Public Policy Responses to the Pandemic, and Building Back Better

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

-Lofters, A. (2021, February 22). Ontario’s health-care system must develop an anti-racist response to COVID-19. First Policy Response. https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Ontario’s health-care system must develop an anti-racist response to COVID-19

FEBRUARY 22, 2021

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Published as part of a collaboration between TVO.org and First Policy Response

Over the past year, the COVID-19 pandemic has had a profound impact, with more than 100 million cases and more than 2.4 million deaths worldwide. But despite what feels like the universal nature of the pandemic, not all of us have been affected equally. After months of community advocacy, public-health officials, researchers, and policy-makers finally started to look at the impact of COVID-19 on racialized people. The results were striking, although sadly not surprising. In Toronto, by the end of December, it was reported that nearly 80 per cent of people with COVID-19 were racialized. To put that in perspective, only 52 per cent of Toronto’s population is racialized.

Racialized people in Ontario are at higher risk of COVID-19 because they are more likely to be “essential workers” who cannot work from home and less likely to be able to take paid sick leave, physically distance, or receive adequate protective equipment in the workplace. Our system’s response to the pandemic has too often ignored, trivialized, and been slow to protect these groups, leaving them at ever higher risk of infection. We also have to ask about the why behind the why. Why are racialized people more likely to be in these precarious working and living situations? Because this is one of the many ways in which systemic, long-standing racism manifests. Racialized people are not genetically engineered to be precarious workers and did not end up on the lowest rungs of the social ladder by chance. Societal structures that play out in education, employment, housing, and other areas disproportionately push racialized people into these positions.

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

Aisha Lofters is a family physician and researcher at Women’s College Hospital and the University of Toronto. She is the chair in implementation science at the Peter Gilgan Centre for Women’s Cancers in partnership with the Canadian Cancer Society.

-Bhimani, Z. (2020, November 5). For more equitable health outcomes, start with the health-research system. First Policy Response. https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/

https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/

Zahra Bhimaniis a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

-Sinha, S. (2020). Underfunded long-term care system is still vulnerable to COVID-19 outbreaks. First Policy Response. https://policyresponse.ca/underfunded-long-term-care-system-is-still-vulnerable-to-covid-19-outbreaks/

https://policyresponse.ca/underfunded-long-term-care-system-is-still-vulnerable-to-covid-19-outbreaks/ This interview with Dr. Samir Sinha, director of health policy research and co-chair of theNational Institute on Ageingat Ryerson University, is part of a series of interview transcripts. You can read the full serieshere. This transcript has been edited for clarity. First Policy Response: As of May, the National Institute on Ageing was reporting that more than 80 per cent of COVID-19 deaths in Canada were in long-term care homes. Is that still accurate at this point? Dr. Samir Sinha: Yes. Towards the end of March, we launched what we call ourNIA Long-term Care COVID-19 Tracker. It’s available online and we continue to update it to this day. By May, or at the height of the pandemic, if you will, we were even up as high as 82, 83 per cent of Canadian deaths that occurred in long-term care settings. By the time the Canadian Institute for Health Information did ananalysistowards the end of May looking at our data, they confirmed about 80 to 81 per cent. Right now that number is about 77 per cent of Canadian deaths that have occurred in long-term care homes. So the number is decreasing a little bit, but it’s staying around the 80 per cent mark, and this reflects that more younger people are now becoming infected. And certainly younger populations, with the second ripple or second wave that’s starting to develop across the country, we’re starting to see more deaths occurring outside long-term care homes in the general population, as well. But the bottom line is that Canada still holds this record of 77 per cent or close to 80 per cent of its deaths occurring in our long-term care homes. And that’s about double what we’re seeing on the international stage. FPR: Why do you think that is? I think there are two fundamental reasons why we’ve actually been seeing such a high proportion of our deaths occur in long-term care homes. The first part is good news: Canada did a really, really good job early on in the pandemic, as cases were starting to climb in Canada, to actually take some definitive public health measures to lock us all down, essentially, and limit our ability to travel and interact, and close our borders as well. And by doing that, we helped to significantly limit the rate of community spread that could potentially occur, that we had seen become real issues in places like the U.K., Spain, Italy, etc. And so, because we had fair warning compared to some European countries, for example, we were able to heed those warnings and close our borders, create our lockdown situation early, which helped to limit the amount of community spread and the number of cases and deaths. And overall we’ve seen only about 1 per cent of Canadians in total have actually been infected, probably, with COVID-19. The challenge is that, when it came to the way that we were preparing ourselves in our health-care system, a huge amount of focus was placed on our hospitals at the expense of our long-term care and our retirement-home systems, which really in the end were not well equipped and well supported enough to deal with COVID-19. So even though COVID-19 was circulating in the communities, we weren’t making sure that all of our long-term care homes were fully equipped with personal protective equipment. While we assumed that our staff in these homes knew how to follow IPAC [Infection Prevention and Control] procedures and use their PPE, this wasn’t quite the case. And then we already had a system that was plagued with staffing shortages and issues. And as COVID got into homes and spread easily – because we weren’t aware early on of the possibilities of asymptomatic spread and transmission – staff weren’t equipped with enough PPE and we already had severe staffing shortages to begin with. As soon as COVID started taking effect in these homes, this just exacerbated all these problems even further, and especially in provinces like Ontario and Quebec, really set us off on a wrong foot overall. FPR: What does that tell us about the long-term care system in Canada? I think what it really exposed to us is that, when we think about how Canada did compared to the rest of the world, we could say, yes, some of our high case numbers or rates of deaths in these settings was partly related to the fact that we actually had done a reasonably good job of limiting the amount of general community spread. But you know, when you’re double the international rate of deaths in long-term care homes, it also speaks to the fact that COVID-19 exposed how vulnerable our long-term care system was to begin with. So when you look at OECD [Organisation for Economic Co-operation and Development] countries, in general, which experienced half the rate of deaths in its care homes that we did, what we see is that we spend 30 per cent less on providing long-term care services in Canada compared to other OECD countries. We’re already funding significantly less as a proportion of our GDP compared to other countries, only 1.3 per cent versus 1.7 per cent on average. So that’s the first challenge. And then, when you underfund an entire long-term care system, it means that we have staff who aren’t paid as well as those who are generally working in our hospitals, for example. And we also have the challenge where more people tend to work part-time in these settings than, say, in other health-care settings, and as a result, to try and make a full-time salary, people are working multiple jobs in multiple settings. All of this means that if you have infection in one home, when staff are working between multiple homes, they could inadvertently become vectors to transmit this virus from one home to the other. So when you underfund the system, it affects the level at which we staff these homes. It also affects the resources we actually provide these homes to provide the care that residents need. And it really just exposed the fact that we had these systemic vulnerabilities – that not only were we having challenges staffing and making sure that homes have the resources they did, but we also see this phenomenon in Canada, compared to many other countries, where in Ontario, for example, a large portion of the rooms happened to be two-, three- or four-bedded rooms, where in many other jurisdictions, they moved to an all-single-room format. The problem is, if you move to all single rooms, that’s a much more expensive home to build than packing people two or three or four to a room. And so again, when you underfund the system, you’re going to have poor-quality facilities and many older facilities that are vastly in need of redevelopment, but also a system that can’t actually even attract the basic staff it needs to keep these homes properly staffed and supported, especially during a pandemic. FPR: Was it a surprise to you, how much higher the rate was in Canada compared to the rest of the world? It was. I mean, the data doesn’t lie. And when you see that Canada has such a high rate of death in long-term care settings, especially when we had other countries that had significant community spread but their long-term care settings seem to fare better, we started realizing what other countries were doing and what we weren’t doing, and it reinforced how our approaches were not well balanced in Canada. For example, other countries, realizing that their long-term care homes or settings were highly vulnerable settings, were making sure that they actually increased the staffing in those settings. They were making sure that homes had adequate supplies of PPE. They were making sure that staff in those homes were having their skills augmented in terms of how to use PPE, and making sure that they were well versed in their infection prevention control efforts. And in some jurisdictions, they had developed early response teams, so that if a home did go on outbreak, it would actually have extra resources deployed almost immediately. Yet we didn’t have a lot of those mechanisms in place or those considerations in place. I think so many people were concerned about our hospitals getting overwhelmed at the beginning; we were concerned about conserving PPE for these settings at the expense of our long-term care settings. So while we were masking all the staff in our hospital settings, we weren’t doing that for staff in long-term care homes for even weeks after we started mandating this in our own hospitals. This really just showed that we almost created a bit of a double standard, and ironically, a double standard in environments that had the most to lose if COVID-19 got in.

“Fundamentally, as a society, we’re ageist.”

FPR: How do you think we ended up in this position where the long-term care homes were so much less prepared than hospitals? I think part of it was just the fact that what we were seeing around the world was that countries that were really struggling had hospitals that were utterly overwhelmed. And so I think a lot of people just naturally felt that if we shore up our hospitals, then the rest of the system will be OK. But what we weren’t hearing about was the fact that in countries like Spain or Italy, people weren’t even getting the opportunity to be sent to hospital for care from a long-term care home. Because the hospitals were so overwhelmed, they kind of left long-term care homes on their own. And it’s only after the fact that we found that thousands of additional people were dying in these settings, weren’t even being tested and weren’t even being given the chance of going to a hospital. And I think part of it is because fundamentally, as a society, we’re ageist. And we’re more focused on maybe protecting the shinier and more expensive parts of our health-care system that we can all relate to, versus the more underfunded and forgotten parts of our system that tend to a group of people towards the end of their lives, who no longer have as much relevance in our society as, say, children and adults in general. So when you think that these homes basically housed hundreds of thousands of Canadians who are in their last few years of their life, 70 per cent of whom have dementia, I think that sometimes the attitude is, “Well, if they get COVID and die, they were going to die in a few years anyways, so is this really a loss?” We see the utter hysteria right now happening at this time around schools reopening, and parents really worried about their children and protecting the children. If we imagine these homes being boarding schools, and all of these victims, the thousands of Canadians who have died in these homes, were actually young children, I wonder if we would have even more of a visceral response as Canadians, feeling that if these were young lives, that they would have mattered more, because they lost the lives that were completely ahead of them. But because these were older people towards the end of their lives, did their lives matter as much as others? And we saw these attitudes and these issues play out in places like Italy. When they ran out of ventilators, for example, they would just simply say, “If we have to choose between two people, we’re going to choose a young person over an older person, because frankly, that older person has probably less of a chance of surviving on a ventilator and they have fewer years of life ahead of them.” I think there were a lot of different issues that came into play. This was a less well-known part of our system. It’s always been, traditionally, a less well-supported and funded part of our system, and I think that partly reflects societal attitudes and views. And then when it came to an overall response, I think that many people were just feeling that if we just better support our hospitals and make sure that our efforts are focused on them, then the rest of the system will follow. But what we really saw is that by having poorly coordinated and under-supported responses early on for our long-term care homes, especially as COVID was spreading in communities in Ontario and Quebec, we saw what the consequences ended up being. And in provinces like B.C. that actually took much more definitive action early – perhaps because they were next to Washington state, which was seeing some of the first major outbreaks occurring in their nursing homes – I think B.C., frankly, gets top marks so far because they recognized quickly how vulnerable these homes were. I think they really focused on making sure that they were particularly well supported with the right policies, staffing solutions and PPE supplies. By doing those things early and definitively, our work has shown that only 12 per cent of B.C. homes ended up in outbreak. You compare that to the province next door of Alberta, where 24 per cent of its homes in a less populous province ended up in outbreak; then you go to Ontario, and you see 35 per cent of Ontario homes, 27 per cent of Quebec homes in outbreak. You see that B.C., as one of Canada’s most populous provinces, by definitively taking earlier and more direct actions to support their long-term care homes, saw only 12 per cent of their homes ever end up in outbreak. FPR: What policy interventions so far do you think have been helpful? Universal masking, for example – making sure that all the staff in these care settings and all visitors to these settings are wearing masks. Especially when we realized that COVID-19 can have such a high rate of asymptomatic transmission and spread. By universally masking – what we’re asking citizens to do in their everyday lives now, as well – we knew that putting that in place had a significant level of impact. But B.C. did this fairly early on. They did this towards the end of March, for example, where this still wasn’t implemented in other provinces, like Nova Scotia, Ontario and Quebec, until well into April. We also know that COVID-19 can be rather asymptomatic in its presentation and spread. Traditionally when there’s an influenza outbreak, it’s pretty easy to tell who has influenza and who doesn’t, but with COVID-19, because a person could look perfectly well and actually have COVID-19, it became really important to start changing our approaches to testing and isolating residents. So, making sure that we don’t simply just isolate and test people who look symptomatic, but we also think about people who possibly could have been positive contacts and making sure that we test and isolate them, as well. It was quickly adopting more advanced testing and isolation strategies that also recognized the rates of asymptomatic transmission. And then also making sure that we could actually support staff or enable staff to not have to work in multiple care settings, because when you have a lot of foot traffic occurring between different settings, we have a risk where these staff can inadvertently start transmitting this virus between homes. That was an early lesson learned in B.C., where the very first outbreak led to the second outbreak, when it was staff working between two homes who actually introduced it to a second home.

