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

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

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

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.

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 TorontoOttawa 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.


‘Nothing we’ve done has helped’: In Toronto’s poor, racialized neighbourhoods, second-wave lockdowns are again failing to slow COVID cases

Good detailed analysis:

The data is clear, and has been for months: Ontarians who are poor, under-housed and racialized are disproportionately attacked by COVID-19.

And yet, deep into the second wave, this central feature of the pandemichas not been central to our pandemic response, health experts say. The current “one size fits all” restrictions have so far failed to protect the vast majority of people getting infected by COVID-19. As a result, lockdowns in hot spots like Toronto and Peel are on track to be longer, harder and more devastating for everyone. 

“If we don’t tackle this problem, we will continue to struggle through the winter. I can guarantee you that right now,” says Dr. Peter Juni, scientific director of the Ontario COVID-19 Science Advisory Table, which provides evidence to inform the province’s pandemic response.

In the first wave, lockdowns worked instantly in richer, whiter Toronto neighbourhoods but failed to flatten the curve in the poorest, most racialized ones, Star analyses showed. 

Experts fear the same thing is happening again. Over a recent four-week period, the 20 Toronto neighbourhoods with the highest proportions of visible minorities recorded more than 3,300 cases. The 20 whitest neighbourhoods reported just 360. This racialized tilt is not a function of race itself, research shows, rather of who performs essential but low-paying work and is more likely to live in sub-standard housing.

“This is really about the people who do all the work for us and who allow you and me to stay home,” says Juni.

“The restrictions work very nicely in my neighbourhood, Moore Park,” an affluent area in North Toronto, Juni adds. “In some other neighbourhoods, they don’t. Why? Because we do not support people to actually be able to decrease the amount of contact they have.”

Summer offered a reprieve from the virus — a chance to reflect on the first wave of the pandemic and prepare for the second. And perhaps the harshest lesson from the spring was that COVID-19 predominantly impacted poor and racialized Torontonians, especially from Black and South Asian communities.

According to Toronto Public Health data released in July, racialized residents accounted for 83 per cent of cases despite making up 52 per cent of the population. People in the poorest households accounted for the largest share of cases of any income group.

Many of the worst-hit neighbourhoods were in the city’s northwest and northeast. And while the rest of Toronto — particularly whiter, more affluent downtown neighbourhoods — enjoyed a relatively pandemic-free summer, residents in these areas continued to see transmission simmer along at low levels.

As the second wave took off, the same first-wave patterns quickly took hold: the downtown Waterfront neighbourhood initially emerged as a hot spot, then infections began to spike in neighbourhoods more densely populated by poor and racialized residents. 

The province and the city began a series of interventions over the fall that escalated in severity — all of which have been too lax, many epidemiologists have argued. In late September, capacity limits were imposed for indoor dining and bars. In early October, indoor dining was nixed entirely along with fitness classes, and gathering sizes reduced. 

These measures did have an impact — but most dramatically in downtown neighbourhoods like Little Portugal and the Waterfront. In the northwest and northeast corners especially, cases continued to climb.

“Rates in some of those downtown communities have dramatically decreased. You can see the direct effects of the intervention on those neighbourhoods, and you can hypothesize that (restaurants and indoor dining) were a very big driver for the cases in those neighbourhoods,” says Dr. Vinita Dubey, an associate medical officer of health with Toronto Public Health. 

Dubey acknowledges that the inequalities of the first wave are repeating. “We are still seeing some of the same patterns that have actually persisted,” she says. “We’re doing more, we’ve learned more, we’re working with the communities more. But some of those systemic inequalities or disparities haven’t (been) fixed between the first and second wave.”

In an emailed statement, a health ministry spokesperson said the provincial government has had “an explicit focus on equity issues” with respect to the pandemic’s impact and cited several steps it’s taken to address these, including: public-health marketing efforts in more than 18 languages; a relief fund of $510 million for food banks, shelters and other organizations; and working with community groups to improve testing access in hard-hit areas.

If the lockdown that began Nov. 23 has had any effect on the hardest-hit neighbourhoods, it is not yet apparent. But while the inequities underlying differences in COVID risk may be deep-rooted, they can still be tackled, health experts say.

“We’ve set up a response, I think, at the extreme … it’s been only for the rich, or at least with the rich in mind first,” says Dr. Stefan Baral, an epidemiologist at the Johns Hopkins School of Public Health, who provides clinical care in homeless shelters in Toronto.

“There were very specific and tangible things that I think could have been done to prepare for what was going to be a very difficult winter.”

In early October, the Star obtained provincial data showing that some Toronto neighbourhoods had alarmingly high positivity rates, suggesting that pockets of the city were in worse shape than previously known.

Provincial health officials admitted they first saw this data in the newspaper, and Premier Doug Ford cited mobile testing as part of what the province was doing to support marginalized communities.

But just days earlier, community health organizations in some of Toronto’s hardest-hit neighbourhoods were pressured by the province to stop offering pop-up testing, those involved say. 

The province was transitioning to an appointment-only testing system as the backlog of unprocessed specimens ballooned. But community groups knew that easier-to-access pop-up testing sites were critical for reaching residents at highest risk of COVID-19.

The community groups pushed back, and “highlighted that without their pop-ups, there would be nothing available for (their) communities,” says Sané Dube, with the University of Health Network’s social medicine program, who was working in the community at the time. 

It was “disturbing and concerning,” she adds. Though the province “backtracked” and the pop-up sites happened as planned, she says, “it raised serious questions about how decisions were being made.”

The health ministry says “there was absolutely no plan or proposal to ever cancel testing” in the neighbourhoods in question. 

“Ontario Health Regions are working with high priority communities to offer additional testing sites.”

Many advocates describe a chronic inability to reach people in marginalized communities, where the need for COVID-19 testing is most dire.

In September — when testing volumes peaked in Toronto and the second wave started taking off — there was no pop-up testing in Scarborough and just three sites in the city’s northwest corner, two regions with high densities of poor, racialized communities that have been hardest hit by the pandemic. 

