racial disparities | Multicultural Meanderings

The Impact of Disparities on Children’s Health

2020/06/18 Leave a comment

Significant:

You might not have noticed it (there’s a lot going on) but there was some good news last week in a study in JAMA that suggested that racial disparities in extremely premature infants were shrinking. The study looked at more than 20,000 extremely preterm infants (22 to 27 weeks gestation) born from 2002 to 2016. Mortality rates dropped over the course of the study, and though serious infections were more frequent in black and Hispanic infants early on, the rates converged with those of white infants as time went on.

This is striking because the racial disparities around maternal mortality, premature birth and infant mortality have been so persistent. Black women and American Indian and Alaskan Native women are two to three times more likely than white women to die of pregnancy-related causes — about a third of these deaths take place during pregnancy, a third are specifically related to delivery, and a third happen in the year after delivery, but from causes related to pregnancy.

This came up last week, when I wrote about late preterm infants, and Dr. Wanda Barfield, the director of the division of reproductive health at the Centers for Disease Control and Prevention, pointed to rising rates of premature birth, which disproportionately affect black and Hispanic women.

These stark disparities at the very beginning of life have received a fair amount of public health attention, as have the racial and ethnic disparities in infant mortality: In the United States in 2017, 5.8 of every 1,000 infants born alive died before reaching their first birthday. Black infants died at more than twice the rate of white infants (11.9 versus 4.9 per 1,000). And this in turn is tied closely to those issues of maternal health and length of gestation; two of the leading causes of deaths before the first birthday are prematurity and the complications of pregnancy.

Often the public discussion of health disparities then jumps to adult health, where we track inequities in chronic diseases, in heart disease, cancer, diabetes and, of course, in life expectancy.

But the disparities in how children grow, how they get sick and how they get taken care of may all play into those chronic diseases, and are essential to understand.

“We focus on these chronic diseases of older age as results of racism, continuing discrimination,” said Dr. Nia Heard-Garris, a pediatrician and researcher at Lurie Children’s Hospital in Chicago, and the chair of the American Academy of Pediatrics Section on Minority Health, Equity and Inclusion.

“We do see the impact of racism on health in childhood, though it’s harder to see physical health changes immediately.”

Eating habits and behavioral patterns, which contribute to the health disparities in adults, have roots in childhood, Dr. Heard-Garris said, as does distrust of the health care system that can lead to gaps in care.

Dr. Elsie Taveras, a professor of nutrition in the department of pediatrics at Harvard Medical School, said, “While there has been some progress in leveling off the exponential increase in childhood obesity over the last 20 years, there still remains disproportionate obesity among African-American and Hispanic children.” The disparities are present by the age of 2, she said. “It points to the first thousand days, behaviors and risk factors that begin in utero.”

As with infant mortality, some of this is tied to risk factors during pregnancy. Dr. Taveras pointed to higher rates of excess gestational weight gain in black and Hispanic women, and higher rates of gestational diabetes, both associated with excess weight in infants. During infancy, she said, these infants are less likely to be breastfed exclusively, more likely to have solid foods introduced too early, more likely to get sweetened beverages, and less likely to get the recommended amount of sleep — again, all risk factors associated with childhood obesity.

Dr. Ruchi Gupta, a professor of pediatrics who is the director of the Center for Food Allergy and Asthma Research at Northwestern and Lurie Children Hospital, studies these conditions which, like eczema, represent forms of atopy, hypersensitivity in which the body’s defenses overreact, potentially causing harm.

She said that while it is well known that black and Hispanic children are more likely to be hospitalized and even to die of asthma, it has been less fully appreciated that there are also disparities around food allergies, which had initially been thought of as having more of an impact on white children. In fact, in a 2018 study by her team, the prevalence was higher among African-American children.

But research has shown, Dr. Gupta said, that while food allergies affect about 8 percent of all children, black children were diagnosed less frequently, and were not getting access to medical care. In one study by Dr. Gupta and her team, published in March, children on Medicaid were less likely to be diagnosed with food allergies. When a child seems to react badly to a food, “A lot of people just avoid the food and don’t talk to the pediatrician, a lot of the time, they never get to an allergist,” she said. “You avoid the food and sort of hope for the best.”

Research shows there is less spending on specialty care, less spending on special foods, and more spent on emergency department visits — the visits that could perhaps be avoided with specialized foods and with specialized medical care.

So disparities can manifest as conditions that occur more frequently in socially marginalized or disadvantaged groups — like premature birth, or like severe asthma, which may be related to exposure to pollution and other factors related to neighborhood and housing — but also as differential access to medical care and treatment.

Differential medical response also shows up in rarer and more serious diseases affecting children. “I became a pediatric nephrologist because I care deeply about influencing health disparities, I don’t think there’s anywhere else in pediatrics where there’s so much of a need for advocacy and intervention,” said Dr. Ray Bignall, an assistant professor of pediatrics at Nationwide Children’s Hospital in Columbus, Ohio. He said that most children who develop kidney failure have underlying congenital anomalies of their kidneys and urinary tracts; African-American children are referred less quickly for kidney transplant than white children.

Children constitute a relatively small proportion of the 37 million Americans with chronic kidney disease, he said, about 700,000 of whom are on dialysis, and need transplants. There are about 1,300 children with end-stage kidney disease; they need dialysis or transplant to survive.

“African-American children spend a longer time on dialysis than their non-African-American counterparts, they’re spending more time on dialysis because their time to transplant referral is delayed — and there’s significant cardiovascular morbidity associated with being on dialysis — and then they get transplanted and their transplants don’t last as long.”