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

FPR: I am also struck by the fact that the NIA is collecting data on this. Does that identify a gap in the system, that nobody else has been doing this? Yeah. I think certainly at the start of the pandemic, did we think this was something that needed to be done? Absolutely. Did we think we needed to be the ones doing it? Certainly not. I think what we anticipated early on was that there would be some kind of national system to help, just as we would hear in the daily news brief – how many cases, how many deaths, etc. What we were seeing was the most vulnerable part of the system wasn’t really getting a lot of air time, other than hearing stories about significant outbreaks occurring in parts of Canada, but not necessarily seeing the data being reported. We would hear number of cases, deaths, how many people are hospitalized, how many people are using ICUs, but never how many homes are in outbreak across the country? How many residents have been infected? How many staff have been infected? How many residents and staff have died? And because we didn’t see this being collected, first of all, at a national level – or at least being reported publicly at a national level – and then we were seeing provinces collect information in different ways and not collecting it in a systematic way that would allow us to compare and learn from different provincial experiences, we clearly saw a gap here that nobody else seemed to be filling. And that’s why I think the NIA decided to step in and actually start collecting this information in a robust way that we could present in an open way back to the public, with a goal to fill in a clear data-collection gap that nobody else seemed to be focusing on in Canada at the time. And we certainly have seen over time that certain provinces have improved some of their reporting systems, but we’ve seen some provinces that have kind of backed away from being so public in the way they’re reporting things and even becoming a bit more, I think, secretive in the data that they’re even willing to share. Quebec is one of those classic examples. I think, as things were getting really bad in Quebec, for example, there wasn’t really clear, definitive information on what was actually happening in its long-term care homes. And then I think by April, the Quebec government started releasing a daily list showing what the size of the outbreaks were, which homes were in outbreak, etc. But then they abruptly stopped reporting that data on April 30. They said there was some kind of accounting or technical error that they would fix and start reposting that information back within a few days. But then it was literally about two weeks that, that information system was down. When it got re-posted, it was even, I would even argue, a little bit less transparent than it was before, and it made it really hard for people to understand exactly what was happening. So even with our tracker data in Quebec, we know that we’re probably under-reporting the total number of resident cases and staff cases and overall [cases]. And that’s a concern because, again, without accurate data, we’re making assumptions about what happened in Quebec that may actually be under-reporting the issue there, and maybe [affecting] how accurately we can interpret the Quebec situation in a way that can be helpful for other provinces and territories not wanting to make some of the same mistakes. We’ve had real problems trying to get clear, definitive answers towards our data in both Nova Scotia and Quebec, whereas other provinces like B.C. and Alberta have been incredibly transparent and supportive of our work and helping us to make sure that we have good quality, accurate data, because they appreciate that what we’re trying to do is just be open and transparent about what the data actually shows to better inform better policy responses. FPR: At this stage, as we’ve kind of gone through the first six months of this, what kind of policy responses do you think are needed as we’re going forward over the next few months? I think right now, the good news is that we have learned a lot during the first six months that helped us to understand why long-term care homes are particularly vulnerable and what potentially makes them particularly vulnerable. And I think through provinces that have been particularly hard hit, like Ontario and Quebec, they’ve started to appreciate the resources and mechanisms that they didn’t have in place before. They now better understand what the virus is, how it operates, the things that we can do that can effectively prevent its introduction and spread, and again, mimicking some of the good policy decisions that B.C. made early on. I think now other jurisdictions are starting to increasingly emulate that. The key is that we haven’t fundamentally changed any of the underlying staffing problems that we had prior to the pandemic, so there still remains significant issues that relate to the staffing of care homes and what we need to be doing that way. So I think we’ve come away with a lot of lessons learned, both internationally and locally. And I think that will hopefully stand us in better stead. But it also reminds us how vigilant we need to be, not just saying, “Oh well, we appreciate that we needed to have adequate supplies of PPE.” We actually have to make sure that all of our staff are really well trained in infection prevention and control strategies, as well. So I think all of these sorts of things have been good lessons learned. The question is, only time will tell how well we’ve actually learned those lessons. For example, more recently, we’re seeing new outbreaks occur in places like B.C., in places like Manitoba and Alberta, as well. So we’re seeing new outbreaks that are actually developing. And in some of these cases, people are saying, “Well, when we look at it, we certainly were making sure staff are trained in PPE, we thought we were doing all the right things, but we also realized that we have to maintain a high level of vigilance.” And in places where we see right now that they still haven’t resolved their staffing issues overall, it’s going to make them particularly vulnerable yet again if there’s another outbreak in that setting. I think the other challenge has been, in homes that remain understaffed, they’re finding it increasingly difficult to try and do things like even permit homes to reopen to visitors. So for family caregivers and families and friends who want to visit their loved ones in care, a lot of people have just been shut out of these homes because the staffing situation of the home remained below the level where they can provide the basic care that they need to be providing, let alone actually provide additional staffing resources to facilitate families and friends wanting to come and visit their loved ones in care. So I don’t think we’ve resolved a lot of the core, underlying, fundamental issues that were the problems related to long-term care in the first place. I think we’re still just kind of grappling and thinking about what needs to be done. But I think what COVID-19 is done is exposed, certainly, a lot of the vulnerabilities within the system. I think it’s really shaken a lot of Canadians’ trust and confidence in the system, whether that be residents, whether that be family members and friends, whether that be members of the general public thinking about their own future. I think a lot of individuals and a lot of staff who were working in the system have probably lost a lot of faith in it – lost faith in it to be able to protect the residents, but also protect the staff who work in these systems, as well. So there’s going to need to be a lot more work done to further figure out what the future of long-term care needs to look like in Canada, and how do we actually advance that.

Author(s)

Samir Sinha

https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/

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Additional Possible Media From First Policy Response:

-Ahmed, N., & Harper-Merrett, T. (2020, November 13). The ‘digital divide’ is about equity, not infrastructure. First Policy Response. https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/ The ‘digital divide’ is about equity, not infrastructure

Nasma Ahmed is a technologist working toward building more just and equitable futures. Toby Harper-Merrett has led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polley oeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything from post-secondary education to contact tracing during the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access (does the service reach you?) and another of uptake (are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of the Standing Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ. Social determinants have a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes in Development as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In a recent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnik wrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses were initiated – for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from the UNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments to begin by using technology to reach the unreached, and to ensure that the most marginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports by ACORN Canada through its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada has said: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Canada’s policy approach to internet pricing has historically been to subsidize the development of telecommunications infrastructure in less profitable markets with revenues from denser ones, encouraging competition through various regulatory levers. Though the pace sometimes resembles the Precambrian forces that shaped the same physical landscape, there has been progress. Whether this approach remains the optimal one is the subject of some discussion. Internet subscription price comparisons abound. Many would agree, however, that the Canadian telecommunications market isn’t especially unfettered, given the government stage-setting and regulation shepherding it. Public dollars install miles of fibre-optic cable; public processes allocate bands of wireless spectrum; now public attention should turn to matters of uptake. Decentralizing the identification of target populations could produce coalitions involving municipalities, service providers and community organizations to deliver programs with the required social intelligence and impact. These complex issues require innovation policies that acknowledge digital inequity doesn’t reflect an entirely, or even primarily, technological divide. A focus on equity would recognize that Canadian experiences are diverse, and solutions should be inclusive. Universal uptake of quality internet in Canada will have a multiplier effect; it will mean more of us can engage with and contribute to our communities. As we try to build forward better from COVID-19, we suggest digital policies target more equitable outcomes by addressing the social determinants hindering innovation uptake.

Author(s)

Nasma Ahmed

Toby Harper-Merrett

-Abdelaal, N. (2021, March 11). Online vaccine portals underscore the urgent need to close Canada’s digital divides. First Policy Response. https://policyresponse.ca/online-vaccine-portals-underscore-the-urgent-need-to-close-canadas-digital-divides/

Online vaccine portals underscore the urgent need to close Canada’s digital divides

https://policyresponse.ca/online-vaccine-portals-underscore-the-urgent-need-to-close-canadas-digital-divides/ As Ontario prepares to launch its online COVID-19 vaccination portal forpriority target groups, many Canadians still don’t have the broadband internet access or digital literacy skills they need to successfully navigate such a process. Once again, the pandemic has shown us that access and adoption of internet services is no longer a luxury: the ability to navigate online services has become a key determinant of health outcomes. Lessons learned from American states that already have online vaccination portals in place should help inform our vaccination strategy and uncover potential vaccine distribution inequities before it’s too late. Early evidence from California’sSkedulovaccine registration portal (which Ontario’s system will reportedly follow) showolder adults,low-income individual sandpeople of colour(including Black and Latino) are being vaccinated at a disproportionately lower rate, with many underserved groupscitinglong wait times,technology troubleshootinganddigital literacy challengesas their greatest hurdles to booking a vaccine appointment. Here in Canada, the situation is unlikely to veer far from the U.S. experience. Based on what we know about theunequal distribution of home internet adoption and digital literacy skillsin Canada, older adults, low-income individuals, remote residents and people with disabilities will find it difficult to book vaccination appointments online if proactive measures are not taken to correct Canada’s digital divides. While online vaccine registration is certainly needed in Canada, its effectiveness is limited if the people who need vaccination the most are the same people facing the most difficulty accessing and navigating these portals.

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Lower internet connectivity rates and digital literacy skills among older Canadians present a significant hurdle to securing online vaccine appointments, particularly for those living alone. For the28 per cent of those aged 65 and older in Canada who do not have home internet, online vaccination portals will simply be ineffective. Moreover, even among older adults with home internet access,lower internet speedscontinue to present a problem: 48 per cent of those aged 60 and older in Toronto report home download speeds below the CRTC’s 50 megabits per second (Mbps) target, compared to only 38 per cent overall. Particularly for vaccine portals in high demand, those with better internet quality are most likely to secure the limited vaccination slots. Equally important for navigating vaccine portal pages is having the right digital literacy skills. AStatistics Canada studyshows older adults are less likely than younger Canadians to be exposed to the internet through close acquaintances or social networks, and a larger proportion do not rely on consistent access to the internet for work or personal use. Lack of familiarity with basic navigation skills is particularly a problem given online vaccine portals have been fraught with errors and delays. InFloridaandAlberta, online vaccine registration sites crashed upon their launch due to a much higher-than-anticipated volume of people trying to book appointments. Older adults without sufficient digital literacy skills are less likely to be able to troubleshoot their way around technical difficulties.

Low-income communities

Low-income households in Canada alsoreport lower internet access rates and quality: as of 2017, 31 per cent of households in the lowest income bracket did not have a computer and internet service at home, compared to only 1.5 per cent of households with the highest incomes. Moreover, almost half of households with an annual income of $30,000 or lessdid not have high-speed internetin 2018. Ontario’s vaccine distribution plan does not explicitly designate low-income individuals as a priority group, although it does recognize those living in congregate settings, such as supportive housing and emergency homeless shelters. However, we know that low-income individuals face a disproportionately high chance of contracting COVID-19. The most recent numbers fromToronto Public Healthshow that people living in households with an income less than $30,000 make up 14 per cent of the city’s population, but nearly a quarter of its COVID-19 cases. By contrast, households with incomes above $150,000 represent 21 per cent of the population but only nine per cent of cases. Low-income communities also reportmore pre-existing health conditionsthat could aggravate risks associated with COVID-19. Home internet access is more crucial than ever now that access to the internet in public spaces has been limited by the closure of libraries, recreational facilities and cafés. Without equitable access to online public health services, many low-income Canadians will not get the help they need.

Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need.

People with Disabilities

Individuals with intellectual or developmental disabilities are a priority group eligible for vaccination in Phase 2 of Ontario’s vaccine rollout plan, set to begin next month. With more than6.2 million people in Canada over the age of 15living with a disability, critical public health services such as vaccine portals must provide a completely accessible, barrier-free process. In 2018, aboutone-fifth of people with disabilities did not use the internet, compared to only 10 per cent overall. Whenasked about equity concerns by theToronto Star, an executive from Skedulo said the company was committed to working with the provincial government to address accessibility needs. With2.1 million Canadianswith a disability at risk of facing barriers in accessing information and communications technology, there should be no compromising on website accessibility, particularly for those who have been excluded from digital services in the past.

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Creating an online vaccine registration portal that effectively distributes limited vaccine supplies to those most in need must take into account at-risk priority groups that cannot easily access internet services. In the short term, policy-makers must proactively target digitally excluded groups by providing alternative registration methods or direct assistance to those without the digital skills or resources to connect online. But we must also remember that these issues won’t go away after our current crisis is over, as more critical public health information and services haveshifted to online-only or online-first. In the long term, closing Canada’s digital divides should be a top priority for policy-makers if they are serious about establishing a more equitable delivery of government services in an increasingly online world.

Author(s)

Nour Abdelaal

Nour Abdelaal is a Policy and Research Assistant at the Ryerson Leadership Lab, specializing in technology and cybersecurity, and was formerly a Political Assistant at the U.S. Consulate General in Toronto.

-Dube, S. (2020, September 16). COVID-19 shows that racism is a public health issue. First Policy Response. https://policyresponse.ca/covid-19-shows-that-racism-is-a-public-health-issue/

COVID-19 shows that racism is a public health issue

https://policyresponse.ca/covid-19-shows-that-racism-is-a-public-health-issue/ September marks six months since the World Health Organization declared a global pandemic of COVID-19. We’re using this milestone to take stock of the policy response so far and consider next steps as Canada continues to move from reaction to rebuilding. As part of this, First Policy Response is speaking to several policy experts to gather their thoughts on the key policy developments of these past six months, and what they think our next priorities should be. This interview withSané Dube,policy and government relations lead, with a focus on Black health, at theAlliance for Healthier Communities, is part of a series of interview transcripts that will run this week and next. You can read the full serieshere. This transcript has been edited for clarity. First Policy Response: So to start off with, you and the Alliance for Healthier Communities had advocated really strongly for race-based data collection on COVID-19. Why was that? Sané Dube: Early in the pandemic we started to see the disparities that were being created. It became evident pretty early in the game that COVID wasn’t affecting people in the same way. There were some communities and some groups that were harder hit and disproportionately impacted. We were already seeing that in Ontario and in Canada. At about the same time, we started to see data coming out of the United States and the United Kingdom, and a lot of their data was showing a real, deep impact on Black communities. So that included Black folks who were patients with COVID, but then it also was Black health-care workers, specifically in the case of the U.K., who were the ones who were contracting the virus. And what the data was showing was that when these communities contracted the virus, their outcomes also tended to be worse, so we were seeing that they were higher numbers and then when people did get the virus, they were more likely to have fatal or negative impacts. So many people were really concerned that Ontario was not looking at COVID with this lens. Really, that’s where the calls for data collection became prominent. Data collection calls are not new. People have been calling for this data to be collected for a long time. The Alliance is one of the organizations that’s also been on record for a very long time calling for this data to be collected. What made it even more urgent for this data to be collected was what we were already seeing in COVID, and also just knowing that without that data, the province couldn’t respond in the way that they needed to. And the same issues remain in Canada. . . . Ontario and Manitoba are the only two provinces that have mandated data connection, at least during COVID. A few other provinces are on their way to doing that. But the fact that we don’t have data that tells us exactly what COVID looks like broken down by race, broken down by other socio-economic markers, is really troubling and it actually hinders our ability to respond to this pandemic. FPR: So what has the data shown us so far about how this is affecting different communities differently? I would point to the example of Toronto. The public health or the regional authorities here were really great with collecting data earlier and also starting to release that data. They had astudythat showed that 83 per cent of the people who had contracted COVID were Black or racialized people, and also showed that a lot of those people came from low-income families or households, and they also tended to live in parts of the city where the average income was lower. And more recently, they’ve had another study that just came out, which was looking atwho lockdown worked for. They were saying that if you look at predominantly white, affluent neighborhoods, people there were able to do the lockdown and be able to follow public health guidelines. Whereas if you’re looking at other communities where people continued to work, they were often the low-income, essential workers like grocery shop attendants, or they were janitorial staff or working in public transportation, cab drivers and such. Many of those people didn’t have the option, necessarily, to either work from home or not go to work altogether. And even if people got sick in their household, just because of the housing crisis and the unaffordability of the city, many people also did not have the option of, “I will go to a hotel and isolate,” or “There’s a room in my house, or there’s a part of my house where I would have my own bathroom.” People couldn’t do those things. So yeah, the data is really striking. A few regions of Ontario have started to release their data and it’s showing how COVID has impacted other communities, and the same stories repeat themselves over and over again in every region, everywhere where data has been released. And the story is always that it is the people who already are so marginalized who feel this pandemic the most, and whose chances of recovering will be most impacted as well, just because not enough has been invested in making sure that people are getting the help they need and that they can recover well. FPR: How does that fit in with the idea of social determinants of health? Social determinants of health is a way of understanding health care and health policies. So it’s a framework, and it really says that we have to understand that a person’s health is impacted not just by the ability of a person to go to a doctor or walk into a nurse’s office – health is really impacted by social and economic factors. So things like your housing, your ability to have good housing, that’s actually a huge determinant. It impacts the health outcomes you’re able to achieve. We know that racial bias in health care means that Indigenous and Black people, in particular, will face more barriers in getting equitable and good health care, so over the long run, that also impacts people’s health. So there’s a range of social determinants of health – housing, race, income, neighborhood, a range of factors. And what we have said is that in dealing with something which is as severe as COVID, or has impacted us as much as it has both in Ontario and on a global scale, our responses should really be framed in a social determinants of health framework. We can’t actually address this pandemic without addressing all of the other factors that make some people more susceptible to illness, or the factors that make it so that when some people get this virus, they will have worse outcomes. So I think this goes back to what I was saying before: it’s one thing to contract the virus and be unable to stop working, be unable to isolate or be unable to have the resources that you need. That’s a very different story from someone who contracts the virus, has all the support that they need, doesn’t have to worry about facing racism when they go to a health care centre, is guaranteed that they will be treated well. So, our COVID response really needs to centre that social determinants of health approach, because that is what addresses underlying systemic and structural issues. FPR: You’ve also been quite vocal about how racism is a public health crisis in Canada. Can you talk a little bit more about how that intersects with COVID? So this has been an . . .interestingseason. I use that term generously. What we have also seen over COVID is the amplification of movements that were already happening – specifically movements for Black lives and movements for Indigenous sovereignty and life. In late May or early June, there were several Black folks who were killed by police in the U.S.: George Floyd, Breonna Taylor. In Canada, we saw the deaths of people like Regis Korchinski-Paquet and Rodney Levi. And all of these movements spurred a push to really address the ways that people experience racism, systemic and structural inequality. The experiences that people have with racism really impact the way that they are able to move through the world. I’ll give the example of Regis Korchinski-Paquet, who was a 29-year-old Afro-Indigenous woman who died in police presence, who had been called for a mental health call. We, as advocates, would argue that racism is what contributed to her death, because we see instances where, if police are called to assist a white person who is in mental health distress, they are less likely to end up dead. Whereas studies have shown that Black and Indigenous people have higher rates of fatal outcomes – people are more likely to end up dead. And this is from a system that should be helping them. A system that should be keeping people safe. It should be providing people the protection that they need. And we would argue that part of that is the racism that underlies policing, and that underlies many of the health-care systems and structures that we operate in. So what we have said is that we want recognition of racism as a public health crisis because by declaring it a public health crisis, then you are saying that this is a serious issue that must be addressed. It is something that is endemic. It is something that touches all sorts of systems and structures. Declaring it a public health crisis would recognize the harm that it does to our communities, and actually put things in place to start fixing the situation. Black health leaders, particularly after those deaths in June and May, many people started calling for the declaration of racism as a public health crisis. A few regions and cities in Ontario have done that. Toronto has, but we still don’t have a provincial recognition of racism as a public health crisis. FPR: How does that intersect with COVID? I think that COVID has really shown the ways that racism harms people who already more marginalized. I’ll give the example of Toronto’s northwest. We know that this is where some of the worst cases for COVID are right now. But we also know that the systemic and structural racism that is in our system means that even when we know that this is where COVID is really hurting people, not enough resources have been directed there. And racism, it takes many forms. You even hear people talking about how, in the regions where they live, the testing and COVID response hasn’t been done with an appropriate cultural lens. So you will find that someone is being sent in to do testing who doesn’t even speak the language that people in that community speak, who doesn’t understand the cultural norms in a place. And it means that people are not able to access the care that they need. We would say that is actually just an iteration of racism, where you are not willing to work with communities in a way that recognizes and honours how they want to access health care. So I think racism takes many different forms. And even something like refusing to collect data so that we know who is impacted and how they are impacted, some would say that can also be a form of systemic and structural racism because it makes invisible the ways that we are failing to provide appropriate care to some people.