But people in the richest and whitest neighbourhoods were likely being overtested. In late September, testing rates in Toronto’s whitest neighbourhoods were double that of the most racialized communities, according to a Star analysis of public health data.

After the province overhauled its strategy in late September, including restricting access for those with no symptoms, testing rates fell dramatically in the richest, whitest neighbourhoods. Today, they are more or less in line with rates in the city’s poorest, most racialized neighbourhoods — even though testing rates in the latter neighbourhoods “should be through the roof” given the soaring infection rates in those areas, says Dr. Sharmistha Mishra, a scientist with the Li Ka Shing Knowledge Institute and a member of the province’s modelling consensus table.

In response to the Star’s questions about testing access in northwest Toronto, the health ministry spokesperson cited the dozens of testing sites across the larger region that encompasses these neighbourhoods — but also acknowledged that uptake was still too low, and that the “expansion planning is underway.”

“Next efforts focus on mobilizing increased uptake of testing within targeted communities and providing culturally relevant and community tailored messaging addressing the social determinants of health, such as income, food security, and housing, that make it difficult for some people to seek or access care.” 

Coun. Joe Cressy said that though COVID-19 testing is the province’s purview, the city recently ramped up supports for testing in targeted neighbourhoods. All city facilities — from fire stations to libraries — are now available for pop-up testing, he said. The city also recently kicked off a $5 million program in partnership with 11 communities agencies that have played a crucial role in supporting marginalized neighbourhoods.

Cressy said community involvement is key to increasing testing rates in the hardest-hit areas. Dube agrees, noting that many people are understandably mistrustful of a health system that has long excluded their needs.

“The failures we have with testing are actually linked to the failures of our pandemic strategy in general,” she says.

The province’s science table has begun referring to something called the “prevention gap” — the observation that “light touch” restrictions will flatten the curve in mildly affected areas, but allow large amounts of transmission to carry on in the hardest-hit regions. 

Different tools are needed to meaningfully protect people at highest risk of COVID-19, experts say — for example, paid sick leave or a moratorium on evictions. Both measures would allow people to self-isolate without worrying about losing their job or home, and are now being formally requested by the City of Toronto in forthcoming letters to the provincial and federal governments.

Low-wage earners, who are the most likely to contract COVID-19, are also the least likely to have paid sick leave, according to data from the Labour Force Survey. Among Torontonians who make $17 an hour or less, only 17 per cent of workers who took a week-long sick leave between March and September were paid to take that time off. 

This statistic almost certainly underestimates the problem, since it only captures workers who took an entire week off; low-wage workers are much more likely to only take a few days off at most, according to Dr. Kate Hayman with the Decent Work and Health Network.

Hayman, an emergency room physician in downtown Toronto, says paid sick leave is “a concrete tool for behavioural change that the government is underutilizing.” She frequently sees patients with COVID-19 who would benefit from paid sick leave; the food services worker whose employer wouldn’t allow her to self-isolate without a doctor’s note, for example, or the construction worker who continued working to pay the bills, even though he lives with his mother who had the virus.

“This is actually an intervention that has the (biggest) potential to benefit people who need it the most,” Hayman said. “Which is completely different from a lockdown, which might benefit people who can work from home the most.”

The ministry spokesperson said the Ontario was the first province to sign onto the federal Liberals’ Safe Restart Agreement, which provided $1.1 billion for paid sick leave. The province had earlier changed labour laws to provide unpaid, job-protected emergency leave, a requirement to receive the federal funding. 

“No one should have to choose between their job and their health, which is why our legislation ensures those who stay home to self-isolate or care for loved ones will not be fired.”

Hayman says the federal program — $500 a week, for two weeks maximum — is both onerous and insufficient, with too many barriers, exclusions and delays to meet many workers’ needs. 

Hayman notes there is good evidence paid sick leave can be a powerful tool for outbreak control. American researchers recently found that states with paid sick leave had a statistically significant reduction in COVID-19, according to a paper that will be published in an upcoming issue of the journal Health Affairs.

A COVID-19 research survey from Israel also suggests that when pay was available, workers’ compliance with public health measures was 94 per cent. When pay was removed, compliance dropped to less than 57 per cent.

And following the H1N1 flu pandemic in 2009, a U.S. study estimated that up to eight million workers did not take time off despite being infected — leading to an estimated seven million additional infections.

Without paid sick leave, precarious workers are both less likely to get tested — because being forced to self-isolate can have devastating financial consequences — or make use of the city’s voluntary isolation centre, experts say. Toronto Public Health did not respond to questions about how many admissions there have been at the city’s 140-person isolation centre, which opened in September.

Failing to take targeted, meaningful steps to stop the spread in hardest-hit communities — those primarily populated by Black and other racialized people — is just another example of “how systemic racism actually moves,” says Dube.

“Because the truth is we value some lives over others.”


Alberta’s worst COVID-19 rates are in racialized communities, data show

As happens in most cities, given the poorer socio-economic conditions and housing, along with the fact that many are front-line workers who cannot work remotely:

The worst rates of COVID-19 infection in Alberta’s two largest cities are in areas with higher proportions of racialized people, including the northeastern corner of Calgary, where the per-capita number of cases is more than twice the provincial average.

The province has yet to publish detailed statistics on the relationship between race and COVID-19 infections, despite promising to track and release that type of information months ago. But Statistics Canada data show a relationship between high rates of COVID-19 infections and the proportion of people who identify as visible minorities. In northeastern Calgary, for example, 80 per cent of people were recorded in the census as non-white.

Premier Jason Kenney has singled out large multigenerational households and social gatherings among South Asian people. He was criticized for telling a local radio station on the weekend that a sharp increase in infections in northeast Calgary should be a “wake-up call” to follow public-health advice.

Arjumand Siddiqi, who holds the Canada Research Chair in population health equity and teaches at the University of Toronto, said data from places such as Toronto, Montreal and some American cities all point to the same conclusion: People of colour are more likely to get sick from COVID-19 because of their socio-economic status, not culture.