Chronic kidney disease and dialysis also are hardest on families living in poverty, where there may not be sufficient money for food — and these are again children who may need a special diet with added calories. A 2019 study by Dr. Michelle Starr and her colleagues showed a prevalence of food insecurity among families of children with end-stage kidney disease that was three times higher than in the general population. Home dialysis requires space, privacy and a generally stable environment.

“A curious interplay between biology and society makes it hard for these disparities to go away,” Dr. Bignall said. “I worry about my black patients all the time.”

Dr. Heard-Garris said that many different domains, including housing and education, have to be considered to affect these health parameters. Still, she said, “As a pediatrician and researcher who cares very much about this work, I think we’ve started to see some interest from the public in changes — I’m hopeful.”

Filed under Multiculturalism Tagged with birthweight, children, Dr. Perri Klass, health, racial disparities

Coronavirus Is Hitting Black and Hispanic Americans Harder. CDC Data Shows How Much.

2020/06/17 Leave a comment

Yet more evidence (and waiting for Canada to catch up with such data):

In a new, massive federal survey of novel coronavirus cases in the United States, a report by the Centers for Disease Control and Prevention offers an in-depth breakdown by gender, race, ethnicity, and health factors.

Among 1,320,488 laboratory-confirmed COVID-19 cases considered by the CDC between January 22 and May 30, 2020—of which only 45 percent had race or ethnicity data—33 percent were Hispanic or Latino of any race and 22 percent of infections were among Black Americans, the Morbidity and Mortality Weekly Report released Monday found. For context, those communities account for about 18 percent and 13 percent of the U.S. population, respectively.

The numbers amount to the best evidence yet that the deadly pandemic has had an outsized impact on communities of color.

“These findings suggest that persons in these groups … are disproportionately affected by the COVID-19 pandemic,” the report said, calling them consistent with previously reported data “that found higher proportions of Black and Hispanic persons among hospitalized COVID-19 patients.”

Of the 287,320 cases with data on underlying health conditions, the most common were cardiovascular disease at 32 percent, diabetes at 30 percent, and chronic lung disease at 18 percent.

Even as officials nationwide have forged ahead with re-openings, more than a dozen states—including Arizona, Arkansas, Oklahoma, North Carolina, South Carolina, California, Florida, and Texas—hit new daily COVID-19 case tally records in recent weeks. As the CDC put it in Monday’s report: “The COVID-19 pandemic is an ongoing public health crisis in the United States that continues to affect all populations and result in severe outcomes, including death.”

And as ProPublica previously reported, environmental, economic, and political factors have for years put Black Americans at higher risk of chronic conditions that overlap with COVID-19 risks, including asthma, heart disease, and diabetes.

Communities of color in every state have had a unique experience of the contagion, and these numbers suggest the outbreak is reflecting glaring health-care inequalities that no vaccine or treatment can cure.

Source: Coronavirus Is Hitting Black and Hispanic Americans Harder. CDC Data Shows How Much.

Filed under Multiculturalism Tagged with CDC, COVID-19, racial disparities

Chicago Tackles COVID-19 Disparities In Hard Hit Black And Latino Neighborhoods

2020/06/10 Leave a comment

Wonder whether any of these types of targeted initiatives are taking place in Montreal and Toronto?

When COVID-19 first hit the United States, it spread through communities of color at alarmingly disproportionate rates.

This was especially true in Chicago. More than 70% of the city’s first coronavirus deaths were African-American. Those numbers have declined, but black residents continue to die at a rate two- to three-times higher than the city’s white residents. Researchers believe underlying health conditions that are prevalent in Latinx and black communities, such as hypertension and diabetes, make residents there more vulnerable to the disease.

While blacks suffer the most deaths, the number of people who have contracted the disease is the highest now in the city’s Latinx communities. Chicago Mayor Lori Lightfoot calls it a public health “red alarm.” She’s worked with community groups to create a Racial Equity Rapid Response Team or RERRT. They are tackling long-standing needs for residents in African-American and Latinx neighborhoods — everything from adequate nutrition to jobs to healthcare.

One of those Chicago neighborhoods is Auburn-Gresham. It’s a predominantly African-American and working class area on the city’s South side. It’s seen its share of troubles — 30% unemployment, gang warfare. Then came the wrath of COVID-19.

The first to die was Patricia Frieson, 61, a retired nurse who lived in the neighborhood. Her older sister, Wanda Bailey, 63, also died from the coronavirus days later.

Recently, a drive-in test site opened up on 79th street, one of the main commercial strips that’s seen better times.

“Oh, this is critical. We’ve been screaming for weeks to get testing in Auburn Gresham,” says Carlos Nelson, CEO of the Greater Auburn-Gresham Development Corporation. He says it’s been dire with more than 1,000 confirmed coronavirus cases and “we are dying, because we don’t have the same resources or access to information.”

Mayor Lightfoot says the racial gap is unacceptable and is the result of a racist system that for generations left black neighborhoods with little access to health care, jobs, education and healthy food. Conditions she adds that aren’t unique to Chicago.

“We’re seeing this manifest in large urban areas with large black populations,” says Lightfoot. “All over the United States — Cleveland, Detroit, Milwaukee and other places are experiencing the same thing, but we are going to step up and do something about it.”

Distributing free masks, hundreds of door hangers and thousands of postcards about COVID-19 are part of the effort by the rapid response team.

Recently, hundreds of people on foot and in cars lined the blocks for a pop-up food pantry run by Carlos Nelson’s group and the Greater Chicago Food Depository. Volunteers helped Carolyn Bowers load boxes of canned goods, meat and produce into a cart. Bowers works part time caring for seniors and says COVID-19 has caused lots of financial havoc.

“I’m not been able to service as many people as I have been because a lot of people are afraid to let people in their home,” Bowers says.

She’s been working 8 hours a week instead of her typical 30 to 35 hours. But Bowers considers herself lucky since since she and her adult children live with her mother. She says everyone chips in but Bowers says, “the food pantry is a real help to the family because I am not able to buy food.”

In Chicago’s Latinx neighborhoods, there’s the same push by RERRT to educate people about the pandemic with bilingual messaging. There’s also a focus on workplaces where there’s been a cluster of coronavirus cases. Unions are part of the outreach effort.

Efrain Elias is vice president and residential division director of SEIU Local 1. The union represents janitors, security officers and others.

“These are workers who are heading to the front line of this crisis to keep the public clean, safe and healthy every day and our workers are not able to stay at home,” Elias says.

In a neighborhood near Chicago’s downtown, the sound of a vacuum cleaner dies down as Javier Flores goes over the day’s cleaning schedule with his maintenance crew at a nearly 200-unit residential building.

“Thank God, we haven’t had any cases here or any type of incidents what so ever,” Flores says. Both he and his wife are considered essential employees. She is a cook for the Chicago Public Schools and prepares free breakfast and lunch for students that families pick up.

The couple live with their two young daughters in Chicago’s Belmont-Cragin area. With nearly 3,000 confirmed cases, it’s one of the Latinx communities with the most coronvirus cases in the state. It also makes Flores anxious.

“My youngest daughter started coughing, telling me her throat hurt,” Flores says, “and I can’t avoid just thinking about, man, COVID-19?”

His daughter turned out to be fine. Flores says he hopes the city’s racial equity work will help make that true for so many others in communities of color hard hit by the COVID-19 pandemic.

Source: Chicago Tackles COVID-19 Disparities In Hard Hit Black And Latino Neighborhoods

Filed under Multiculturalism Tagged with Chicago, COVID-19, racial disparities

@Doug Saunders George Floyd and the dangerously unequal effects of ‘stay at home’ orders

2020/06/08 Leave a comment

Good column by Saunders:

My pandemic emergency began on March 2, when my daughter’s school in Berlin was abruptly evacuated, the students sent to the safety of their homes. Two weeks later, I was told to work from home, because it would be healthier and less infectious. The next eight weeks were mildly inconvenient. We took long walks, did online homework and felt reassured as we watched the local police wander through the parks and politely ask crowds to sit a bit further apart.

George Floyd’s pandemic emergency began on March 13, when the governor of Minnesota ordered non-essential businesses to shut down and employed people to work from home. That meant losing his income from restaurant work and apparently resorting to a mishmash of temp jobs and hustles to get by. Staying home, for low-income people of colour in his inner-ring Minneapolis suburb, was neither healthier nor safer – it typically meant sharing a poorly ventilated apartment building and getting around on a city bus crowded with essential workers. Likely as a result, he contracted COVID-19. And police were not a source of reassurance, but of fear – as the world now knows, they targeted Mr. Floyd, who was picked up on a petty crime charge and then slowly suffocated to death beneath a police officer’s knee, a death provoked by his race and likely hastened by his coronavirus infection.

“Stay at home” seemed like sound public health advice – but it implies a notion of “home” confined to middle-class, mainly white neighbourhoods, an assumption that your house and street are a less infectious, more isolated and less dangerous place than school or work. For kids in these vulnerable suburbs, being at home, with many children to a bedroom and no computer and a shared ventilation system, is more dangerous than staying at school or crowding into a park. For Mr. Floyd, staying at home meant becoming exposed to the pandemic, being thrust into economic marginality and spending his days in far more danger.

George Floyd was not just typical of most victims of police violence in the United States. He was also very typical of most victims of COVID-19, not just in the United States but across the Western world. In most countries, including Canada, the disease is disproportionately targeting people from racial and ethnic minority communities and those with lower incomes. This is not a result of some biological proclivity – it’s because of the places where people live and work, by choice or by force of housing markets.

In Toronto and Montreal, and in most European cities, the disease has largely skipped majority-white neighbourhoods, and is highly concentrated in places, mainly suburban, where immigration settlement occurs or where housing-market discrimination forces people to live. In Toronto, COVID-19 is overwhelmingly present in parts of Scarborough, North York and northern Etobicoke that have the largest populations of Canadians of African and Caribbean descent. Black Canadians say they feel doubly victimized by the disease and by a police and justice system that discriminates based on colour – and on both counts, the data show they’re right.

According to a Yale School of Medicine study released in May, Black Americans are 3.5 times more likely to die of COVID-19 than white Americans – and again, this appears to be because their neighbourhoods and workplaces are much more vulnerable (lower-income minorities are far more likely to work in jobs deemed “essential services”). They are also, according to the Economic Policy Institute, likelier to live in crowded housing, and often in multigenerational households where younger members can easily infect older ones. This is also true of many racial-minority communities in Canada and Europe – the ones COVID-19 has hit hardest.

Toronto urbanist Jay Pitter notes that poor and racially marginalized people in Canadian cities tend to live in neighbourhoods that feature “ageing infrastructure, over-policing, predatory enterprises like cheque-cashing businesses and liquor stores, inadequate transportation options, and sick buildings.” As she writes, the inner-suburban identity of these neighbourhoods and their overall low population density contrast with crowding within buildings and on transit routes to create a toxic combination.

“The true underlying root is white supremacy, not geography,” says George Galster, a Detroit scholar who’s been analyzing the economic effects of neighbourhood segregation for six decades. “But it helps to have somebody live separately from you if you are going to psychologically brand them as different and other… The bottom of the segregated housing market is quite unsafe in terms of vermin infestation, lead-paint contamination, poor air conditioning and ventilation systems, basic sanitary facilities that don’t work – and that’s if you’re lucky enough to have a physical dwelling.”

