Canada’s COVID-19 blind spots on race, immigration and labour

2020/05/21 Leave a comment

Yet another article on racial and economic disparities and COVID-19. Nothing new here and perhaps a sign that governments just need to get on with collecting the data. Should be a role for CIHI in this:

The low-paid and precarious positions in industries that are considered essential during the COVID-19 pandemic (sanitation, health care, and those in the food supply chain) are filled with women, recent immigrants, and racialized Canadians. Many of these workplaces are notoriously plagued with exploitative labour practices that, in many ways, contributed to the spread of the virus in the first place. Recent immigrants and racialized Canadians, notably Filipinos and Sudanese Dinka, who work in these industries, for example, meat-packing plants in Brooks, High River and Balzac, Alberta, are at great risk of negative health outcomes during this pandemic.

And, yet, we do not collect the necessary data in Canada on the social determinants of health for racialized minorities. Stories from across the country paint a bleak picture. In April, a 40-year-old Haitian asylum seeker contracted COVID-19 while working as a personal support worker. He died in his home after having been denied refugee status. In Toronto, researchers have recently connected positive COVID tests to neighbourhoods characterized by a higher proportion of visible minorities and recent immigrants, poor housing and low income.

There have been numerous calls to gather disaggregated data on COVID-19, health and race. After initial reluctance, the federal government and some provincial jurisdictions are now considering collecting more demographic data. We join our voices to the call and argue that Canadian governments need data not only on race and health, but also on immigration status during this COVID-19 crisis and beyond.

While collecting data on race will show that people of colour are disproportionately affected by COVID-19, we know that not all racialized Canadians are equally vulnerable to being exposed to this disease. From our work in community health, and gender and politics, we know that despite the best intentions of epidemiological approaches to the pandemic, marginalized groups face barriers to accessing and benefiting from public services. In fact, recent research by the University of Lethbridge’s Eunice Anteh shows that in places like Brooks, newcomers’ health profiles will vary based on numerous factors, including gender, race, language barriers, and the health and social infrastructures in their settlement locations.

We need longitudinal data that intersects the usual factors – gender, age, education, income, for example – with race and immigration profiles to enable policymakers to better understand the pathways and structures that create hierarchies of vulnerabilities within racialized and newcomer communities. This will enable public health officials to work with other stakeholders in eliminating the institutional barriers to health equity for all within our borders.

Intersecting reasons why some are more vulnerable to COVID-19

In Quebec, disparities in COVID-19 infection rates are shaped by the intersection of race, gender, immigration, labour, and public health. Health care workers account for 20 percent of infections, and in the hard-hit Greater Montreal area, up to 80 percent of the aides in long term care facilities are racialized women, mostly Black and Maghrebi. Industries of care are feminized and undervalued despite being critical to preserving the health and safety of the population.

For years workers have complained about these institutions’ chronic understaffing, high patient-to-aide ratios, and unsafe working conditions. As occurred in other provinces, the government subcontracted public services to private entities, with limited public oversight, enabling these institutions to avoid paying employment benefits by privileging part-time over full-time work. This left many health care aides with no other choice but to work at multiple sites to make ends meet. These are the conditions that upended Quebec’s response to COVID-19.

In Alberta, the links between race, immigration, labour, and public health manifested themselves in the food supply chain. Over 1200 COVID-19 cases were linked to the Cargill meat plant. Seventy percent of employees are of Filipino descent, most of whom work as general labourers amongst the lowest-paid employees, and some who have spouses working as health-care aides in Calgary. Public health officials named carpooling and crowded living arrangements as contributing factors to the rapid spread of the virus but overlooked labour practices and socioeconomic conditions that lead to shared living and transportation arrangements in the first place.

The second-largest meat packaging plant in Canada, JBS, is also facing an outbreak. It is the main employer in the city of Brooks, Alberta. A third of the population there are visible minorities, mostly from East Africa, South Asia, and Latin America. Today, JBS employees account for approximately 26 percent of Alberta’s active cases, and over 6 percent of Brooks’ population, one of the highest rates across Canadian municipalities. These outbreaks revealed mistakes and oversight linked to concerns around the food supply chain and showed the price that racialized and marginalized workers pay due to neglect and prioritization of profit over safety.

Temporary foreign workers are also at risk

As the agricultural season enters in full swing and concerns grow about Canada’s food supply chain, we must take stock of employment inequities in how we treat temporary foreign workers (TFWs) and the implications for overall community health and wellbeing. For decades TFWs from the Caribbean and Latin America have taken on work that Canadian often refuse to do, generally because of long working hours, unsanitary bunkhouses, and low wages. Many of these workers are reluctant to speak out about their work conditions given the precariousness of their employment and residency status, which are both tied to their employers.

These conditions, like those of personal service workers or meat plant employees, are not new or even unique to Canada. Across the world, industrialized countries depend on temporary migrant workers to sustain their basic infrastructures. Around the world and in Canada, it is clear that the temporary migration of racialized individuals serves as the backbone of essential services in Canada. From the West Indian Domestic Scheme (1955) and the Caribbean Seasonal Agricultural Workers Program (1966) to our modern TFW program, the utilitarian approach to immigration and the neglect of these populations have resulted in systematic and deep-rooted inequities that weaken health and safety institutions.

A lack of political will to address neglect

Why do Canadians tolerate these types of working conditions that can become public health issues during a crisis like COVID-19? Is it because of who is overrepresented in these fields: female, racialized, and immigrant workers who struggle to get substantive political representation? Some in the broader society rationalize these challenges by saying that newcomers are better off here than where they came from. Others turn a blind eye altogether to these conditions.

In reality, we ignored the working conditions of racialized and immigrant workers who help sustain our health and food supply infrastructures, and way of life.

Yes, we need to gather COVID-19 related data on race and immigration to better address the needs of vulnerable communities that also tend to work in essential sectors. But going forward, we also need long-term changes to what we consider to be health-relevant demographic data.

Provincial healthcare professionals need to pay as much attention to collecting data on race and immigration profiles as they do in collecting data on gender, education, and income. This data needs to feed into national environmental population surveys that will allow public health officers to tie specific demographic markers to health status over time. It will paint a clearer picture of social, economic, and health disparities between various communities and point to needed improvements and progress. This will also enable provincial health officials to identify variations and gaps between federal and provincial jurisdictions. For example, while refugees are resettled and supported by the federal government, their access to health services is the responsibility of the provinces.

Finally, this data should then be the starting point for engagement between public health officers, immigration and labour policy-makers, and relevant stakeholders from relevant industries. Together, they can help develop more robust social and labour protection for racial minorities, newcomers and migrants. We need to be invested in the health and work conditions of racialized and immigrant populations in Canada, not only because, as COVID-19 has demonstrated, safety for them means safety for all, but most importantly because this is what this country says it stands for.

Source: Canada’s COVID-19 blind spots on race, immigration and labour

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Why Have Britain’s Ethnic Minorities Been Hit Harder by COVID-19? It’s Hardly a Mystery

2020/05/04 Leave a comment

Another example of denial of the links between minority status and socioeconomic factors as a way to minimize the influence of systemic and other issues affecting socioeconomic outcomes and thus health. Not an either/or but an and:

COVID-19 is a disease that can strike anyone. A recent study of 5,700 sequentially hospitalized COVID-19 patients in a New York City health network, for instance, found that patients’ ages ranged from single digits to 90-plus. Roughly 60 percent were male. About 40 percent were white. Nine percent were Asian. And 23 percent were black.

