

Last Friday, Ontario’s Science Advisory Table published a brief recommending immediately moving half of the province’s vaccine supply to the 74 highest-risk neighbourhoods for four weeks, a strategy it said could dramatically cut case counts, hospitalizations and deaths. 

Safia Ahmed, executive director of the Rexdale Community Health Centre, said she was not surprised by the ICES report’s findings, noting that many recent immigrants are essential workers who are not able to get to vaccination sites unless the locations are open on evenings and weekends. 

“When you think about the way vaccines have rolled out across the city, with mass vaccination sites that require online bookings, that’s a challenge, definitely, for new Canadians and immigrant seniors,” she said. 

Having clinics closer to home staffed with people who speak different languages, and who are a “familiar face,” all helps.

She noted that her organization learned during COVID-19 testing that “the more local, the more community-based services are, the more trust people have.”

Sabina Vohra-Miller, co-founder of the South Asian Health Network, said many older new Canadians may not have the digital literacy or language skills to navigate the complex web of online vaccine booking portals. And their children and grandchildren may not have time to support them if they are essential workers.

“It’s a Hunger Games style right now,” she said, adding those that are tech savvy and work from home have a huge advantage. 

“Who’s sitting in front of the computer waiting for appointments?”


The Pandemic Imperiled Non-English Speakers In A Hospital

Of note, both the findings and the measures the hospital took to address the problem:

In March, just weeks into the COVID-19 pandemic, the incident command center at Brigham and Women’s Hospital in Boston was scrambling to understand this deadly new disease. It appeared to be killing more black and brown patients than whites. For Latino patients, there was an additional warning sign — language.

Patients who didn’t speak much, if any, English had a 35% greater chance of death.

Clinicians who couldn’t communicate clearly with patients in the hospital’s COVID units noticed it was affecting outcomes.

“We had an inkling that language was going to be an issue early on,” says Dr. Karthik Sivashankar, the Brigham’s then medical director for quality, safety and equity. “We were getting safety reports saying language is a problem.”

Sivashankar dove into the records, isolating and layering the unique characteristics of each of the patients who died: their race, age, gender and whether they spoke English.

“That’s where we started to really discover some deeper, previously invisible inequities,” he says.

Inequities that weren’t about race alone.

Hospitals across the country are reporting higher hospitalizations and deaths for Black and Latino patients as compared to whites. Black and brown patients may be more susceptible because they are more likely to have a chronic illness that increases the risk of serious COVID. But when the Brigham team compared Black and brown patients to white patients with similar chronic illnesses, they found no difference in the risk of death from COVID.

But a difference did emerge for Latino patients who don’t speak English.

That sobering realization helped them home in on a specific health disparity, think about some possible solutions, and begin a commitment to change.

“That’s the future,” says Sivashankar.

Identifying the mortality risk is just the first step

But first, the Brigham had to unravel this latest example of a life threatening health disparity. It started outside the hospital, in lower-income communities within and just outside Boston, where the coronavirus spread quickly among many native Spanish speakers who live in close quarters with jobs they can’t do from home.

Some avoided coming to the hospital until they were very sick, because they didn’t trust the care in big hospitals or feared detection by immigration authorities. Nevertheless, just weeks into the pandemic, COVID patients who spoke little English began surging into Boston hospitals, including Brigham and Women’s.

” We were frankly not fully prepared for that surge,” says Sivashanker. “We have really amazing interpreter services, but they were starting to get overwhelmed.”

“In the beginning, we didn’t know how to act, we were panicking,” says Ana Maria Rios-Velez, a Spanish-language interpreter at the Brigham.

Rios-Velez remembers searching for words to translate this new disease and experience for patients. When called to a COVID patient’s room, interpreters were confused about whether they could go in, and how close they should get to a patient. Some interpreters say they felt disposable in the early days of the pandemic, when they weren’t given adequate personal protective equipment.

When she had PPE, Rios-Velez says she still struggled to gain a patient’s trust from behind a mask, face shield and gown. For safety, many interpreters were urged to work from home. But speaking to patients over the phone created new problems.

“It was extremely difficult, extremely difficult,” she says. “The patients were having breathing issues. They were coughing. Their voices were muffled.”

And Rios-Velez couldn’t look her patients in the eye to put them at ease and try to build a connection.

“It’s not only the voice, sometimes I need to see the lips, if smiling,” she says. “I want them to see the compassion in me.”

