Your Questions Answered: COVID-19 and Health Equity for Marginalized Populations
On April 9, 2020, DLSPH hosted our third COVID-19 webinar, which explored the health disparities that COVID-19 has exposed among marginalized populations in Canada.
Is COVID-19 the ‘great equalizer’? Many disagree. While all levels of governments are trying to find ways to curtail the virus’ spread, measures like physical distancing, precarious employment and the closure of non-essential businesses have exposed the disparities between various social and economic groups in Canada. The virus is spreading in facilities and communities that are home to some of Canada’s most marginalized people.
Our panellists didn’t have time to address all the audience questions during the webinar. For more answers, we turned to panellists Assistant Professor Angela Mashford Pringle, Associate Director at the Waakebiness-Bryce Institute for Indigenous Health, and Assistant Professor Kate Mulligan, Director, Policy & Communications at Alliance for Healthier Communities.
Have any of you looked at how COVID-19 is affecting people who are incarcerated?
Mulligan: Yes, the Alliance for Healthier Communities is working with the Elizabeth Fry Society, John Howard Society, BLAC and the Ontario Native Women’s Association and has been in direct contact with the Solicitor General’s office and other government ministries on this. We are particularly focused on ensuring adequate health and social care plans for people released on remand.
Mashford Pringle: I have not, but with 33-36% of the federal prison population being Indigenous, I know there have been a number of concerns raised about confinement to cells for 17-20 hours per day as a further imposed penalty in COVID-19. There has been discussion among criminologists and legal scholars.
What are some steps the government and facilities can take NOW to address less privileged high-risk populations? What would help?
Mashford Pringle: For First Nations and Inuit people, providing clean useable (read potable) water for hand washing and laundry would be something that could happen now. There are many First Nations communities who are under boil advisories and do-not-consume advisories. To actually meet the public health messaging, it would be essential to have useable water. Housing is a long-standing issue that will not be addressed in the short-term, however, the federal government should be working with First Nations and Inuit community leaders (not just the national organizations like AFN and ITK) to provide established schedules to increase the number of houses built and how to repair and improve the homes that already exist.
Mulligan: Go to allianceon.org/news for all our latest open letters and advocacy, which set out specific actions we need to see in strategies for marginalized populations. These include collecting and using race-based and sociodemographic data; prioritizing action in group living settings such as shelters, group homes, correctional facilities and dorms for migrant agricultural workers; ensuring safe housing for unhoused people; bridging the digital divide by providing devices and broadband for those who need it; and more.
What are some practical changes that the government needs to make to serve marginalized populations?
Mashford Pringle: Marginalized populations continue to be marginalized with our socio-political-economic policies. To truly provide equality, policies and legislation needs to be drafted in this vulnerable time so that we don’t forget how the landscape (social, political, economic, cultural, legal) looks like when the economy is not used as a barrier. While much of the government resources are focussed on COVID-19, this is an opportunity to explore alternative forms of wealth distribution including but not limited to education, environmental issues, employment, sustainable goals and the reasons that there is a ‘marginalized’ population. Those that are marginalized often face racism, discrimination, unequal opportunities, and are forced into spaces (physical, social, emotional, mental) that further put them at the edges/margins. We could be working on a social justice/practical skills education system for K-12 that would be instilled in September 2020. We could be working on creating policies or laws that put rent control in place or a basic income for all. We could look at more equal access to culturally relevant and safe health services (whether that is health care or tertiary services); providing legislation or policies that require all professionals to take mandatory cultural safety training that requires individual practitioners to look at their power, position and privilege in our current society would be a start. There could be a ‘buy-back’ to publicly held companies, utilities and services much like after WWII. We have seen a steadily collapsing public system being sold to for-profit companies that have little regard for people or environment (all of creation). This could be reversed in this vulnerable time.
Why isn’t there testing capacity in every Indigenous community?
Mashford Pringle: There are not enough test kits in some provinces for the general population, thus, there are less made available to First Nations communities. Indigenous Services Canada has been working on purchasing test kits specifically for First Nations communities, but there will still be an issue with how many tests can be processed in provincial labs.
Could you elaborate on the intersection between differences in how we treat and move in the environment in tandem with public health responses?
Mashford Pringle: We are likely to see more and more novel viruses as climate change is changing the soil, water, and air. There are many academic articles circulating over the past two months that discuss how the environmental/climate changes have contributed to new novel viruses like MERS, H1N1, H5N1, SARS and now COVID-19. To ensure that the environment (plants, trees, animals, birds, fish, insects, soil, water, etc.) is protected, there is a need for policies and legislation that is regulated to protect and improve the environment. For example, cap and trade didn’t (doesn’t) work as one company can sell off their non-use of the environment to a company that is over-polluting, which becomes a net zero in some political circles. However, it’s not a net-zero because depending on the environmental contamination, it can have ripple effects on different interconnected relations (i.e., affects soil, which affects water tables, which will, in turn, affect fish, birds and animals that some people consume). So, there needs to be a review of how using disposable gloves, masks, plastic bags are a public health response to COVID-19 but can do extra harm to the environment over the long run. How will these materials be recycled? Will we have an overabundance of waste that isn’t able to be recycled?