As Coleman Hughes recently noted in Quillette, black people are overrepresented among American COVID-19 fatalities overall. In Chicago, for example, black people account for more than 70 percent of COVID-19 deaths, despite comprising just 30 percent of the local population. But this doesn’t necessarily tell us much about the disease itself, because “black people are more likely than white people to die of many diseases—not just this one. In other cases, the reverse is true. According to CDC mortality data, white people are more likely than black people to die of chronic lower respiratory disease, Alzheimer’s, Parkinson’s, liver disease, and eight different types of cancer.”

In the UK, too, COVID-19 has had a disproportionate effect on communities that get lumped in under the (somewhat dated) term “BAME”—black, Asian, and minority ethnic. The Intensive Care National Audit and Research Centre has reported that 34 percent of a studied group of 6,720 critically ill COVID-19 patients self-identified as black, Asian or minority ethnic. By way of comparison, the comparable figure for a group of 5,782 patients with non-COVID-19 viral pneumonia tracked between 2017 and 2019 was about 12 percent. Moreover, as the Telegraph reports, “despite only accounting for 13% of the population in England and Wales, 44% of all [National Health Service] doctors and 24% of nurses are from a BAME background. Of the 82 front-line health and social care workers in England and Wales [who] have died because of COVID-19, 61% of them were black or from an ethnic minority.”

The release of these numbers prompted an official inquiry. And last week, the Labour Party appointed civil-rights campaigner Doreen Lawrence to head up its own review of the issue. A BBC article entitled “Coronavirus: Why some racial groups are more vulnerable” informs readers that the issue might be rooted in the “physiological burden from the stresses caused by racism and race-related disadvantage, such as the frequent secretion of stress hormones.” London Mayor Sadiq Khan recently wrote an article in the Guardian, demanding that more data be collected. However, he didn’t wait for such data before suggesting that the issue is rooted in “the barriers of discrimination and structural racism that exist in our society.”

I’m a refugee from Afghanistan who came to England as a child in the back of a refrigerated truck. So I know a little bit about these issues. I also know that the above-described statistical disparities may well be related to factors that have nothing to do with racism. Firstly, as everyone in the country knows, BAME communities are disproportionately urban. Specifically, they tend to live in Britain’s larger cities, such as London, Birmingham, and Manchester—often within populous urban wards. Contagion rates are high in these areas, in part because it’s easier for an epidemic to spread in a big city than in the country’s sparsely populated (and disproportionately white) countryside.

Secondly, BAME groups in the UK tend to have more aggravating health conditions, known as comorbidities. Given the epidemiological data, this is of enormous importance. In the aforementioned study of 5,700 COVID-19 patients in New York City, for instance, the leading comorbidities were found to be hypertension (57 percent of all patients), obesity (42 percent), and diabetes (34 percent). Overall, a stunning 94 percent of patients in the study had at least one comorbidity. And 88 percent had more than one.

According to 2006 data, South Asians in the UK are up to six times more likely to develop type-2 diabetes as compared to white people, and black people were up to five times more likely. Similarly, as the BMJ has reported, people of South Asian and Black ethnicity “are known to have worse cardiovascular outcomes than those from the white British group”—in large part because of the “significant” effect of differences in average hypertension levels.

Thirdly, immigrant households are far more likely to contain more than two generations living under one roof. (The authors of a 2017 report found that 70 percent of surveyed white households in the UK containing people aged 70-plus didn’t contain younger individuals. The comparable figure for black households was about 50 percent. For South Asians, it was 20 percent.) In such circumstances, social isolation is more difficult, and grandparents are put at risk of catching infectious diseases from (possibly asymptomatic) younger relatives. From the beginning of this pandemic, intra-household contagion has been a leading form of COVID-19 transmission. The bigger the household, the more people get infected in each cluster.

Fourthly, the problem of getting public-health information to citizens is compounded in the case of those immigrants who have limited English abilities. There is much less official information in Somali, Hindi, Farsi, or Pashto, for instance. There is lots of “fake news” circulating on WhatsApp groups, which is especially problematic in the case of those who don’t understand information coming from official channels in English. Much of this fake-news information flow flies under the radar of public officials.

Finally, as noted above, BAME workers make up a disproportionate share of National Health Service medical staff. A fifth of nurses and midwives, and a third of doctors, are from BME backgrounds. In many cases, these actually represent employment success stories. But as one would expect, these cohorts also tend to be younger, and so are disproportionately employed in entry-level roles and front-line care, as opposed to working in specialized clinics or managerial positions.

An objective assessment of such issues is welcome. But the government’s fact-finding project should take into account the underlying factors, as opposed to simply echoing some of the unhelpful generalizations that now have become common currency in the media.

The public-health policies that are put in place in coming years will affect our ability to withstand the next pandemic. And we should be mindful of the manner by which they impact different communities in different ways. Such a discussion would not only help save lives, but also help spark a larger discussion about why such differences continue to exist, and, more generally, what factors have prevented BAME communities from sharing in the benefits that come with social integration.

Source: Why Have Britain’s Ethnic Minorities Been Hit Harder by COVID-19? It’s Hardly a Mystery

For background:

Kamrul Islam doesn’t dare visit his local supermarket. Over the last few weeks, he said three of his closest friends fell ill with the coronavirus shortly after shopping there. One friend’s mother became seriously unwell after contracting the virus and died.

The 40-year-old former cab driver says a day doesn’t go by when he isn’t aware of a death or infection of someone he knows. While the coronavirus has spread widely across the UK, the pandemic has taken a huge toll on the area where Islam lives, the east London borough of Newham, which has recorded the worst mortality rate in England and Wales.

The borough’s rate – 144.3 deaths per 100,000 people – is closely followed by Brent in north London (141.5), and Newham’s neighbour Hackney (127.4), according to figures published by the Office for National Statistics. The data confirms what Islam has suspected all along: people living in the poorest parts of the country are dying from Covid-19 at a much higher rate than those in the richest.

On Islam’s road and neighbouring street, 22 people have died after contracting coronavirus. “Every day I get a message from someone in my community telling me of people who have died. They are young and old. It’s been really tough,” Islam said. His wife, who wished to remain anonymous, said: “You hear sad stories of people dying and no one was with them. It does affect people mentally.”

The deaths from the coronavirus include Betty and Ken Hill, who were together for more than 40 years and died hours apart; Dr Yusuf Patel, who was the fifth GP to succumb to the virus in the UK; “exceptional” secondary school English teacher Dr Louisa Rajakumari; and Abdul Karim Sheikh, the former ceremonial mayor who founded one of the first mosques in the area.

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Islamophobia row over choice of consultant for UK Covid role

2020/04/28 Leave a comment

Trevor Phillips continues to court controversy in this appointment. Suspect there were others the UK government could have called on for the analysis given the communications difficulties this has raised:

The appointment of a prominent consultant to investigate why Covid-19 is killing a disproportionately high number of minorities in the UK has sparked a backlash because of his involvement in an Islamophobia row.

Trevor Phillips, a former head of an equality watchdog, was suspended from the opposition Labour party this year over claims of Islamophobia but has been chosen to advise the UK’s main public health body on coronavirus death rates.

Data suggests that 34.5 per cent of critically ill patients were from black, Asian and minority ethnic backgrounds.

The 2011 census suggested that less than 11 per cent of the population was from a black or Asian background.

Mr Phillips was suspended from the Labour party over comments he made about the outlook of the British Muslim community and a case in which Pakistani men abused children.

“To appoint someone who is being investigated for racism is inappropriate and deeply insensitive,” said Yasmin Qureshi, an MP, in a letter to the head of Public Health England.

Ms Qureshi said that the appointment undermined the integrity and credibility of the review.

“It is critical that this review is independent and has the confidence of all communities, and so I urge you to reconsider this appointment as a matter of urgency,” she said.

Dr Zubaida Haque, deputy director of the Runnymede Trust, a race equality think tank, also criticised the appointment.

“Covid 19 is not a culture war It’s the difference between life and death,” Dr Haque said in a tweet.

“The fact that Public Health England have appointed Trevor Phillips, someone with concerning attitudes towards Muslim communities as the main adviser into the racial disparities review is highly concerning.”

Mr Phillips claims to have introduced the term Islamophobia to Britain when he commissioned a 1997 report into discrimination.

He later said a “chasm” had opened between the thinking of Muslims and non-Muslims on social issues. He suggested that multiculturalism in the UK had failed.

The research consultancy run by Mr Phillips and Prof Richard Webber, a demographics expert, was appointed because of the large-scale studies it carries out on ethnicity.

Initial work conducted by his consultancy suggested that washing before prayers may have helped to curb the spread of the disease in some places, he said.

The investigation found that 13 of 17 Covid-19 hotspots in England and Wales had non-white populations above the national average.

“Everyone should be contributing anything they can to tackling this crisis,” Mr Phillips told the Huffington Post.

“Anyone can see the research Richard and I have already done on our website, which explains why we’ve been asked to help.”

Source: Islamophobia row over choice of consultant for UK Covid role

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How Canada’s crucial data gaps are hindering the coronavirus pandemic response

2020/04/25 Leave a comment

Good long read on data gaps. Have excerpted the intro and the section on the lack of visible and ethnic minority data:

Gaps in key health and economic data are hindering Canada’s response to the COVID-19 pandemic, leaving Canadians in the dark about who is being infected or struggling with the devastated economy, say researchers, politicians and scientists.

These blind spots could blunt the federal economic rescue effort, hide inequities in deaths from the disease and slow our emergence from self-isolation in the months ahead. Experts are urging provincial and federal leaders to open up more streams of data immediately, as doing so might save lives and livelihoods.

Canada has a long-standing problem of information gaps, The Globe and Mail found in a year-long series, and that has left us vulnerable during public health crises before. A government audit found that during the 2009 swine flu pandemic, data deficiencies left the Public Health Agency of Canada “unable to answer basic questions such as the rate of spread” of the virus.

….

Nationally, the ethnicity of those who have been infected or have died is unknown. Because of data gaps, the death toll likely is being underestimated.

On the economic front, Canadians don’t know how many in each province are applying for employment insurance every week (as the United States does by state). They don’t have up-to-date numbers on bankruptcies, mortgages in arrears, how workers in the gig economy are faring, the extent of layoffs or the degree to which the federal government’s plan for an enhanced wage-subsidy program has spurred rehiring.

Arjumand Siddiqi, the division head of epidemiology at the University of Toronto’s Dalla Lana School of Public Health, said she and her colleagues are eager to help analyze the fast-moving crisis to a greater extent, but have been stalled by a lack of detailed figures on the demographics and locations of confirmed cases, among other things.

“We have the will, we have the expertise, but we don’t have the data,” she said. “It would be good to know what is actually happening.”

One of the most pressing gaps, Dr. Siddiqi said, is information about the ethnicity of those who have tested positive for COVID-19 or died of the disease. No Canadian province makes this data available, in keeping with a long-standing national aversion to publishing statistics about racial disparities in health. (Toronto’s Medical Officer of Health, Eileen de Villa, has announced that the city is exploring ways to collect race-based coronavirus data on its own.)

But there is reason to suspect race may be a factor in determining who is being infected and dying from the virus, Dr. Siddiqi said, both because of the prevalence of various underlying health conditions in some racialized communities, and their over-representation in low-wage jobs such as nursing, delivery and retail, which make them highly prone to exposure to the virus. Early U.S. data indicate that black Americans are being admitted to hospital and dying from COVID-19 at a disproportionate rate.

“We are very clear that we want to know who is at risk,” Dr. Siddiqi said. “But we’re just very hesitant – and that’s kind of putting it mildly – to add race to the set of dividing factors that we’re willing to entertain.”

This blind spot extends to Indigenous people, whose health care is largely provided by the federal government. NDP MP Charlie Angus would like to change that. In a letter to Health Minister Patty Hajdu last week, he urged the government to start keeping data on COVID-19 cases among Indigenous people, saying, “It would be irresponsible at this time to turn a blind eye to the movement of COVID through vulnerable populations.”

“It seems bloody obvious that you would want to track this and make policy based on this information,” he said in an interview. “I think there’s a naive arrogance in the principle of saying: ‘We’re not the United States, we don’t have their problems, we don’t discriminate like that.’ ”

Even government-funded groups such as the Canadian Institute for Health Information (CIHI) have begun calling for race-based data around coronavirus cases. The organization now supports the idea of health care providers asking a common question about the race of COVID-19 patients and says it would be willing to compile the data.

“The COVID pandemic is certainly exposing gaps in important data flows within and between health care systems in Canada,” CIHI spokeswoman Alex Maheux said.

…

Source: How Canada’s crucial data gaps are hindering the coronavirus pandemic response ‘We have the will, we have the expertise, but we don’t have the data’: Nationally, the lack of coronavirus-related health and economic data is stalling efforts to analyze the fast-moving COVID-19 crisis

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COVID-19 takes unequal toll on immigrants in Nordic region

2020/04/25 Leave a comment

More on racial disparities:

The first person in Sadad Dakhare’s two-bedroom apartment in Oslo, Norway, to show symptoms was his 4-year-old niece. Next, his mother, his sister and he himself fell ill. Then, about a week after his niece became sick, Dakhare heard his 76-year-old father coughing heavily.

Sadad Dakhare (R), his father Mohamed Dakhare Farah and niece Safa Mohamed Hassan (L) who fell ill with the coronavirus disease (COVID-19) but have now recovered pose in a photo taken in Oslo, Norway April 23, 2020. Picture taken April 23, 2020. Samsam Muhammed Dakhare/Handout via REUTERS. THIS IMAGE HAS BEEN SUPPLIED BY A THIRD PARTY

He found his father lying in bed, gasping for air. “Just call an ambulance,” the father told Dakhare.

At an Oslo hospital, Dakhare’s father tested positive for COVID-19 and was treated for a few days before he was discharged to finish his recovery at home.

The Dakhare family’s story is a familiar one among Somalis in Norway and other Nordic countries, where the pandemic is taking a disproportionate toll on some immigrant groups. Governments in Sweden, Norway and Finland are taking extra steps to try to slow the spread of the disease in these communities.

Across Europe, little is known about who is affected by the virus because governments are releasing limited demographic information about the sick and those who die. But a Reuters examination of government data in three Nordic countries where more details are available shows that some immigrant groups are among those affected at higher rates than the general populace.

“WORRYING” DISPARITY

In Norway, where 15% of residents were born abroad, 25% who had tested positive for COVID-19 by April 19 were foreign-born. Somalis, with 425 confirmed cases, are the largest immigrant group testing positive, accounting for 6% of all confirmed cases — more than 10 times their share of the population.

Somalis are the most overrepresented immigrant group among Sweden’s confirmed cases, as well. Their 283 positive tests account for about 5% of the nearly 6,000 cases documented between March 13 and April 7. That’s seven times their share of the population. Iraqis, Syrians and Turks also made up disproportionately large shares of positive cases.

In Finland’s capital city of Helsinki, the mayor said it was “worrying” that almost 200 Somalis had tested positive by mid-April. They accounted for about 17% of positive cases — 10 times their share of the city’s population.

More than 100,000 Somalia-born live in the three countries, mostly in Sweden and Norway, one of the largest Somali diasporas in the world. Many arrived as refugees of war in the 1990s, 2000s and 2010s. Several factors place them more at risk of getting sick, public health officials and researchers say.

VIRUS OUTPACES RESPONSE

It is common in all three countries for multiple generations of Somalis to live, like the Dakhares do, in crowded apartments, making it easier for the virus to spread from one family member to the next. They also tend to work in high-contact jobs — healthcare workers, drivers and cleaners, for example — with a higher risk for exposure.

Language barriers also are at play, and some have criticized governments in Sweden and Norway for failing to move fast enough in communicating about the virus to immigrant groups.

“By the time information translated to different languages was spread sufficiently, the infection rate among minority groups was already very high,” said Linda Noor, a social anthropologist who is managing director of Minotenk, a think tank focused on minority-related politics in Norway. She said a lot of information in Norway was distributed through national health authorities’ websites that are unfamiliar to many people in immigrant communities.

Public health officials in both Norway and Sweden pointed to COVID-19 information they published in multiple languages, including Somali, in early to mid-March. But they acknowledged that they did not reach some immigrants fast enough.

GETTING THE WORD OUT

“I think it is clear from the epidemiological situation, especially looking at the high proportion of Somalis with COVID-19, that we did not reach this group in time,” said Hilde Kløvstad, department director at the Norwegian Institute of Public Health.

Once the virus started to spread, officials realized they needed to be more focused in their outreach, she said, adding that the spread of the virus among immigrant communities is slowing.

In Oslo, officials contacted leaders in immigrant communities, who helped them get the word out via social media, word of mouth, posters and online videos targeting Somalis, said Hanne Gjørtz, head of communications for the city. Health alerts in Somali aired on the radio, and text messages with translated information were sent to Somali residents.

“We saw that this led to increased traffic on our websites,” she said.

“But we are constantly learning,” she added. “It would definitely have been an advantage to have videos and posters in place earlier in this crisis. This has been and still is a crisis of great speed, and it took some time for us to find the right ways to reach different groups.”

Sadad Dakhare (R) and his niece Safa Mohamed Hassan who fell ill with the coronavirus disease (COVID-19) but have now recovered pose in this photo taken April 22, 2020 in Oslo, Norway. Picture taken April 22, 2020. Samsam Muhammed Dakhare/Handout via REUTERS THIS IMAGE HAS BEEN SUPPLIED BY A THIRD PARTY.

HITTING THE STREETS

In Rinkeby-Kista and Spånga-Tensta, two Stockholm boroughs where immigrants and their children make up most of the population, rates of infection are more than two times higher than in the city overall. Trying to slow the spread of the virus in these areas, where Somalis are the biggest minority group, the government is offering temporary furnished rental apartments to at-risk-groups, such as elderly people who live in multi-generational housing, said Benjamin Dousa, chairman of the Rinkeby-Kista district council.

Government workers who speak a variety of languages, including Somali, have hit the streets in immigrant-heavy neighborhoods — near libraries, religious buildings, municipal offices, metro stations and grocery stores — to warn people about COVID-19, said officials from government body Region Stockholm.

In a statement to Reuters, Region Stockholm said it could have been faster in distributing multilingual information before the virus began spreading disproportionately among immigrant groups.

“However, we are working in the middle of a situation which is before unseen,” the statement said. “Therefore, it is difficult to be as fast as is needed and to foresee all needs.”

The statement added that the infection rate is slowing in Spånga-Tensta and Rinkeby-Kista.

“SITUATION DEMANDS TEAMWORK”

Helsinki is gearing up for similar outreach.

“The situation demands enhanced teamwork, continued development of multilingual services and effective targeted communications,” said Mayor Jan Vapaavuori. “We have entered into discussions with the Finnish Somali League about new measures to improve the situation.”

Somalis themselves also are trying to spread the word about how to stay safe.

Ayan Abdulle posted an informational video on Facebook, but she found she wasn’t reaching the people who needed the information most.

Abdulle, 29, who was born in Somalia and came to Norway at age 9, heads a non-governmental organization in the city of Bergen called Arawelo, which usually focuses on helping young immigrants apply for jobs and find friends. After the coronavirus outbreak, Abdulle started to focus on the elderly as well, helping them with grocery shopping. When she spoke with elderly Somali women out shopping last month, she learned they were not getting enough information about the coronavirus because they weren’t using social media and not all of them understood Norwegian.

“In Somali culture, most information is spread by word of mouth,” Abdulle said. “Now we are going from door to door and hanging posters informing people about the symptoms and how dangerous the disease can be.”

Source: COVID-19 takes unequal toll on immigrants in Nordic region

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Job Losses Higher Among People Of Color During Coronavirus Pandemic as are Nursing Home Deaths

2020/04/24 Leave a comment

Two related articles on racial disparities regarding COVID-19, starting with job losses:

Until a few weeks ago, Melissa St. Hilaire worked the night shift taking care of a 95-year-old woman for a family in Miami.

“I help her to go to the bathroom, use the bathroom, and I watch TV with her, and I comb her hair sometimes in the night,” she said.

But one day in March, the woman’s daughter told her not to come back, saying she wanted to protect her mother during the coronavirus pandemic.

St. Hilaire is black and a Haitian immigrant. And her situation is an example of what early data from this crisis shows: People of color have lost work at greater rates than white workers.

The March jobs data show a number of racial and ethnic disparities in the economic impact of the coronavirus. For example: the share of white people who are employed fell by 1.1% last month. That rate fell by substantially more for black people (a 1.6% drop), Asian Americans (1.7%), and Latinos (2.1%). Economist Christian Weller highlighted this data and more at Forbes earlier this month.

In addition, a survey from the left-leaning Data for Progress found that 45% of black workers have lost jobs or had their hours cut, compared with 31% for white workers. (Samples were not large enough to break out other racial and ethnic groups.)

Losing her job landed St. Hilaire in dire straits. She was able to delay her rent payment after she talked to her landlord.

“​I said to her my situation. She said, ‘OK.’ She understood my situation. She gave me more days,” St. Hilaire said, but she added that shelter isn’t her only concern. “Two weeks before [that], I was out of food. That’s crazy.”

She ended up getting some food supplies from a local aid group. She plans to apply for unemployment and also has a GoFundMe whose proceeds she plans to share with fellow domestic aides.

A big reason for these racial and ethnic gaps has to do with the workplaces that have been hurt most by the economic crisis.

“We know which industries are being hit the hardest,” says Gbenga Ajilore, senior economist at the left-leaning Center for American Progress. “So we look at leisure and hospitality, transportation, utilities, industries that are first ones were hit really hard. We also know service — think hairdressers, salons. We know which ones are getting hit hard, and we know who’s in those occupations.”

