There are more Black people living in Toronto neighbourhoods that have the highest number of novel coronavirus infections — indicating that there are health inequities impacting those communities due to anti-Black racism, experts told Global News.
Worse health outcomes for Black people have only been exacerbated by the coronavirus pandemic, and more robust data is needed to fully understand how COVID-19 has disproportionately impacted Black people specifically, they said.
Global News analyzed Toronto demographic data alongside new data about which neighbourhoods in Canada’s most populous city have the most coronavirus cases.
The analysis found a strong association between high coronavirus rates and low income, conditions of work, visible minority status and low levels of education. There was an even stronger association between neighbourhoods with a high number of coronavirus cases and those with a higher population of Black people.
The findings for Toronto mirror similar findings for neighbourhoods in Montreal. Data published by the City of Montreal showed that immigrants, refugees and lower-income people live in the hardest-hit regions.
And these demographic characteristics are not limited to Canada. New York, one of the most severely impacted cities globally by COVID-19, has higher death rates in poorer neighbourhoods. Black and Hispanic people living in New York City are also twice as likely to die from the virus, compared to white people, according to data from the city.
New data this month from the APM Research Lab, a Minnesota-based research and analysis firm, found that Black Americans are dying of COVID-19 at a rate that’s three times higher than white people. Their analysis found that one in 2,000 Black people in the U.S. has died from the virus so far.
In Canada, while Manitoba, Ontario and Toronto have committed to collecting data on how race has impacted racialized communities, that data hasn’t been released yet. The federal Public Health Agency of Canada has discussed collecting the data, but no firm commitments have been made.
It’s crucial when examining Toronto neighbourhood data on coronavirus cases that it’s understood why these disparities exist in the first place — which is systemic racism, said Dr. Onyenyechukwu Nnorom, a public health physician and assistant professor at the Dalla Lana School of Public Health at the University of Toronto.
“Specific to the Black community there are so many layers of what we are experiencing, but it is all anchored in anti-Black racism,” said Nnorom.
“For us in Canada, it’s very historical, tracing back to slavery that we had here in Canada. Anti-Black racism is embedded in our intuitions. So what Black communities are feeling is an amplification of what we were already experiencing.”
There are multiple layers and intersections of discrimination that all compound into a population facing worse health outcomes, she said. Global News’ data analysis illustrates some of those layers.
Denser, lower-income neighbourhoods
By looking at income levels, Global News found coronavirus infection rates in Toronto had a strong association with low-income neighbourhoods.
- Neighbourhoods with the highest number of households that had after-tax household incomes from $20,000-40,000 and $40,000-60,000 have the strongest positive association with coronavirus rates.
- As incomes get higher, the relationship weakens. At $60,000-80,000, it’s diminished, and at $80,000-100,000 it’s no longer detectable.
- And over $100,000, the relationship reverses: the more households over that level, the lower the infection rate.
Nnorom points to the U.S. Centers for Disease Control and Prevention (CDC), which has outlined factors that impact the health of racial and ethnic minorities in the country.
One factor is living conditions, characterized by poorer neighbourhoods that have more densely packed housing where it may be hard to practise social distancing.
It’s more difficult to isolate more vulnerable family members or quarantine sick family members in smaller living quarters as well, the CDC notes.
“It’s not because people who are racialized enjoy living in a densely populated context; it’s because poverty in this country is racialized,” Nnorom said.
This is because people who are Black, along with other visible minorities, may take on precarious work due to discrimination in the job market. A report released in February this year by Statistics Canada found that 13 per cent of Black people found they were discriminated against in the hiring process, compared to six per cent of non-Black people. The study also found that young Black males were twice as likely as non-Black males to be unemployed, and not in an education or training program.
“You end up taking on service industry jobs or you end up unemployed. But all of those contribute to living in situations where you can’t socially or physically distance. It leads to some people feeling that they do need to put their lives at risk,” Nnorom said.
Black people may end up working front-line jobs where they are less valued and where they don’t have adequate access to personal protective equipment like masks, she said. These communities also rely on early morning public transit to get to work on time, putting them further at risk.
