February 21, 2021 Ottawa (Ontario) Public Health Agency of Canada
In my October 2020 Annual Report on the State of Public Health in Canada, I looked at how the COVID-19 pandemic has impacted the health, social and economic well-being of people in Canada. The findings were troubling but not unexpected - while COVID-19 has impacted all of us, these impacts have been worse for some groups, including racialized communities.
When we look at outcomes related to COVID-19, it is clear that race matters. Although race-based data are not consistently available across all of Canada, local sources indicate that racialized communities are being disproportionately impacted by COVID-19. For example, surveillance data from Toronto and Ottawa indicates that COVID-19 cases are 1.5 to 5 times higher among racialized populations than non-racialized populations in these two cities. Data from First Nations peoples living on reserve also point to higher rates of infection with SARS-CoV-02 compared to the general population (currently 69% higher). These trends are not unique to Canada; evidence from other high-income countries, such as the US and the UK, also indicate a higher impact of COVID-19 among racialized communities.
These disproportionate impacts among racialized and Indigenous communities are not due to biological differences between groups or populations. Rather, they reflect existing health inequities that are strongly influenced by a specific set of social and economic factors - things like income, education, employment and housing that shape an individual's place in society. These factors are commonly referred to as the social determinants of health. For certain groups, such as Indigenous peoples, racialized communities, and LGBTQ2 Canadians, experiences of discrimination, racism and historical trauma are also important social determinants of health.
Members of racialized communities are more likely to experience inequitable living and working conditions that make them more susceptible to COVID-19, such as lower incomes, precarious employment, overcrowded housing, and limited access to health and social services. Many face increased risk of exposure to COVID-19 due to their employment in front-line essential occupations with frequent contact with other people and a limited ability to work from home. For example, many of the care providers in long-term care facilities in large Canadian cities are racialized women. Racialized employees also make up a large component of workers in our agriculture and food production system. The working conditions in these facilities, often coupled with higher risk living conditions at home, put these employees at an increased risk for COVID-19.
Our history matters
Both the direct and indirect impacts of COVID-19 in Canada have been worsened by systems that continue to perpetuate racism, ageism, sexism, and homophobia, in addition to other structural or social factors that further marginalize, such as homelessness. It is important to recognize that these are historical inequities that have existed within Canadian (and indeed other national and international) systems and institutions over many generations.
As the original inhabitants of Canada, Indigenous peoples are a recognized sovereign people in Canada. However, to this day, despite this unique relationship with the Crown, they face ongoing inequities. Historical drivers at the root of these inequities include unequal racial power dynamics created by colonization and reinforced by ongoing colonialism; forced removal from traditional lands, the creation of the reservation system; the residential and day school systems, the 60s Scoop, and the disproportionate rates of child apprehension and incarceration. These disruptions and injustices have resulted in intergenerational trauma and real inequities that lead to vulnerabilities.
The treatment of Joyce Echaquan, a woman of the Atikamekw Nation, by our healthcare system is a grim reminder that these issues are far from resolved. It is a reminder that although Joyce's story is in the forefront there a many other personal accounts of mistreatment of Indigenous people utilizing the system of care today.
There is also a long history of racism and discrimination against Black communities in Canada which is perpetuated by racial power dynamics from slavery and colonization; forced removal from traditional lands; social, educational, residential, and occupational segregation and race-based stereotypes. For example, the United Nations recognizes the distinct and unique experience of African Nova Scotians, as one of the oldest and largest Black communities in Canada, and yet many of these communities continue to experience inequities and disparities in health which are further exacerbated by COVID-19.
There are troubling examples of anti-Black racism that continue to this day within the Canadian health care system, particularly involving racial bias on the part of health professionals and systemic racism within institutional practices. This is compounded by the low proportion of Black health care practitioners in Canada.