People of color — and in the case of domestic workers like St. Hilaire, women of color — are disproportionately in those occupations. Nearly three-quarters of domestic workers were out of work the week of April 6, according to a survey from the National Domestic Workers Alliance.

Similar patterns turn up in other industries hurt most by the coronavirus slowdown. The latest jobs report showed more than 450,000 job losses in leisure and hospitality — a category that includes hotels and restaurants. Black, Asian and Latino workers are all disproportionately represented in the hotel industry, and Latino workers have heavy representation in restaurants.

That includes Erick Velasquez, who is Mexican American and who until recently was head bartender at a Greek restaurant in Houston.

“Everything just happened so quick. We’re watching the news, and they talk about COVID-19, and nobody really thought much about it,” he said. “And then a few days after then that’s when they — the city or the county — closed down dining rooms for restaurants everywhere.”

Velasquez has managed to find a temporary job — helping his fellow laid-off workers. He’s a case worker now at the Southern Smoke Foundation, a nonprofit that supports people in the restaurant industry. And he sees racial and ethnic gaps among the people he’s helping.

“​Everybody in the restaurant industry is hurting, but more so, it’s the people that you don’t really see when you go into a restaurant,” Velasquez said. “It’s like the back of the house workers, the immigrant community, the people of color.”

There’s also evidence of disparities in who is able to work from home during this crisis: 30% of white people and 37% of Asian Americans could work from home in 2017 and 2018, according to the Labor Department. Meanwhile, only 20% of black people could. In addition, only 16% of Latinos could work from home, compared to nearly twice as many non-Latinos.

The March jobs report that much of this analysis is based on only captured the start of the economic crisis created by COVID-19. The April report, which will be released May 8, will show if racial gaps have persisted.

If those gaps do continue, it could make existing inequalities worse. The unemployment rates for blacks and Latinos, for example, are always higher than the broader national unemployment rate. Wages for blacks and Latinos are also lower than for other groups.

Ajilore thinks it was easier to ignore these types of gaps when the economy was humming along with record-low unemployment. Now, the economic crisis brought about by the pandemic is holding a magnifying glass to those gaps.

​”Once this pandemic hit, then it’s like you see the cracks in the structure,” he said.

Source: Job Losses Higher Among People Of Color During Coronavirus Pandemic

And nursing home deaths in NYC:

There’s one thing that distinguishes the nursing homes in New York that have reported patient deaths from COVID-19. According to an NPR analysis, they are far more likely to be made up of people of color.

NPR looked at 78 nursing homes in New York in which six or more residents have died of COVID-19. In one facility, 55 people have died as of April 20. Ten others report 30 or more deaths.

Seven of the 11 nursing homes with the highest number of deaths report that 46 percent or more of their residents are “non-white.” Most of these “non-white” residents are black and latinx. At one facility, the Franklin Center for Rehabilitation and Nursing in Queens, which reported 45 deaths, 80 percent of the residents are minority, including 47 percent who are Asian.

NPR filed a public records request with the Centers for Medicare and Medicaid Services and collected data on every nursing home in the United States. We focused our analysis on New York because that state has the most deaths of COVID-19, by far.

Fifty-eight percent of the deaths in the state happened in nursing homes in New York City. Those nursing homes, the NPR numbers show, are notable for their high percentages of residents of color.

But even most of the residents who died in facilities in other parts of the state were living in nursing homes that had a high percentage of residents of color. The population in those facilities tend to reflect the demographics of the counties where they were located.

The racial imbalance in the deaths in New York nursing homes reflects another national trend: That among all fatalities, across the country, from COVID-19, black and Hispanic people make up a disproportionate share of the dying.

NPR analyzed other data too, including the federal government’s system for rating nursing homes that gives each facility a star rating from one to five.

In New York state, nursing homes that recorded deaths actually had better quality scores than other nursing homes. Half of the facilities that report deaths get four or five star ratings from Medicare’s Nursing Home Compare website, indications of “above average” or “much above average” quality.

On other indicators, there was little difference between nursing homes with deaths reported and other facilities in the state. Staffing levels were about the same. Their reliance on Medicaid patients — who bring lower reimbursements — was similar, too. Their occupancy rates — which can indicate problems at a facility if low — also were roughly the same.

But the nursing homes with outbreaks were often larger facilities. Three of those facilities have 700 or more residents. Almost half — 38 out of the 78, including some of the largest in the state — are in New York City.

Nationwide, people living in nursing homes and other long-term care facilities make up close to one out of five deaths nationwide from COVID-19, according to The New York Times.

“It is not surprising that this is exaggerated,” Dr. Clyde Yancy, chief of cardiology at Northwestern University’s Feinberg School of Medicine, said of NPR’s findings of the racial imbalance in deaths at nursing homes. He wrote in the Journal of the American Medical Association about the long history of racial disparities in health care and how it plays out now in this pandemic.

For “someone living in a nursing home who has suffered more extensive complications to a disease process because of already embedded health disparities,” says Yancy, “one can only imagine what happens when that individual now is facing coronavirus infection, potential COVID-19 complications.”

Years of inequality can lead to less access to health care, to hard lives and jobs, to a greater likelihood of developing diabetes, asthma and other conditions that now put people in those nursing homes at greater risk.

Nursing homes are now being recognized as one of the front lines of the pandemic. The residents are often frail, they have underlying health problems.

Nurse aides — who work for low wages — do the hands-on care. They get people out of bed, bathe them and take them to the toilet. They and other staffers were some of the last to get masks, gloves and other personal protective equipment. That made it easier for the virus to spread, notes Dr. Dora Hughes, of the Milken Institute School of Public Health at George Washington University.

“For all of our pandemic response, much of our attention has focused, appropriately, on hospitals. But I think for what we’ve seen with the nursing home is a fairly stark reminder that we need to really expand our thinking in terms of essential workers,” says Hughes. “The direct care staff, should have been a greater priority.”

Source: In New York Nursing Homes, Death Comes To Facilities With More People Of Color

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Opinion: U.S. Must Avoid Building Racial Bias Into COVID-19 Emergency Guidance

2020/04/23 Leave a comment

Another angle and concern regarding racial disparities in healthcare:

Across the United States, we are seeing alarming statistics about the disproportionate toll of COVID-19 on Latino and black people. In New York City, the New York Times tells us, coronavirus is twice as deadly for these minorities as for their white counterparts. In both Chicago and Louisiana, black patients account for 70% of coronavirus deaths, even though they make up roughly a third of the population.

At Massachusetts General Hospital, where we practice, an estimated 35% to 40% of patients admitted to the hospital with the coronavirus are Latino — that’s a 400% increase over the percentage of patients admitted before the outbreak who were Latino.

In the emergency room, conversations about a patient’s end-of-life wishes are taking place in broken Spanish, seconds before they get intubated. In the intensive care unit, doctors barely have time to update family members, because they’re too bogged down by patient-care tasks to call an interpreter. For patients healthy enough to go home, our usual script around social distancing falls short, as many of our black and Latino patients are unable to self-isolate within large multigenerational households. In addition, many of these patients either are essential workers or live with one — they cannot simply “stay home”.

In a pandemic that has stretched U.S. health care resources thin, it’s not surprising to see a worsening of already existent health care disparities. Several states and organizations have started to release Crisis Standards of Care guidelines in recent weeks — these are meant to help hospitals ration critical resources like ventilators and intensive care unit beds, if and when the need is dire.