”This pattern of racialized people having the worst health outcomes relative to whites is something we see for almost every health outcome I can think of,” Dr. Siddiqi said.

“What we think is probably the primary driver of racial inequalities in COVID is who is doing essential-service work. That’s the trigger, because with COVID, you have to be outside to be exposed.”

Alberta has not reported neighbourhood-level data for COVID-19 infections, but divides each of the two major cities into more than a dozen health areas.

Calgary’s upper northeast area has by far the highest rates – for both active cases and the total number of infections since the pandemic began – in either city. It also has the highest proportion of people who identify as visible minorities, as well as the largest household size, the largest percentage of people who do not speak English and the largest number of recent immigrants.

The second highest-rates in the city are Calgary’s lower northeast, which also has the second highest proportion of visible minorities, at 56.2 per cent.

In Edmonton, the highest infection rates are also largely in areas with higher-than-average proportions of people who identify as visible minorities, although the relationship is not as stark.

For example, the Castle Downs and Northgate areas both have the highest rates of infections since the pandemic began and both have higher proportions of racialized people than the rest of the city. Mill Woods South and East has the second-highest proportion of people who identified as a visible minority and the area currently has the fourth-highest rate of active infections in the city.

Dr. Siddiqi said the theory that those higher rates are primarily linked to culture or social gatherings is misguided and not supported by the data.

“This is not a matter of individual choice and decision making,” she said. “People have to go to work.”

Mr. Kenney appeared on RedFM for an interview in which he talked about COVID-19 among South Asian people in northeastern Calgary. He referred to “a tradition to have big family gatherings” as he explained the outbreak in the area.

The Premier has since said he was not attempting to cast blame and that he recognizes the risks faced by South Asian and other racialized people, including taking on higher-risk front-line jobs.

“It is not a phenomenon unique to Alberta,” Mr. Kenney said on Wednesday.

“I think it’s most obviously connected to the issue of socio-economic status. Many newcomers, when they start their lives in Canada … they are typically starting out at lower levels of incomes and that often creates greater vulnerability to situations like this.”

He said the province is responding by increasing support for people who need to isolate, including by offering them a place to stay outside the home, and is also looking at how to help overcome issues such as language barriers and transportation.

Deena Hinshaw, Alberta’s Chief Medical Officer of Health, said her office has been collecting data on race and COVID-19 infections and is looking into how best to release it.

Aimée Bouka, a Calgary doctor who has written about the relationship between race and COVID-19, said the province appears to have very little data about how racialized people are getting sick. She pointed out the province’s contact-tracing system has fallen apart, making it impossible to know what is happening during the recent spike in cases.

”It’s even more shocking and surprising to have it brought up publicly with such a level of confidence,” she said.

“How come none of us can actually see this? Where is the data that really links what he says is cultural behaviours to the actual spread of COVID-19?”

Dr. Bouka said narrowing in on cultural factors ignores a growing body of evidence that working and living conditions are driving infections in racialized populations. She also points out there have been many examples – across cultures and racial backgrounds – of people flouting the rules by holding parties or other events.

Jay Chowdhury, who lives in northeastern Calgary, became infected with COVID-19 at a prayer meeting in early March, before the lockdowns and restrictions that swept the country in the spring. He was in a medically induced coma for more than three weeks and is still recovering.

Mr. Chowdhury agreed that many in the area are in jobs that place them at higher risk.

“The people living in [northeastern Calgary] are people working at the airport, working at the hospital, working at McDonald’s,” he said.

“These are people who don’t have a job where they can work from home. … They are hard hit because they have to be physically present.”

Still, he said he has heard of instances of people flouting the guidance around social events, which he attributed to a “meet and greet” culture. He said it appears that South Asian people he knows in the area are getting more serious about following the new restrictions, including a recent ban on all gatherings.

Amanpreet Singh Gill, president of the Dashmesh Culture Centre, a large Sikh Gurdwara in northeastern Calgary, said people who attend his Gurdwara have been diligent about following public-health advice. Many weddings have been cancelled or changed to respect limits on gatherings and recent Diwali celebrations were significantly scaled back.

George Chahal, who represents the area on city council, said he viewed the Premier’s comments on the weekend as targeting the South Asian population. Mr. Chahal said work and housing appeared to be the primary factors, adding people in the area are taking the pandemic seriously.

“There is a lot of fear out there,” he said. “People are worried about their families.”


Gary Mason on Premier Kenney’s singling out of the South Asian community and his avoidance of recognizing the impact of socio-economic factors (although cultural factors also play a role):

If there’s one community that has been singled out for its role in the spread of COVID-19 in this country, it is the South Asian.

Alberta Premier Jason Kenney stirred controversy last week when he delivered what he called a “wake-up call” to South Asians in his province. In an interview with South Asian radio station RED 106.7 FM, he said there had been a much higher rate of the virus among this particular group, and linked the phenomenon to “big family gatherings” and “social functions” in their homes.

Likewise, South Asians have been the focus of attention in the B.C. city of Surrey, where they are the dominant minority and where there has been a disproportionately higher number of cases of the virus than elsewhere in Metro Vancouver.

The same applies to the Ontario region of Peel, where South Asians make up 31.6 per cent of the population, but have accounted for 45 per cent of COVID-19 cases.

So what gives? Are South Asians flagrantly disregarding government orders to help prevent the spread of the virus? Are they putting culture ahead of public-health security? Or does something else explain the numbers?

While there have assuredly been members of the South Asian community who have flouted public-health edicts, there’s no evidence that their numbers are significantly greater, percentage wise, than those in the broader population who have done the same.

Yes, weddings, spiritual holidays, music nights and celebrations of life are often enormous, sacred happenings in South Asian culture. Over the summer, for instance, B.C. Provincial Health Officer Dr. Bonnie Henry said some of these events had helped accelerate the spread of the virus in Surrey, and she called for restraint.

The message seemed to have been heard: Last month, despite broad concern about the public-health consequences of the major five-day Indian festival of Diwali, there were no reported instances of a dramatic surge in the virus in those areas with high populations of South Asians.

The more likely cause of higher-than-normal rates of COVID-19 among South Asians is their socioeconomic status. Many occupy low-paying, public-facing jobs that are essential to the economy, from truck drivers and hospital workers to cleaners and aides in long-term care homes. They rely on public transit to get to and from work. And when they do get home, it’s often to a house that includes multiple generations of a family. There can be 10 or more people sleeping under the same roof, sometimes because of tradition, and sometimes out of financial necessity.

The fact that South Asians are disproportionately suffering the consequences of the disease is also the result of another ugly reality: Racialized people in this country have worse health outcomes than white Canadians. They often have higher rates of the kind of underlying conditions that the virus preys on: heart disease, diabetes and obesity among them.

And many new immigrants, from South Asia or elsewhere, don’t speak English. Public-health information related to COVID-19 has often only been made available in English and French, and not in languages such as Punjabi or Hindi. That can come at a cost.

While Mr. Kenney later acknowledged that some of the occupations held by South Asians put them more directly in the path of the virus, the scolding tone of his warning to the community did not sit well with many. It just helps perpetuate a false narrative: that an irresponsible minority is to blame for the whole province’s high COVID-19 numbers.

There is also the rank hypocrisy of it all. This is the same Premier who effectively gave a pass to hundreds of mostly white anti-mask protesters in Calgary, but has now deemed gatherings in the homes of South Asians to be the real problem.

The fact that the death rate from the virus is 25 per cent higher in neighbourhoods with large South Asian communities should concern us all – our politicians and public-health officials in particular. But the response shouldn’t be condemnation. It should be investigating what the root causes behind the numbers are, and what can be done about it.

What can we do, for instance, about low-paid workers who might feel sick but go to work anyway because they won’t otherwise have money to pay their rent? What can be done about the dismal state of our overwhelmed contact-tracing systems, which are failing those whose jobs put them most at risk of contact?


Lastly, second year medical student Sharan Aulakh takes a similar tack:

COVID-19 cases soar in Alberta, with the province now accounting for nearly 25 per cent of all active cases in Canada, Premier Jason Kenney appeared on a popular South Asian radio station in Calgary, calling for the South Asian community to do more to bring down surging infection rates.

According to Kenney, the South Asian community is responsible for the rapid rise in COVID-19 cases in Alberta, zeroing in on northeast Calgary, an area with a significant South Asian population, for having a particularly high number of COVID-19 cases. While Kenney tried to assure listeners that he doesn’t mean to blame or target any particular individual or community, his message misses the mark.

While the community is diverse, a large proportion of Albertans of South Asian descent are employed in essential frontline services and do not have the privilege of being able to work from home. They are grocery-store workers, transit operators, and truck drivers; they are the nurses, health-care aides, and support staff in clinics, hospitals, and long-term care homes. Along with an increased risk of exposure to COVID-19, many have limited employment benefits and access to compensated sick leave. South Asians are also more likely to live in multigenerational housing. Often, this is a result of financial constraints that are more likely to be faced by recent immigrants. Many within the South Asian community are on the front lines of the COVID-19 pandemic response. For the premier to selectively call out and chastise the South Asian community for seemingly shirking their responsibility in this pandemic betrays a fundamental misunderstanding of the different structural factors that shape how COVID-19 disproportionately impacts certain communities. It further perpetuates unfair and harmful narratives of the community.

In reality, the reason for the rise in COVID-19 rates in Alberta over the past month has been the Kenney government’s relative inaction in the face of a worsening pandemic. Kenney’s refusal to implement appropriate public health restrictions is the reason for the rapid spread of the virus, not South Asian culture.

Alberta is currently the only jurisdiction in Canada that has not introduced a provincewide mask mandate. Even in the face of a broken contact tracing system, Kenney refuses to adopt the federal contact tracing app, citing the monstrous challenge of deleting the provincial app and downloading a different one. When Alberta physicians called for a two-week “circuit breaker” lockdown to limit the strain of the virus on the health-care system, Kenney responded with the closure of group yoga and spin classes.

Over the weekend, hundreds of maskless Albertans took to the streets to participate in anti-mask demonstrations in Edmonton, Calgary, and Red Deer. Even though current provincial regulations limit outdoor gatherings to 10 people, Calgary police officers watched from a distance. While Kenney delivered a reprimanding “wake-up call” to South Asians, threatening the community with policing and monetary fines, he refused to condemn these anti-mask rallies. It is clear that for Kenney, the right to protest trumps Albertans’ right to safety and health.

Rather than scapegoat a community that has done much to combat the COVID-19 pandemic — from staffing hospitals to cleaning schools to driving buses — the provincial government would far better serve Albertans by prioritizing a pandemic response based on public health, not on ideology. While efforts to combat the virus are our collective responsibility, it starts at the top.

Sharan Aulakh is a second-year medical student at the University of Alberta with a background in public health.

Source: Kenney should blame his inaction for COVID surge, not South Asian community

Paradkar: Covidiots come in all colours. Using race-based data to demonize South Asians is a cruel twisting of the evidence

The politically correct response to the thoughtful discussion of the cultural aspects by South Asian doctors (South Asians play a part in COVID-19 transmission and we need to acknowledge it).

More interesting analysis and commentary would contrast the low COVID-19 rates in Richmond, largely Chinese Canadians, with the high rates in Surrey, largely Indo-Canadians to assess the relative importance of socioeconomic and cultural factors.

Average household size is largely comparable: 2.6 in Richmond Centre and 2.7 in Steveston-Richmond, 2.7 in Surrey Centre but 3.4 in Surrey-Newton.

Participation rates are slightly higher in Surrey while male unemployment rates are comparable. However, female unemployment rates are higher in Surrey. Median incomes for both men and women are largely comparable although Steveston-Richmond median incomes are slightly higher.

