Black health: Will the pandemic spark change?

Health inequities have been exacerbated by COVID-19. Many don't want a return to 'normal' after the pandemic.

Sadaf Ahsan April 30, 2021
black health covid-19

-A pedestrian wearing a mask walks past signage for a vaccination clinic in Toronto, Wednesday April 28, 2021. Peter J Thompson/National Post

The line of people stretches on forever.

Dr. Naheed Dosani, a palliative care physician, shared a video to Twitter last week showing people lined up for the COVID-19 vaccine in Scarborough. Some lean on the guard rail separating the sidewalk from Firvalley Woods, others have brought along camping chairs and blankets, coffees in hand, preparing to wait as long as it takes, no matter how chilly it gets.

The area is in one of the government-designated hotspots as Ontario struggles with a third wave and attempts to focus on vaccinating residents in postal codes that have seen an explosion in infections. Dosani’s message? “The lineups in Scarborough are a reminder that racialized [and] low-income communities want vaccines. They just lack access because of an inequitable vaccine rollout … Reallocate vaccines to hotspots or people will die.”

Since March 2020, Canada has been fighting two pandemics: COVID-19 and racism, the latter predating the birth of this country. But tragedy, including deaths incurred by a virus and at the hands of police, have led to a racial reckoning and placed health equity under a much-needed microscope. The question is, will it be enough to lead to sorely needed change? Or will there be a return to “normal” that many members of the city’s Black community would rather not see?

Amid a summer that saw the resurgence of Black Lives Matter after the police killing of George Floyd in Minneapolis, data from the city began to show that the COVID-19 pandemic has had a disproportionate impact on Black people. They and other people of colour make up a staggering 76 per cent of reported COVID-19 cases in Toronto. More specifically, Black people make up 12 per cent of reported cases in the city and 16 per cent of hospitalizations while accounting for only nine per cent of the overall population.

Why the hit to the racialized is so hard
Many of the people currently working in the care sector or taking on precarious work are women of colour. They not only face lost jobs and reduced wages, but there are also matters of housing insecurity, food security, and lack of access to sick leave.

Toronto Public Health first called for a provincial paid sick program a year ago in May 2020. While Progressive Conservative MPPs have repeatedly voted against paid sick days, after a barrage of criticism, the government recently announced that workers would be eligible for three paid sick days. This, even though many health units require those infected with COVID-19 to isolate for 10 days.

“Unfortunately, [COVID-19] has had a greater impact on those in our community who face greater health inequities,” Dr. Eileen de Villa, the city’s medical officer of health, said in a press conference last June.

Health inequities also extend to the systemic differences in access to resources and care. According to the World Health Organization, “social factors, including education, employment status, income level, gender and ethnicity have a marked influence on how healthy a person is.”

Access is about being able to walk through the door
Paul Bailey, executive director of the Black Health Alliance (BHA), says that when it comes to accessing health services, it’s not just about finding the door and being able to walk through it, but about the treatment that people receive once they’re through that door.

“On a day-to-day basis, people are facing anti-Black racism,” he says. “We also have folks that may have had really negative experiences in healthcare environments, and then they’re less likely to return when they need to. You see it in them just having to dress up before they go to the emergency room when they’re in pain because they don’t want to be perceived as somebody who is abusing drugs.”

According to the BHA, Black Canadians in Toronto often face “service deserts” as well — a lack of safe, affordable and effective healthcare and community services.

One only has to look at the location of the pharmacies that first offering vaccines — the five neighbourhoods with the highest COVID-19 cases were in the northwestern part of the city, including parts of Rexdale and Black Creek, which are home to large Black and South Asian communities. Yet, up until this April, not one had pharmacies providing vaccines, and many of those that are now offering them are independent locations with limited capacity.

Scarborough, a region that has 17 postal codes representing hot spots, has felt that scarcity too, with Scarborough Health Network having closed its vaccination clinics at Centennial College and Centenary hospital in mid-April due to a lack of supply, thereby cancelling 10,000 scheduled appointments. This same region faces a lack of reliable public transportation, with what could be a 10-minute drive becoming a one-hour commute on an overcrowded TTC bus. It leads to a domino effect: the inability to easily reach health services is discouraging, decreasing trust in the system and making it more likely that sick people won’t seek care.

“There are a lot of intensified health problems happening in our communities based on continued anti-Black racism,” says Roberta Timothy, principal investigator on the Black Health Matters: National and Transnational COVID-19 Impact, Resistance and Intervention Strategies Project, and a University of Toronto professor of public health. “Black and Indigenous communities are grieving because of all of this. Most have lost someone to COVID-19. That, and police brutality, is costing us in terms of mental health impact, anxiety, depression, trauma. People are isolated and afraid to go to hospitals.”

covid health inequities

Health-care workers care for a COVID-19 patient in the ICU who is intubated and on a ventilator at the Humber River Hospital during the COVID-19 pandemic in Toronto on Wednesday, December 9, 2020. THE CANADIAN PRESS/Nathan Denette

And that lack of trust comes at a huge cost.

The term “vaccine hesitancy” has been thrown around frequently in recent months to account for lower vaccination rates in parts of the city that are home to Black Torontonians and other racialized communities. The World Health Organization defines “vaccine hesitancy” as influenced by “complacency, convenience and confidence.” And while that may be true for some, it’s been associated most with marginalized people — minus a tremendous amount of context.

Timothy, who isn’t a big fan of the term, says it’s important to understand what it’s rooted in.

“That mistrust comes from a logical place if you think about the harm that has been caused to people and how they don’t want to go back to it,” she explains. “Lots of folks want to get the vaccine and are quite aware that they need it. But the government and most public health organizations have not come out with a plan or even a statement on how to heal the past impact of anti-Black racism.”

She looks back to last March, when the rumblings about vaccines began.

“I remember pleading, ‘If you’re talking about the beginnings of a vaccine at this point, and you’re not talking about the historical realities of health violence in our communities, there has to be some kind of conversation or apology acknowledging the distrust in the community.’”

The fires of distrust were fanned when Ontario Premier Doug Ford accused Indigenous MPP Sol Mamakwa of “jumping the line” to get the vaccine after he travelled to Muskrat Dam and Sandy Lake First Nations in his riding in March to get publicly vaccinated in order to encourage his community to do the same. Ford later apologized, while Mamakwa noted that it was unfortunate the premier didn’t use his message to be actively inclusive and instead expressed the exact kind of “colonial sentiments” communities of colour are trying to push against.

“There was no survey, no polls, because they have a problem with collecting data about us, but they went ahead and said, ‘okay, vaccine hesitant!’” says Timothy. “They’re saying Black and Indigenous communities don’t want [the vaccine], but they’re also not giving us priority or support, which is a problematic dichotomy. So we are our own responsibility.”

That responsibility looks largely like community organization, or mutual aid, which is a voluntary exchange of resources where people work together to meet each other’s needs. While this concept has been getting considerable press during the pandemic, it has existed for, well, ever.

“Cooperative economics have been around in our world since we began in order to thrive,” explains Caroline Hossein, associate professor of business and society at York University, and founder of the Diverse Solidarity Economies (DiSE) Collective. “When survival is being threatened, or people are being harmed or excluded, what we do is group together and bond over a common cause to mitigate those harms.”

This drive to support one’s community functions like an evolutionary mechanism born from where people are rooted, Hossein says. For westerners of African descent, then, it finds its roots in colonization and the Underground Railroad, and an intuitive sense of “resourcing funds from within.” Today, these groups often share the same socioeconomic status, which builds trust and reciprocity.

“When [people have] been harmed in mainstream society, they know that there’s a group of people who understand that and will lift them up,” says Hossein. “They’re also suspicious of subsidies and external resources, because they fear the kinds of oppressions that might follow them. It’s a politicized action to do things on your own terms.”

Collectivity is present in local mutual aid efforts, like Community Fridges Toronto and the Black Lives Matter’s Canada Black Mutual Aid Fund, which was announced in February and has so far raised enough to provide for the needs of 1,080 Black individuals and families through $250 microgrants. The support also extends to mitigating the COVID-19 crisis: Toronto’s Jane and Finch community, which had one of the highest infection rates and lowest vaccination rates, has seen volunteers and community health organizations mobilize, leading to massive lines at a recent pop-up clinic.

Today, Timothy is hopeful systemic change will come, but for it to happen, everyone must be involved.

“Black people are trying to thrive and heal from the grief and violence that we experience on a daily basis, while also talking about how we can dismantle white supremacy, which we’ve continued to do through generations,” she says. “But there’s only so much that we can do as Black, Indigenous and racialized folks. It’s up to the white population that has been benefiting from white supremacy to do their work. They have the power to disrupt the systems they created to benefit themselves.”

Change for an equitable future
Some of the changes necessary to see a more equitable future include more Black and Indigenous doctors and more minority-focused data. About 4.7 per cent of Ontario’s population is Black, while, according to Statistics Canada, but only 2.3 per cent of doctors in all of Canada are Black.

And there’s the issue of what medical students are taught. Advocates say the Canadian curriculum — from high school to medical school — needs to be decolonized. That means educating students on the history of racism and public health, rather than shying away from it. Such a curriculum can include everything from police brutality to understanding the high risk of complications during pregnancy for Black women due to the ignorance of Black pain, to pivotal moments in history like the Tuskegee Syphilis Study — which enrolled African American men in a study on syphilis based on a false promise of free healthcare — eugenics campaigns, how the Black Panther party fought against medical discrimination, and the list goes on.

Decolonizing healthcare as a whole also means offering support for Afrocentric ways of healing and spaces that reflect cultural beliefs and practices, like community healing circles,expression therapy classes and mental health workshops. And when it comes to mainstream health services, experts say there needs to be set disciplinary practices when incidents of racism take place. Without consequences, there can be no change.

“When people say, ‘I can’t wait for life to go back to what it was,’ I don’t want it to go back to what it was for our communities,” Timothy says.

“If we can think of a post-COVID-19 world that is a real place of health equity, of inclusion, of anti-oppression, of decolonized practices, of treating people with goodness, then we need to dismantle this idea of returning to ‘normal’ and look at how we can move forward in a way that Black, Indigenous and racialized people can actually experience good health.”

Sadaf Ahsan is a Toronto-based culture writer, editor and stereotypical middle child. She can be reached here.

 

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