The overall aim of such guidelines, which can vary in their specifics from state to state and hospital to hospital, is to allocate limited resources to the people who are most likely to benefit from them.

To determine which patients get priority in treatment, several of the CSCs published so far, such as guidelines from Colorado and Massachusetts, recommend that the hospital use frameworks that include the patient’s age and “SOFA” score (a measure of how critically ill the patient is at arrival, based on objective laboratory values). Importantly, they also include what we doctors call “comorbidities” — other, underlying medical conditions that can put patients who are infected with this virus at a higher risk for worse outcomes.

We know that historically disadvantaged populations — including black and Latino patients — have a higher burden of the comorbidities traditionally used by hospitals to stratify patients by risk. This is largely because of structural and socioeconomic factors. Studies and statistics suggest that, compared to their white counterparts, black patients are 40% more likely to have high blood pressure, twice as likely to have heart failure, three times as likely to die from asthma-related complications, three times more likely to have chronic kidney disease, twice as likely to be diagnosed with colon and prostate cancer, and represent 44% of the HIV positive population. Similarly, Latino patients are twice as likely to both have and die from diabetes, and twice as likely to have chronic liver disease than non-Hispanic whites.

Although the foundational principle of Crisis Standards of Care guidelines are utilitarian and aim to benefit the greatest number of people while treating “individual cases fairly,” a system that penalizes on the basis of comorbidities will undoubtedly and unfairly penalize the populations that are already more vulnerable to those conditions.

Furthermore, given the novelty of COVID-19, we still don’t have a complete picture of which factors lead to worse outcomes. While some data suggest that patients with severe COVID-19 are more likely to have hypertension or respiratory or cardiovascular illnesses, there are also findings suggesting that men have more severe disease than women. Yet, the Crisis Standards of Care are not factoring sex into their scoring system. This means that we are arbitrarily choosing metrics to guess which patients will do better, and we’re doing so at the expense of populations that have historically been marginalized by the health care system.

COVID-19 is already affecting and killing a disproportionate number of black and Latino patients across the United States. Using comorbidities as a proxy for disease severity to allocate resources, without taking into account race and ethnicity, will almost certainly mean that racial and ethnic minorities will be placed in the “back of the line” for critical care resources.

In order to do the greatest good for the greatest number of people ethically and fairly, standards of care must be informed by the existing inequalities in our country.

While we’re not suggesting that comorbidities be removed from crisis standards of care altogether, we urge states to reevaluate current guidelines and include only major comorbidities with a known short-term impact on a patient’s prognosis.

States should also track and make publicly available demographic data — including race and ethnicity — for patients hospitalized with COVID-19 in order to ensure that people of color are not being denied resources disproportionately. Lastly, states should ensure that the committees designing crisis standards of care are composed of a racially and ethnically diverse group of individuals in a way that is representative of their population.

It was devastating enough to have to tell my African American patient’s young son that his dad’s illness was so life-threatening we needed to place a breathing tube down his throat and send him to the intensive care unit. I can only imagine how he would feel if, in some unfortunate circumstance, we would have to tell him that his father would need to be taken off the ventilator to conserve resources.

Dr. Jossie Carreras Tartak and Dr. Hazar Khidir are residents in Emergency Medicine at Massachusetts General Hospital in Boston.

Source: Opinion: U.S. Must Avoid Building Racial Bias Into COVID-19 Emergency Guidance

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Racial divide of COVID-19 patients in U.S. grows even starker as new data suggests disproportionate black patients

2020/04/21 Leave a comment

Yet more evidence and advocacy:

As a clearer picture emerges of COVID-19’s decidedly deadly toll on black Americans, leaders are demanding a reckoning of the systemic policies they say have made many African Americans far more vulnerable to the virus, including inequity in access to health care and economic opportunity.

A growing chorus of medical professionals, activists and political figures are pressuring the federal government to not just release comprehensive racial demographic data of the country’s coronavirus victims, but also to outline clear strategies to blunt the devastation on African Americans and other communities of colour.

On Friday, the Centers for Disease Control and Prevention released its first breakdown of COVID-19 case data by race, showing that 30% of patients whose race was known were black. The federal data was missing racial information for 75% of all cases, however, and did not include any demographic breakdown of deaths.

The latest Associated Press analysis of available state and local data shows that nearly one-third of those who have died are African American, with black people representing about 14% of the population in the areas covered in the analysis.

Roughly half the states, representing less than a fifth of the nation’s COVID-19 deaths, have yet to release demographic data on fatalities. In states that have, about a quarter of the death records are missing racial details.

Health conditions that exist at higher rates in the black community – obesity, diabetes and asthma – make African Americans more susceptible to the virus. They also are more likely to be uninsured, and often report that medical professionals take their ailments less seriously when they seek treatment.

“It’s America’s unfinished business – we’re free, but not equal,” civil rights leader Rev. Jesse Jackson told the AP. “There’s a reality check that has been brought by the coronavirus, that exposes the weakness and the opportunity.”

This week, Jackson’s Rainbow PUSH Coalition and the National Medical Association, a group representing African American physicians and patients, released a joint public health strategy calling for better COVID-19 testing and treatment data. The groups also urged officials to provide better protections for incarcerated populations and to recruit more African Americans to the medical field.

Jackson also expressed support for a national commission to study the black COVID-19 toll modelled after the Kerner Commission, which studied the root causes of race riots in African American communities in the 1960s and made policy recommendations to prevent future unrest.

Daniel Dawes, director of Morehouse College’s School of Medicine’s Satcher Health Leadership Institute, said America’s history of segregation and policies led to the racial health disparities that exist today.

“If we do not take an appreciation for the historical context and the political determinants, then we’re only merely going to nibble around the edges of the problem of inequities,” he said.

The release of demographic data for the country’s coronavirus victims remains a priority for many civil rights and public health advocates, who say the numbers are needed to address disparities in the national response to the pandemic.

The AP analysis, based on data through Thursday, found that of the more than 21,500 victims whose demographic data was known and disclosed by officials, more than 6,350 were black, a rate of nearly 30%. African Americans account for 14.2% of the 241 million people who live in the areas covered by the analysis, which encompasses 24 states and the cities of Washington D.C., Houston, Memphis, Pittsburgh and Philadelphia – places where statewide data was unavailable.

The nation had recorded more than 33,000 deaths as of Thursday.

In some areas, Native American communities also have been hit hard. In New Mexico, Native Americans account for nearly 37% of the state’s 1,484 cases and about 11% of the state’s population. Of the 112 deaths where race is known in Arizona, 30 were Native Americans.

After Democratic lawmakers introduced legislation this week to try to compel federal health officials to post daily data breaking down cases and deaths by race, ethnicity and other demographics, the CDC released only caseload data that – similar to the AP’s analysis of deaths – show 30 per cent of 111,633 infected patients whose race is known were black. African American patients in the 45-to-64 and 65-to-74 age groups represented an even larger share of the national caseload.

The lawmakers sent a letter last month to Health and Human Services Secretary Alex Azar urging federal release of the demographic data. And Joe Biden, the former vice-president and presumptive Democratic presidential nominee, also called for its release.

Meanwhile, some black leaders have described the Trump administration’s response to COVID-19 as inadequate, after what they said was a hastily organized call with Vice-President Mike Pence and CDC Director Robert Redfield last week.