Both socioeconomic and cultural factors play a role, it is not one or the other:

From the barbaric East Asians and their bat-eating habits to the villainous South Asians and their dangerous socializing habits, the COVID-19 narrative has traced an interesting if richly racist trajectory in the eight months since it has afflicted us.

Across the U.K., Canada, the U.S. and other nations, the pandemic is unveiling what health experts have always known: structures birthed in bias and driven by principles of profit have gone on to exacerbate the suffering of people living in the margins.

In June, a study by Public Health England said Black and Asian people in England are up to 50 per cent more likely to die after being infected with COVID-19. 

In the U.S., analysis by the APM research lab shows Black, Indigenous and Latino Americans experience a death rate triple or more that of white Americans from COVID-19, adjusted for age.

And in Canada a StatsCan report last month found people in large visible minority neighbourhoods in B.C, Quebec and Ontario had a much higher likelihood of dying than mostly white neighbourhoods. 

There is a growing discussion, in particular, on the role of South Asians who account for nearly half the cases of COVID-19 in the GTA’s Peel region, although they populate about a third of it. Of the 1,417 new cases of COVID-19 Ontario reported Wednesday, about a third, or 463, came from Peel.

All this data. 

Data is important to pinpoint where weaknesses lie and where solutions are needed. But of what use data if the collection itself is seen as action against those inequities? Of what use data if the analysis is used to blame communities for cultural deficiencies and individuals for systemic failures?

As the Peel example shows, layer that data with anecdotes and personal experiences of irresponsible socializing and snap, a simplistic narrative is born.

In an essay published last week in the Royal Society of Canada, University of Toronto professor Rinaldo Walcott slammed the gap between calls for race-based data collection and claims it leads to better policy making.

“Race-based data can quite frankly slow down reform,” he wrote. “ ‘Doing the research’ when a problem is already identified and its solutions known, means the collection of race-based data does not actually add much to policymaking. In fact, in some cases, it can do more harm than good.” 

Toronto Public Health data has consistently shown disproportionate impacts of COVID in the city’s northwest. Sané Dube, a manager of Community and Policy with Social Medicine at the University Health Network, often takes the 29 Dufferin bus that goes through some of the worst-affected areas. “The 29 often looks like there’s no pandemic. The bus is so full. And people who are going to work are on that bus. Same with the 35 on Jane.” 

Public health could ask the TTC to provide more buses on those routes, she says, so that people — many of whom are essential workers, “you know, the people we need to work to be able to survive the pandemic” — don’t have to be on crowded buses. 

That is one example of evidence-based action. 

If Black people have long been treated as having a cultural abnormality with their broken families — think of the single-mom and absent-father tropes — without a thought to why those families have been ripped apart, now it’s the turn of South Asians to be demonized for the opposite, their multi-generation family homes and their socializing habits. 

That there is an affordable housing crisis is well-known. Earlier this month Brampton Mayor Patrick Brown announced Peel was getting an isolation hotel, a place for people with precarious employment or living in crowded housing to isolate safely. This is another example of evidence-based action. But why the delay?

“That Peel is getting this now — we are in Month 8 of the pandemic. Why are we just getting this now?” Dube asks. 

“There is complexity behind this data that goes far deeper than South Asian “culture” or “values,”” Seher Shafiq wrote in First Policy Response, a new project by Ryerson Leadership Lab and other institutions that publishes policy ideas, where she is a managing editor. 

“South Asians, like their other racialized peers on the frontlines of this pandemic, are disproportionately employed in precarious jobs in the service industry and gig economy – brewing Tim Hortons coffee, bagging groceries and delivering UberEats orders. This means they are exposed to the virus in their day-to-day lives.”

This “model minority” was hardest hit by the pandemic recession in October, according to StatsCan. 

It’s easier to pathologize communities than implement evidence-based action. Easier to berate people for parties and “multi-day weddings” than to examine if there are adequate testing sites, if they are easily accessible by public transit and if there are adequate supports for those who do test positive.

I have little doubt there are brown covidiots out there, in large homes and small, who think they are impervious to the virus and socialize irresponsibly. I have seen no evidence yet that they are disproportionately more so than any other racial or ethnic group. If there is a blip in numbers after Diwali this past weekend, will it be solidly more than the blip after Thanksgiving? More than after Christmas? 

Covidiocy may be unrelated to race but this much is clear: race and culture are very much related to who gets scrutiny and who escapes it. 

As East Asians — ironically among the least impacted by the virus — will testify, it doesn’t take long for the blame game to spill over to people and their cultures.


COVID-19 mortality rate higher in neighbourhoods with more visible minorities: StatsCan

Yet more evidence of correlation between visible minorities, lower income and poorer housing:

Residents of communities home to more visible minorities had a higher likelihood of dying from COVID-19 in Canada’s three largest provinces, according to Statistics Canada, in a trend health experts say underscores the need for provinces such as B.C. and Quebec to improve their data collection on race and mortality.

report issued by StatsCan late last month looking into COVID-19 mortality rates in “ethno-cultural neighbourhoods” found communities in B.C. that were home to more than 25 per cent visible minorities had an age-adjusted COVID-19 mortality rate that was 10 times higher than neighbourhoods that were less than one per cent visible minority.

In Ontario and Quebec, neighbourhoods with large visible minority populations had age-adjusted mortality rates three times higher than the general public.

That COVID-19 deaths in B.C.’s ethno-cultural neighbourhoods are ten times higher than comparable rates for Canada’s broader population could be partially linked to a lower general death rate in the province.

As of Monday, 299 people with the virus had died in B.C., out of more than 11,000 deaths across Canada.

The Statistics Canada analysis was compiled when B.C. had fewer than 200 coronavirus deaths. But the analysis is part of a growing body of literature showing that visible minority communities in Canada have been hit harder by the virus than the general population.

Dr. Andrew Boozary, the executive director of Social Medicine and Population Health at the University Health Network in Toronto, said it’s important to have specific, reliable data so affected populations can be protected.

