Mr. Chair and honourable members, thank you for inviting me to speak to the standing committee.
I am a physician and also the CEO of Wellesley Institute, a think tank that aims to improve health and health equity through research and policy development focused on the social determinants of health. This morning you should have been given the executive summary of the briefing note we submitted to the standing committee. The executive summary gives more detail on the recommendations I am making today. The full briefing note goes into background and gives references for my comments.
I'd especially like to thank Erica Pereira, the procedural clerk, for getting the executive summary translated so quickly.
Survival for those on the Titanic over a century ago was directly related to their social status: 60% of those in first class lived, while 42% of those in second class and only 24% of those in third class lived. The Titanic’s escape plan was the same for everyone, but third-class passengers were in lower internal berths and had difficulty getting to the lifeboats. The huge death toll was because there was not an adequate plan for them, though they were the passengers most in need.
Fast-forward 108 years to Canada’s COVID response. This has actually been very good. We've done really well. But like the Titanic, we have not developed an adequate plan for our highest-risk populations, such as people living in congregate settings, those with lower incomes, and of course our racialized populations. Our initial response was focused on flattening the curve, not on who was under the curve. If we'd focused on both, we would have had a better response and we'd have saved thousands of lives.
We now need four groups of actions to ensure that our current and future responses to pandemics are equitable and better. First, we need legislation that ensures that our public health responses, our health response and our social policy responses produce equitable outcomes. Second, we need equity-based federal and provincial COVID-19 health and public health plans. Third, we need equity-based social policy and recovery plans that ensure that the most hard-hit populations are served properly. Last, we need data streams, research and capacity building to ensure that we have good socio-demographic, race and ethnicity information on which to build and monitor public health, health and social policy interventions. I'll go through each of those in a little bit more detail.
Recommendation one is for legislation. We've actually seen racial disparities in infection rates and deaths in previous pandemics. During the H1N1 pandemic in Ontario, the Southeast Asian population was three times more likely to be infected, the South Asian population six times more likely to be infected, and the black population 10 times more likely to be infected than anybody else. Despite this, we did not change our systems to collect socio-demographic data. We did not do research or sit with communities to try to find out why the disparities exist. We went into COVID-19 without the surveillance systems or knowledge that would help us identify and deal with racialized health disparities. Then we set up a Titanic response—a one-size-fits-all, colour- and culture-blind pandemic plan that was predictably going to lead to health inequities. Some have argued that this was negligent. I just say that it shouldn't be legal. We have legislation for things we care about. We do not leave them to the largesse of professionals, public servants or politicians. If we want public services to produce equitable responses, we should enshrine this in enforceable law.
Recommendation two is for equity-based federal and provincial COVID-19 health plans. We would have a fairer response if we took a health equity approach to what is left of the first wave, to the second wave and to the recovery. A health equity approach aims to decrease avoidable disparities among groups. It ensures that people with similar needs get the same pandemic response and people with greater needs get a bigger response.
There are lots of evidence-based tools out there such as health equity impact assessments, which could be used to build these sorts of responses, and they have been shown to be effective in public health in Canada. But when we build equitable plans we also have to work with communities to develop strategies that allow them to protect themselves from COVID-19.
Recommendation three is saying let's have those equitable plans, but also let's link to what Dr. Siddiqi was talking about, because health equity recognizes that the risk of illness and the ability to recover are not just linked to health interventions, but also to the social determinants of health.
The Canadian Medical Association has calculated that 85% of our risk of illness is linked to these social determinants such as income, housing, education, racism and access to health care. This offers significant policy opportunities for improving health, because many health disparities are avoidable.
COVID-19 harms health in four ways: through the disease itself, through the side effects of public health response, through health care changes such as cancelled operations, and by the downturn in the economy. These interact with the social determinants of health so that some parts of our population are harder hit than others. As Dr. Siddiqi said, Canada's black populations have been hardest hit by COVID-19.
Our pandemic social policies and recovery plan need to be developed so they decrease inequality and reach the hardest-hit people. Decreasing differential risk linked to social determinants of health is an important intervention here, and probably one of the most important interventions. The idea of a focused recovery plan for the hardest-hit populations would not only improve our response, but would make those populations more resilient to future pandemics and future waves.
The last is numbers and data. I'm a researcher and I'm in a think tank. We think numbers and data are vital, and they have been vital in the fight against COVID. We've relied on the number of cases, the number of deaths, and suddenly everybody understands what an R number is, which I never thought would happen in my lifetime.
Numbers are also useful in indicating whether our interventions are working for everyone, and to do this we need disaggregated data. We desperately need better data streams on race and ethnicity and other social determinants of health for COVID-19, and for health in general. We need similar data, of course, for social policy. These data need to be good quality and there needs to be good data governance and accountability. Communities increasingly want a say in and control of the use of their data.
Wellesley Institute recommends that Canada collect individual-level associated demographic data for COVID-19, including race and ethnicity, and that Canada urgently undertake innovative analysis using existing data to get as accurate a picture of disparities as possible. Also recommended is that Canada develop a strategy for ongoing socio-demographic data collection for health and social policy, including race and ethnicity.
But data is not an end in itself. Data has to be linked to meaningful strategies to decrease disparities. This will mean engagement with communities, research and action to develop equitable public health and social policy interventions.
In conclusion, public health is the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society. Health equity interventions and the concept of social determinants of health are important tools in helping us to organize the best pandemic response. They are also a sound basis for health and social policy.
The one-size-fits-all strategy actually led to a huge death toll on the Titanic, and so far it's led to a significantly increased death toll for some parts of the Canadian population during the COVID-19 pandemic.
If we want a COVID-19 response and health systems to be more fitting for the 21st century, we need legislation that ensures equity; we need equity-based COVID-19 pandemic plans; we need social policy and recovery plans focused on decreasing current inequities and we need data streams and research that allow us to properly identify risk groups, build appropriate interventions and monitor their impact.
If we can put all of these in place, we'll move Canada's good response to being a great response, and we'll save lives.
Thank you very much.