Adding interpreters and telemedicine tech

The Brigham responded by adding more interpreters and buying more iPads so that remote workers could see patients. The hospital purchased amplifiers to raise the volume of the patient’s voice above the beeps and machines humming in an ICU. The Mass General Brigham network is piloting the use of interpreters available via video in primary care offices. A study found lower use of telemedicine visits by Spanish-speaking patients as compared to white patients during the pandemic.

The Brigham’s goal is that every patient who needs an interpreter will get one. Sivashankar says that happens now for most patients who make the request. The bigger challenge, he says, is including an interpreter in the care of patients who may need the help but don’t ask for it.

In the midst of the first surge, interpreters also became translators for the hospital’s website, information kiosks, COVID safety signs and brochures.

“It was really tough. I got sick and had to take a week off,” saysYilu Ma, the Brigham’s director of interpreter services.

Mass General Brigham is now expanding a centralized translation service for the entire hospital network.

Seeing the inequities within the hospital workforce

Brigham and Women’s analytics team uncovered other disparities. Lower-paid employees were getting COVID more often than nurses and doctors. Sivashankar says there were dozens of small group meetings with medical assistants, transport workers, security staff and those in environmental services where he shared the higher positive test rates and encouraged everyone to get tested.

“We let them know they wouldn’t lose their jobs,” if they had to miss work, Sivashankar says. And he, along with managers, told these employees “that we realize you’re risking your life just like any other doctor of nurse is, every single day you come to work.”

Some employees complained of favoritism in the distribution of PPE, which the hospital investigated. To make sure all employees were receiving timely updates as pandemic guidance changed, the Brigham started translating all coronavirus messages into Spanish and other languages, and sending them via text, which people who are on the move all day are more likely to read. The Mass General Brigham system offered hardship grants of up to $1,000 for employees with added financial pressures, such as additional child care costs.

Angelina German, a hospital housekeeper with limited English, says she appreciates getting updates via text in Spanish, as well as in-person COVID briefings from her bosses.

“Now they’re more aware of us all,” German says through an interpreter, “making sure people are taking care of themselves. ”

Moving beyond the hospital walls to address disparities

The hospital also set up testing sites in some Boston neighborhoods with high coronavirus infection rates, including neighborhoods where many employees live and were getting infected. At least one of those sites now offers COVID vaccinations.

“No one has to be scheduled, you don’t need insurance, you just walk up and we can test you,” explained Dr. Christin Price during a visit to one of the testing sites last fall. It was located in the parking lot of Brookside Community Health Center, in Boston’s Jamaica Plain neighborhood.

Nancy Santiago left the testing site carrying a free 10-pound bag of fruits and vegetables, which she’ll share with her mother. Santiago said she’s grateful for the help.

“I had to leave my job because of [lack of] daycare, and it’s been pretty tough,” she said, “but you know, we gotta keep staying strong and hopefully this is over sooner rather than later.”

The Brigham recently opened a similar indoor operation at the Strand Theater in Dorchester. Everyone who comes for a coronavirus test is asked if they have enough to eat, if they can afford their medications, whether they need housing assistance and if they’re registered to vote.

The bags of free food, and the referrals to social support, are evidence of a debate playing out about the role hospitals will play, outside their walls, to curb health disparities rooted in racism.

“Poverty and social determinants of health needs are not going away any time soon, and so if there’s a way to continue to serve the communities, I think that would be tremendous,” says Price, who helped organize the Brigham’s community testing program.

Mass General Brigham leaders say they’ll take what they’ve learned dissecting disparities during the COVID-19 pandemic, and expand the remedies across the hospital network.

“Many of the issues that were identified during the COVID equity response are unfortunately pretty universal issues that we need to address, if we’re going to be an anti-racist organization and one that promotes equity strongly as one of our core strategies,” says Tom Sequist, chief of patient experience and equity for Mass General Brigham.

The Brigham’s work on health disparities comes, in part, out of a collaboration with the Institute for Healthcare Improvement (IHI), and included a focus on gathering, analyzing and tracking data.

“There’s a lot of defensive routines into which we slip as clinicians, that the data can help cut through and reveal that there are some biases in your own practice,” explains IHI President and CEO Dr. Kedar Mate.

“If we don’t name and start to talk about racism and how we intend to dismantle it or undo it,” Mate adds, “we’ll continue to place Band-Aids on the problem and not actually tackle the underlying causes.”

But has the Brigham’s work lowered the risk of death from COVID for Spanish-speaking patients? The hospital hasn’t updated the analysis yet, and even when it does, determining whether (or how) the interventions worked will be hard to prove, Sivashankar says.