“We’ve not been a leader on that front and it has been awfully expensive in not allowing our response to be as precise as we hoped, but also not allowing us to galvanize the response as quickly as we should have.”

‘Extremely important to be collecting that data’

Unlike Ontario, Quebec and B.C. are still not collecting the data that would identify which communities are most at risk, or why they are at risk, despite repeated calls to do so.

Source: COVID-19 mortality rate higher in neighbourhoods with more visible minorities: StatsCan

South Asians play a part in COVID-19 transmission and we need to acknowledge it

Important and courageous piece by South Asian Canadian doctors:

Canadian society is an interwoven matrix of multiculturalism that contributes to the strength of our nation. The South Asian community comprises a significant part of this rich heterogeneity. Today, we write to you both as physicians, and also members of this vibrant community.

South Asian culture itself is extremely diverse, but there are some themes that are common throughout the vast subcontinent. One such theme is hospitality to others, no matter what background or creed. A guest leaving your house on an empty stomach is considered a travesty, and results in long meals and conversation. 

We grew up with a strong bond with our elderly relatives, and many of us still live in multi-generational families, respecting the traditions of our ancestors before us. Our weddings, cultural holidays, and music nights celebrate not only our unique culture, but embrace the family and friends that enrich our lives. This is the ethos that shaped us as health care providers and human beings. 

COVID-19 has changed the life of everyone on the planet, and South Asians are certainly no exception. The virus that transmits from person to person (especially in close, indoor environments) are the same places we find the most comfort in our community. While we all have been given the same public health advice and messaging, it is increasingly apparent that some groups are being affected harder than others. 

It is time to acknowledge that South Asians are acquiring and dying of COVID-19 at a degree higher than other Canadians, and we need to take immediate action.

The evidence is fairly profound. In Peel Region, one of the hardest hit areas across the country, South Asians account for about a third of the population, but account for almost half the COVID-19 cases. 

COVID-19 has changed the life of everyone on the planet, and South Asians are certainly no exception. The virus that transmits from person to person (especially in close, indoor environments) are the same places we find the most comfort in our community. While we all have been given the same public health advice and messaging, it is increasingly apparent that some groups are being affected harder than others. 

It is time to acknowledge that South Asians are acquiring and dying of COVID-19 at a degree higher than other Canadians, and we need to take immediate action.

The evidence is fairly profound. In Peel Region, one of the hardest hit areas across the country, South Asians account for about a third of the population, but account for almost half the COVID-19 cases. 

In Toronto, despite only being about a tenth of the population, South Asians account for a fifth of total cases. The city of Surrey in British Columbia, where approximately 30 per cent identify as South Asian, there have been three times the number of cases of any other greater Vancouver area. 

Many well publicized COVID-19 outbreaks in Canada have been associated with South Asian events, such as weddings. When these infections are later introduced into a large, multi-generational household, it’s easy to see how the problem can compound quickly. 

What are the consequences of this spread? South Asian populations are at higher risk for dying of COVID-19. Canadian data suggests the rate of death is 25 per cent higher in neighbourhoods with large South Asian communities as compared to those with small communities. 

A large study from the United Kingdom suggested South Asians were more likely to die of COVID-19 than the general population. The high rates of underlying diabetes, hypertension, cardiovascular disease, stroke, and obesity within the South Asian population are the very profile of risk factors that increase the risk of hospitalization, intensive care stay, and death with COVID-19. 

Furthermore, South Asians have a strong presence in public-facing professions in health care, commercial business, and the service/manufacturing industry, creating a higher risk of acquiring COVID-19 outside of home. 

Financial instability, particularly amongst new Canadians, creates disincentives for testing and participating in contact tracing. People afraid of losing income are liable to go to work even if feeling unwell thereby further propagating the spread of infection. 

Family structures, embracing our multi-generational cultures, create situations where young and old mix with prolonged close contact. Stigmatization, particularly of those who need to go into isolation or infect others, creates more hesitancy around testing when symptomatic. 

The next few months pose a difficult journey for COVID-19 cases and deaths, and the time for action is now. Our health care providers, communication experts, cultural and religious leaders, and the community as a whole need to embrace this challenge. 

Our values teach us the ethics of protecting our communities, and in this pandemic, protecting our most vulnerable members is a part of that. We need to examine our day-to-day activities, and provide support for one another, but in a safe way where non-essential contact is minimized. 

Indoor gatherings of individuals outside of our direct household must be temporarily stopped in order to limit spread — particularly with large celebrations, such as Diwali, upcoming. 

We need to be creative with outdoor spaces, trying to allow for some in person interaction while minimizing risk. 

We need to create virtual support networks to provide the stability and welfare of our community. 

We need to reach those suffering mental health and other consequences of the pandemic. 

Finally, we need to create culturally and linguistically appropriate materials to disseminate amongst our hardest to reach, encouraging distancing, hand hygiene, masking, self evaluation for symptoms, how to access testing, and holistic support for those who test positive. 

From a societal standpoint — a recognition of this minority community that has been hit particularly hard is paramount. Partnering with our local public health units and trying to engage our community leaders is essential for creating a position of trust. Understanding the cultural contexts that are unique to our population, such as multi-generational families, public-facing occupations, poor English literacy, and densely populated communities, allow for individualized planning that benefits society as a whole. 

The next few months pose a difficult journey for COVID-19 cases and deaths, and the time for action is now. Our health care providers, communication experts, cultural and religious leaders, and the community as a whole need to embrace this challenge. 

Creating campaigns discouraging large gatherings around festive events, rites of passage, and religious ceremonies, with local cultural leaders will help to prevent scenarios involving sustained indoor spread. Encouraging healthy workplaces, particularly reinforcing indoor masking and avoidance of prolonged close contact is paramount. 

The successes of these campaigns will not only benefit the South Asian population, but given how interwoven we are, the larger community will also prosper. The financial and human resource needs should be prioritized for the greater good of our society.