“We need approaches that put health equity at the centre.”

I’ll give one more example. In Ontario, there’s a group called the Black Health Equity Working Group, which is a group of experts and health-care providers who, now that Ontario has said they will start collecting the data, are developing a governance and accountability framework for how that data is used, one that is developed by and for Black communities. And part of why Black communities are pushing so hard for this is because they know that racism also affects us in this particular instance. We call for data because we know that this is something that could improve our lives, but what racism does – it means that the data is collected, but then the way that it’s used further harms our communities. So that’s just another way that racism plays out. So again, the example of northwest Toronto – the data has been collected, but then the way that the story is being told in the media, the way that we talk about what’s happening in the northwest of Toronto, is to once again stigmatize the people who are in those communities. So it makes it seem like high COVID rates are somehow because there’s something that’s inherently wrong, or something that’s pathological, with those communities. The way that we tell these stories is that there’s never a full accounting for the systemic underfunding of those communities, that lack of resources, the way those communities have been starved, and the high rates of COVID-19 are actually a result of that. So, racism takes many forms. It’s not always the glaring, the obvious thing. But it’s a conversation that we have to have as we’re talking about COVID. FPR: The Alliance has written about how race-based data collection may actually further entrench harm and inequity. Could you speak a little bit more about how and why that might happen? When we’re thinking about further entrenching harm, it goes back to how that data is used. A lot of Black communities right now are saying that the collection of the data is not actually justice; it’s not the end goal. The end goal should be improving Black people’s lives. Where we’re coming from with the Alliance is that collecting this data, if it’s not used appropriately, if it’s not understood, if it doesn’t become a tool for systemic change, then it is again just replicating harm for people. FPR: From a policy perspective, what do you think needs to be done from here to try and address some of those issues? I would say possibly the most important thing is that our health system response very much needs to be based on social determinants of health frameworks. We also need approaches that put health equity at the centre, where health equity is not an afterthought, but it is something that is integrated throughout the policy and health-system development process, right from the beginning right through to the end of any system. We at the Alliance are fully supportive of the collection of data, but we also want the province to engage the right people in these conversations. Data collection does not mean the same thing for all communities. For example, Indigenous communities have very specific concerns. Black communities have specific concerns. The province needs to be speaking to the right people as it develops its processes for the collection of this data. Those communities need to play a key role in determining how the data is used and what the outcomes are, in the long run, from that. And then I think that we also just need to have approaches that are proactive. We are, for sure, going into a second wave of COVID, if the numbers are any indication. . . . It would appear that we are going back to a place where we will see more cases, and who knows what that will look like once schools open and once people are back to their lives. So, we want a health system that’s responsive. We want a health system that will understand the context, that will understand developments as they are occurring. And a health system that also will work with the most marginalized, those with the least resources, those with the least access. Because right now, in many ways, the health system is working for people who already have access to resources. It’s not working for some of the most marginalized. FPR: Is there anything that any level of government has done so far that’s been helpful to more marginalized communities? The thing with COVID is, it’s also been really illuminating. COVID has been a time when we’ve seen that systems can be responsive. Policies can be created that really will change people’s lives. Like the example of early in the pandemic, the province of Ontariosuspended the OHIP wait period– they made it so that people could get treatment, they could get health care, even if they don’t have health cards. So that provided treatment to people without status, many of whom work in essential roles – they were able to get health care. And we know that’s made a difference in terms of making care accessible for some of the most marginalized. So that’s an example of where a system has worked really well. Even something like pandemic pay for some essential workers. So when you look at workers who are working in supervised consumption sites or overdose prevention sites, a lot of those folks were able to access pandemic pay, which was good because they work very hard and there was a lot on them in those early days of the pandemic. So it was useful. Unfortunately, the pandemic pay is coming to an end for many essential workers, but that is something that makes a tangible difference in people’s lives. And definitely, we know that this is something people are talking about and saying that the province needs to be thinking about longer-term assistance for people, particularly as it looks like we will be in this pandemic for a while. So there’s definitely things that have been done that have really, positively impacted people’s lives. And we want the province, and both federal and provincial bodies, we want them to continue to make those types of decisions that actually support people who are in need.

Author(s)

Sané Dube

-Morris, G., Salti, S., & Sultana, A. (2020, May 1). Foreign-trained doctors are untapped resource in pandemic fight. First Policy Response. https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/

Foreign-trained doctors are untapped resource in pandemic fight

MAY 1, 2020|IN EQUITY + COVID-19|BY GEORGETTE MORRIS, SHIREEN SALTI AND ANJUM SULTANA

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/ “I was a doctor back home.” “I’m writing my exams to get my licence here.” “It’s been three years since I practised last.” “Seven years.” “Ten.” We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country. The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors. Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots. Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship. As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita. Crisis and opportunity The COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years. Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians. These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps. We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this: · Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency. · Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards. · Increase the number of residency spaces for internationally trained physicians. · Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country. Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care. Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Salti is the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.

Author(s)

Georgette Morris

Posts by this author

Shireen Salti

Posts by this author

Anjum Sultana

Posts by this author

Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

https://policyresponse.ca/systemic-racism-is-at-the-heart-of-economic-inequality-and-of-how-we-get-sick-and-die/

]]>

Chapter 2-Health (articles formatted #1)

dsossi — Mon, 25 Oct 2021 19:53:27 +0000

Chapter 2-Health (articles formatted) Links to Readings: -Galabuzi, G.-E. (2021, February 24). Systemic racism is at the heart of economic inequality – and of how we get sick and die. First Policy Response. https://policyresponse.ca/systemic-racism-is-at-the-heart-of-economic-inequality-and-of-how-we-get-sick-and-die/ -Lofters, A. (2021, February 22). Ontario’s health-care system must develop an anti-racist response to COVID-19. First Policy Response. https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/ -Bhimani, Z. (2020, November 5). For more equitable health outcomes, start with the health-research system. First Policy Response. https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/ -Sinha, S. (2020). Underfunded long-term care system is still vulnerable to COVID-19 outbreaks. First Policy Response. https://policyresponse.ca/underfunded-long-term-care-system-is-still-vulnerable-to-covid-19-outbreaks/ Additional Possible Media From First Policy Response: -Ahmed, N., & Harper-Merrett, T. (2020, November 13). The ‘digital divide’ is about equity, not infrastructure. First Policy Response. https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/ -Abdelaal, N. (2021, March 11). Online vaccine portals underscore the urgent need to close Canada’s digital divides. First Policy Response. https://policyresponse.ca/online-vaccine-portals-underscore-the-urgent-need-to-close-canadas-digital-divides/ -Dube, S. (2020, September 16). COVID-19 shows that racism is a public health issue. First Policy Response. https://policyresponse.ca/covid-19-shows-that-racism-is-a-public-health-issue/ -Morris, G., Salti, S., & Sultana, A. (2020, May 1). Foreign-trained doctors are untapped resource in pandemic fight. First Policy Response. https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/

Full Readings:

```Systemic racism is at the heart of economic inequality — and of how we get sick and die

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

```Ontario’s health-care system must develop an anti-racist response to COVID-19

FEBRUARY 22, 2021

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/

Zahra Bhimaniis a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

Samir Sinha

https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/

.................................................. .................................................. ..................................................

Additional Possible Media From First Policy Response:

```The ‘digital divide’ is about equity, not infrastructure

Digital inequity in a crisis

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

```Online vaccine portals underscore the urgent need to close Canada’s digital divides

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need.

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

-Dube, S. (2020, September 16). COVID-19 shows that racism is a public health issue. First Policy Response. https://policyresponse.ca/covid-19-shows-that-racism-is-a-public-health-issue/

```COVID-19 shows that racism is a public health issue

“We need approaches that put health equity at the centre.”

Author(s)

Sané Dube

`````````

``````Foreign-trained doctors are untapped resource in pandemic fight

MAY 1, 2020|IN EQUITY + COVID-19|BY GEORGETTE MORRIS, SHIREEN SALTI AND ANJUM SULTANA

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/ “I was a doctor back home.” “I’m writing my exams to get my licence here.” “It’s been three years since I practised last.” “Seven years.” ```` “Ten.” We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country. The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors. Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots. Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship. As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita. Crisis and opportunity The COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years. Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians. These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps. We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this: · Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency. · Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards. · Increase the number of residency spaces for internationally trained physicians. · Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country. Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care. Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Salti is the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.

Author(s)

Georgette Morris

Posts by this author

Shireen Salti

Posts by this author

Anjum Sultana

Posts by this author

Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

https://policyresponse.ca/systemic-racism-is-at-the-heart-of-economic-inequality-and-of-how-we-get-sick-and-die/

]]>

Chapter 2-Health (articles formatted #2)

dsossi — Mon, 25 Oct 2021 20:17:43 +0000

[```] Systemic racism is at the heart of economic inequality — and of how we get sick and die

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

[```] Ontario’s health-care system must develop an anti-racist response to COVID-19

FEBRUARY 22, 2021

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/

Zahra Bhimaniis a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

Samir Sinha

https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/

.................................................. .................................................. ..................................................

Additional Possible Media From First Policy Response:

[```] The ‘digital divide’ is about equity, not infrastructure

Nasma Ahmed is a technologist working toward building more just and equitable futures.Toby Harper-Merretthas led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polleyoeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything frompost-secondary educationtocontact tracingduring the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access(does the service reach you?)and another of uptake(are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of theStanding Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ.Social determinantshave a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes inDevelopment as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In arecent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnikwrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses wereinitiated– for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from theUNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments tobeginby using technology to reach the unreached, and to ensure that themostmarginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports byACORN Canadathrough its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada hassaid: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

[```] Online vaccine portals underscore the urgent need to close Canada’s digital divides

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need.

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

-Dube, S. (2020, September 16). COVID-19 shows that racism is a public health issue. First Policy Response. https://policyresponse.ca/covid-19-shows-that-racism-is-a-public-health-issue/

[```] COVID-19 shows that racism is a public health issue

“We need approaches that put health equity at the centre.”

Author(s)

Sané Dube

-Dube, S. (2020, September 16). COVID-19 shows that racism is a public health issue. First Policy Response. https://policyresponse.ca/covid-19-shows-that-racism-is-a-public-health-issue/

`````````

[```] Foreign-trained doctors are untapped resource in pandemic fight

MAY 1, 2020|IN EQUITY + COVID-19|BY GEORGETTE MORRIS, SHIREEN SALTI AND ANJUM SULTANA

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/ “I was a doctor back home.” “I’m writing my exams to get my licence here.” “It’s been three years since I practised last.” “Seven years.” ```` “Ten.” We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country. The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors. Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots. Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship. As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita. Crisis and opportunity The COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years. Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians. These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps. We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this: · Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency. · Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards. · Increase the number of residency spaces for internationally trained physicians. · Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country. Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care. Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Saltiis the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.

Author(s)

Georgette Morris

Posts by this author

Shireen Salti

Posts by this author

Anjum Sultana

Posts by this author

Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

https://policyresponse.ca/systemic-racism-is-at-the-heart-of-economic-inequality-and-of-how-we-get-sick-and-die/

.-Morris, G., Salti, S., & Sultana, A. (2020, May 1). Foreign-trained doctors are untapped resource in pandemic fight. First Policy Response. https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/

]]>

Chapter 2-Health (articles formatted #3)

dsossi — Mon, 25 Oct 2021 20:46:49 +0000

[```]

Systemic racism is at the heart of economic inequality — and of how we get sick and die

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

Citation: Galabuzi, G.-E. (2021, February 24). Systemic racism is at the heart of economic inequality – and of how we get sick and die. First Policy Response. https://policyresponse.ca/systemic-racism-is-at-the-heart-of-economic-inequality-and-of-how-we-get-sick-and-die/

[```]

Ontario’s health-care system must develop an anti-racist response to COVID-19

FEBRUARY 22, 2021

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

Citation: Lofters, A. (2021, February 22). Ontario’s health-care system must develop an anti-racist response to COVID-19. First Policy Response. https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/

Zahra Bhimaniis a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

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“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

Samir Sinha

https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/

Citation: Sinha, S. (2020). Underfunded long-term care system is still vulnerable to COVID-19 outbreaks. First Policy Response. https://policyresponse.ca/underfunded-long-term-care-system-is-still-vulnerable-to-covid-19-outbreaks/

Additional Possible Media From First Policy Response:

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The ‘digital divide’ is about equity, not infrastructure

Nasma Ahmed is a technologist working toward building more just and equitable futures.Toby Harper-Merretthas led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polleyoeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything frompost-secondary educationtocontact tracingduring the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access(does the service reach you?)and another of uptake(are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of theStanding Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ.Social determinantshave a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes inDevelopment as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In arecent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnikwrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses wereinitiated– for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from theUNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments tobeginby using technology to reach the unreached, and to ensure that themostmarginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports byACORN Canadathrough its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada hassaid: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

Citation: Ahmed, N., & Harper-Merrett, T. (2020, November 13). The ‘digital divide’ is about equity, not infrastructure. First Policy Response. https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/

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Online vaccine portals underscore the urgent need to close Canada’s digital divides

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need.