This continued generational systemic racism and mistreatment within the health system has led to considerable wariness within racialized communities, and a significant lack of trust in these systems and institutions. This lack of trust has contributed to significant COVID-19 vaccine hesitancy among the Black and Indigenous, as well as other racialized communities.
Protecting racialized populations: Government and community action
It is critical that we work to eliminate racism in our workplaces, education, health and social systems. At the same time, we must support priority populations and help protect them from COVID-19.
Immunization of at-risk populations has the potential to reduce or prevent the exacerbation of immediate health inequities related to COVID-19. The National Advisory Committee on Immunization (NACI) has already identified the need to prioritize vaccinations for those whose living or working conditions put them at elevated risk of COVID-19 where infection could have disproportionate consequences, including Indigenous communities. Just this week this guidance was updated to additionally prioritize adults in other racialized and marginalized communities disproportionately affected by COVID-19 in the second phase of national vaccine roll-out.
I have been following the remarkable progress being made within communities to increase trust and access to COVID-19 vaccines as we ramp up vaccination roll-out. Community-based organizations, leaders, and members are supporting their communities in a variety of ways, working to build trust, providing culturally appropriate advice and messaging, and countering misinformation. These initiatives take into account the lived experiences of these communities. There are many striking examples:
- First Nations in Manitoba have been working with provincial public health officials to prioritize traditional healers and knowledge keepers in the allocation of vaccines;
- The Cowessess First Nation in southern Saskatchewan has been working with an Indigenous-led health research lab, Morning Star Lodge, to provide vaccine information to the community and answer community members' questions;
- Several First Nations Chiefs in the Yukon have set examples for their community members by being the first in line to receive a COVID-19 vaccine;
- Toronto's Black Scientists Task Force on Vaccine Equity, made up of many of Canada's leading Black health experts, are hosting a series of virtual town hall meetings to help counter distrust and misinformation around vaccines using an empathetic approach; and
- The Health Association of African Canadians and the Association of Black Social Workers in Nova Scotia have organized COVID-19 response teams and regularly host town hall community meetings that have included Nova Scotia's deputy chief medical officer of health, and other health professionals of African descent to educate, inform and support the communities and create a level of trust around the importance of vaccination.
Health equity saves lives: How all Canadians can help
An important first step for all of us in improving health equity is to acknowledge and address underlying inequities racialized populations face. We can all work towards reconciliation and a better, more equitable future by considering and continuing to monitor our own potential biases. Biases can hold policies and practices in place that perpetuate power dynamics and withhold resources from those who may need them the most.
Moving forward, it will be crucial that we prioritize the collection and analysis of race-based data across the country and follow culturally-responsive data collection, management, and reporting standards and practices when doing so. We need this information to understand where and how people are most impacted so that we can take public health action to better serve those people. It's been encouraging to see the addition of race as a variable in the COVID-19 National Case Data Dataset this past fall. Provinces and territories are now at various stages of collecting and reporting race-based data and we continue to work together at all levels of government to move this work forward. Collectively pressing for more equitable health services and action to improve the social and economic conditions for racialized Canadians is important; and quality, detailed data are needed to help us do so.
To boost vaccine acceptance within racialized communities, we must start by acknowledging the reasons for their mistrust of medicine and of the health system. We need to listen to their concerns and connect racialized communities with accurate and accessible information. It is important that people feel a sense of empowerment and control over their own health and their own decisions. Racialized communities must be intentionally engaged as a partner in the process of distributing and administering a COVID-19 vaccine, educating people about it, and encouraging uptake. As we have already seen, community leaders can be instrumental in creating trusted community access points and helping to allay fears and the spread of misinformation.
We must address inequities in COVID-19 risk. This means recognizing that we do not treat everyone the same. Someone with more risk may need more support. During this pandemic, those at greater risk need to be vaccinated first. By protecting those who are at greatest risk, including members of racialized communities, you are protected.
You have heard me say this before, but I do feel it cannot be emphasized enough-we're all truly in this together - no one is protected until we are all protected.