“Stay home” must have seemed like sound, safe advice. But for too many of our fellow citizens, home is where the danger is.

Source: George Floyd and the dangerously unequal effects of ‘stay at home’ orders Subscriber content Doug Saunders 20 hours ago Updated

Filed under Multiculturalism Tagged with COVID-19, Doug Saunders, racial disparities

Race, Ethnicity Data To Be Required With Coronavirus Tests In U.S.

2020/06/06 Leave a comment

Canada should follow suit (Canada should have led):

All laboratories will now be required to include detailed demographic data when they report the results of coronavirus tests to the federal government, including the age, sex, race and ethnicity of the person tested, the Trump administration announced Thursday.

The new requirement, which will go into effect Aug. 1, is designed to help provide long-sought, crucial information needed to monitor and fight the pandemic nationally.

“The requirement to include demographic data like race, ethnicity, age, and sex will enable us to ensure that all groups have equitable access to testing, and allow us to accurately determine the burden of infection on vulnerable groups,” said Adm. Brett Giroir, assistant secretary for health in the Department of Health and Human Services.

The U.S. government has faced intense criticism for failing to gather such data on a timely basis. Many public health experts consider this information necessary to blunt the impact of virus, which has claimed the lives of more than 107,000 Americans.

During a congressional hearing Thursday, Robert Redfield, director of the Centers for Disease Control and Prevention, apologized for the agency’s slowness in gathering better data.

“I personally want to apologize for the inadequacy of our response,” Redfield said. “We didn’t have the data that we needed.”

Public health experts say what’s been needed are detailed breakdowns on how the virus is affecting African American and other minority communities. These groups appear to have been hit especially hard, suffering higher rates of infection, serious illness and death.

“One problem that epidemiologists in particular have seen with all of this new lab testing sites data (pharmacies, drive-throughs, non-traditional lab settings) is incomplete data,” Scott Becker of the Association of Public Health Laboratories wrote in an email to NPR. “The data guidance issued today will aid state and local public health officials to better do their job.”

Better testing data should help identify groups that are being hit hard by the virus and who require priority access to better testing and treatment. In addition, improved data will help health departments more quickly track down people who might have been exposed to the virus, to try to prevent new outbreaks.

“I am particularly encouraged that they plan to included demographic data, which will be important for helping us to better understand observed racial/ethnic and other disparities in case numbers,” Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told NPR via email.

Some state and local health officials, as well as some hospital and commercial labs, have complained that the federal government has issued confusing, contradictory and counter-productive guidance and requirements for testing.

The Centers for Disease Control and Prevention has also been criticized for combining the results of different kinds of testing in its tallies of testing, providing an inaccurate picture of the pandemic.

The new requirement comes as civil unrest has erupted in many places around the U.S. in response to police brutality and the killings of black people.

In announcing the new guidelines, Giroir singled out hospital laboratories and commercial labs for failing to routinely provide detailed demographic information with testing results.

Julie Khani, president of the American Clinical Laboratory Association, which represents commercial laboratories, defended the group’s members.

“Our members have faced obstacles tracking down missing information that is not collected or reported by the provider when the specimen is collected,” Khani wrote in an email to NPR, “and that’s why we’ve been engaged with providers, the CDC, public health agencies and others since the beginning of this public health emergency to ensure we’re doing all we can to collect this information.”

Source: Race, Ethnicity Data To Be Required With Coronavirus Tests In U.S.

Filed under Multiculturalism Tagged with COVID-19, racial disparities, tests, Trump administration

NDP calls for race-based data collection to combat racism, spur change

2020/06/03 Leave a comment

Valid call. Will see whether the government’s Centre for Gender, Diversity and Inclusion Statistics within Statistics Canada starts to generate results and in which areas:

NDP Leader Jagmeet Singh says the federal government must start collecting race-based data in order to make policy changes that will start to turn the tide on what the United Nations has called the “deplorable” treatment of African Canadians.

Protests against the police-killing of George Floyd in the U.S. spilled into Canada last weekend and Toronto was seized by the death of Regis Korchinski-Paquet, who fell from a 24th-floor Toronto apartment while police were in the home. Her death is under investigation by the province’s police watchdog.

On Monday, Canada’s political leaders tried to address the growing outrage. Mr. Singh proposed firm steps to address anti-black racism in Canada, while Prime Minister Justin Trudeau promised his government would do more but didn’t outline specific steps or a timeline to act. Conservative Leader Andrew Scheer proposed no new policies but said all levels of government have “much more to do.”

In contrast to protests south of the border, violence at Canadian demonstrations was limited to Montreal, where 11 people were arrested after dozens of businesses were damaged at the tail end of the formal march, which took place without incident.

Mr. Trudeau promised to “keep taking meaningful action to fight racism and discrimination in every form.” That progress in Canada has been too slow though, according to a 2017 United Nations Human Rights Council report on anti-black racism.

Across Canada, the report found disproportionately high unemployment rates for African Canadians, leading to more precarious and low-paid work, and worse health outcomes, where people in black communities are less likely to access health care services and more likely to suffer from chronic health conditions. In Nova Scotia, it found “deplorable” socioeconomic conditions and no change in educational inequities, 30 years after schools were integrated.

While federal leaders acknowledged the persistence of racism and systemic discrimination in Canada, Quebec Premier François Legault denied that it stems from structural problems.

“All humans are equal, are all the same, regardless of the colour of their skin,” Mr. Legault said. The UN report found African Canadians in Montreal have the highest poverty rates among visible minorities in the city.

The UN report recommended a mandatory nationwide policy on the collection of data disaggregated by race, colour, ethnic background, national origin and other identities “to determine if and where racial disparities exist for African Canadians so as to address them accordingly.”