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

Citation: Abdelaal, N. (2021, March 11). Online vaccine portals underscore the urgent need to close Canada’s digital divides. First Policy Response. https://policyresponse.ca/online-vaccine-portals-underscore-the-urgent-need-to-close-canadas-digital-divides/

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COVID-19 shows that racism is a public health issue

“We need approaches that put health equity at the centre.”

Author(s)

Sané Dube

Citation: Dube, S. (2020, September 16). COVID-19 shows that racism is a public health issue. First Policy Response. https://policyresponse.ca/covid-19-shows-that-racism-is-a-public-health-issue/

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Foreign-trained doctors are untapped resource in pandemic fight

MAY 1, 2020|IN EQUITY + COVID-19|BY GEORGETTE MORRIS, SHIREEN SALTI AND ANJUM SULTANA

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/ “I was a doctor back home.” “I’m writing my exams to get my licence here.” “It’s been three years since I practised last.” “Seven years.” ```` “Ten.” We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country. The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors. Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots. Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship. As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita. Crisis and opportunity The COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years. Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians. These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps. We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this: · Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency. · Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards. · Increase the number of residency spaces for internationally trained physicians. · Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country. Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care. Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Saltiis the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.

Author(s)

Georgette Morris

Posts by this author

Shireen Salti

Posts by this author

Anjum Sultana

Posts by this author

Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

https://policyresponse.ca/systemic-racism-is-at-the-heart-of-economic-inequality-and-of-how-we-get-sick-and-die/

Citation: Morris, G., Salti, S., & Sultana, A. (2020, May 1). Foreign-trained doctors are untapped resource in pandemic fight. First Policy Response. https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/

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Chapter 2-Health (articles formatted #4)

dsossi — Mon, 25 Oct 2021 20:53:46 +0000

Systemic racism is at the heart of economic inequality — and of how we get sick and die

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

Ontario’s health-care system must develop an anti-racist response to COVID-19

FEBRUARY 22, 2021

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/

Zahra Bhimaniis a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

SEPTEMBER 18, 2020|INSUPPORT FOR THE MARGINALIZED|BYSAMIR SINHA

“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

Samir Sinha

https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/

Additional Possible Media From First Policy Response:

The ‘digital divide’ is about equity, not infrastructure

Nasma Ahmed is a technologist working toward building more just and equitable futures.Toby Harper-Merretthas led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polleyoeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything frompost-secondary educationtocontact tracingduring the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access(does the service reach you?)and another of uptake(are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of theStanding Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ.Social determinantshave a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes inDevelopment as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In arecent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnikwrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses wereinitiated– for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from theUNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments tobeginby using technology to reach the unreached, and to ensure that themostmarginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports byACORN Canadathrough its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada hassaid: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

Online vaccine portals underscore the urgent need to close Canada’s digital divides

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need.

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

COVID-19 shows that racism is a public health issue

“We need approaches that put health equity at the centre.”

Author(s)

Sané Dube

Foreign-trained doctors are untapped resource in pandemic fight

MAY 1, 2020|IN EQUITY + COVID-19|BY GEORGETTE MORRIS, SHIREEN SALTI AND ANJUM SULTANA

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/ “I was a doctor back home.” “I’m writing my exams to get my licence here.” “It’s been three years since I practised last.” “Seven years.” `“Ten.” We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country. The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors. Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots. Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship. As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita. Crisis and opportunity The COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years. Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians. These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps. We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this: · Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency. · Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards. · Increase the number of residency spaces for internationally trained physicians. · Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country. Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care. Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Saltiis the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.

Author(s)

Posts by this author

Posts by this author

Posts by this author

Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

https://policyresponse.ca/systemic-racism-is-at-the-heart-of-economic-inequality-and-of-how-we-get-sick-and-die/

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Chapter 2-Health (articles formatted #5)

dsossi — Mon, 25 Oct 2021 22:31:24 +0000

Systemic racism is at the heart of economic inequality — and of how we get sick and die

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don'tmissthiseventwithTVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

Ontario’s health-care system must develop an anti-racist response to COVID-19

FEBRUARY 22, 2021

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don't miss this event with TVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/

Zahra Bhimani is a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

SEPTEMBER 18, 2020|INSUPPORT FOR THE MARGINALIZED|BYSAMIR SINHA

“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/

Additional Possible Media From First Policy Response:

The ‘digital divide’ is about equity, not infrastructure

Nasma Ahmed is a technologist working toward building more just and equitable futures.Toby Harper-Merretthas led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polleyoeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything frompost-secondary educationtocontact tracingduring the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access(does the service reach you?)and another of uptake(are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of theStanding Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ.Social determinantshave a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes inDevelopment as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In arecent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnikwrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses wereinitiated– for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from theUNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments tobeginby using technology to reach the unreached, and to ensure that themostmarginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports byACORN Canadathrough its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada hassaid: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

Online vaccine portals underscore the urgent need to close Canada’s digital divides

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need.

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

COVID-19 shows that racism is a public health issue

“We need approaches that put health equity at the centre.”

Author(s)

Sané Dube

Foreign-trained doctors are untapped resource in pandemic fight

MAY 1, 2020|IN EQUITY + COVID-19|BY GEORGETTE MORRIS, SHIREEN SALTI AND ANJUM SULTANA

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/ “I was a doctor back home.” “I’m writing my exams to get my licence here.” “It’s been three years since I practised last.” “Seven years.” `“Ten.” We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country. The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors. Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots. Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship. As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita. Crisis and opportunity The COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years. Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians. These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps. We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this: · Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency. · Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards. · Increase the number of residency spaces for internationally trained physicians. · Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country. Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care. Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Saltiis the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.

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Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

https://policyresponse.ca/systemic-racism-is-at-the-heart-of-economic-inequality-and-of-how-we-get-sick-and-die/

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Chapter 2-Health (v6)

dsossi — Mon, 25 Oct 2021 23:53:47 +0000

Systemic racism is at the heart of economic inequality — and of how we get sick and die

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don't miss this event with TVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

Ontario’s health-care system must develop an anti-racist response to COVID-19

FEBRUARY 22, 2021

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don't miss this event with TVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

https://policyresponse.ca/for-more-equitable-health-outcomes-start-with-the-health-research-system/

Zahra Bhimani is a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

SEPTEMBER 18, 2020|INSUPPORT FOR THE MARGINALIZED|BYSAMIR SINHA

https://policyresponse.ca/underfunded-long-term-care-system-is-still-vulnerable-to-covid-19-outbreaks/ September marks six months since the World Health Organization declared a global pandemic of COVID-19. We’re using this milestone to take stock of the policy response so far and consider next steps as Canada continues to move from reaction to rebuilding. As part of this, First Policy Response is speaking to several policy experts to gather their thoughts on the key policy developments of these past six months, and what they think our next priorities should be. This interview with Dr. Samir Sinha, director of health policy research and co-chair of the National Institute on Ageing at Ryerson University, is part of a series of interview transcripts. You can read the full series here. This transcript has been edited for clarity. First Policy Response: As of May, the National Institute on Ageing was reporting that more than 80 per cent of COVID-19 deaths in Canada were in long-term care homes. Is that still accurate at this point? Dr. Samir Sinha: Yes. Towards the end of March, we launched what we call ourNIA Long-term Care COVID-19 Tracker. It’s available online and we continue to update it to this day. By May, or at the height of the pandemic, if you will, we were even up as high as 82, 83 per cent of Canadian deaths that occurred in long-term care settings. By the time the Canadian Institute for Health Information did ananalysistowards the end of May looking at our data, they confirmed about 80 to 81 per cent. Right now that number is about 77 per cent of Canadian deaths that have occurred in long-term care homes. So the number is decreasing a little bit, but it’s staying around the 80 per cent mark, and this reflects that more younger people are now becoming infected. And certainly younger populations, with the second ripple or second wave that’s starting to develop across the country, we’re starting to see more deaths occurring outside long-term care homes in the general population, as well. But the bottom line is that Canada still holds this record of 77 per cent or close to 80 per cent of its deaths occurring in our long-term care homes. And that’s about double what we’re seeing on the international stage. FPR: Why do you think that is? I think there are two fundamental reasons why we’ve actually been seeing such a high proportion of our deaths occur in long-term care homes. The first part is good news: Canada did a really, really good job early on in the pandemic, as cases were starting to climb in Canada, to actually take some definitive public health measures to lock us all down, essentially, and limit our ability to travel and interact, and close our borders as well. And by doing that, we helped to significantly limit the rate of community spread that could potentially occur, that we had seen become real issues in places like the U.K., Spain, Italy, etc. And so, because we had fair warning compared to some European countries, for example, we were able to heed those warnings and close our borders, create our lockdown situation early, which helped to limit the amount of community spread and the number of cases and deaths. And overall we’ve seen only about 1 per cent of Canadians in total have actually been infected, probably, with COVID-19. The challenge is that, when it came to the way that we were preparing ourselves in our health-care system, a huge amount of focus was placed on our hospitals at the expense of our long-term care and our retirement-home systems, which really in the end were not well equipped and well supported enough to deal with COVID-19. So even though COVID-19 was circulating in the communities, we weren’t making sure that all of our long-term care homes were fully equipped with personal protective equipment. While we assumed that our staff in these homes knew how to follow IPAC [Infection Prevention and Control] procedures and use their PPE, this wasn’t quite the case. And then we already had a system that was plagued with staffing shortages and issues. And as COVID got into homes and spread easily – because we weren’t aware early on of the possibilities of asymptomatic spread and transmission – staff weren’t equipped with enough PPE and we already had severe staffing shortages to begin with. As soon as COVID started taking effect in these homes, this just exacerbated all these problems even further, and especially in provinces like Ontario and Quebec, really set us off on a wrong foot overall. FPR: What does that tell us about the long-term care system in Canada? I think what it really exposed to us is that, when we think about how Canada did compared to the rest of the world, we could say, yes, some of our high case numbers or rates of deaths in these settings was partly related to the fact that we actually had done a reasonably good job of limiting the amount of general community spread. But you know, when you’re double the international rate of deaths in long-term care homes, it also speaks to the fact that COVID-19 exposed how vulnerable our long-term care system was to begin with. So when you look at OECD [Organisation for Economic Co-operation and Development] countries, in general, which experienced half the rate of deaths in its care homes that we did, what we see is that we spend 30 per cent less on providing long-term care services in Canada compared to other OECD countries. We’re already funding significantly less as a proportion of our GDP compared to other countries, only 1.3 per cent versus 1.7 per cent on average. So that’s the first challenge. And then, when you underfund an entire long-term care system, it means that we have staff who aren’t paid as well as those who are generally working in our hospitals, for example. And we also have the challenge where more people tend to work part-time in these settings than, say, in other health-care settings, and as a result, to try and make a full-time salary, people are working multiple jobs in multiple settings. All of this means that if you have infection in one home, when staff are working between multiple homes, they could inadvertently become vectors to transmit this virus from one home to the other. So when you underfund the system, it affects the level at which we staff these homes. It also affects the resources we actually provide these homes to provide the care that residents need. And it really just exposed the fact that we had these systemic vulnerabilities – that not only were we having challenges staffing and making sure that homes have the resources they did, but we also see this phenomenon in Canada, compared to many other countries, where in Ontario, for example, a large portion of the rooms happened to be two-, three- or four-bedded rooms, where in many other jurisdictions, they moved to an all-single-room format. The problem is, if you move to all single rooms, that’s a much more expensive home to build than packing people two or three or four to a room. And so again, when you underfund the system, you’re going to have poor-quality facilities and many older facilities that are vastly in need of redevelopment, but also a system that can’t actually even attract the basic staff it needs to keep these homes properly staffed and supported, especially during a pandemic. FPR: Was it a surprise to you, how much higher the rate was in Canada compared to the rest of the world? It was. I mean, the data doesn’t lie. And when you see that Canada has such a high rate of death in long-term care settings, especially when we had other countries that had significant community spread but their long-term care settings seem to fare better, we started realizing what other countries were doing and what we weren’t doing, and it reinforced how our approaches were not well balanced in Canada. For example, other countries, realizing that their long-term care homes or settings were highly vulnerable settings, were making sure that they actually increased the staffing in those settings. They were making sure that homes had adequate supplies of PPE. They were making sure that staff in those homes were having their skills augmented in terms of how to use PPE, and making sure that they were well versed in their infection prevention control efforts. And in some jurisdictions, they had developed early response teams, so that if a home did go on outbreak, it would actually have extra resources deployed almost immediately. Yet we didn’t have a lot of those mechanisms in place or those considerations in place. I think so many people were concerned about our hospitals getting overwhelmed at the beginning; we were concerned about conserving PPE for these settings at the expense of our long-term care settings. So while we were masking all the staff in our hospital settings, we weren’t doing that for staff in long-term care homes for even weeks after we started mandating this in our own hospitals. This really just showed that we almost created a bit of a double standard, and ironically, a double standard in environments that had the most to lose if COVID-19 got in.

“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

https://policyresponse.ca/the-digital-divide-is-about-equity-not-infrastructure/

Additional Possible Media From First Policy Response:

The ‘digital divide’ is about equity, not infrastructure

Nasma Ahmed is a technologist working toward building more just and equitable futures.Toby Harper-Merretthas led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polleyoeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything frompost-secondary educationtocontact tracingduring the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access(does the service reach you?)and another of uptake(are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of theStanding Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ.Social determinantshave a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes inDevelopment as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In arecent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnikwrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses wereinitiated– for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from theUNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments tobeginby using technology to reach the unreached, and to ensure that themostmarginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports byACORN Canadathrough its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada hassaid: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

Online vaccine portals underscore the urgent need to close Canada’s digital divides

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need.

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

COVID-19 shows that racism is a public health issue

“We need approaches that put health equity at the centre.”

Author(s)

Sané Dube

Foreign-trained doctors are untapped resource in pandemic fight

MAY 1, 2020|IN EQUITY + COVID-19|BY GEORGETTE MORRIS, SHIREEN SALTI AND ANJUM SULTANA

Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency.
Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards.
Increase the number of residency spaces for internationally trained physicians.
Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country.

Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care. Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Saltiis the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.