Many of our community made incredible sacrifices leaving their homes across the globe to reestablish themselves in Canada for the promise of a better life. We are fortunate in Canada to live in a society where our customs and traditions can be practiced freely, and we can contribute to the growth and success of our nation in all sectors. 

The time has come for us to recognize that collaboration with internal and external stakeholders in the South Asian community will lead to more sustainable outcomes for COVID-19 transmission, and the health of our community. 

Dr. Zain Chagla is an infectious diseases physician, St Joseph’s Healthcare in Hamilton and associate professor at McMaster University.Dr. Sumon Chakrabarti is an infectious diseases physician in Mississauga and a lecturer at the University of Toronto.Dr. Tajinder Kaura is an emergency medicine physician at the William Osler Health System and a clinical assistant professor (Adj) at McMaster University.


‘A fight for the soul of the city’: Report shows how COVID-19 has deepened Toronto’s racial and economic divide

No real surprise as it confirms other reports and analysis, both in Toronto and elsewhere. Nevertheless, extremely disturbing:

Higher COVID-19 infection rates. Higher unemployment. Deepening poverty.

Racialized and lower-income Torontonians are bearing a heavier burden during the coronavirus pandemic, which is widening the gap between rich and poor in this city.

That’s the grim conclusion delivered by the Toronto Fallout Report, which provides a snapshot of where Torontonians stand in the midst of the pandemic.

Released Thursday by the Toronto Foundation — which also produces the annual Vital Signs report — this latest report offers an interim look at how the pandemic has exacerbated pre-existing inequality in the city.

Among the report’s findings:

  • People earning less than $30,000 a year are 5.3 times as likely to catch COVID-19 than those making $150,000 or more.
  • Black, Latin American and Arab, Middle Eastern or West Asian Torontonians have COVID-19 infection rates at least seven times as high as white residents.
  • About 30 per cent of Torontonians are struggling to pay rent, mortgage, food, utilities and other essentials.
  • Across the country, Canadians who are Black, Indigenous and people of colour (BIPOC) have unemployment rates almost twice as high as white Canadians. Nearly one-third of BIPOC youth are unemployed, compared to 18 per cent of white youth.

The report shows just how much of a “crisis moment” this is for Toronto, said Mohini Datta-Ray, the executive director of the North York Women’s Shelter and one of the dozens of non-profit leaders who were consulted for the report.

“The consensus is really, really loud and clear that this is a fight for the soul of the city, for who we are as a city.”

The pandemic didn’t create this inequality, she said, but it has magnified it and exploded it into view.

“We’ve all been ringing the alarm bells for years, decades really,” Datta-Ray said. “There’s been a worsening over time and any of us that are working with vulnerable, marginalized, low-income families know how desperate these times have already been.”

The report looks at a broad range of issues, from income and employment, to food security and housing, and what comes up again and again is the widening gulf between rich and poor, and how that divide is increasingly occurring along racialized lines.

“When I looked through the report, for me it really highlighted how deeply embedded racism and white supremacy are in just about all of our systems and institutions,” said Paul Taylor, executive director of FoodShare Toronto, which has dramatically increased its services in response to rising food insecurity during the pandemic.

“It seems like communities that are made up predominantly of white folks have had a very different experience of the pandemic.”

In Toronto, racialized people make up 52 per cent of the population, but currently account for 79 per cent of the COVID-19 infections. The highest infection rates in the city are concentrated in the neighbourhoods with the most racialized people.

It’s in those neighbourhoods where people are often living in crowded housing, Taylor said, and where people are more likely to have to take public transit to low-wage jobs without adequate sick days, PPE or the opportunity to physically distance.

“We really have to ask ourselves what allows us to chronically underinvest in the communities where there are higher incidences of COVID infections,” Taylor said.

Datta-Ray, who lives in a relatively affluent downtown neighbourhood and works in the hard-hit northwest corner of the city, has seen first hand the city’s divergent pandemic experiences.

Where she lives, the pandemic has been novel, almost festive, she said. “You wouldn’t even know that the virus is around.”

But in the city’s northwest, where infection rates are 10 times as high, most people aren’t able to work from home and public transit is crowded. “Those neighbourhoods feel the city in crisis.”

Neethan Shan, executive director of the Urban Alliance on Race Relations, said governments need to put racial equity at the heart of any pandemic recovery plan.

“Universal programs aren’t going to be enough,” he said. “If you’re serious about racial equity you have to start looking at it.”

If you target the most vulnerable and most affected communities, he said, everyone will benefit.

“But if you just keep continuing with universal programs that are in some ways colour-blind, we’re not going to see the solutions that we need.”

Liben Gebremikael, executive director of the TAIBU Community Health Centre in Scarborough, said attention on Black communities is often driven by high-profile news events — such as the so-called “Summer of the Gun” in 2005 — which leads to cyclical but unsustained investment.

“We can’t really do systemic change with cyclical investment,” he said. “We have to have a long-term strategy, from the city, the province and the federal government, on how to address these injustices and inequities that are mostly impacting Indigenous and Black communities.”

Gebremikael said he’s hopeful the inequities laid bare by COVID-19 will garner enough attention for more substantial, long-term investment. He cited the provincial government agreeing to collect race-based data during the pandemic — after their initial reluctance — as an example of a step in the right direction.

“If we have evidence then we can really advocate for the resources and the policies and the strategies we need.”

Source: ‘A fight for the soul of the city’: Report shows how COVID-19 has deepened Toronto’s racial and economic divide

How A Minneapolis Clinic Is Narrowing Racial Gaps In Health

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.

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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

The startling impact of COVID-19 on immigrant women in the workforce

Good detailed analysis of disparities:

While the mantra for the COVID-19 crisis has been “let’s build back better,” it will be impossible to do so without acknowledging that this pandemic has hit demographic groups unequally. Immigrant women faced many challenges in the workforce before COVID, but this pandemic has had a way of further exacerbating existing social and economic inequities. To ensure we come out of this crisis with a more resilient economy and better institutions, it is essential that we understand the differentiated impact of the pandemic on our diverse communities and bring forth policy ingenuity to make sure workers and their families are not left behind.