According to a recording of the call obtained by the AP, Redfield said the CDC has been collecting demographic data from death certificates but that the comprehensiveness of the data depends on state and local health departments, many of which are overburdened by virus response. No plan was offered to help health officials in hard-hit communities collect the data, leaders who were on the call said.

Kristen Clarke, president of the Lawyers’ Committee for Civil Rights Under Law, which took part in the call, said African Americans “have every reason to be alarmed at the administration’s anemic response to the disproportionate impact that this crisis is having on communities of colour.”

Mistrust runs deep among residents in many communities.

St. Louis resident Randy Barnes is grappling not just with the emotional toll of losing his brother to the coronavirus, but also with the feeling that his brother’s case was not taken seriously.

Barnes said the hospital where his brother sought treatment initially sent him home without testing him and suggested he self-quarantine for 14 days. Five days later, his brother was back in hospital, where he was placed on a ventilator for two weeks. He died April 13. Barnes’ brother and his wife also were caring for an 88-year-old man in the same apartment, who died from the virus around the same time.

“Those people are not being tested. They’re not being cared for,” Barnes said.

Eugene Rush lives in one of the areas outside large urban cities that have been hit hard with coronavirus cases. He is a sergeant for the sheriff’s department in Michigan’s Washtenaw County, west of Detroit, where black residents account for 46% of the COVID-19 cases but represent only 12% of the county’s population.

Rush, whose job includes community engagement, was diagnosed with COVID-19 near the end of March after what he initially thought was just a sinus infection. He had to be hospitalized twice, but is now on the mend at home, along with his 16-year-old son, who also was diagnosed with COVID-19.

“I had a former lieutenant for the city of Ypsilanti who passed while I was in the hospital and I had some fraternity brothers who caught the virus and were sick at the hospital,” Rush said. “At that point, I said, ‘Well, this is really, really affecting a lot of people’ and they were mostly African American. That’s how I knew that it was really taking a toll a little bit deeper in the African American community than I realized.”

Source: Racial divide of COVID-19 patients in U.S. grows even starker as new data suggests disproportionate black patients

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Who’s Hit Hardest By COVID-19? Why Obesity, Stress And Race All Matter

2020/04/20 Leave a comment

More on disparities in health outcomes:

As data emerges on the spectrum of symptoms caused by COVID-19, it’s clear that people with chronic health conditions are being hit harder.

While many people experience mild illness, 89% of people with COVID-19 who were sick enough to be hospitalized had at least one chronic condition. About half had high blood pressure and obesity, according to data from the Centers for Disease Control and Prevention. And about a third had diabetes and a third had cardiovascular disease. So, what explains this?

“Obesity is a marker for a number of other problems,” explains Dr. Aaron Carroll, a public health researcher at the Indiana University School of Medicine. It’s increasingly common for those who develop obesity to develop diabetes and other conditions, as well. So, one reason COVID-19 is taking its toll on people who have obesity is that their overall health is often compromised.

But does obesity specifically affect the immune system? Perhaps.

Prior research has shown that people with obesity are less protected by the flu vaccine. They tend to get sicker from the respiratory disease even if they’ve been immunized. In fact, researchers have found that as people gain excess weight, their metabolism changes and this shift can make the immune system less effective at fighting off viruses.

“What we see with obesity is that these [immune] cells don’t function as well,’ says Melinda Beck, a health researcher at University of North Carolina, Chapel Hill. Basically, she explains, obesity throws off the fuel sources that immune cells need to function. “The [immune cells] are not using the right kinds of fuels,” Beck says. And, as a result, the condition of obesity seems to “impair that critical immune response [needed] to deal with either the virus infection or [the ability] to make a robust response to a vaccine.”

So this is one explanation as to why people with obesity seem more vulnerable to serious infection. But, there are many more questions about why some people are hit harder, including whether race is a factor.

The CDC found that 33% of people who’ve been hospitalized with COVID-19 are African American, yet only 13% of the U.S. population is African American. Some local communities have found a similar pattern in their data. Among the many (26) states reporting racial data on COVID-19, blacks account for 34% of COVID deaths, according to research from Johns Hopkins University.

This disproportionate toll can be partially explained by the fact that there’s a higher prevalence of obesity, high blood pressure and diabetes among African Americans compared with whites.

And as Dr. Anthony Fauci of the National Institutes of Health said last week at a White House coronavirus task force briefing, this crisis “is shining a bright light on how unacceptable that is, because yet again, when you have a situation like the coronavirus, [African Americans] are suffering disproportionately.”

There are several factors, including some genetic ones, that may make African Americans more vulnerable to COVID-19. “There have been a few studies that have pointed to African Americans potentially having genetic risk factors that make them more salt-sensitive,” says Renã Robinson, a professor of chemistry who researches chronic disease at Vanderbilt University. This may increase the likelihood of high blood pressure, which, in turn, is linked to more serious forms of COVID-19. “It could be a contributing factor,” she says, but there are likely multiple causes at play.

Another issue to consider, she says, may be high stress levels. She says when a person experiences racial discrimination, it can contribute to chronic stress. She points to several studies that link discrimination and stress to higher levels of inflammationamong black adults. “And chronic stress can make one more vulnerable to infection because it can lower your body’s ability to fight off an infection,” she says.

Chronic stress is linked to poverty — so this could be a risk factor for low-income communities. In fact, research has shown that people who report higher levels of stress are more likely to catch a cold, when exposed to a virus, compared with people who are not stressed.

According to a new survey from Pew Research Center, health concerns about COVID-19 are much higher among Hispanics and blacks in the U.S. While 18% of white adults say they’re “very concerned” that they will get COVID-19 and require hospitalization, 43% of Hispanic respondents and 31% of black adults say they’re “very concerned” about that happening.

And other aspects of structural racism could contribute to the elevated risk for black Americans.

“Every major crisis or catastrophe hits the most vulnerable communities the hardest,” say Marc Morial, president and CEO of the National Urban League. And he points to several factors that help to explain the racial divide.

“Black workers are more likely to hold the kinds of jobs that cannot be done from home,” Morial says. So, they may be more likely to be exposed to the virus, if they are working in places where it’s difficult to maintain social distancing. In addition, he points to longstanding inequities in access to quality care.

“There also is bias among health care workers, institutions and systems that results in black patients … receiving fewer medical procedures and poorer-quality medical care than white individuals,” he says. He says an expansion of Medicaid into those states that still haven’t expanded would be one effective policy to address these inequities.

The characteristics of the communities where people live could affect risk, too especially for those who live in low-income neighborhoods. The roots of chronic illness stem from the way people live and the choices that may or may not be available to them. People who develop the chronic illnesses that put them at higher risk of COVID-19 often lack access to affordable and healthy foods or live in neighborhoods where it’s not safe to play or exercise outside.

“Let’s take a patient with diabetes for example. They are already at high risk for COVID-19 by having a chronic condition,” says Joseph Valenti, a physician in Denton, Texas, who promotes awareness of the social determinants of health through his work with the Physicians Foundation.

“If they also live in a food desert, they have to put themselves in greater risk if they want access to healthy food. They may need to take a bus, with people that have COVID-19 but aren’t showing symptoms, to get access to nutritious food or even their insulin prescription,” he says.

Poor nutrition, and the obesity linked to it, is a leading cause of premature death around the globe. And, this pandemic brings into focus the vulnerability of the millions of people living with lifestyle-related, chronic disease.

“We’re seeing the convergence of chronic disease with an infection,” says UNC’s Beck. And the data suggest that the combination of these two can lead to more serious illness. “We’re seeing that obesity can have a great influence on infection,” she says.