Author(s)

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Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

Equity, Economic Recovery & COVID-19

]]>

Chapter 2-Health (v7-delete text titles)

dsossi — Tue, 26 Oct 2021 00:42:48 +0000

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don't miss this event with TVO

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don't miss this event with TVO

Equity, Economic Recovery & COVID-19

February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

Zahra Bhimani is a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

https://policyresponse.ca/underfunded-long-term-care-system-is-still-vulnerable-to-covid-19-outbreaks/

September marks six months since the World Health Organization declared a global pandemic of COVID-19. We’re using this milestone to take stock of the policy response so far and consider next steps as Canada continues to move from reaction to rebuilding. As part of this, First Policy Response is speaking to several policy experts to gather their thoughts on the key policy developments of these past six months, and what they think our next priorities should be. This interview with Dr. Samir Sinha, director of health policy research and co-chair of the National Institute on Ageing at Ryerson University, is part of a series of interview transcripts. You can read the full series here. This transcript has been edited for clarity. First Policy Response: As of May, the National Institute on Ageing was reporting that more than 80 per cent of COVID-19 deaths in Canada were in long-term care homes. Is that still accurate at this point? Dr. Samir Sinha: Yes. Towards the end of March, we launched what we call ourNIA Long-term Care COVID-19 Tracker. It’s available online and we continue to update it to this day. By May, or at the height of the pandemic, if you will, we were even up as high as 82, 83 per cent of Canadian deaths that occurred in long-term care settings. By the time the Canadian Institute for Health Information did ananalysistowards the end of May looking at our data, they confirmed about 80 to 81 per cent. Right now that number is about 77 per cent of Canadian deaths that have occurred in long-term care homes. So the number is decreasing a little bit, but it’s staying around the 80 per cent mark, and this reflects that more younger people are now becoming infected. And certainly younger populations, with the second ripple or second wave that’s starting to develop across the country, we’re starting to see more deaths occurring outside long-term care homes in the general population, as well. But the bottom line is that Canada still holds this record of 77 per cent or close to 80 per cent of its deaths occurring in our long-term care homes. And that’s about double what we’re seeing on the international stage. FPR: Why do you think that is? I think there are two fundamental reasons why we’ve actually been seeing such a high proportion of our deaths occur in long-term care homes. The first part is good news: Canada did a really, really good job early on in the pandemic, as cases were starting to climb in Canada, to actually take some definitive public health measures to lock us all down, essentially, and limit our ability to travel and interact, and close our borders as well. And by doing that, we helped to significantly limit the rate of community spread that could potentially occur, that we had seen become real issues in places like the U.K., Spain, Italy, etc. And so, because we had fair warning compared to some European countries, for example, we were able to heed those warnings and close our borders, create our lockdown situation early, which helped to limit the amount of community spread and the number of cases and deaths. And overall we’ve seen only about 1 per cent of Canadians in total have actually been infected, probably, with COVID-19. The challenge is that, when it came to the way that we were preparing ourselves in our health-care system, a huge amount of focus was placed on our hospitals at the expense of our long-term care and our retirement-home systems, which really in the end were not well equipped and well supported enough to deal with COVID-19. So even though COVID-19 was circulating in the communities, we weren’t making sure that all of our long-term care homes were fully equipped with personal protective equipment. While we assumed that our staff in these homes knew how to follow IPAC [Infection Prevention and Control] procedures and use their PPE, this wasn’t quite the case. And then we already had a system that was plagued with staffing shortages and issues. And as COVID got into homes and spread easily – because we weren’t aware early on of the possibilities of asymptomatic spread and transmission – staff weren’t equipped with enough PPE and we already had severe staffing shortages to begin with. As soon as COVID started taking effect in these homes, this just exacerbated all these problems even further, and especially in provinces like Ontario and Quebec, really set us off on a wrong foot overall. FPR: What does that tell us about the long-term care system in Canada? I think what it really exposed to us is that, when we think about how Canada did compared to the rest of the world, we could say, yes, some of our high case numbers or rates of deaths in these settings was partly related to the fact that we actually had done a reasonably good job of limiting the amount of general community spread. But you know, when you’re double the international rate of deaths in long-term care homes, it also speaks to the fact that COVID-19 exposed how vulnerable our long-term care system was to begin with. So when you look at OECD [Organisation for Economic Co-operation and Development] countries, in general, which experienced half the rate of deaths in its care homes that we did, what we see is that we spend 30 per cent less on providing long-term care services in Canada compared to other OECD countries. We’re already funding significantly less as a proportion of our GDP compared to other countries, only 1.3 per cent versus 1.7 per cent on average. So that’s the first challenge. And then, when you underfund an entire long-term care system, it means that we have staff who aren’t paid as well as those who are generally working in our hospitals, for example. And we also have the challenge where more people tend to work part-time in these settings than, say, in other health-care settings, and as a result, to try and make a full-time salary, people are working multiple jobs in multiple settings. All of this means that if you have infection in one home, when staff are working between multiple homes, they could inadvertently become vectors to transmit this virus from one home to the other. So when you underfund the system, it affects the level at which we staff these homes. It also affects the resources we actually provide these homes to provide the care that residents need. And it really just exposed the fact that we had these systemic vulnerabilities – that not only were we having challenges staffing and making sure that homes have the resources they did, but we also see this phenomenon in Canada, compared to many other countries, where in Ontario, for example, a large portion of the rooms happened to be two-, three- or four-bedded rooms, where in many other jurisdictions, they moved to an all-single-room format. The problem is, if you move to all single rooms, that’s a much more expensive home to build than packing people two or three or four to a room. And so again, when you underfund the system, you’re going to have poor-quality facilities and many older facilities that are vastly in need of redevelopment, but also a system that can’t actually even attract the basic staff it needs to keep these homes properly staffed and supported, especially during a pandemic. FPR: Was it a surprise to you, how much higher the rate was in Canada compared to the rest of the world? It was. I mean, the data doesn’t lie. And when you see that Canada has such a high rate of death in long-term care settings, especially when we had other countries that had significant community spread but their long-term care settings seem to fare better, we started realizing what other countries were doing and what we weren’t doing, and it reinforced how our approaches were not well balanced in Canada. For example, other countries, realizing that their long-term care homes or settings were highly vulnerable settings, were making sure that they actually increased the staffing in those settings. They were making sure that homes had adequate supplies of PPE. They were making sure that staff in those homes were having their skills augmented in terms of how to use PPE, and making sure that they were well versed in their infection prevention control efforts. And in some jurisdictions, they had developed early response teams, so that if a home did go on outbreak, it would actually have extra resources deployed almost immediately. Yet we didn’t have a lot of those mechanisms in place or those considerations in place. I think so many people were concerned about our hospitals getting overwhelmed at the beginning; we were concerned about conserving PPE for these settings at the expense of our long-term care settings. So while we were masking all the staff in our hospital settings, we weren’t doing that for staff in long-term care homes for even weeks after we started mandating this in our own hospitals. This really just showed that we almost created a bit of a double standard, and ironically, a double standard in environments that had the most to lose if COVID-19 got in.

“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

Additional Possible Media From First Policy Response:

Nasma Ahmed is a technologist working toward building more just and equitable futures.Toby Harper-Merretthas led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polleyoeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything frompost-secondary educationtocontact tracingduring the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access(does the service reach you?)and another of uptake(are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of theStanding Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ.Social determinantshave a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes inDevelopment as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In arecent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnikwrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses wereinitiated– for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from theUNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments tobeginby using technology to reach the unreached, and to ensure that themostmarginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports byACORN Canadathrough its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada hassaid: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

As Ontario prepares to launch its online COVID-19 vaccination portal forpriority target groups, many Canadians still don’t have the broadband internet access or digital literacy skills they need to successfully navigate such a process. Once again, the pandemic has shown us that access and adoption of internet services is no longer a luxury: the ability to navigate online services has become a key determinant of health outcomes. Lessons learned from American states that already have online vaccination portals in place should help inform our vaccination strategy and uncover potential vaccine distribution inequities before it’s too late. Early evidence from California’sSkedulovaccine registration portal (which Ontario’s system will reportedly follow) showolder adults,low-income individual sandpeople of colour(including Black and Latino) are being vaccinated at a disproportionately lower rate, with many underserved groupscitinglong wait times,technology troubleshootinganddigital literacy challengesas their greatest hurdles to booking a vaccine appointment. Here in Canada, the situation is unlikely to veer far from the U.S. experience. Based on what we know about theunequal distribution of home internet adoption and digital literacy skillsin Canada, older adults, low-income individuals, remote residents and people with disabilities will find it difficult to book vaccination appointments online if proactive measures are not taken to correct Canada’s digital divides. While online vaccine registration is certainly needed in Canada, its effectiveness is limited if the people who need vaccination the most are the same people facing the most difficulty accessing and navigating these portals.

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

September marks six months since the World Health Organization declared a global pandemic of COVID-19. We’re using this milestone to take stock of the policy response so far and consider next steps as Canada continues to move from reaction to rebuilding. As part of this, First Policy Response is speaking to several policy experts to gather their thoughts on the key policy developments of these past six months, and what they think our next priorities should be. This interview withSané Dube,policy and government relations lead, with a focus on Black health, at theAlliance for Healthier Communities, is part of a series of interview transcripts that will run this week and next. You can read the full serieshere. This transcript has been edited for clarity. First Policy Response: So to start off with, you and the Alliance for Healthier Communities had advocated really strongly for race-based data collection on COVID-19. Why was that? Sané Dube: Early in the pandemic we started to see the disparities that were being created. It became evident pretty early in the game that COVID wasn’t affecting people in the same way. There were some communities and some groups that were harder hit and disproportionately impacted. We were already seeing that in Ontario and in Canada. At about the same time, we started to see data coming out of the United States and the United Kingdom, and a lot of their data was showing a real, deep impact on Black communities. So that included Black folks who were patients with COVID, but then it also was Black health-care workers, specifically in the case of the U.K., who were the ones who were contracting the virus. And what the data was showing was that when these communities contracted the virus, their outcomes also tended to be worse, so we were seeing that they were higher numbers and then when people did get the virus, they were more likely to have fatal or negative impacts. So many people were really concerned that Ontario was not looking at COVID with this lens. Really, that’s where the calls for data collection became prominent. Data collection calls are not new. People have been calling for this data to be collected for a long time. The Alliance is one of the organizations that’s also been on record for a very long time calling for this data to be collected. What made it even more urgent for this data to be collected was what we were already seeing in COVID, and also just knowing that without that data, the province couldn’t respond in the way that they needed to. And the same issues remain in Canada. . . . Ontario and Manitoba are the only two provinces that have mandated data connection, at least during COVID. A few other provinces are on their way to doing that. But the fact that we don’t have data that tells us exactly what COVID looks like broken down by race, broken down by other socio-economic markers, is really troubling and it actually hinders our ability to respond to this pandemic. FPR: So what has the data shown us so far about how this is affecting different communities differently? I would point to the example of Toronto. The public health or the regional authorities here were really great with collecting data earlier and also starting to release that data. They had astudythat showed that 83 per cent of the people who had contracted COVID were Black or racialized people, and also showed that a lot of those people came from low-income families or households, and they also tended to live in parts of the city where the average income was lower. And more recently, they’ve had another study that just came out, which was looking atwho lockdown worked for. They were saying that if you look at predominantly white, affluent neighborhoods, people there were able to do the lockdown and be able to follow public health guidelines. Whereas if you’re looking at other communities where people continued to work, they were often the low-income, essential workers like grocery shop attendants, or they were janitorial staff or working in public transportation, cab drivers and such. Many of those people didn’t have the option, necessarily, to either work from home or not go to work altogether. And even if people got sick in their household, just because of the housing crisis and the unaffordability of the city, many people also did not have the option of, “I will go to a hotel and isolate,” or “There’s a room in my house, or there’s a part of my house where I would have my own bathroom.” People couldn’t do those things. So yeah, the data is really striking. A few regions of Ontario have started to release their data and it’s showing how COVID has impacted other communities, and the same stories repeat themselves over and over again in every region, everywhere where data has been released. And the story is always that it is the people who already are so marginalized who feel this pandemic the most, and whose chances of recovering will be most impacted as well, just because not enough has been invested in making sure that people are getting the help they need and that they can recover well. FPR: How does that fit in with the idea of social determinants of health? Social determinants of health is a way of understanding health care and health policies. So it’s a framework, and it really says that we have to understand that a person’s health is impacted not just by the ability of a person to go to a doctor or walk into a nurse’s office – health is really impacted by social and economic factors. So things like your housing, your ability to have good housing, that’s actually a huge determinant. It impacts the health outcomes you’re able to achieve. We know that racial bias in health care means that Indigenous and Black people, in particular, will face more barriers in getting equitable and good health care, so over the long run, that also impacts people’s health. So there’s a range of social determinants of health – housing, race, income, neighborhood, a range of factors. And what we have said is that in dealing with something which is as severe as COVID, or has impacted us as much as it has both in Ontario and on a global scale, our responses should really be framed in a social determinants of health framework. We can’t actually address this pandemic without addressing all of the other factors that make some people more susceptible to illness, or the factors that make it so that when some people get this virus, they will have worse outcomes. So I think this goes back to what I was saying before: it’s one thing to contract the virus and be unable to stop working, be unable to isolate or be unable to have the resources that you need. That’s a very different story from someone who contracts the virus, has all the support that they need, doesn’t have to worry about facing racism when they go to a health care centre, is guaranteed that they will be treated well. So, our COVID response really needs to centre that social determinants of health approach, because that is what addresses underlying systemic and structural issues. FPR: You’ve also been quite vocal about how racism is a public health crisis in Canada. Can you talk a little bit more about how that intersects with COVID? So this has been an . . .interestingseason. I use that term generously. What we have also seen over COVID is the amplification of movements that were already happening – specifically movements for Black lives and movements for Indigenous sovereignty and life. In late May or early June, there were several Black folks who were killed by police in the U.S.: George Floyd, Breonna Taylor. In Canada, we saw the deaths of people like Regis Korchinski-Paquet and Rodney Levi. And all of these movements spurred a push to really address the ways that people experience racism, systemic and structural inequality. The experiences that people have with racism really impact the way that they are able to move through the world. I’ll give the example of Regis Korchinski-Paquet, who was a 29-year-old Afro-Indigenous woman who died in police presence, who had been called for a mental health call. We, as advocates, would argue that racism is what contributed to her death, because we see instances where, if police are called to assist a white person who is in mental health distress, they are less likely to end up dead. Whereas studies have shown that Black and Indigenous people have higher rates of fatal outcomes – people are more likely to end up dead. And this is from a system that should be helping them. A system that should be keeping people safe. It should be providing people the protection that they need. And we would argue that part of that is the racism that underlies policing, and that underlies many of the health-care systems and structures that we operate in. So what we have said is that we want recognition of racism as a public health crisis because by declaring it a public health crisis, then you are saying that this is a serious issue that must be addressed. It is something that is endemic. It is something that touches all sorts of systems and structures. Declaring it a public health crisis would recognize the harm that it does to our communities, and actually put things in place to start fixing the situation. Black health leaders, particularly after those deaths in June and May, many people started calling for the declaration of racism as a public health crisis. A few regions and cities in Ontario have done that. Toronto has, but we still don’t have a provincial recognition of racism as a public health crisis. FPR: How does that intersect with COVID? I think that COVID has really shown the ways that racism harms people who already more marginalized. I’ll give the example of Toronto’s northwest. We know that this is where some of the worst cases for COVID are right now. But we also know that the systemic and structural racism that is in our system means that even when we know that this is where COVID is really hurting people, not enough resources have been directed there. And racism, it takes many forms. You even hear people talking about how, in the regions where they live, the testing and COVID response hasn’t been done with an appropriate cultural lens. So you will find that someone is being sent in to do testing who doesn’t even speak the language that people in that community speak, who doesn’t understand the cultural norms in a place. And it means that people are not able to access the care that they need. We would say that is actually just an iteration of racism, where you are not willing to work with communities in a way that recognizes and honours how they want to access health care. So I think racism takes many different forms. And even something like refusing to collect data so that we know who is impacted and how they are impacted, some would say that can also be a form of systemic and structural racism because it makes invisible the ways that we are failing to provide appropriate care to some people.

“We need approaches that put health equity at the centre.”

Author(s)

Sané Dube

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/

“I was a doctor back home.” “I’m writing my exams to get my licence here.” “It’s been three years since I practised last.” “Seven years.” `“Ten.” We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country. The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors. Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots. Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship. As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita. Crisis and opportunity The COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years. Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians. These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps. We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this:

Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency.
Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards.
Increase the number of residency spaces for internationally trained physicians.
Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country.

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Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

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Chapter 2-Health (v8-delete text titles, format)

dsossi — Tue, 26 Oct 2021 01:00:53 +0000

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don't miss this event with TVO

Equity, Economic Recovery & COVID-19February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

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Equity, Economic Recovery & COVID-19February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

Zahra Bhimani is a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

https://policyresponse.ca/underfunded-long-term-care-system-is-still-vulnerable-to-covid-19-outbreaks/

“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

Additional Possible Media From First Policy Response:

Nasma Ahmed is a technologist working toward building more just and equitable futures.Toby Harper-Merretthas led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polleyoeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything frompost-secondary educationtocontact tracingduring the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access(does the service reach you?)and another of uptake(are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of theStanding Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ.Social determinantshave a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes inDevelopment as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In arecent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnikwrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses wereinitiated– for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from theUNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments tobeginby using technology to reach the unreached, and to ensure that themostmarginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports byACORN Canadathrough its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada hassaid: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

September marks six months since the World Health Organization declared a global pandemic of COVID-19. We’re using this milestone to take stock of the policy response so far and consider next steps as Canada continues to move from reaction to rebuilding. As part of this, First Policy Response is speaking to several policy experts to gather their thoughts on the key policy developments of these past six months, and what they think our next priorities should be.This interview withSané Dube,policy and government relations lead, with a focus on Black health, at theAlliance for Healthier Communities, is part of a series of interview transcripts that will run this week and next. You can read the full serieshere. This transcript has been edited for clarity.First Policy Response: So to start off with, you and the Alliance for Healthier Communities had advocated really strongly for race-based data collection on COVID-19. Why was that?Sané Dube: Early in the pandemic we started to see the disparities that were being created. It became evident pretty early in the game that COVID wasn’t affecting people in the same way. There were some communities and some groups that were harder hit and disproportionately impacted. We were already seeing that in Ontario and in Canada. At about the same time, we started to see data coming out of the United States and the United Kingdom, and a lot of their data was showing a real, deep impact on Black communities. So that included Black folks who were patients with COVID, but then it also was Black health-care workers, specifically in the case of the U.K., who were the ones who were contracting the virus. And what the data was showing was that when these communities contracted the virus, their outcomes also tended to be worse, so we were seeing that they were higher numbers and then when people did get the virus, they were more likely to have fatal or negative impacts. So many people were really concerned that Ontario was not looking at COVID with this lens. Really, that’s where the calls for data collection became prominent.Data collection calls are not new. People have been calling for this data to be collected for a long time. The Alliance is one of the organizations that’s also been on record for a very long time calling for this data to be collected. What made it even more urgent for this data to be collected was what we were already seeing in COVID, and also just knowing that without that data, the province couldn’t respond in the way that they needed to. And the same issues remain in Canada. . . . Ontario and Manitoba are the only two provinces that have mandated data connection, at least during COVID. A few other provinces are on their way to doing that. But the fact that we don’t have data that tells us exactly what COVID looks like broken down by race, broken down by other socio-economic markers, is really troubling and it actually hinders our ability to respond to this pandemic. FPR: So what has the data shown us so far about how this is affecting different communities differently?I would point to the example of Toronto. The public health or the regional authorities here were really great with collecting data earlier and also starting to release that data. They had astudythat showed that 83 per cent of the people who had contracted COVID were Black or racialized people, and also showed that a lot of those people came from low-income families or households, and they also tended to live in parts of the city where the average income was lower. And more recently, they’ve had another study that just came out, which was looking atwho lockdown worked for. They were saying that if you look at predominantly white, affluent neighborhoods, people there were able to do the lockdown and be able to follow public health guidelines. Whereas if you’re looking at other communities where people continued to work, they were often the low-income, essential workers like grocery shop attendants, or they were janitorial staff or working in public transportation, cab drivers and such. Many of those people didn’t have the option, necessarily, to either work from home or not go to work altogether.And even if people got sick in their household, just because of the housing crisis and the unaffordability of the city, many people also did not have the option of, “I will go to a hotel and isolate,” or “There’s a room in my house, or there’s a part of my house where I would have my own bathroom.” People couldn’t do those things. So yeah, the data is really striking.A few regions of Ontario have started to release their data and it’s showing how COVID has impacted other communities, and the same stories repeat themselves over and over again in every region, everywhere where data has been released. And the story is always that it is the people who already are so marginalized who feel this pandemic the most, and whose chances of recovering will be most impacted as well, just because not enough has been invested in making sure that people are getting the help they need and that they can recover well. FPR: How does that fit in with the idea of social determinants of health?Social determinants of health is a way of understanding health care and health policies. So it’s a framework, and it really says that we have to understand that a person’s health is impacted not just by the ability of a person to go to a doctor or walk into a nurse’s office – health is really impacted by social and economic factors. So things like your housing, your ability to have good housing, that’s actually a huge determinant. It impacts the health outcomes you’re able to achieve. We know that racial bias in health care means that Indigenous and Black people, in particular, will face more barriers in getting equitable and good health care, so over the long run, that also impacts people’s health. So there’s a range of social determinants of health – housing, race, income, neighborhood, a range of factors. And what we have said is that in dealing with something which is as severe as COVID, or has impacted us as much as it has both in Ontario and on a global scale, our responses should really be framed in a social determinants of health framework. We can’t actually address this pandemic without addressing all of the other factors that make some people more susceptible to illness, or the factors that make it so that when some people get this virus, they will have worse outcomes. So I think this goes back to what I was saying before: it’s one thing to contract the virus and be unable to stop working, be unable to isolate or be unable to have the resources that you need. That’s a very different story from someone who contracts the virus, has all the support that they need, doesn’t have to worry about facing racism when they go to a health care centre, is guaranteed that they will be treated well. So, our COVID response really needs to centre that social determinants of health approach, because that is what addresses underlying systemic and structural issues. FPR: You’ve also been quite vocal about how racism is a public health crisis in Canada. Can you talk a little bit more about how that intersects with COVID?So this has been an . . .interestingseason. I use that term generously. What we have also seen over COVID is the amplification of movements that were already happening – specifically movements for Black lives and movements for Indigenous sovereignty and life. In late May or early June, there were several Black folks who were killed by police in the U.S.: George Floyd, Breonna Taylor. In Canada, we saw the deaths of people like Regis Korchinski-Paquet and Rodney Levi. And all of these movements spurred a push to really address the ways that people experience racism, systemic and structural inequality.The experiences that people have with racism really impact the way that they are able to move through the world. I’ll give the example of Regis Korchinski-Paquet, who was a 29-year-old Afro-Indigenous woman who died in police presence, who had been called for a mental health call. We, as advocates, would argue that racism is what contributed to her death, because we see instances where, if police are called to assist a white person who is in mental health distress, they are less likely to end up dead. Whereas studies have shown that Black and Indigenous people have higher rates of fatal outcomes – people are more likely to end up dead. And this is from a system that should be helping them. A system that should be keeping people safe. It should be providing people the protection that they need. And we would argue that part of that is the racism that underlies policing, and that underlies many of the health-care systems and structures that we operate in. So what we have said is that we want recognition of racism as a public health crisis because by declaring it a public health crisis, then you are saying that this is a serious issue that must be addressed. It is something that is endemic. It is something that touches all sorts of systems and structures. Declaring it a public health crisis would recognize the harm that it does to our communities, and actually put things in place to start fixing the situation. Black health leaders, particularly after those deaths in June and May, many people started calling for the declaration of racism as a public health crisis. A few regions and cities in Ontario have done that. Toronto has, but we still don’t have a provincial recognition of racism as a public health crisis. FPR: How does that intersect with COVID?I think that COVID has really shown the ways that racism harms people who already more marginalized. I’ll give the example of Toronto’s northwest. We know that this is where some of the worst cases for COVID are right now. But we also know that the systemic and structural racism that is in our system means that even when we know that this is where COVID is really hurting people, not enough resources have been directed there.And racism, it takes many forms. You even hear people talking about how, in the regions where they live, the testing and COVID response hasn’t been done with an appropriate cultural lens. So you will find that someone is being sent in to do testing who doesn’t even speak the language that people in that community speak, who doesn’t understand the cultural norms in a place. And it means that people are not able to access the care that they need. We would say that is actually just an iteration of racism, where you are not willing to work with communities in a way that recognizes and honours how they want to access health care.So I think racism takes many different forms. And even something like refusing to collect data so that we know who is impacted and how they are impacted, some would say that can also be a form of systemic and structural racism because it makes invisible the ways that we are failing to provide appropriate care to some people.

“We need approaches that put health equity at the centre.”

I’ll give one more example. In Ontario, there’s a group called the Black Health Equity Working Group, which is a group of experts and health-care providers who, now that Ontario has said they will start collecting the data, are developing a governance and accountability framework for how that data is used, one that is developed by and for Black communities. And part of why Black communities are pushing so hard for this is because they know that racism also affects us in this particular instance. We call for data because we know that this is something that could improve our lives, but what racism does – it means that the data is collected, but then the way that it’s used further harms our communities. So that’s just another way that racism plays out.So again, the example of northwest Toronto – the data has been collected, but then the way that the story is being told in the media, the way that we talk about what’s happening in the northwest of Toronto, is to once again stigmatize the people who are in those communities. So it makes it seem like high COVID rates are somehow because there’s something that’s inherently wrong, or something that’s pathological, with those communities. The way that we tell these stories is that there’s never a full accounting for the systemic underfunding of those communities, that lack of resources, the way those communities have been starved, and the high rates of COVID-19 are actually a result of that. So, racism takes many forms. It’s not always the glaring, the obvious thing. But it’s a conversation that we have to have as we’re talking about COVID. FPR: The Alliance has written about how race-based data collection may actually further entrench harm and inequity. Could you speak a little bit more about how and why that might happen?When we’re thinking about further entrenching harm, it goes back to how that data is used. A lot of Black communities right now are saying that the collection of the data is not actually justice; it’s not the end goal. The end goal should be improving Black people’s lives. Where we’re coming from with the Alliance is that collecting this data, if it’s not used appropriately, if it’s not understood, if it doesn’t become a tool for systemic change, then it is again just replicating harm for people. FPR: From a policy perspective, what do you think needs to be done from here to try and address some of those issues?I would say possibly the most important thing is that our health system response very much needs to be based on social determinants of health frameworks. We also need approaches that put health equity at the centre, where health equity is not an afterthought, but it is something that is integrated throughout the policy and health-system development process, right from the beginning right through to the end of any system. We at the Alliance are fully supportive of the collection of data, but we also want the province to engage the right people in these conversations. Data collection does not mean the same thing for all communities. For example, Indigenous communities have very specific concerns. Black communities have specific concerns. The province needs to be speaking to the right people as it develops its processes for the collection of this data. Those communities need to play a key role in determining how the data is used and what the outcomes are, in the long run, from that.And then I think that we also just need to have approaches that are proactive. We are, for sure, going into a second wave of COVID, if the numbers are any indication. . . . It would appear that we are going back to a place where we will see more cases, and who knows what that will look like once schools open and once people are back to their lives. So, we want a health system that’s responsive. We want a health system that will understand the context, that will understand developments as they are occurring. And a health system that also will work with the most marginalized, those with the least resources, those with the least access. Because right now, in many ways, the health system is working for people who already have access to resources. It’s not working for some of the most marginalized. FPR: Is there anything that any level of government has done so far that’s been helpful to more marginalized communities?The thing with COVID is, it’s also been really illuminating. COVID has been a time when we’ve seen that systems can be responsive. Policies can be created that really will change people’s lives. Like the example of early in the pandemic, the province of Ontariosuspended the OHIP wait period– they made it so that people could get treatment, they could get health care, even if they don’t have health cards. So that provided treatment to people without status, many of whom work in essential roles – they were able to get health care. And we know that’s made a difference in terms of making care accessible for some of the most marginalized. So that’s an example of where a system has worked really well.Even something like pandemic pay for some essential workers. So when you look at workers who are working in supervised consumption sites or overdose prevention sites, a lot of those folks were able to access pandemic pay, which was good because they work very hard and there was a lot on them in those early days of the pandemic. So it was useful. Unfortunately, the pandemic pay is coming to an end for many essential workers, but that is something that makes a tangible difference in people’s lives. And definitely, we know that this is something people are talking about and saying that the province needs to be thinking about longer-term assistance for people, particularly as it looks like we will be in this pandemic for a while.So there’s definitely things that have been done that have really, positively impacted people’s lives. And we want the province, and both federal and provincial bodies, we want them to continue to make those types of decisions that actually support people who are in need.

Author(s)

Sané Dube

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/

“I was a doctor back home.”“I’m writing my exams to get my licence here.”“It’s been three years since I practised last.”“Seven years.”`“Ten.”We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country.The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors.Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots.Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship.As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita.Crisis and opportunityThe COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years.Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians.These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps.We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this:

Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency.
Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards.
Increase the number of residency spaces for internationally trained physicians.
Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country.

Over the past number of years, we’ve seen various orders of government, academic institutions and self-governed medical professions work together to make some progress, such as investing in bridging programs and placements for internationally trained physicians. This is a helpful start but more needs to be done. COVID-19 provides an opportunity to accelerate the many good program and policy ideas that have already been discussed or introduced in ways that are too limited. Now is the time to make real and lasting progress to help our health-care system, internationally trained medical professionals and Canadians in need of health care.Georgette Morris is a doctoral student at Carleton University, contributes her time to Jaku Konbit and holds a Masters in Public Policy, Administration and Law. Shireen Saltiis the Interim Executive Director of the Canadian Arab Institute and holds a Masters in Public Policy, Administration and Law. Anjum Sultana is the Founder of Millennial Womxn in Policy, the Director of Public Policy & Strategic Communications at YWCA Canada and holds a Masters in Public Health from the Dalla Lana School of Public Health from the University of Toronto.

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Anjum Sultana is national director of Public Policy, Advocacy and Strategic Communications for YWCA Canada.

https://policyresponse.ca/ontarios-health-care-system-must-develop-an-anti-racist-response-to-covid-19/

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Chapter 2-Health (v9-delete text titles, format)

dsossi — Tue, 26 Oct 2021 13:16:55 +0000

Published as part of a collaboration between TVO.org and First Policy Response

The early proclamations about COVID-19 suggested that the virus does not discriminate. There was a sense that everyone was equally susceptible to this once-in-generations pandemic. But these assertions were quickly invalidated by the names and faces of those who were contracting the virus and perishing from it. Our pandemic response has shown clearly how race, class, and gender determine who is most likely to be in the line of fire: the Black, Brown, and Indigenous Canadians who keep working during the crisis while others shelter. They must work to live because they are precariously employed, as the standard employment relationship — with one permanent employer and stable, full-time hours — is gradually disintegrating as a labour-market norm. They earnlow wagesand havelittle wealthto fall back on. COVID-19 has demonstrated starkly how social determinants of health include employment opportunities — the sectors of the economy and forms of work that racialized, and often poor, people have access to. In contrast, white Canadians, who have more economic resources, are far more likely to be protected against these outcomes.

The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income.

While there is some debate over whether class or race is to blame, this is an artificial dichotomy. We have enough documented evidence to show that insecure work, low income, and poor health outcomes are inextricably linked to both race and class. Systemic racism lies at the heart not just of economic inequality in Canada but also of how we get sick and die. Throughout the pandemic, we have seen protection measures, particularly stay-at-home orders, exclude Canadians whose jobs were deemed to be an “essential service” — long-term-care workers, grocery store clerks, transit operators, and so on. These occupations carry a higher risk of infection by virtue of their ongoing proximity to others. Data collected so far has shown massive differences in COVID-19 infection rates between the working-class Black and Brown people who predominantly do these jobs in Canadian society and the white people who are more likely to be in office jobs that allow them to stay at home and shelter from risk without jeopardizing their incomes. For example, racialized people — particularly Black and Filipino women — are more likely than those from other groups to be personal support workers, and there have been a significant number of COVID-19 cases among personal support workers in long-term-care homes, according toStatistics Canadadata. This makes them disproportionately vulnerable to infections, and possibly death, because of the power relationships in their work. The labour-market sorting by race, class and, gender that makes these disproportionate risks possible is the result of structural features of society that start in the school systems, operate into disparate opportunities in the labour market, and lead to uneven access to generational wealth and family income. It also stems from a lack of adequate social policy, including unequal funding formulas that mean less government support for public education in some neighbourhoods; a lack of paid sick days; crowding on transit lines serving highly racialized and low-income neighbourhoods; a lack of investment in health resources in those neighbourhoods; and the persistence of racial discrimination in hiring processes that prevent Black and Brown people from obtaining high-wage, high-status jobs, even when they have the education and experience necessary. A number of actions are advisable here: Action on strengthening equitable access to employment for Black, Indigenous, and racialized workers. Public policy to address precarious employment and the conditions ofworking povertyit generates. Employment-standards reforms, such as ensuring access to paid sick days for low-income earners. Anti-poverty measures, such as improved access to housing to decrease overcrowding among immigrant populations. And disaggregated data collection so we have a fuller picture of these impacts on particular communities. There is a role for local public-health agencies to engage directly with communities so that they can generate recommendations relevant to each community’s conditions. At the national level, the Public Health Agency of Canada should leverage its resources to declare racism asocial determinant of healthand work to confront it. In total, we need a pan-Canadian strategy that includes the province and cities in implementing aggressive workplace and health-sector reforms to address the impact of systemic racism on work and life.

Don't miss this event with TVO

Equity, Economic Recovery & COVID-19 February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Grace-Edward Galabuzi

Grace-Edward Galabuzi is an associate professor in the Politics and Public Administration Department at Ryerson University and a research associate at the Centre for Social Justice in Toronto.

Keywords:

Published as part of a collaboration between TVO.org and First Policy Response

So what can be done to address all this? In the short term, we need to take a hard look at the system response to the COVID-19 pandemic through an anti-racist and health-equity lens. An anti-racist system response requires specific policies and systems to explicitly protect and prioritize those who are marginalized and at higher risk of infection. It will mean providing paid sick days for everyone and viewing affordable housing and food security as human rights. It will mean providing support to community organizations to lead COVID-19 testing and contact tracing. It will mean not blaming people’s genetics or culture for disproportionate COVID-19 rates. It will mean infrastructure to provide wrap-around care and social-service supports for those who test positive. And, crucially, it will mean developing a community-based and community-led vaccine strategy that prioritizes those living and working in settings at higher risk of COVID-19. There are promising initiatives we can learn from. The Centre for Wise Practices in Indigenous Health, at Women’s College Hospital, is working in partnership with multiple other Indigenous-focused community and health-care organizations on Sharing Medicine, a project that will develop community-centred resources specifically tailored to Indigenous communities. Importantly, they are using a decolonial approach to understand and address vaccine concerns (and how they are related to colonial histories). Examples such as this make it clear that taking a hard look at our current policies, systems, and plans from an anti-racist perspective cannot be done behind closed doors. Community leaders and advocates from racialized communities must be central voices in the response and be recognized as the experts that they are. In the longer term, we need to take that anti-racist lens to all our social and public-health policies. Housing insecurity, food insecurity, job insecurity, precarious work, unsafe working conditions, and everyday racism will all still be with us after everyone has been vaccinated. The current pandemic is just one example of how these factors play out, but there are countless others. We also need to increase representation of racialized people in positions of power and decision-making across all sectors. There has been focus on the over-representation of racialized people at the margins of our society in this pandemic, but the flipside of that is the under-representation at the centres of our society, including at the decision-making tables. A meaningful, sustainable increase in representation will require the involvement of all governmental sectors. How can we ensure that our racialized students are not streamlined away from career paths they’d be more than capable of pursuing? How can we ensure that racialized people have equal employment opportunities and receive equal pay? The road that led us to where are now is centuries long. We cannot expect the solutions to be quick and easy. But we must choose — today — to take a different path.

Don't miss this event with TVO

Equity, Economic Recovery & COVID-19February 25, 2021

Addressing the disproportionate impact of COVID-19 on low-income areas

Author(s)

Aisha Lofters

Keywords:

Zahra Bhimani is a public health research professional based in Toronto.

Over the course of the pandemic, we have seen deep inequalities rise to the surface. The acknowledgement of these disparities has led to thepush for race-based data collectionand other policy measures aimed at reducing inequality.Sociodemographic data revealthat racialized, marginalized and low-income communities have been most affected by COVID-19, andToronto Public Healthreports that non-white residents make up 52 per cent of the population but 82 per cent of COVID-19 cases in the city. Now, amid the second wave, these inequalities continue to persist in the health system. This prompts the question: Are we doing all we can to learn how health outcomes can be improved for those most affected by this pandemic? To date, more than$275 millionhas been invested to enhance Canada’s capacity in research and development, as part of Canada’s COVID-19 research response. Now more than ever, research is one of the most powerful tools we have for improving health outcomes. But before we can attain answers, we need to address institutional barriers within clinical research. Canada’s clinical research response to studying patients with COVID-19 and related treatments must be representative and inclusive of racially marginalized populations across Canada. The Canadian Institutes of Health Research (CIHR)recently released a statementcommitted to fostering a more “equitable, diverse and inclusive research-funding system,” noting that its predominant focus to date has been on sex and gender diversity. The homogeneity of clinical trial participants has long been recognized as both anethical and scientific issue; relying on data that may not be generalizable (but may be considered as such) is problematic. Taking action that will result in tangible change is important, and the time to act is now. The current pandemic offers an opportunity to address this problem by reducing disparities in health outcomes across the country, but that depends on organizations that fund Canadian health research adopting system-wide policy solutions:

Increase transparency of funding decisions by enabling public involvement

First and foremost, the Canadian health research-funding system should consider enabling demographically representative public participation in its funding decisions. Public involvement is imperative to increase transparency and accountability in government decision-making. Just as recent demand for greater citizen engagement in matters that affect the health outcomes of Canadians has been met withpatient-oriented research strategies, a demographically representative sample of the Canadian public should become a mandated requirement when decisions that fund health research take place. Public representatives drawing from lived experience would be able to judge research proposals by the quality of their equity, diversity and inclusion strategies. In the early stages of the COVID-19 pandemic, when critical policies were being made about patients (such as long-term care facilities and visitation rights),patient and public voices were largely left outof the decision-making. The second wave offers an opportunity to make policy decisions transparent and inclusive.

Require equitable inclusion of racially marginalized populations in clinical research

While researchers may have the willingness to improve the diversity of clinical trials, they have to consider many important barriers, such as historical abuses. One particularly successful means for building trust, educating patients and raising awareness is throughcommunity‐based participatory research. Trial sponsors and research teams are forging new paths to diversity by obtaining the support of trusted community leaders. Given our history, building the trust of Indigenous and Black communities in Canada will be particularly critical, and our research-funding system should make this a requirement for all clinical researchers seeking funding.

Address disparities in clinical trial access

All funded research should require that research sites have the resources and personnel to simplify research and translate consent documents to languages spoken by local populations. Though translation services are often available, their use is not mandated by our funding system, which limits trial participation from patients who speak little or no English or French.Low income and education levelsare also barriers to increased participation in clinical research. Requiring research teams to include professionals trained and educated on the potential barriers that racially marginalized populations face, who share cultural and language similarities with patients and who use simplified language to explain their research, will help overcome the barriers to including low-income and racially marginalized populations in research. This solution would not only be a step closer toward inclusive science, but also toward health equity and consequently, improved health outcomes. As we strive as a country to tackle the second wave of the pandemic, and as CIHR develops a new strategic plan for 2021-25 Canada’s health research-funding community must take a close look at current research practices that may be exacerbating inequalities in clinical research, and act swiftly to enact these recommendations.

Author(s)

Zahra Bhimani

Keywords:

https://policyresponse.ca/underfunded-long-term-care-system-is-still-vulnerable-to-covid-19-outbreaks/

“Fundamentally, as a society, we’re ageist.”

“We’re trying to be open and transparent about what the data actually shows to better inform better policy responses.”

Author(s)

https://policyresponse.ca/foreign-trained-doctors-are-untapped-resource-in-pandemic-fight/

Keywords:

Additional Possible Media From First Policy Response:

Nasma Ahmed is a technologist working toward building more just and equitable futures.Toby Harper-Merretthas led information and communication technology for development (ICT4D) programs internationally and in Canada, particularly in the education sector, since before the iPhone.

Everyone in Canada should be able to use the internet to share information, connect with friends and family, do schoolwork, access government services, find work and do their job and, yes, enjoy a selection from the Sarah Polleyoeuvre. But the chasm between those who do and do not have these capabilities will not be closed, filled or bridged by technology alone. COVID-19 has underscored the consequences of that chasm, as inequities in Canadians’ ability to access digital technologies – the basis for everything frompost-secondary educationtocontact tracingduring the pandemic – have threatened to exacerbate social and economic inequities. We want to ensure an inclusive society and better health, education and prosperity outcomes for all. What is currently viewed as the “digital divide” is based on two questions that are frequently confounded: one of internet access(does the service reach you?)and another of uptake(are you using the service?). On the question of access, internet infrastructure across Canada is built through investment by facilities-based service providers and governments. Billions of Canadians’ dollars are being used to expand networks to the places they don’t already reach and upgrade technology to the next generation. If network infrastructure does not yet reach all Canadians, it should and it will. As MP Will Amos, member of theStanding Committee on Industry, Science and Technology, has said, there is “violent agreement” that internet access is vital, pivotal, essential and basic. (Call it anything other than a right: we have a right to the outcomes, not the technologies.) However, the issue of uptake cannot be addressed with cables, satellites and antennae. On their own, these risk amplifying digital inequity, widening divides. Instead, to address uptake, we must ask what bars people from using the services they do have access to? Think of it like health care. In Canada, every citizen has access to health care, yet depending on their income, where they live and what they look like, the availability and experience of health services may differ.Social determinantshave a direct impact on health outcomes. The same can be said for how we experience access to and uptake of internet services. As Amartya Sen writes inDevelopment as Freedom, regardless of a person’s rights, what’s important is whether they are capable of exercising them. The “digital divide” is at the intersection of other divides including sex, race, age, language, ability, education, income and location. The Charter of Rights protects Canadians from discrimination based on these factors, yet women, Black, Indigenous and people of colour, people living in rural and remote communities, those who are low-income and those living with disability are at higher risk of digital exclusion. Communities living at these intersections are more likely to face barriers in both access to and uptake of the internet. Issues of digital equity are deeply rooted, connected and systemic. Innovation policy should not address them uninformed by their social determinants. It is essential to respond to divides with care; they existed prior to current technologies and can be exacerbated by new ones. In arecent report, Alison Gillwald and Onkokame Mothobi shared their research findings on what happens “After Access.” They found, paradoxically, “as more people are connected … inequality is increasing not decreasing.” This means “connectivity alone will not be sufficient for countries to overcome the digital divide.”

Digital inequity in a crisis

In late March, Adam Gopnikwrote: “Crises take an X-ray of a city’s class structure.” The past months of the COVID-19 pandemic have proven that observation scales to regions, countries and the globe, and it certainly applies to the digital world. People who take up new technologies forge ahead, widening rather than closing divides. Innovation that isn’t inclusive becomes the agent of further inequity. The COVID-19 crisis has demonstrated the need for more holistic and inclusive approaches to innovation investment. For example, digital devices, connectivity and skills are vital for Canadians to benefit from public education. For some learners who were able to connect to the internet only at school or in a public space, those options have been limited by the pandemic. Generous sectoral responses wereinitiated– for instance, many Internet Service Providers waived overage and data caps, didn’t disconnect accounts for non-payment, and donated devices and service plans to populations most at-risk of digital exclusion. Yet these measures were temporary and equity issues must be addressed at their core, so that we are better prepared for the next crisis. According to a recent guidance document for governments from theUNESCO Chair in Internet and Communications Technology for Development: “One of the main lessons from responses to the outbreak of COVID-19 is that education systems across the world were unprepared for the changes that would be necessary to shift rapidly from a physical schools-based infrastructure to a widely dispersed online system of learning.” The document adds that “the provision of good public education is a crucial factor in building a successful economy and society…. However, such a vision must begin with a profound commitment by governments tobeginby using technology to reach the unreached, and to ensure that themostmarginalized are considered first in any proposed roll-out of digital technologies” (emphasis our own.) Why don’t millions of Canadians benefit from internet uptake? This is about choices, or a lack thereof. The reasons why residents say they are not internet users can be reduced to quality of services, affordability of devices and connection, and digital literacy. Internet quality measurement is complex. If internet infrastructure does reach you, does the quality of the available service limit the things you want to use it for? “Evaluation of internet performance should relate to human quality of experience,” Fenwick McKelvey, associate professor in Information and Communication Technology Policy at Concordia University, told us. “This means that speed is not the only factor.” Affordability is the primary reason low-income households don’t have internet subscriptions. Many, including the International Telecommunication Union, have attempted to benchmark what portion of household budget is invested in telecommunication services. Most Canadians spend less than five per cent, while the lowest income – for example, people accessing disability benefits – can spend upwards of 10 per cent of their income, as shared within reports byACORN Canadathrough its Internet For All campaign. This means families must navigate competing essential needs ranging from internet service to food and housing. This issue has only expanded during the COVID-19 pandemic, when an internet subscription has become the default way people engage with each other and their employment. Additionally, digital literacy remains a significant barrier to uptake, especially as Canada’s population ages. Mack Rogers of ABC Life Literacy Canada hassaid: “The number of adult learners and seniors with access to the internet is growing significantly, but many of them don’t have the appropriate digital literacy skills to use the internet safely.”

A new approach to digital policy

Author(s)

Nasma Ahmed

Toby Harper-Merrett

Keywords:

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Older adults

Low-income communities

People with Disabilities

Moving forward: Policy recommendations for a more equitable vaccine distribution

Allowing the highest priority target groups to effectively access vaccines requires proactive programming and policy approaches that recognize Canada’s digital divides.

Narrow age cut-offs for vaccine distribution phases: Online vaccine portalsface high demand, especially upon launch, with the most tech-savvy users swiftly seizing available booking times. Phase 1 of Ontario’s vaccine distribution strategy designates those aged 80 and older as a priority target group, followed by those aged 75 and older in Phase 2, and decreasing in five-year increments over the course of the vaccine rollout.Alberta’s planallowed those aged 75 and older to book a vaccine appointment upon the launch of their online portal, leading to amuch greater than anticipated number of older Canadianscompeting for limited slots. The vaccination plan receivedcriticismfor failing to provide adequate age limits to ensure the oldest citizens get the vaccine first. Having a plan that limits age group access more narrowly will allow those most at risk to receive the vaccine first, with other priority groups following consecutively.
Amplify community voices and consult equity-focused health experts: Making it easier for digitally underserved communities to access and navigate online vaccine portals requires preemptive solutions that bring the right technology tools and skills directly to communities in need. Ontario’sOperation Remote Immunity initiativeis a step in the right direction: the provincial government delivered the first doses of the vaccine directly to all 31 fly-in, remote Indigenous communities. Identifying where access to the online portal is lacking, and what specific impediments prevent populations in need from booking appointments online, will inform where technology resources can be delivered and what administration changes would be helpful — such as reserving specific time slots for certain groups or for appointments scheduled by phone, family physicians or community groups.
Send advance notice of new appointment availabilities:U.S. technology and health experts notethat many people, particularly low-income and working individuals, do not have the time to continuously check appointment availabilities that appear unpredictably. The process could also overload websites unnecessarily as individuals continue to check back for updates. Instead, Washington, D.C., hasexperimentedwith notifying people of a specific, predetermined time when new availabilities will be released so that individuals in need can plan to log on well ahead of time.
Simplify the online process by requiring less information to register: Managing high portal demand requires streamlining the online process to ensure individuals can complete registration as quickly as possible and make room for other incoming users. After Alberta’s website crashed, technology fixes now allow the vaccine portal to handle more than5,000 bookings per hour— a rate that will be too slow for Ontario, which is home to almost three times Alberta’s population. To streamline the portal, the government should require users to only input personal information that is strictly necessary.New York City’s two-step verification processsends time-limited codes to an email address, and many seniors have complained that the process of re-entering information while flipping through different browser windows istoo cumbersome. Verification could be most efficiently conducted during face-to-face appointments rather than through overly complicated processes using high-demand online portals.

Author(s)

Nour Abdelaal

Keywords:

First Policy Response: So to start off with, you and the Alliance for Healthier Communities had advocated really strongly for race-based data collection on COVID-19. Why was that?Sané Dube: Early in the pandemic we started to see the disparities that were being created. It became evident pretty early in the game that COVID wasn’t affecting people in the same way. There were some communities and some groups that were harder hit and disproportionately impacted. We were already seeing that in Ontario and in Canada. At about the same time, we started to see data coming out of the United States and the United Kingdom, and a lot of their data was showing a real, deep impact on Black communities. So that included Black folks who were patients with COVID, but then it also was Black health-care workers, specifically in the case of the U.K., who were the ones who were contracting the virus. And what the data was showing was that when these communities contracted the virus, their outcomes also tended to be worse, so we were seeing that they were higher numbers and then when people did get the virus, they were more likely to have fatal or negative impacts. So many people were really concerned that Ontario was not looking at COVID with this lens. Really, that’s where the calls for data collection became prominent.Data collection calls are not new. People have been calling for this data to be collected for a long time. The Alliance is one of the organizations that’s also been on record for a very long time calling for this data to be collected. What made it even more urgent for this data to be collected was what we were already seeing in COVID, and also just knowing that without that data, the province couldn’t respond in the way that they needed to. And the same issues remain in Canada. . . . Ontario and Manitoba are the only two provinces that have mandated data connection, at least during COVID. A few other provinces are on their way to doing that. But the fact that we don’t have data that tells us exactly what COVID looks like broken down by race, broken down by other socio-economic markers, is really troubling and it actually hinders our ability to respond to this pandemic.

FPR: So what has the data shown us so far about how this is affecting different communities differently?

I would point to the example of Toronto. The public health or the regional authorities here were really great with collecting data earlier and also starting to release that data. They had astudythat showed that 83 per cent of the people who had contracted COVID were Black or racialized people, and also showed that a lot of those people came from low-income families or households, and they also tended to live in parts of the city where the average income was lower. And more recently, they’ve had another study that just came out, which was looking atwho lockdown worked for. They were saying that if you look at predominantly white, affluent neighborhoods, people there were able to do the lockdown and be able to follow public health guidelines. Whereas if you’re looking at other communities where people continued to work, they were often the low-income, essential workers like grocery shop attendants, or they were janitorial staff or working in public transportation, cab drivers and such. Many of those people didn’t have the option, necessarily, to either work from home or not go to work altogether.And even if people got sick in their household, just because of the housing crisis and the unaffordability of the city, many people also did not have the option of, “I will go to a hotel and isolate,” or “There’s a room in my house, or there’s a part of my house where I would have my own bathroom.” People couldn’t do those things. So yeah, the data is really striking.A few regions of Ontario have started to release their data and it’s showing how COVID has impacted other communities, and the same stories repeat themselves over and over again in every region, everywhere where data has been released. And the story is always that it is the people who already are so marginalized who feel this pandemic the most, and whose chances of recovering will be most impacted as well, just because not enough has been invested in making sure that people are getting the help they need and that they can recover well.

FPR: How does that fit in with the idea of social determinants of health?

Social determinants of health is a way of understanding health care and health policies. So it’s a framework, and it really says that we have to understand that a person’s health is impacted not just by the ability of a person to go to a doctor or walk into a nurse’s office – health is really impacted by social and economic factors. So things like your housing, your ability to have good housing, that’s actually a huge determinant. It impacts the health outcomes you’re able to achieve. We know that racial bias in health care means that Indigenous and Black people, in particular, will face more barriers in getting equitable and good health care, so over the long run, that also impacts people’s health. So there’s a range of social determinants of health – housing, race, income, neighborhood, a range of factors. And what we have said is that in dealing with something which is as severe as COVID, or has impacted us as much as it has both in Ontario and on a global scale, our responses should really be framed in a social determinants of health framework. We can’t actually address this pandemic without addressing all of the other factors that make some people more susceptible to illness, or the factors that make it so that when some people get this virus, they will have worse outcomes. So I think this goes back to what I was saying before: it’s one thing to contract the virus and be unable to stop working, be unable to isolate or be unable to have the resources that you need. That’s a very different story from someone who contracts the virus, has all the support that they need, doesn’t have to worry about facing racism when they go to a health care centre, is guaranteed that they will be treated well. So, our COVID response really needs to centre that social determinants of health approach, because that is what addresses underlying systemic and structural issues.

FPR: You’ve also been quite vocal about how racism is a public health crisis in Canada. Can you talk a little bit more about how that intersects with COVID?

So this has been an . . .interestingseason. I use that term generously. What we have also seen over COVID is the amplification of movements that were already happening – specifically movements for Black lives and movements for Indigenous sovereignty and life. In late May or early June, there were several Black folks who were killed by police in the U.S.: George Floyd, Breonna Taylor. In Canada, we saw the deaths of people like Regis Korchinski-Paquet and Rodney Levi. And all of these movements spurred a push to really address the ways that people experience racism, systemic and structural inequality.The experiences that people have with racism really impact the way that they are able to move through the world. I’ll give the example of Regis Korchinski-Paquet, who was a 29-year-old Afro-Indigenous woman who died in police presence, who had been called for a mental health call. We, as advocates, would argue that racism is what contributed to her death, because we see instances where, if police are called to assist a white person who is in mental health distress, they are less likely to end up dead. Whereas studies have shown that Black and Indigenous people have higher rates of fatal outcomes – people are more likely to end up dead. And this is from a system that should be helping them. A system that should be keeping people safe. It should be providing people the protection that they need. And we would argue that part of that is the racism that underlies policing, and that underlies many of the health-care systems and structures that we operate in. So what we have said is that we want recognition of racism as a public health crisis because by declaring it a public health crisis, then you are saying that this is a serious issue that must be addressed. It is something that is endemic. It is something that touches all sorts of systems and structures. Declaring it a public health crisis would recognize the harm that it does to our communities, and actually put things in place to start fixing the situation. Black health leaders, particularly after those deaths in June and May, many people started calling for the declaration of racism as a public health crisis. A few regions and cities in Ontario have done that. Toronto has, but we still don’t have a provincial recognition of racism as a public health crisis.

FPR: How does that intersect with COVID?

I think that COVID has really shown the ways that racism harms people who already more marginalized. I’ll give the example of Toronto’s northwest. We know that this is where some of the worst cases for COVID are right now. But we also know that the systemic and structural racism that is in our system means that even when we know that this is where COVID is really hurting people, not enough resources have been directed there.And racism, it takes many forms. You even hear people talking about how, in the regions where they live, the testing and COVID response hasn’t been done with an appropriate cultural lens. So you will find that someone is being sent in to do testing who doesn’t even speak the language that people in that community speak, who doesn’t understand the cultural norms in a place. And it means that people are not able to access the care that they need. We would say that is actually just an iteration of racism, where you are not willing to work with communities in a way that recognizes and honours how they want to access health care.So I think racism takes many different forms. And even something like refusing to collect data so that we know who is impacted and how they are impacted, some would say that can also be a form of systemic and structural racism because it makes invisible the ways that we are failing to provide appropriate care to some people.

“We need approaches that put health equity at the centre.”

I’ll give one more example. In Ontario, there’s a group called the Black Health Equity Working Group, which is a group of experts and health-care providers who, now that Ontario has said they will start collecting the data, are developing a governance and accountability framework for how that data is used, one that is developed by and for Black communities. And part of why Black communities are pushing so hard for this is because they know that racism also affects us in this particular instance. We call for data because we know that this is something that could improve our lives, but what racism does – it means that the data is collected, but then the way that it’s used further harms our communities. So that’s just another way that racism plays out.So again, the example of northwest Toronto – the data has been collected, but then the way that the story is being told in the media, the way that we talk about what’s happening in the northwest of Toronto, is to once again stigmatize the people who are in those communities. So it makes it seem like high COVID rates are somehow because there’s something that’s inherently wrong, or something that’s pathological, with those communities. The way that we tell these stories is that there’s never a full accounting for the systemic underfunding of those communities, that lack of resources, the way those communities have been starved, and the high rates of COVID-19 are actually a result of that. So, racism takes many forms. It’s not always the glaring, the obvious thing. But it’s a conversation that we have to have as we’re talking about COVID. FPR: The Alliance has written about how race-based data collection may actually further entrench harm and inequity. Could you speak a little bit more about how and why that might happen? When we’re thinking about further entrenching harm, it goes back to how that data is used. A lot of Black communities right now are saying that the collection of the data is not actually justice; it’s not the end goal. The end goal should be improving Black people’s lives. Where we’re coming from with the Alliance is that collecting this data, if it’s not used appropriately, if it’s not understood, if it doesn’t become a tool for systemic change, then it is again just replicating harm for people. FPR: From a policy perspective, what do you think needs to be done from here to try and address some of those issues? I would say possibly the most important thing is that our health system response very much needs to be based on social determinants of health frameworks. We also need approaches that put health equity at the centre, where health equity is not an afterthought, but it is something that is integrated throughout the policy and health-system development process, right from the beginning right through to the end of any system. We at the Alliance are fully supportive of the collection of data, but we also want the province to engage the right people in these conversations. Data collection does not mean the same thing for all communities. For example, Indigenous communities have very specific concerns. Black communities have specific concerns. The province needs to be speaking to the right people as it develops its processes for the collection of this data. Those communities need to play a key role in determining how the data is used and what the outcomes are, in the long run, from that.And then I think that we also just need to have approaches that are proactive. We are, for sure, going into a second wave of COVID, if the numbers are any indication. . . . It would appear that we are going back to a place where we will see more cases, and who knows what that will look like once schools open and once people are back to their lives. So, we want a health system that’s responsive. We want a health system that will understand the context, that will understand developments as they are occurring. And a health system that also will work with the most marginalized, those with the least resources, those with the least access. Because right now, in many ways, the health system is working for people who already have access to resources. It’s not working for some of the most marginalized. FPR: Is there anything that any level of government has done so far that’s been helpful to more marginalized communities? The thing with COVID is, it’s also been really illuminating. COVID has been a time when we’ve seen that systems can be responsive. Policies can be created that really will change people’s lives. Like the example of early in the pandemic, the province of Ontariosuspended the OHIP wait period– they made it so that people could get treatment, they could get health care, even if they don’t have health cards. So that provided treatment to people without status, many of whom work in essential roles – they were able to get health care. And we know that’s made a difference in terms of making care accessible for some of the most marginalized. So that’s an example of where a system has worked really well.Even something like pandemic pay for some essential workers. So when you look at workers who are working in supervised consumption sites or overdose prevention sites, a lot of those folks were able to access pandemic pay, which was good because they work very hard and there was a lot on them in those early days of the pandemic. So it was useful. Unfortunately, the pandemic pay is coming to an end for many essential workers, but that is something that makes a tangible difference in people’s lives. And definitely, we know that this is something people are talking about and saying that the province needs to be thinking about longer-term assistance for people, particularly as it looks like we will be in this pandemic for a while.So there’s definitely things that have been done that have really, positively impacted people’s lives. And we want the province, and both federal and provincial bodies, we want them to continue to make those types of decisions that actually support people who are in need.

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Sané Dube

Keywords:

“I was a doctor back home.” “I’m writing my exams to get my licence here.” “It’s been three years since I practised last.” “Seven years.” `“Ten.” We’ve heard it countless times over the last few years — from close family friends to people we meet through our work or even on a taxi ride home — and every time we’re disappointed this is the experience of so many internationally trained physicians in our country. The foreign credentialing issue has been a concern since well before the COVID-19 health crisis. It’s disheartening that even with a pandemic in full swing, Canada is still not leveraging one of its most valuable assets: the skills and experience of thousands of doctors. Ontario alone has 13,000 physicians and 6,000 nurses who were trained outside of Canada. Many of them immigrated here with hopes of contributing their medical expertise to the health-care system. Unfortunately, their dreams have been hampered by systemic barriers such as exorbitant testing fees, challenges obtaining insurance and, in the case of physicians, a dismally low number of available residency spots. Part of the rationale for such barriers is the critical importance of Canadian experience and the need for medical professionals to meet Canadian standards. Requirements for residency experience within Canada are coupled with a limited number of spots, which essentially forces many physicians to start over despite having potentially decades of experience under their belt. Even Canadian-trained medical students can struggle to find placements, but for internationally trained physicians it is even more difficult. In 2019, the Canadian Residency Matching Service reported that out of 1,758 international medical graduates, 1,360 were not matched with residency placements. And even if internationally trained physicians receive a spot, they are often underemployed and unsupported, leading to financial and emotional hardship. As foreign experts languish in the system, the need for physicians continues to be great. Many institutions have noted Canada falls behind the majority of OECD nations when it comes to physicians per capita. According to the World Bank, Canada has only 2.6 doctors for every 1,000 residents. Italy, which until recently was the epicentre of the pandemic, has about 50 per cent more per capita. Crisis and opportunityThe COVID-19 crisis has spurred some promising initiatives to leverage this untapped talent pool to address an immense need. Italy, the United Kingdom and some American states have eased the requirements for internationally educated physicians and novice medical graduates to contribute to national COVID-19 efforts. For example, in New Jersey, authorities have granted temporary licences to doctors residing in state with good standing in foreign countries. In New York, internationally trained medical graduates are now allowed to treat patients after one year of residency, compared to the regular requirement of three years. Some medical licensing bodies in Canada are taking similar steps. For example, in Ontario, international medical graduates who have passed their exams in Canada can apply for a 30-day medical licence. The College of Physicians and Surgeons of British Columbia has fast-tracked a new bylaw to amend the province’s Health Professions Act so international medical graduates can apply for a supervised associate physician licence allowing them to work under the supervision of attending physicians. These efforts to lower barriers to entry show promise as a way to address the immediate health crisis. But the pandemic also presents a crucial opportunity to leverage this globally educated talent pool over the long term. The Canadian population is aging and more health care is being delivered outside of hospitals, so we will continue to need more health professionals in the community. Many Canadians also find it challenging to find a physician who understands their mother tongue and cultural context; internationally trained medical professionals can help plug those health equity gaps. We need federal leadership during this crisis to ensure there is coordination across all jurisdictions to achieve clarity for internationally trained physicians. Canada should consider several options to achieve this:

Adopt the solution proposed by the Ontario Council of Agencies Serving Immigrants, Toronto Region Immigrant Employment Council and World Education Services to recruit, train and deploy internationally trained physicians to support our health-care systems during this time of emergency.
Automatically grant physicians who have been provided a temporary licence during the pandemic the ability to practise to their full capacity afterwards.
Increase the number of residency spaces for internationally trained physicians.
Once this pandemic passes, a federal-provincial-territorial working group should be established to examine the issue more deeply and build pan-Canadian consensus. One of the first tasks assigned to this entity should be to create a simplified accreditation process across the country.

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