The impact of the pandemic on the labour market has been profound, particularly for women. The overall gender differences in the impact of COVID-19 are partly due to school and daycare shutdowns and the crisis in our long-term care centres. Gendered norms still designate women as the ones to step up and tend to our homefront, which has compounded the daily care responsibilities of many women during the pandemic. But the closure of economic activity has also directly induced larger drops in the employment of immigrant women.

Undoubtedly, the pandemic has had devastating effects on new entrants to the labour market, young adults and recently arrived immigrants. Yet among workers with more secure jobs – those aged 25 to 54 and immigrants arriving more than 10 years ago – the differentiated impact on immigrant women is startling. Employment rates for these immigrant women dropped by 12.2 percentage points between May 2019 and May 2020, according to our calculations using Statistics Canada’s Labour Force Survey. This compared to drops of 7 percentage points for Canadian-born men and women and of 8 points for immigrant men.

Employment rates offer one view of the labour market. A falling number indicates that workers have quit or lost their jobs. Unemployment rates, on the other hand, measure the fraction of individuals who do not currently have jobs but are actively looking for work.

In the year between May 2019 and May 2020, the unemployment rate of these immigrant women dramatically increased, by around 7 percentage points. During that time, the unemployment rate of Canadian-born men and women and of immigrant men rose significantly less, approximately by 4.5 points. It is worth noting that increases in unemployment rates were even higher among recent immigrant women (9.6-point increase) but not recent immigrant men (4.3-point increase). Even more troubling is the fact that immigrant women with high levels of education were particularly disadvantaged. University-educated immigrant women experienced the largest unemployment rates, 12.6 percent in May 2020, 7.3 percentage points higher than in May 2019. In contrast, university-educated Canadian-born women experienced unemployment rates of 5 percent, only 2.7 percentage points higher than last year.

We know that workers in the service sector were more negatively impacted than in other industries. Clearly, we are travelling less, eating out less, and we shifted our purchases to online shopping instead of visiting bricks and mortar retailers. However, even within the service sector, shutdowns affected immigrant women workers differently.

To illustrate, the bars in Figure 1 show the year’s growth in unemployment (May 2019 to May 2020) across service industries for immigrant women and Canadian-born women. Unemployment rates are most pronounced in retail trade and information, culture and recreation sectors, and are quite significant in finance and insurance. In the retail sector, unemployment rates of immigrant women increased by 9 percentage points, whereas that of Canadian-born women rose only by 2.3 percentage points. To get a rough sense of the severity of the shutdown across industries, the blue dots in Figure 1 show the increase in the number of women from these sectors who report that they are unemployed. The hospitality and retail trade industries have seen the largest of such increases with 142,000 and 132,000 more women being unemployed, respectively, this year over last.

As well as realizing the differential impact of the pandemic, it is important to understand the differences in the recovery process so far. Even if preliminary, the most recent Labour Force Survey data indicates that immigrant women are still further below pre-pandemic employment levels than men and other Canadian women.

Figure 2 shows the difference in employment rates between August and February 2020 for different groups. Larger bars indicate that employment rates are still far from those seen in February, before the pandemic, with immigrant women showing the largest differentials.

The differentiated labour market impact of the pandemic on immigrant women compared to other groups, including the differences within sectors, is more likely to be related to the precariousness of their work. They tend to work in hourly jobs rather than salaried jobs and have weaker protections in their labour contracts. Many immigrant women are underemployed, working in low-skill, part-time, and high-risk occupations. This has been decades in the making.

It is particularly worrisome that education does so little to mitigate the adverse effect of the pandemic for immigrant women.

Among the longstanding challenges immigrant women face in the workforce, the lack of recognition of their foreign credentials, their lack of Canadian work experience, and their limited access to social capital and professional networks are some of the most important. Since many immigrant women are also racialized, these constraints feed into systemic biases in hiring and advancement that affect immigrant women’s careers. It is particularly worrisome that education does so little to mitigate the adverse effect of the pandemic for immigrant women. In the retail and accommodation service sector, for instance, settled immigrant women are more than twice as likely to hold bachelor and postgraduate degrees than Canadian-born workers in the sector, but during this crisis their higher levels of education did not insulate them from being more likely to lose their jobs. These trends in the recovery are worrying and require policy action to course-correct.

As much of the Canadian federal government funding to businesses and workers is winding down, we need to ask what other policy instruments can help us get out of our economic predicament, particularly with increased recognition that some of the economic activity, and the jobs associated with it, will never return. So where do we go from here?

Undoubtedly, business trends point to an acceleration of the digital economy, increased automation of tasks, rise of artificial intelligence, reshoring production in response to supply chain disruptions and increased reliance on gig workers. These plausible trends will challenge policy-makers in charting an economic recovery path and finding the right policy instruments to ensure equality of opportunities for all workers. Looking to emerging economic sectors might be part of the answer. The green economy remains under invested in and society’s normative turn in favour of climate action and sustainability means that green jobs will be needed.

The time is ripe, then, to invest in workers to take advantage of the new economy. The opportunity to direct these investments in ways that address the diversity of our communities should not be passed over. Government should increase support for projects of social value – shovel-worthy over shovel-ready projects – that make use of diversity talent and promote fairer access to employment for immigrant women and those who are racialized, whose talents are currently underutilized. Further, investment in upskilling and retraining displaced workers – those hardest hit by the pandemic – will be needed across the country. Given the large portion of immigrant and racialized women who fall into this unemployed group, training needs to be designed, tailored, and delivered to improve their employment outcome.

Canada’s social and economic well-being cannot afford to let marginalized groups repeatedly fall through the cracks. We need to find innovate ways for immigrant women, particularly those who are racialized and newcomers, to not be left behind in the post-COVID economic recovery. Otherwise, building back better will be for some and not for all.

Source: The startling impact of COVID-19 on immigrant women in the workforce