Ensuring health beyond health care
This is the final article in a six-part series examining how we can build back a better health system for a post-pandemic Canada.
Like yours, our COVID-19 stories have many aspects. As family doctors, we have walked alongside patients through the deaths of loved ones, cancellations of needed surgeries, flares of mental illness and the terror of a COVID diagnosis. We have spent long hours at vaccine clinics and have learned the art of the video medical visit. As mothers, daughters, sisters and friends, we have navigated school closures, caring for aging loved ones, cancelled life events and fear.
It cannot be stressed enough how pervasive the impact has been for women of our generation. As the fourth wave looms, it’s worth asking what can be done to build back better health for all women, including racialized women, newcomers and essential workers, in the so-called generational sandwich.
That the pandemic has had an asymmetric impact on women in the workplace is well known. When employment dropped in February and March of last year, women made up 63 per cent of all losses; but as the economy started to recover in the spring, women only accounted for 29 per cent of new jobs.
What is less talked about is how many women who are still in the workforce are struggling to maintain their pre-COVID job performance. Caring for children and managing remote learning has led to high levels of distracted work from home. Some of us gave up on supervising online learning and left our kids to their own devices (literally). As mothers, we can’t help but worry as depression, anxiety and disordered eating skyrocket among kids during COVID-19. Dropping off groceries and making sure our elders aren’t too lonely has also been disproportionately women’s work for our cohort. Income, systemic racism, and all the many “isms” that diverse women face only amplified this work.
Beyond the day-to-day, we can’t help but feel unmoored in the face of significant social disruption — at times the world feels increasingly uncertain and unsafe. The murder of George Floyd and the protests that followed brought antiBlack racism to the fore, including in the health-care system. Disproportionate COVID-19 rates in Black communities reminded us that it is more than just police organizations that need to look in the mirror. The death of Joyce Echaquan again revealed the anti-Indigenous racism on which our health-care systems are founded. Extreme weather, wildfires and unsafe air quality continue to demonstrate our undeniable impact on the climate, compelling us to question what we are leaving behind for future generations.
And yet, through all this, incredible work has taken place in our communities and public systems, including in health care. We have seen substantial changes in social awareness of systemic anti-Black racism, and brave commitments to change in organizations large and small. Indigenous advocacy has led to a groundswell of cultural safety work in hospitals, universities and beyond. And health organizations that used to expect people to come to their doors have worked on COVID-19 mobile outreach vaccination efforts instead.
The pandemic has also brought about an unexpected gift: It is helping Canadians shift our thinking about what “health” means. Race, ethnicity, gender, sexual orientation, age, income, education and where we live have been so clearly intertwined with the likelihood of getting sick. It is so clear to us all now that a living wage and paid sick days are health interventions; affordable child care and elder care are health interventions; movements for racial justice are health interventions.
Building back better will mean returning to and fully absorbing that lesson. The cure for COVID at an individual level may someday be found in a fancy drug, but prevention of the next pandemic will include population-level work that can’t be administered in a single dose.
With election day looming, we can demand systems that prioritize those who carried the burden over these last 18 months and long before — women, racialized people, newcomers, essential workers and others. Our children’s health is tethered to the decisions that we make — how we treat ourselves — but also how we treat each other.
Dr. Onye Nnorom is a family physician, public health specialist, the president of the Black Physicians’ Association of Ontario and the equity, diversity and inclusion lead at the Department of Family & Community Medicine, University of Toronto.
Dr. Danielle Martin is a family physician and executive vice president at Women’s College Hospital, and author of “Better Now: Six big ideas to improve health care for all Canadians.”