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A year of global tragedy

As we pass the one-year anniversary of the declaration of the COVID-19 pandemic, citizens around the world reflect on an unprecedented year; globally, there have been nearly 120 million cases of COVID-19 and over 2.65 million deaths. Predictably, the impacts of COVID-19 are inequitable; income, ethnicity, gender, and geography have been demonstrated to be among the most significant factors contributing to the severity of the impact of COVID-19.

For example, in the UK, people in the most affluent areas are 50% less likely to die from COVID-19 than those in the poorest areas. Across the US, ethnicity can be used to determine risk to COVID-19; when compared to white, non-Hispanic persons, African Americans have 2.9x the risk of hospitalization and 1.9x the risk of death, Hispanic or Latino persons have 3.1x the risk of hospitalization and 2.3x the risk of death. Across several low-income developing countries (LIDS), the capacity of many governments to respond is hindered by pre-existing vulnerabilities such as high debt levels, significant populations living at or near in subsistence levels, and legacies of past pandemics.

Canada: an uneven experience

In Canada, we’re approaching 1 million cases and 23,000 deaths. Businesses have been shuttered and jobs have been furloughed. And like the uneven impact across the globe, the impact of COVID-19 on Canadians is far from equitable. While only 2.2% of Canadians are over the age of 85, over half of Canada’s COVID-19 fatalities have been felt by this age cohort. Residents of Canada's least affluent neighbourhoods had the greatest number and highest percentage of COVID-19 hospitalizations and emergency department visits. And, perhaps unsurprisingly, Canada’s Indigenous population has been disproportionately impacted; The rate of reported cases of COVID-19 in First Nations living on reserve is 40 per cent higher than the rate in the general Canadian population.

Recent research examining the impact of COVID-19 on rural residents illustrates another inequitable impact: gender. Self-identifying females reported a 55% reduction in excellent self-assessed mental health compared to a 26% reduction in self-identifying males who self-assessed excellent mental health. There was a 79% increase in self-identified females who self-assessed poor mental health and a 76% reduction for self-identified males. In addition to gender, age is a significant determinant of impact. Rural residents under 30 years of age report a 71% decrease in self-assessed excellent mental health, which is a stark difference to individuals in the 70 – 79 age bracket who reported a decrease of 36% self-assessed excellent mental health. If gender and age are taken together, self-identified females under 40 years have been disproportionately impacted, reporting a 76% decrease in self-reported excellent mental health and an 85% increase in self-assessed poor mental health.

So what?

As vaccinations begin to be administered and conversations shift from response to rebuild there is an opportunity to recognize that Canada and the people who live here are not a monolith and our response plans need to reflect this heterogeneity. Canada is comprised of 38 million people who represent a myriad of cultures, ethnicities, ages, locations, and experiences. Our response to COVID-19 has to reflect our differences. The needs of a 35-year-old self-identified female are not the same as a 75-year-old self-identified male. Cultural belief systems of Indigenous Canadians are different than those of non-Indigenous Canadians. And the challenges for residents from Vancouver are the not the same as those from Goderich. Response plans need to be representative of the citizens who they will impact. COVID-19 has offered an opportunity to revisit and reflect on existing policies and programs to ensure they are appropriate and address the needs of the communities they impact. The best response plans are based on reliable data, collected at the community level to ensure that the decisions made are reflective of the needs of the community. The pandemic has not only exacerbated pre-existing deprivations and vulnerabilities but increased the need for services for citizens who have never accessed the “system”. There is no question that COVID-19 has impacted all Canadians; however, when we are developing and designing our response plans, including vaccination rollouts, our varying cultures, locations, and realities must be recognized to ensure that all Canadians are able to access the support they need and want.

COVID-19 is not the great equalizer.