Neighbourhoods where many people said they were members of a visible minority had higher coronavirus rates. The strongest association Global’s analysis could find was with people who identified as Black.
Global’s analysis also found links between coronavirus rates and work circumstances.
There is also an association between coronavirus rates and the number of adults in a neighbourhood with no degree, diploma or trade qualification.
Along with work conditions that put people in these neighbourhoods at risk, there are often underlying health conditions in Black communities that predispose them to dying, explained Nnorom.
“It’s not due to a genetic difference between Blacks and whites, it’s due to the inequities that Black and racialized people experience, such that there’s an extra stress from everyday racism that predisposes us to chronic conditions,” she said.
Anti-Black attitudes embedded in Canadian health care shut people out of the system and prevent them from getting the care they need, she said.
A 2017 report called Black Experiences in Health Care by the Sinai Health System in Toronto outlined the need for race-based data collection and the experiences Black people have in Ontario’s health-care system.
The report found that hospitals need to be continuously thinking about how to tackle health inequities and move to create policies that prevent discrimination in all areas of health care.
Another report from 2017 by the Ontario Ministry of Health and Long-Term Care describes a young Black male patient who went to the emergency room in pain and wasn’t believed until he threw up on himself, and they found he had a massive blood clot.
“One time I was yelling for help and they called security and security threatened to call the cops because I was irate about a lack of care,” the man said in the report.
Only people within these communities notice that these incidents are happening on a daily basis, said Nnorom.
Higher unemployment rates and underemployment rates in Black communities across Canada also mean there are higher food insecurity rates in these communities, and that directly impacts physical health as well, said Paul Bailey, president of the Black Health Alliance, a charity focused on the health of Black Canadians.
“Data has shown in the national context when you start to combine income, access to education, food security, that then leads to increased risk of certain types of chronic diseases, diabetes, cancer, et cetera….pre-COVID, this was already the context lots of advocates are working on,” he said.
“When you insert a pandemic it only exacerbates the existing conditions,” he said.
Continued calls for race-based data collection
This data around neighbourhoods is confirming what is already well known — that infections like the coronavirus impact people who are the least healthy and are in poverty so are unable to protect themselves, said Kwame McKenzie, chief executive officer of the Wellesley Institute, a research and policy think tank that works to improve health equity in the Greater Toronto Area.
“This data to me is exactly what you’d expect. The reason I want the data now is to be able to see whether we have a response that makes a difference,” he said.
Knowing that these populations in specific neighbourhoods are being impacted is important, but there needs to be a strategy that’s developed from this information to get rid of disparities, he said.
While race-based data collection around the coronavirus is starting to happen, Canada is behind, and these initiatives should have begun when the pandemic started, said McKenzie.
Governments should really sit down with vulnerable populations and ask them directly what they need to keep them safe, he explained.
“It may be that we need new interventions because the old ones don’t work. It may be that we tell people to social distance… but we have overcrowding in apartments. Then, we have to be thinking of what help we can give people,” he said.
“We should be doing that now.”
If some neighbourhoods are more at risk, then the entire city becomes more at risk, and this is why governments should be reaching out to these areas to support them, McKenzie said.
“But the first thing is to make sure we know what’s going on, so testing, tracing and giving people the information, and then working with communities to produce real alternatives,” he said.
“These things are not expensive compared to lives being lost.”
Data needs to be collected, otherwise there’s no way to understand the depth of the issues you’re facing, said Bailey.
“Not addressing these things at the front end means that all of us are at increased risk,” he said. “So the fact that it’s an afterthought is egregious… let’s collect this data in the appropriate ways where we can make specific connections between things and then adequately address that upfront so that when the second wave does hit, we’re actually prepared for whatever emerges.”
Questions about COVID-19? Here are some things you need to know:
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out. In situations where you can’t keep a safe distance from others, public health officials recommend the use of a non-medical face mask or covering to prevent spreading the respiratory droplets that can carry the virus.
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