In March 2020, as the World Health Organization declared the outbreak of COVID-19 a global pandemic, a sense of shared vulnerability dominated public discourse in many jurisdictions – the idea that the virus affects everyone, everywhere. But the subsequent course of the pandemic has shown that, far from affecting everyone equally, the virus has interacted with existing socio-economic disparities to create significantly worse outcomes for groups marginalized at the intersections of race, class and gender. As these inequalities have sharpened, the policy rhetoric of being ‘all in this together’ has rung increasingly hollow.
While public health measures such as physical distancing and remote working arrangements have protected employees whose jobs can be performed from home, frontline workers have continued to provide essential services to others during periods of lockdown, exposing themselves to heightened risks in the process. Given that many urban workforces rely heavily on immigrant, racialized and gendered labour to perform essential roles, it is no surprise that these groups have experienced worse health outcomes during the pandemic. While such racial disparities have been identified in many pandemic-affected cities, Toronto, Canada provides a particularly illustrative case study.
Toronto is Canada’s largest metropolitan area, an economic powerhouse, and one of the most diverse cities in North America – with 52 per cent of the population belonging to a racialized group. Like many other well-connected urban hubs, it quickly became an epicentre of infection when the COVID-19 pandemic hit the country. Yet, as community advocates struggled to respond to the needs of the most vulnerable, the absence of racially disaggregated public health data made it impossible to verify what many suspected – that the pandemic was taking a disproportionate toll on racialized workers.
Three months after the first COVID-19 case was detected in Toronto, the city’s public health authorities finally began to collect case data on ethno-racial identity (unlike the US, Canada does not systematically disaggregate public health data according to ethnicity). When the first dataset was released to the public in July 2020, the findings were striking. No less than 83 per cent of reported COVID-19 cases were among racialized groups, despite the fact that the latter accounted for just over half of the city’s population. Some groups included in the data – particularly those identifying as Arab, Middle Eastern, West Asian, Latin American, South East Asian and Black – were particularly over-represented. For example, Black people made up 21 per cent of reported cases but only 9 per cent of the population.
No less than 83 per cent of reported COVID-19 cases were among racialized groups, despite the fact that the latter accounted for just over half of the city’s population.
At the same time, mapping exercises showing the concentration of COVID-19 cases across Toronto’s neighbourhoods revealed that the city’s most racially diverse neighbourhoods had infection rates three times higher than the least diverse neighbourhoods. COVID-19 cases in these neighbourhoods were also more likely to lead to severe health outcomes, with hospitalization and ICU (intensive care unit) admission rates four times higher and death rates twice as high.
Why these discrepancies? The neighbourhoods with the highest infection rates are predominantly home to low-income, racialized workers, who are more likely to be classified as ‘essential’ and therefore continue working on the frontlines during periods of lockdown. They include delivery drivers, cleaners, cashiers, long-term care and personal support workers, taxi drivers and employees in retail, food service, manufacturing and transportation. These workers have kept core economic activity going, while also responding to increased demand for some services from wealthier workers staying at home.
The nature of many of these industries exposes workers to a higher risk of virus transmission. Many of these occupations cannot be performed from home and require employees to work in close proximity to others. For example, many large outbreaks in Canada and the US have been linked to meat-processing facilities, where employees on the production line work close together and the fast pace of work makes it difficult to adhere to mask-wearing and disinfection protocols. In Canada, 41 per cent of meat-processing workers are members of racialized groups. Work in the personal support and health care sectors also means an increased risk of exposure to disease and infection. Many of these occupations are highly feminized, meaning that immigrant and racialized women are often disproportionately represented. For example, in Toronto and other metropolitan areas, over 70 per cent of nursing, residential care and home care positions are filled by immigrants, most of whom are women.
While the nature of the job puts essential workers at risk, so does the structure of the employment relationship. Since the 2008–9 financial crisis, Toronto has become increasingly reliant on precarious labour, which has especially affected racialized, young and female essential workers. Precarious labour often means low-paying, part-time or temporary work without job security or benefits. The lack of paid sick leave in particular, as well as the presence of employer policies such as attendance bonuses, may incentivize employees to continue working while sick. Precariously employed workers often work more than one job to make ends meet, increasing their degree of contact with others, and are also more likely to have experienced reductions in their hours and overall income as a result of the pandemic. Racialized youth have been hit particularly hard by these developments. As of August 2020, the unemployment rate among racialized youth in Canada was 32.3 per cent, compared to 18 per cent for white youth.
In Toronto and other metropolitan areas, over 70 per cent of nursing, residential care and home care positions are filled by immigrants, most of whom are women.
The risks that racialized workers face on the job are compounded by factors outside the workplace. Low-income essential workers are more likely to rely on public transportation to get to and from work, putting them in close contact with others. This is particularly true for racialized women: according to the 2016 Census, 51 per cent of racialized women in Toronto relied on public transit for their commute, compared to 27 per cent of white men. The housing crisis in Toronto also means that low-income workers often reside in multi-member households, making it impossible to self-isolate at home. They are more likely to live in high-rise buildings in densely populated neighbourhoods, with limited access to outdoor space for physical activity. Women and girls from low-income households also have fewer supports to rely on when it comes to domestic work and childcare. They often shoulder a large share of those responsibilities themselves, making it harder to look after their own physical and mental health.
In the presence of structural inequalities such as these, the imposition of uniform public health policies leads to differential health outcomes for marginalized groups. Consequently, when lockdowns occurred in Toronto, high-income, predominantly white neighbourhoods saw rapid declines in the number of new infections, while the opposite happened in low-income, racialized neighbourhoods. This is consistent with decades of research on the close connection between health outcomes and socio-economic variables, including factors such as racial identity, gender and class. The Canadian Medical Association states that these ‘social determinants of health’ have a greater impact on individual and population health than biological and environmental conditions, and that their impact can even be greater than that of the health care system itself.
The experience of Toronto has highlighted the need for disaggregated data collection to inform an equity approach to public health and avoid the imposition of blind policies that do not account for racial and other disparities. There is already evidence of these policy failures being repeated, with early stages of the vaccine rollout criticized for bypassing the city’s racialized, working class neighbourhoods. Moreover, despite the clearly identified patterns in Toronto, public health authorities in Canada are still not collecting racially disaggregated case data at the provincial or national level. By overlooking the needs of those most vulnerable to infection, such policy choices not only harm marginalized communities, but also hold back societies as a whole from recovering holistically from the pandemic.
Photo: An employee walks past cordoned off aisles of non-essential goods at a Walmart store, as new measures are imposed on big box stores due to the Covid-19 pandemic, in Toronto, Ontario, Canada. Credit: REUTERS/Carlos Osorio.