That hasn’t yet happened and without it Canada is missing critical information that countries like the United States have readily available, said Arjumand Siddiqi, Canada Research Chair in population health equity. For example, Canada does not have information about how employment statistics break down along racial lines, making it difficult to know if some groups are being excluded from the suite of financial aid the Liberals have rolled out in the wake of the economic shutdown sparked by COVID-19.

While race-based data is collected in the census every five years, there is no routine collection of data, and on top of that, the data that is collected is not readily available, said Prof. Siddiqi, who is also an associate professor at the University of Toronto’s Dalla Lana School of Public Health.

The difference between the data available in the U.S. and Canada is “night and day,” she said. Without that data, evidence-based policy changes are stymied and it’s harder to hold governments to account.

The failure to collect the valuable data comes even as the impact of having the information is clear, Mr. Singh said, noting that changes to police carding were only made when numbers laid bare that the practice disproportionately targeted black and Indigenous people.

He said the data collection would help spur systemic changes in policing, the justice system and to inequities in health care, education, housing and employment, which “perpetuates the undervaluing of black life, of racialized people’s lives.”

The Liberals funded a new Centre for Gender, Diversity and Inclusion Statistics within Statistics Canada in 2018. A spokesperson for Innovation, Science and Industry Minister Navdeep Bains did not explain why a separate centre was created rather than integrating it with all of the work done by the federal agency.

Evidence from other countries and small pockets of information in Canada show that poorer people and people of colour are being hit harder by the novel coronavirus. But the Prime Minister acknowledged that collecting that information widely in Canada is an uphill battle, given that at the moment the government doesn’t even have the age data for a “large portion” of the people diagnosed with COVID-19.

Mr. Singh also said he supported the use of body cameras for police officers to ensure accountability and said police need more training in how to de-escalate incidents.

The UN report released a long list of recommendations to the federal government, which included apologizing for Canada’s history of slavery and other historical injustices, as well as considering paying reparations. The federal government on Monday did not say whether it was going to accept either of those recommendations.

Source: NDP calls for race-based data collection to combat racism, spur change NDP Leader Jagmeet Singh echoed the call made in a 2017 UN Human Rights Council report on anti-black racism in Canada <img src=”https://www.theglobeandmail.com/resizer/06BMxG3XANkkpiQPUyh4FRZLZTY=/0x0:3600×2400/740×0/filters:quality(80)/cloudfront-us-east-1.images.arcpublishing.com/tgam/OV42UZ73E5JO7BMPP6YND6GQ3I.jpg” alt=””>

Filed under Multiculturalism, Racism Tagged with data, NDP, racial disparities

What Do Coronavirus Racial Disparities Look Like State By State?

2020/06/01 Leave a comment

Health agency reveals race-based data guideline as calls grow for nation-wide collection

2020/05/28 Leave a comment

Yes!

Will take some time given the coordination required to ensure consistent data across provinces, with Quebec unlikely to play ball unfortunately (CIHI data does not automatically include Quebec data. When I asked the Ministère de la Santé et des Services sociaux for the comparable birth tourism (non-resident) birth statistics, I was met by bureaucratic obfuscation and had to go to major hospitals directly):

In response to calls for better demographic data to understand health inequities and COVID-19, this week the Canadian Institute for Health Information is releasing an interim race data standard that public health agencies can use.

Many advocates, though, are pushing for more than advice, saying the federal government has a leadership role to play to ensure there’s consistent data, regardless of jurisdiction. That gap in information affects the provincial, territorial, and federal response to the pandemic and until the country moves forward with race-based and disaggregated income data, Canada “can’t possibly target resources” and care where they’re most needed, said Dr. Jennifer Rayner, an epidemiologist and director of research at the Alliance for Healthier Communities.

“It’s ignorance and blindness to where there’s gross inequities. Until we know where the discrepancies and inequities in health are, we can never tackle them,” she said, saying communities need action and the work needs to start somewhere. “I hate to keep waiting until we get it all perfect.”

The alliance is part of a national working table headed by Canadian Institute for Health Information (CIHI)—which the institute notes are not formal—that’s considering two things: what data to collect, and how to train health professionals so they’re comfortable asking these questions. While this work has been going on for years, the report on the interim standard noted a “heightened awareness and interest” in collecting such data to better understand COVID-19’s spread.

The lack of data on race in Canada makes it difficult to monitor racial health inequalities and CIHI’s interim standard was created in an effort to “harmonize and facilitate collection of high-quality data,” according to a copy shared with The Hill Times of the standard, “Race-Based Data Collection and Health Reporting,” to be released later this week.

It proposed two questions asking patients to identify their race categories (also giving the option of “prefer not to answer”) and whether they identify as First Nations, Inuit, or Métis.

Though the Public Health Agency of Canada (PHAC) has said it is looking into the possibility of collecting more demographic data related to COVID, most said it’s a matter of political will, under the direction of Health Minister Patty Hajdu (Thunder Bay-Superior North, Ont.) and Indigenous Services Minister Marc Miller (Ville-Marie–Le Sud-Ouest–Île-des-Soeurs, Que.).

When asked, neither of the ministers’ offices, the PHAC, or CIHI offered a position on whether such data should be collected nation wide.

However, Ms. Hajdu’s spokesperson, Cole Davidson, said in an email that “[d]emographic data collection and data sharing between the federal and provincial/territorial governments is crucial to advancing our knowledge of COVID-19 and understanding potential inequalities in our health care system. We’re working with provinces and territories to ensure we’re collecting the data we need to better understand this pandemic.”

And while these conversations are happening, advocates say it’s not leading to the outcome that is becoming more urgent by the day—a commitment and timeframe for nationwide data collection.