“It’s never going to be as simple as ‘We just didn’t give them enough iPads or translators and that was the only problem,’ and now that we’ve given that, we’ve shown that the mortality difference has gone away,” said Sivashankar.

But Sivashankar says more interpreters, iPads, and better messaging to non-English speaking employees, plus all the other steps the Brigham has taken during COVID have improved both the patient and employee experience. That, he says, counts as a success, while work on the next layer of discrimination continues.

Source: The Pandemic Imperiled Non-English Speakers In A Hospital

Doug Ford’s ‘stay home’ message is absurd. Workers in the hardest-hit areas can’t stay home — they’re essential

Seeing more of these kinds of articles, making the needed comparisons:

A retiree in Rosedale is vaccinated against a virus she’s highly unlikely to catch. Meanwhile, the 35-year-old warehouse worker from North Toronto who is boxing up the retiree’s water resistant throw pillows just in time for patio season is still awaiting his shot. 

Maybe the warehouse worker (who is far more likely than the retiree to catch COVID-19) isn’t eligible for a vaccine yet, or maybe he is eligible but he isn’t sure where or when to get jabbed because everything is so goddamned confusing.

He checked the provincial website but no luck. 

He heard something about vaccine pop-up clinics emerging in his area, but the details are vague. He lives in a so-called “hot spot” but he isn’t involved in community groups; he doesn’t belong to a church or a mosque that would advertise such a clinic. If one pops up, unless he’s lucky, he may miss it. 

The good news is that the Rosedale retiree’s pillows will arrive at her house ahead of schedule. Saturday’s physically distanced backyard tea party will be lovely. 

The above is not an excerpt from the “Hunger Games,” or some Toronto-themed dystopia novel. It’s the reality of the COVID-19 vaccine rollout in Canada’s most populous city, one that despite city officials’ efforts has produced the following uneven result: those least likely to get the virus are vaccinated in large numbers while those most likely to get it are not. 

According to recent reporting by Olivia Bowden and May Warren, affluent Moore Park is “the most vaccinated neighbourhood in Toronto” (22 per cent of residents have received one shot), while Jane and Finch “where more than half the residents do not speak English as a first language, and where thousands of essential workers live, had the lowest vaccination rate” (5.5 per cent of residents have received one shot).

But this disparity isn’t just glaring in terms of vaccination rates. It’s glaring in terms of mobility too: how much time Torontonians are spending at home vs. out of the house. 

According to data presented at a Toronto Board of Health meeting Monday morning, Torontonians who live in the city’s northwest end — where essential workers tend to live — are leaving their homes more often than those in neighbourhoods where infection rates are lower. 

What’s more, between late March and early April when Premier Doug Ford pulled the “emergency brake,” time spent at home for Torontonians who live in some essential worker enclaves appears to have actually decreased slightly.

Toronto’s top doctor, Dr. Eileen de Villa, presented a map highlighting the disparity at Monday’s meeting. “What we have seen recently is a reduced mobility overall in the city but not equally experienced in all parts of the city,” she said. “We’re seeing more mobility in the northwest of the city which we know has had disproportionate impact of COVID-19.” 

This isn’t a coincidence says Toronto Board of Health chair Joe Cressy. “What’s critical to understand here is that as the people who aren’t staying home, they’re not going out partying — they’re going to their essential jobs. Since the stay-at-home order was issued, people are staying home more often, but not in those hard-hit neighbourhoods.” 

People are staying home more often, but not in those hard-hit neighbourhoods.

If ever there was a statement that defined the urgency of vaccinating essential workers immediately, this is it. If ever there was a statement that defined the urgency of easy to access paid sick leave, this is it. And if ever there was a statement that defined the absurdity of politicians’ repeated directives to “stay home” this is it. 

“Stay-at-home orders only work for people who can stay at home,” says Cressy. And yet, leaders like Ford continue to hammer home the “stay home” message to people who are already complying, or who can’t comply because they have essential jobs. 

On April 7, Ford tweeted the following: “Stay home. Stay safe. Save lives.” On April 10 he tweeted: “Gardening is a great way to enjoy the outdoors while staying at home.” Earlier this year, the premier butchered about a dozen languages asking Ontarians to stay home. 

The problem is that when people have to go to work it doesn’t matter if you ask them nicely in their native tongue not to. 

It doesn’t matter how many empty directives our leaders give. Until vaccines pick up dramatically in Toronto’s inner suburbs and essential workers get paid sick leave that is effective immediately, the cycle will continue. 

The vaccinated will sit safe at home awaiting the contactless delivery of throw pillows. The people who make that life possible will get sick. Contactless delivery is not contactless for everyone.