Advocates urge Ontario to adopt California’s policy
State requires cities to flatten curve in all neighbourhoods before it will ease restrictions
In an attempt to address disproportionately higher COVID-19 infection and death rates among lower-income and racialized Californians, state officials announced last week they would now use a “health equity metric” to guide their economic reopening.
The new policy means cities cannot simply use an overall average to measure their success at flattening the curve. A city will only be allowed to move forward into a less-restrictive phase of reopening if its most socio-economically disadvantaged neighbourhoods also meet certain statistical benchmarks.
In other words, nobody moves forward until everybody can move forward.
“We want to make sure that our focus on COVID has a look at every community, regardless of skin colour or wealth, and that we are concerned about equity,” California’s health secretary, Dr. Mark Ghaly, told NPR’s “All Things Considered.” “That means a disproportionate investment in populations and groups that have a disproportionate impact.”
Given the stark racial, economic and geographic disparities in COVID-19 infection rates in Toronto, public health experts here say the province should adopt a similar strategy.
“It’s a great idea and something that we have been calling for here in Ontario throughout the pandemic,” said Kate Mulligan, assistant professor at the University of Toronto’s Dalla Lana School of Public Health. “We have not had the same success as they seem to be having in California in using the data that we have.”
Back in the spring, when Ontario’s Ministry of Health would not collect race or income information with COVID-19 tests, Toronto Public Health started doing it themselves and they have been releasing periodic updates since July.
The latest data show that people of colour, who represent 52 per cent of the city’s population, account for 82 per cent of COVID-19 infections. The data also show that more than half of the city’s infections are among people with a household income of $50,000 or less, a group that represents 29 per cent of the city’s population.
Neighbourhoods in the northwest corner, meanwhile, have infection rates that are nearly 10 times higher than other parts of the city.
“COVID-19, like many diseases before, preys on poverty,” said Coun. Joe Cressy, who chairs the city’s board of health.
The board is meeting on Monday to discuss the latest recommendations from medical officer of health Dr. Eileen de Villa, who is calling on city council to urge federal and provincial governments to “mitigate the impacts of COVID-19 on groups that have been disproportionately affected” by the virus.
De Villa’s recommendations include increased access to testing in neighbourhoods with the highest infection rates and more accessible public health information. She also wants council to ask the province to implement a stay on residential evictions and guarantee paid sick leave for all workers.
“The slogan that we have heard throughout this pandemic that we’re all in this together, it only means something if we’re taking care of the most marginalized and disproportionately affected,” Cressy said.
Dr. Kwame McKenzie, CEO of the Wellesley Institute and director of health equity at the Centre for Addiction and Mental Health, said the public health strategies from all levels of government have been “discriminatory” because they haven’t met the needs of low-income and racialized people.
“How can everybody pay their taxes and yet we can set up public health or pandemic plans which we know are not going to work as well for some parts of the population than others and then when we get the data we don’t do anything about it?” he said.
McKenzie said the data show we have a “wonderfully effective strategy” for the richer, less racialized parts of the city. “For them, it’s working,” he said.
Cressy said the city is trying to do its part, and that started with collecting and sharing the data on race and income, which led to more targeted interventions, such as voluntary isolation facilities for people who can’t safely selfisolate at home and pop-up mobile testing sites in hard-hit neighbourhoods. He said equity is not enough of a priority for the province.
A spokesperson for the Ministry of Health did not directly answer a question about whether it has considered implementing something similar to California’s health equity metric. The spokesperson did say that all public health units are now required to collect and report data on race, income, household size and language for people with COVID-19 to the ministry.
Mulligan said making equity a priority is simply good public health practice.
“Setting aside issues of justice in equity, the rational response would be to invest in these communities that are facing the highest risk — to protect the people living in those communities, but also as a containment strategy.”