“As a national strategy, if you don’t value gathering the data it’s hard to motivate other places to do so,” said Aimée-Angélique Bouka, the College of Family Physicians of Canada vice-chair-elect for residents. “You’ll see disparity across the board if you don’t see proper federal leadership in the project.”

‘It’s all about political will’

Canada has a blind spot regarding its treatment of racialized groups and immigrants, despite the evidence, she said.

COVID-19 was thought to be “the grand equalizer,” but some populations have proved more vulnerable. In the United States, by mid-April nearly one-third of those who died were African American, an Associated Press report revealed, though Black people represent about 14 per cent of the population where they reported. Such disparities exist in Canada, though Dr. Bouka said society is uncomfortable with painful questions that reveal a pattern of neglect.

“COVID is only a snapshot and a clear representation of what happens in our country in a systematic way.”

She said she would add a question about immigrant status, and how long a person has been in Canada as other important markers that influence health, said Dr. Bouka, who wrote about that blind spot for Policy Optionsthis month.

Because we don’t have this self awareness we are slow to accept it, but once the outbreaks became evident, demographics became impossible to ignore, she said.

For more than two decades, Independent Senator Wanda Thomas Bernard has been calling for race-based data collection.

“It’s so frustrating and infuriating,” said Sen. Bernard (East Preston, N.S.), a former social worker and researcher who co-authored a 2010 book, Race and Well-Being, which she said demonstrated racism is an everyday experience for Black Canadians and has an impact on all forms of their health.

“I can’t help but ask myself, ‘How many more casualties do we have to see before there’s a true appreciation for why the collection of this data across all provinces and territories [is] essential?’”

Sen. Bernard said she has been asking these questions of Liberal ministers and their aides—she’s not comfortable divulging the details of these conversations—and while she remains hopeful, she said it’s “all the more urgent to make the decision now.”

“We need to be on the same page with this, and let’s cut through the politics,” she said, and look at COVID-19 as a starting point, an “awakening” for the inequities in health that long predated the pandemic.

Unfortunately, it takes more than proof to shift policy, said Dr. Bouka and it becomes about building more evidence and raising enough voices to make inaction impossible.

“It’s mostly us being reminded so politicians can’t ignore it. Ultimately, it’s all about political will. If your weaknesses are shown repeatedly, then you can’t just pretend that you didn’t know,” she said.

Though it’s left up to the individual jurisdictions, Sen. Bernard said it’s important to have data that’s consistent across the country, which requires leadership so that it is collected in the same way.

Alex Maheux, CIHI spokesman said by email it’s up to the provinces and territories to decide how to proceed, but it has expressed willingness to support jurisdictions in that data collection and is currently working with partners to understand race and ethnicity data needs.

Earlier this month, Manitoba became the first province to track the ethnicity of COVID-19 patients while Quebec and Ontario have said they will as well. At a local level, Toronto has also said it tracks demographics.

In mid-July, CIHI said it will also publish a broader discussion document, followed by ongoing engagement with relevant stakeholders to “refine” the standard, if needed.

Public Health Agency of Canada spokesperson Maryse Durette said by email the government is committed to working with the provinces and territories—as well as other partners—to improve data completeness and access, including demographic information.

“These indicators will help to further our understanding of COVID-19 among different population subgroups and to monitor trends going forward,” she said, and it plays “a critical role” in helping to understand disease severity and risk factors, to monitor trends over time, and to ensure that public health measures can be effectively designed and delivered where needed.”

Data collection on Indigenous people ‘distinct’

CIHI’s standard notes that though Indigenous groups are often considered alongside racial and ethnic categories, First Nations, Inuit, and Métis have “inherent and collective rights to self-determination,” including ownership and governance of their data. That warrants “distinct consideration” and must include engagement with Indigenous communities and data governance agreements.

Canada tracks on-reserve cases of the coronavirus, but with nearly half of First Nations living off-reserve, the picture is incomplete. Yellowhead Institute independently researched, and on May 12 published findings revealing more than triple the cases reported by Indigenous Services Canada. Mr. Miller has acknowledged the department’s data is insufficientand on May 9 announced $250,000 towards improving data collection—not enough, according to Yellowhead researcher Courtney Skye.

“If we’re going to recognize First Nations, Indigenous, and Inuit are more impacted and more at risk for poor outcomes because of COVID-19, there needs to be a multi-jurisdictional prioritization of getting proper information available to communities to make informed decisions,” she said.

“Communities have a right to that information and the federal government has a fiduciary responsibility to make sure this work is adequately funded.”

Rose LeMay, CEO of the Indigenous Reconciliation Group and regular Hill Timescolumnist, penned a plea in April for COVID-19 data that notes background and Indigeneity. A month later, she said she remains baffled there’s been limited movement to close the data gap.

“This is a once-in-a-lifetime data dump, if we were to access it, because this shows the inequities of the system”, she said, noting Canada has “substantial work” to build trust given its problematic history collecting information on Indigenous people, and declaring who is and isn’t status.

That could be addressed by involving organizations perceived as objective to lead the way alongside Indigenous groups, and would likely require building new partnerships to do it well.

The lack of trust shouldn’t stop this work from happening, she said, adding the “how” is a “purely technical exercise” that she said she thinks Canada’s health-care system is capable of managing.

Ms. Skye said the patchwork approach isn’t working and it needs to be led by Indigenous people and be properly resourced. She added that this is another indication that the Liberal government’s approach to reconciliation is more for “show” than addressing “tangible barriers,” like health, that impact the daily lives of Indigenous people.

“These realities are known, are well-documented, and have existed for a long time, and there hasn’t been enough of the practical work done on behalf of the federal government and provinces,” she said. “It does come down to the will of the government.”