Mulligan: COVID-19 began in human-environment interactions, particularly at the suburban and periurban edges of cities. See e.g. https://theconversation.com/outbreaks-like-coronavirus-start-in-and-spread-from-the-edges-of-cities-130666. Urban planning can play a strong role in preventing zoonotic disease transmission if it is informed by an ecological public health approach. While in isolation, more people are recognizing the importance of regular time in nature for individual health and wellbeing – something we have worked on a fair bit through social prescribing for nature and community gardening (https://blogs.scientificamerican.com/observations/more-time-out-in-nature-is-an-unexpected-benefit-of-the-covid-19-sheltering-rules/). As we think about bouncing forward, we have the opportunity to focus on just transitions over bailouts of resource extraction giants, a reconsideration of how much we need to travel, and a green approach to any new policies and developments.
Given what seems like a reactive approach to the pandemic, what can we do know to ensure the voices of vulnerable people are heard? What needs to happen? Are you or another group demanding better data from governments on COVID by gender, race, disability and other social locations?
Mulligan: Yes, the Alliance is putting all we’ve got into this. While we’ve been vocal since the beginning of the pandemic (and before), the reality is now catching up with the predictions. We are seeing it unfold in real-time – all three health care workers who have died from COVID-19 are racialized people, for example, and thousands of people have joined the call for race-based data; migrant worker dorms and refugee shelters are seeing outbreaks, more people are overdosing without their usual supports and services, and so on. This is beginning to make the health equity argument more salient for decision-makers.
How do we sustain efforts to effect systemic advocacy changes (i.e. housing and harm reduction gaps right now in most of our urban communities)?
Mulligan: Teamwork and partnership go a long way. We work with partner organizations and amplify their work so as not to duplicate the work or burn out.
Kate mentioned synergy – how do we transform the health infrastructure itself to support a response that amplifies the voice of the people who are at risk? How we do coordinate between the systems?
Mulligan: The promised Action Plan for Vulnerable People will bring together considerations from across Ministries, which is a good start. We have not seen any details of this plan yet; the key is to have diverse voices and expertise at decision making tables, equipped with data and informed by front line providers and communities.
Are there any specific policies (not directly related to COVID-19) being enforced (or rejected) that are flying under the radar at the moment?
Mashford Pringle: Likely. EPA standards in Ontario are not being enforced during COVID-19. This will mean that projects in the Ring of Fire area are likely moving forward now and in the foreseeable future that will harm the environment including plants, trees, animals, fish, birds, and other ripple effects toward humans as well.
Mulligan: We continue to watch closely the policies related to the enforcement of physical distancing. Other jurisdictions have fared well without fines, policing or inequities in enforcement.
How can people advocate for those on ODSP regarding financial inequity? Many of my friends on ODSP are disheartened that they do not qualify
Mulligan: There have been a few updates for people on ODSP since the webinar. Emergency benefits and changes to clawbacks should help. But the reality is that the Canadian Emergency Response Benefit provides more than either OW and ODSP. So clearly, it’s not really possible to live long-term on OW and ODSP at current rates. This pandemic may illustrate that for more people who are now getting by on CERB.
Before the pandemic, the Ford government made some significant cuts to public health in Ontario. How do you think these cuts may have exacerbated the current crisis?
Mashford Pringle: Having seen the SARS response, I think the Ford cuts didn’t help, but I think the lack of past and current governments who have not implemented the recommendation to have a Centre for Disease Control (CDC) in Ontario was part of the issue. BC has a CDC and they smashed their curve in less time and without the mass fatalities that Ontario and Quebec had. All provinces were to work to have Influenza Pandemic Plans (which Ontario had), but since there have been no drills of the plan, it was words on paper that few bureaucrats had probably even heard of or had seen. The plans need to be regularly updated and mock drills should be running to ensure that appropriate PPE and other resources are in place. In addition, there are segments of Ontario’s health care system that require review. For example, nurse practitioners (NP) in the province of Ontario can only work in health access centres. According to NPAO on May 5, 2020, NPs do not require physician supervision as they are regulated by CNO. These NPs could have provided another level of triage and assistance if they had a regulatory body and were able to practice as GPs do.
Mulligan: The biggest proposed cuts didn’t happen. They were shelved pending additional consultations. The province did move to a 75:25 funding split with municipalities, which hit some harder than others. The conversation about longer-term “modernization” of public health is now paused and likely to change significantly as a result of COVID-19.
What risk planning can be done for persons working in essential activities in remote locations without medical facilities available? For example, persons involved in research, mining, energy, and research activities in the extreme north/arctic.
Mulligan: These settings are expected to be covered in new guidance for PPE and vulnerable populations. The Ministry of Health says it has reviewed different categories of essential work to guide in triaging personal protective equipment etc.”
Watch the webinar here: