Thank you very much.
Thanks for the opportunity to speak with you today. I come here with a deep sense of gratitude for my parents and all the others who have made this possible, a strong sense of responsibility that comes with my position as a scientist, and a burning desire for my country, Canada, to do right by all its people.
I am associate professor and division head of epidemiology at the University of Toronto's Dalla Lana School of Public Health, where I hold the Canada research chair in population health equity. I am a social epidemiologist and I study health inequities and the social determinants of health, with a particular emphasis on the social policies and other societal factors that are ultimately responsible for giving everyone a chance at health.
Since the gravity of the COVID-19 pandemic became apparent, Canadian officials have assured us that we are all in this together. Indeed, daily briefings have impressed upon us a sense that the overall number of cases and deaths in our cities and provinces is a good proxy for how worried each of us should be about our risk for COVID-19, or how confident we can feel about returning to some of our pre-COVID activities.
However, in late May came a stunning report—if entirely predictable by those of us who study these things and those of us who live them—which suggested that the city-wide numbers we were receiving in briefings from Toronto Public Health concealed enormous differences in the burden and risk of COVID-19 across Toronto neighbourhoods. A similar phenomenon has also been noted for Montreal. Toronto's northwest neighbourhoods, which are heavily black and working class—areas such as Jane and Finch, Rexdale, and Weston—have been hardest hit. The latest figures suggest case rates in excess of 450 per 100,000 in those neighbourhoods.
Meanwhile the downtown core and central areas, which are heavily white and wealthy, have barely been touched. For example, Yonge and Eglinton has a case rate of 14, and Beaches has 15 cases per 100,000.
This means that the overall figures for Toronto have been obfuscating a more than 40 times greater risk of COVID-19 between Toronto's black working-class neighbourhoods compared to its white rich neighbourhoods. While the coronavirus itself does not discriminate, our society unfortunately does. Canada is structured in a way that has placed the burden of risk for COVID-19 squarely on the shoulders and in the lungs of the black working class and to a lesser extent other non-white working-class people.
The spatial distribution of COVID-19 across Toronto neighbourhoods is less a reflection of neighbourhoods themselves being risky, and more a reflection of the fact that the black people in Toronto tend to live in a small set of neighbourhoods, the ones in which they can afford housing and avoid housing discrimination, while rich whites live in a set of neighbourhoods that offer the most convenience and comfort.
Why are we using neighbourhood data if neighbourhoods aren't really the heart of the matter? Unfortunately, those are the best data we have available for understanding the social characteristics—race, income and so on—that carry risk for ill health, including COVID-19. We are effectively using neighbourhood characteristics as proxy for individual characteristics and because Toronto is so starkly and structurally segregated, and people are so clustered by race and income into various neighbourhoods, for now this is sadly a reasonable proxy to make, even if it's imperfect.
My initial plea to you, then, is to think long and hard about better collection of race and socio-economic data whenever we routinely collect data in Canada on health and other matters in our health care system, our schools, the labour market and so on. This is critical for understanding our country and holding our government to account for racial inequity in the same way gender data is used to tackle gender inequity.
If not the neighbourhood itself, what then is creating greater risk for black working-class people? Because the data is lacking, it's difficult to be unequivocal about the answers to this question; however, there is a very large and robust body of research from other countries on which we can draw, as well as indirect evidence from Canada.
The strongest explanation—though there are others I am happy to discuss—is that essential service jobs that have continued during the stay-at-home orders are largely occupied by black and other non-white working class people.
They are our long-term care and personal support workers. They clean our hospitals and shuttle patients around. They stock our grocery stores, drive our delivery trucks and work in the fields to harvest our produce. Conversely, jobs that afford the opportunity to stay home—along with the peace of mind about one's job security and income—are largely occupied by wealthy white people. They are our bankers and financiers, lawyers, and, yes, our professors.
The obvious consequence is that jobs occupied disproportionately by black and other non-white Canadians force them into environments that carry high risk for exposure to COVID-19, while jobs disproportionately occupied by wealthier whites offer protection from exposure to COVID-19.
At the end of the day, knowing that low-wage black and other non-white workers have little choice, we are sacrificing them so that the rest of us can cocoon in the comfort of our homes and wait this thing out.