Source: Health agency reveals race-based data guideline as calls grow for nation-wide collection

Filed under Multiculturalism Tagged with CIHI, COVID-19, data, health, PHAC, racial disparities

New data show that minorities and low-income earners are more susceptible to COVID-19

2020/05/25 Leave a comment

Yet another article on racial disparities, based upon Toronto Public Health census track-level data:

When the public image of Pearson International Airport turned from travel hub to petri dish in March, Rajinder Aujla’s friends and colleagues felt they had no choice but to drive toward it every day, again and again. As airport taxi and limo drivers, this is their livelihood.

A month later, Mr. Aujla, president of the Airport Taxi Association, started hearing about what may have been the consequences of all those trips. By his count, 10 drivers have died in the past month, at least six of whom tested positive for COVID-19. One was Karam Singh Punian, a close friend of Mr. Aujla, who died May 4.

He estimates that about 20 drivers contracted the virus since April. Most of the 1,500 drivers who make their living ferrying passengers to and from the airport are immigrants from places such as India, Pakistan and Egypt, he said.

“They’re all self-employed. They don’t have access to health benefits,” Mr. Aujla said. “Some of the people are the only breadwinners. Some of them have others in their family working, but their spouses are mostly out of jobs now. Everyone is staying at home.”

Preliminary data support the idea that COVID-19 is hitting marginalized communities harder than others. The situation will only worsen as provinces reopen, according to front-line health care workers and experts who study health inequities.

Public-health messages about staying home, which are aimed at curbing the spread of COVID-19, have largely ignored the realities faced by low-income workers, people who are homeless or other at-risk groups, said Andrew Boozary, a doctor who is executive director of health and social policy at University Health Network. He also works with Toronto’s Inner City Health Associates, a group that provides care to people living on the street and in shelters.

“Physical distancing is a privilege by postal code,” he said. “We’re seeing a public-health message that is speaking to a certain part of the population. There’s a completely separate curve that is … facing most of the cases and deaths now.”

A recent Toronto Public Health analysis of COVID-19 cases in the city showed that neighbourhoods in Toronto with the lowest incomes, highest rates of unemployment and highest concentrations of newcomers consistently had twice the number of cases of COVID-19 and more than twice the rate of hospital admissions.

That analysis was based on COVID-19 cases tracked up until May 10. It looked at census tracts throughout the city and divided Toronto into five groups for each category of analysis: income, proportion of newcomers and unemployment.

While the lowest-income group had 205 cases of COVID-19 and 34 admissions to hospital per population of 100,000, the highest income group had only 94 cases and 15 admissions.

Neighbourhoods that had the highest concentration of immigrants recorded 194 cases of COVID-19 and 31 admissions per 100,000 people, compared with the ones with the lowest number of immigrants, which had 93 cases and 12 admissions.

The same pattern emerged when it came to unemployment: Areas with the highest levels of unemployment had 198 cases and 30 admissions per 100,000, versus those with the lowest unemployment, which had 98 cases and 15 admissions.

Toronto Public Health is now tracking demographic data (including race and income) to give an even more accurate picture of who is getting infected.

Arjumand Siddiqi, Canada Research Chair in population health equity, said many of the essential workers keeping society going during COVID-19, including janitors, long-term care workers, grocery clerks and transit operators, fall into the at-risk categories.

“They tend to be lower wage, and they tend to consist of black and brown people,” said Dr. Siddiqi, an associate professor at the University of Toronto’s Dalla Lana School of Public Health. “Every time we see a long-term care worker on TV, it’s almost invariably a black woman.”

In Montreal, Canada’s hardest-hit city, many of those workers live in Montréal-Nord, which has the highest concentration of COVID-19 cases and has become the epicentre of the outbreak.

This low-income enclave is a “springboard” for immigrants from places such as Haiti and North Africa, many of whom live in close quarters in high-rise apartment buildings and work in the vulnerable health and service sectors. All these factors have contributed to its high rate of infection, said Bochra Manai, executive director of Parole d’excluEs, a social-services organization that works in the neighbourhood.

The area had 2,593 cases per 100,000 residents as of May 21, by far the most of any borough and well over double the city average. (In part because of its government structure, made up of 19 boroughs, Montreal has more precise neighbourhood data on cases and deaths.)

In Canada’s largest cities, points out Kwame McKenzie, the CEO of health-policy think thank the Wellesley Institute, accommodation is expensive, “and we know that people with lower incomes tend to be in more concentrated or overcrowded places where it is more difficult to physically isolate.”

That was precisely the challenge Fahim Sultana Rigi faced in late April.

After breathing difficulties landed her in hospital and she tested positive for COVID-19, Ms. Rigi was told to self-isolate at home for two weeks.

This was no small feat: She shares a three-bedroom apartment in an 11-floor housing co-op in the densely populated St. Lawrence neighbourhood in Toronto with her husband, Emad Hussain, and four children. Her eldest son was temporarily moved to a room with a sibling, Mr. Hussain shared a room with two of his other children, and Ms. Rigi was in a room on her own.

As his two-year-old cried and begged to see his mother, Mr. Hussain tried his best to help maintain the quarantine. His work ground to a halt as he took on the job of parenting his children solo.

His wife is only 41 but had pre-existing health conditions – thyroid problems and diabetes – so he worried about her recovery.

Research suggests immigrants and low-income earners are more likely to suffer from diabetes, high blood pressure and other chronic illnesses, and those with these pre-existing conditions can face higher rates of hospital admissions and worse outcomes if they are infected with COVID-19.

Just a few days into isolation, Ms. Rigi woke early one morning struggling to breathe. She summoned her husband to her side and frantically gestured to call 911. After spending nine hours in hospital and receiving oxygen, Ms. Rigi was discharged again, continued to isolate and has since recovered – though she still suffers from body pain and exhaustion.