So, will this shine a spotlight on the need to address these issues? “Hopefully,” Beck says. “I think paying attention to these chronic diseases like obesity is in everybody’s best interest.”

Source: Who’s Hit Hardest By COVID-19? Why Obesity, Stress And Race All Matter

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Being Counted in Canada’s Coronavirus Data, Ontario’s lack of diversity data for COVID-19 is an embarrassment

2020/04/17 Leave a comment

Two good commentaries on the lack of diversity data, starting with Howard Ramos of Dalhousie:

The lack of COVID-19 data on immigrants and racialized minorities collected and shared by Canada’s many layers of government could lead to health inequities.

Canada is not alone in having a data gap on immigrant and racialized groups. In the United States civil rights groups and doctors have called on its federal government to release demographic data on coronavirus infections.

Analysis that looks at the number of COVID-19 cases based on publicly available American data and census information shows that counties that are majority African-American have three times the rate of infection and almost six times the rate of deaths as counties where white residents are in the majority. It is a trend that has raised alarm across American cities.

Understanding Canada-U.S. differences

Past research suggests, however, that Canadians should be cautious in reaching conclusions and not automatically assume that what takes place in the U.S. naturally holds true north of the border.

The ‘healthy immigrant effect’ debate, for instance, which shows that many newcomers to the country self-report better health than native-born Canadians may mean that immigrants, who are also largely racialized, may not follow the same patterns as seen in the U.S.

What is needed to answer that question, and many others, is access to quality data. And just like personal protective equipment – it is currently in short supply.

Part of the problem in capturing immigrants and racialized groups in health data rests with how they are captured. Health data is largely the domain of provinces and territories, leading to uneven data collection and reporting across them.

When asked if Ontario could offer insights on the pandemic’s impact on racialized communities, Dr. David Williams, the province’s chief medical officer of health, noted that “statistics based on race aren’t collected in Canada unless certain groups are found to have risk factors.”

Ironically, if data are not collected, one cannot tell if a group has risk factors to begin with. This could lead to health inequities for African-Canadian, Indigenous, racialized, and other new Canadians.

That scenario is a big reason why the African, Caribbean and Black Network of Waterloo Region recently launched a petition demanding that data on race, ethnicity, sexual orientation, and socio-economic status be collected and reported on.

Data gap flows all the way to Ottawa

The data-gap is also seen at the federal level too. For instance, the new and innovative crowd sourced survey on the social and economic impacts of COVID-19 run by Statistics Canada measures age and gender but not other demographic features. The same absence is also seen in the Public Health Agency of Canada’s ‘detailed confirmed cases of coronavirus disease’ data, which is hosted by Statistics Canada.

The detailed data does not provide geo-coding or additional information on the location of the cases which means that researchers cannot link it to census tracts or other geographic units to do the kinds of analysis that was done for American communities.

As a result, the maps offered through the interactive Canada’s COVID-19 Situational Awareness Dashboard are fairly coarse. In many cases, more detailed information can be found through non-governmental sites such as ViriHealth. But, once again, sociodemographic characteristics are not provided and the location data is where people are treated over where they live.

Lastly, once Canada begins to move towards recovery, Statistics Canada’s data on job loses and employment can report on immigrants and racialized groups. Much of this data is collected through the Labour Force survey, which is good news. It’s only logical that measures of health and wellbeing be captured with the same level of detail.

If there’s one thing silver lining to Canada’s experience during the COVID-19 pandemic, it’s reinforcing the point that collecting data matters. It’s essential to insure that everyone, regardless of race or ethnicity, is treated equally as citizens.

Source: newcanadianmedia.ca/being-counted-…

Secondly, the Ontario situation by Adam Kassam a Toronto-based physician:

The United States recently earned the unfortunate distinction of having the highest number of COVID-19 cases in the world, at more than 575,000. The true number of infected individuals, of course, is likely much higher given the lack of widespread and available testing.

But in that U.S. data, an alarming trend emerged: The coronavirus appeared to be disproportionately killing African-Americans. Last week, the Centers for Disease Control and Prevention (CDC) released a preliminary report suggesting that there were higher rates of hospital admissions and death among black Americans compared with other communities.

These revelations have intensified a nationwide conversation on the social determinants of health and the necessity to collect better data. The CDC report is far from comprehensive, which has led to presumptive Democratic nominee Joe Biden calling on the organization to be more transparent by releasing more information. Even U.S. President Donald Trump has expressed concern, and instructed his African-American Surgeon-General, Dr. Jerome Adams, to formulate a federal response to address the problem.

This discourse about diversity data and its impact on racialized communities in the U.S. stands in sharp relief against the Canadian experience. Last week, Dr. David Williams, Ontario’s Chief Medical Officer of Health, summarily dismissed calls for the collection of racial data. He asserts that statistics on race aren’t collected unless certain groups are found to have risk factors, and that “regardless of race, ethnic or other backgrounds, they’re all equally important to us.”

We have a problem in this country when Donald Trump sounds more progressive about racial disparities than our own public health officials. Imagine if our Chief Medical Officer of Health claimed that it wasn’t important to collect gender-based data? This would be a fireable offence. It is, therefore, inconceivable that this same official, in the country’s most diverse province, would willfully choose to effectively ignore the unique needs of the nearly four million visible minorities who call Ontario home.

This is the manifestation of structural and systemic biases that have been omnipresent within our medical community for generations. Canada’s poverty of diversity data has been an indefensible blind spot, both in terms of health care and in our educational institutions. It is the symptom of an insidious disease, whose current hallmark is a leadership that looks increasingly less like the communities which it serves.

How else could you explain the dearth of visible minorities in some of the top leadership roles in health care across Ontario? Public Health Ontario’s executive does not appear to include a single visible minority. A visible minority has never served as Ontario’s health minister. And because diversity data of this nature is not collected or made public, we don’t know how many deputy ministers of health, deans of medicine or chiefs of medical departments have represented diverse backgrounds.

In many ways, you only measure what you really care about. Ontario’s Chief Medical Officer has unfortunately made that very clear. Never mind that collecting race-based data wouldn’t be an onerous task; crucially, it is part of good science. Only by intentionally studying diverse populations have we learned that women experience certain health challenges, such as heart attacks, differently from men. In the same vein, disease has been shown to manifest differently for patients from different ethnic backgrounds. It is my belief that all people deserve to know the details of their lives and to know that their lives are worthy of study.

While we don’t know whether racial differences influence COVID-19′s effect on individuals, Canada should be invested in determining this definitively, instead of taking its cues from the World Health Organization.

Early reports from the U.S. have pointed to disadvantaged and marginalized groups – the poor, immigrant, black and brown communities – being more significantly affected, and this has prompted crucial scrutiny of the deep and enduring fault lines between the haves and have-nots. Yet we cannot have those conversations here, as we cannot know whether the U.S. data reflect Canada’s, even though just a border separates us.

In Canada, where we are quick to declare that diversity is our strength, we must now dispense with the empty platitudes and put our money where our mouth is. Our governments should openly commit to funding the collection and publication of diverse health data during and after this pandemic. Their explicit goal should be to create policy that improves the health care of all its citizens. What’s clear is that this ethos will only become a priority when our medical leadership more closely reflects the Canada of today.

Source: Ontario’s lack of diversity data for COVID-19 is an embarrassment: Adam Kassam

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