This racial job sorting is clearly not a function of chance or choice. It is the outcome of a confluence of Canadian policies and systems in which racial discrimination is so persistent and pervasive that it cannot be regarded as an isolated incident or even as an add-on to understanding our system of institutions and policies. Rather, it is an integral part of the systems themselves. Various scholars have used terms such as systemic racism, structural racism, institutional racism and racial capitalism to refer to this deep embedding of racism in our societal policies and systems.
Beyond jobs, systemic racism is more generally the major factor that determines who has economic security, wealth and income. It can be even more powerful than gender in this respect. In turn, economic security is the main predictor of health because it facilitates the everyday living conditions that are foundational for health: jobs that don't expose us to health risks, plenty of money to pay the bills, comfortable housing, lovely neighbourhoods, good food and low stress.
And this is true whether we're talking about COVID-19 or cardiovascular disease, depression or diabetes. At the end of the day, you need economic security to have a good chance at living a healthy life, and that is precisely why economic security is so crucial and it is precisely why racial and health inequalities are so pervasive and so persistent. Racism limits black working-class people's access to wealth, jobs, income and so on. As horrible as it is that we have racial inequities in COVID-19, this is really just another manifestation of a deeply entrenched system of racial inequity.
So it's the root cause—systemic racism—that we really need to fix in order to address COVID-19 inequities. In what follows I will outline what the science tells us are our best options for doing so.
The first is to deal forcefully with racial wealth inequity, inequity in stocks of money and assets.
Economists such as Miles Corak in Canada and William Darity Junior and Darrick Hamilton in the United States have made a jarring discovery about wealth inequity which, as I will explain, is arguably even more critical than income inequality. It turns out that the largest source of racial wealth inequity is not racial differences in education or even in jobs and income. Those things matter but they are the consequences, not the causes of racial wealth inequity.
The biggest source of wealth inequity is what economists refer to as intergenerational transfers and what the rest of us would call gifts from Mom and Dad and Grandma and Grandpa. That's right: the white wealth advantage is not an earned advantage. Gifts are what allow whites to pay for advancing their education and thus income, and what allow them to put down payments on homes early in life.
This is unfair for many reasons, perhaps the greatest of which is the historic injustices that have allowed whites but not others to accumulate wealth over generations.
So it is these wealth transfers that create opportunity for income, rather than income creating opportunity for wealth. That means that black Canadians have already fallen behind at birth. This is unacceptable, and Canada must consider, as the United States is doing, a system of baby bonds or something similar in which young children from black and other groups that have historically faced disadvantage are provided a sum that matures as the child ages and that in adulthood can be used in the same way that family gifts have been used by rich white families. Economists have even calculated how long such a policy would take to create wealth equality.
In addition to resolving wealth inequity, we do need to address income security for every Canadian. We need to design a labour market in which every job is a high-quality job.
We need to ensure the wages, benefits and working conditions of all jobs meet a high minimum standard and that employment discrimination is more rigorously penalized.
We have strong randomized trial data that tell us a very disheartening tale of racial discrimination in the labour market that cannot be accounted for by differences in foreign degrees or lack of Canadian job experience.
We have to stop taking comfort in the fact that people are somehow managing to survive and create the conditions to let them thrive. There are countless examples we can take of ways to implement this. For example, a universal job guarantee would put an end to involuntary unemployment and create good jobs to do important work sorely needed by Canada. It would also put pressure on the private sector to compete on wages and job conditions.
Finally, we must universalize access to basic services that create high quality of life: child care, education, health and pharmacare more broadly defined, elder care, and so on. We can't limit opportunities based on race and economic position any longer. It's so unjust and so unbecoming of a country with so much to offer.
There you have it. There's no half-hearted way out for resolving COVID-19 inequities. Even if we developed band-aid policies, we'd be right back here talking about this or another racial health inequity soon, because that's how it works. Without resolving the fundamental structural issues of systemic racism and its impact on economic security, nothing ever changes. That's simply not fair for any Canadian to be subjected to.
While the policy solutions I've laid out are bold, they are very doable. Many scholars have highlighted how these policies can be designed and paid for. It's our responsibility—