Still, Mr. Hussain can’t forget the fear he felt in those first days that spurred some grim research.

“If I got infected, or if I passed away or my wife passed away, how could we manage those children? Those were the legal things I was looking for,” he said.

Source: New data show that minorities and low-income earners are more susceptible to COVID-19 ‘Physical distancing is a privilege by postal code,’ one doctor says of the dichotomy of infection rates between marginalized communities and wealthier neighbourhoods

Filed under Multiculturalism Tagged with COVID-19, racial disparities, Toronto Public Health

Data linking race and health predicts new COVID-19 hotspots

2020/05/22 Leave a comment

While more of the same in terms of argumentation, some better data analysis than other commentary although the researchers should have made more explicit the correlation with lower socioeconomic outcomes which is largely the main driver:

Anecdotal stories about the COVID-19 pandemic suggest that Black, racialized and immigrant people in Canada have been disproportionately affected by COVID-19. This narrative tells the story of immigrants and racialized people pushed to the front lines of the economy, working in settings with greater exposure to the COVID-19 virus.

It tells the story of immigrant groups clustered in city neighbourhoods with high population densities who cannot practise physical distancing. It tells the story of temporary migrants who live in tightly packed communal quarters.

Reports have shown that Black and immigrant communities in the U.S. have been disproportionately affected by COVID-19. But many believe that Canada is different.

After all, Canada has universal health insurance coverage; the U.S. does not. Canada adopted a multiculturalism policy decades ago and racial discrimination is frequently — though wrongly — believed to be absent in Canada.

Under this narrative, many government officials in Canada have not seen a need to collect COVID-19 data on race. They have also excluded racial minorities and immigrants from their list of populations vulnerable to COVID-19.

Which of the two narratives reflect the realities of racial minorities and immigrants in Canada during the COVID-19 pandemic?

Until recently, there was no data to address this question. By making creative use of health and census data, we now know that Black and immigrant communities in Canada are disproportionately affected by COVID-19.

Combining COVID-19 and census data

Our research team based at the department of sociology at Western University tested these competing narratives by creatively combining existing data. We used COVID-19 data released by the Public Health Agency of Canada and census data about the racial and socioeconomic composition of health regions, units set up by provinces in Canada to administer health care.

Using these data, we assessed how racial and socioeconomic factors have shaped COVID-19 infection and death rates. Our findings paint a picture closer to the anecdotal stories

The COVID-19 pandemic is not the “great equalizer.” Black and immigrant communities in Canada are disproportionately affected by COVID-19.

Our findings showed COVID-19 infection rates are significantly higher in health regions with a higher percentage of Black residents. A one percentage point increase in the share of Black residents in a health region is associated with the doubling of coronavirus infection rates. We also found that a one percentage point increase in the share of foreign-born residents is associated with a three-per-cent rise in COVID-19 infection rates.

This may explain why Montréal, where Black residents make up 6.8 per cent of the population, has emerged as one of Canada’s COVID-19 epicentres. The same is also true of other cities with high immigrant and Black populations, like Toronto and Vancouver.

We also found the number of COVID-19 deaths tend to be higher in communities with higher shares of residents who are 65 and older. Many studies have shown COVID-19 is more lethal in older adults and we have seen the tragically high COVID-19 death rates in long-term care facilities.

COVID-19 hotspots

Health regions are large administrative units responsible for the health care of roughly 420,000 residents. They are too large geographically and too socially heterogeneous to adequately tell a story about local communities. So for our study, we subdivided health regions into smaller areas and predicted the spread of COVID-19 in local communities based on their racial, demographic and economic profile. This approach helped us identify several potential COVID-19 hot spots.

Black and immigrant communities like Hamilton, Vancouver and Montréal were particularly vulnerable. Also, other localized communities may be more vulnerable than originally thought.

For example, the oilsands in northeast Alberta, where the petroleum industry hired large numbers of temporary migrant workers who reside in crowded living quarters, may be a potential COVID-19 hotspot. Similarly, another potential COVID-19 hotspot may be found in western Québec, which includes mining sites that employ large numbers of temporary migrant workers.

Public health workers may have overlooked the higher infection rates in Ontario’s towns bordering Michigan, partly reflecting their geographic proximity to U.S. cities like Detroit.

Who is the most vulnerable?

Communities are home to different types of people. With the existing data, we cannot address questions like: are white residents who live in Black communities less vulnerable to COVID-19 than their Black neighbours?

Our study highlights the importance of collecting individual data about COVID-19 patients as well as for smaller geographic units. Having individual data is essential for determining how to direct scarce resources and how to contain the spread of the virus.

With our study, we underscore the importance of acknowledging the challenges of Black and immigrant communities in Canada, including their vulnerability to COVID-19. Without this acknowledgement, we risk exacerbating inequality between them and other groups.

For example, Blacks and immigrant groups were not classified as “vulnerable populations” in the Ontario government’s COVID-19 Action Plan for Vulnerable People. They were excluded even though their risks of infection and death are significantly higher than those of some groups identified as vulnerable under this plan.

Policies aimed at mitigating the consequences of COVID-19 target individuals as well as communities. If we do not address this oversight, the future health disadvantages of Black and immigrants groups may become more pronounced.

Closing one’s eyes to inequality along racial lines will not eliminate disparities. It just eliminates ways to address it.

Source: New COVID-19 hotspots predicted by data linking race and health

Filed under Multiculturalism Tagged with COVID-19, Kate Choi, Michael Haan, racial disparities

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New data show that minorities and low-income earners are more susceptible to COVID-19

Data linking race and health predicts new COVID-19 hotspots

Combining COVID-19 and census data

COVID-19 hotspots

Who is the most vulnerable?

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