COMMON COVID-19 RESEARCH QUESTIONS

WHAT ARE THE MAIN CONCERNS OF INDIVIDUALS LIVING WITHIN THE VICINITY OF THE COMMUNITY CENTRE?

Answer from a GTA Community Centre Senior Analyst – Planning, Quality, and Risk:

As an organization, we have been monitoring COVID prior to the state of emergency. We have been hearing concerns about risk (how likely they are to get it), the lethality of it, the spread of it, and the testing of it (originally only certain groups of people were able to get tested) (the assessment centres focused on individuals that traveled to specific countries; China, Italy…). People in the community were concerned about the exposure but they weren’t actually able to get tested. There was a particular population of travelers tested instead. People were infected with COVID without being tested. They are a lot of people working in the community as PSW’s (personal support workers) and therefore they were at high risk because they had to use public transport and were vulnerable. High numbers of people were infected due to this. Individuals were concerned because they weren’t able to work, and they didn’t have enough money to literally buy groceries. Employment, access to food, family support, socialization are all concerns individuals had. Overall, COVID really exacerbated the inequities that they were facing. Housing was an issue before as well as employment and these concerns were highlighted through COVID.

Answer from a GTA Community Health Centre Executive:

COVID has highlighted some of the existing health disparities that exist in these communities and more specifically we have seen this community is one of the highest COVID positive communities in the city of Toronto, data published by Toronto public health. This is an indication of a few things, a large number of the community works front-facing jobs, can’t work from home, also people are using public transportation to get around because they do not have access to vehicles, another risk they have faced. Also, we have seen a significant increase in food security issues, which has always been an issue but the volume has increased a lot, from about 50-70 families to now 90. Also seen that when someone is positive for COVID and live in overcrowded houses there is no ability to self-isolate at home and the whole family gets exposed. We have also seen a lot of anxiety as people do not know how they are going to be able to provide for their families. Seniors are self-isolating at home, need to support them and check in on them, there is a lack of those who are alone. Hearing police have access to databases and can see if someone has tested positive, seeing a disproportionate impact on communities of colour. Also, there is a Digital divide, shifted things from in-person to virtual care, assumption is people have access to the internet or technology, but not everyone does, this is significant in these communities. Even students in online school, who are proficient in technology, many students in marginalized communities know how to use social media but don’t have skill or opportunity to use technology for learning, they would get frustrated and quit because hard to navigate.

ANSWER FROM another COMMUNITY HEALTH Centre Executive:

There are a lot of issues with mobility, access to technology and access to food. Most are residents of housing community, there is also a large homeless population. Sometimes they’re found sleeping in the woods close by the community centre at night. Also, there have been issues with substance use. The buses haven’t always been terrific. We have two buses that come at the same time, it’s often a half an hour wait time. There are no grocery stores close to the community and due to that people have to take two buses to take to get to grocery stores. Most of the people living in the community in poverty are African descent and recent immigrants. Some of them experience difficulty because English isn’t their first language, or they experience difficulty have difficulty finding employment.

WHAT RESOURCES SHOULD HAVE BEEN PROVIDED EARLY ON TO ENSURE THAT THE BLACK COMMUNITY WOULD BE SUPPORTED DURING THIS UNPRECEDENTED TIME?

Answer from a GTA Community Centre Senior Analyst – Planning, Quality, and Risk:

Looking at the patterns of infection and the populations that were infected with COVID, we knew that this was going to be a big issue in Senior homes. PSW’s could have been provided with enhanced financial support as it was difficult for them to work. We could also see through the rates in our community and source of exposure, the highest rates are through close contact. This is a population working in vertical communities. It was difficult for individuals to self-isolate because the families lived in such close proximity to one another. They lived in apartments and sometimes more than one family would be living in one apartment. It was not possible to practice physical distancing, so the risk of infection was high. The city was trying to advocate for hotel rooms for positive-tested individuals to self-isolate and recover safely. In the meantime, the families need financial support. It is not just about making sure people are getting tested, it is also about the wrap on supports so families can be provided recovery and post-recovery resources. 

Answer from a GTA Community Health Centre Executive:

Can’t really say what should have been but inequity exists in our society and so what we are seeing it has existed, but it is just compounded by all public health measures and viruses. Greater investment in SDOH (social determinants of health), greater investment in prevention and support for vulnerable communities and greater investment for health promotion. These would work, not just for COVID but overall. If you look at statistics for who is at risk of COVID and at risk of dying from COVID, it is communities of colour. The same thing is said especially in this community, because people with all these social determinants of health issues also have comorbidities such as diabetes, high Blood pressure, that also compound their risk factors. Addressing those things and investing in SDOH and creating safety nets would have helped to lessen the impact COVID has had on these communities.

 

ANSWER FROM another COMMUNITY HEALTH Centre Executive:

We didn’t have a strategy that looked specifically at the impact on race. In hindsight, it shows that there was a need for targeted outreach to people within the African Canadian community and to address their access to technology. In Scarborough, the profile of communities of colour. This information is relatively new and coming out. We try to address this at Warden by providing food that is culturally appropriate for those communities. What would have been helpful is having an understanding of the racial disparities. There was a need to do specific targeted outreach for the African Canadian community.  Black and indigenous are at the bottom when it comes to food security. What would have been helpful is an understanding of the racial disparities and what we needed to do to have a specific strategy, what came up was general. Culturally relevant food is secondary and tertiary to getting food, we’re missing some of the very important access to providing assistance. We need to ensure that the needs of the people being taken care are taken into consideration.

WHAT RESOURCES ARE CURRENTLY NEEDED THAT THE COMMUNITY DOES NOT HAVE ACCESS TO?

Answer from a GTA Community Centre Senior Analyst – Planning, Quality, and Risk:

Financial aid, hotel rooms for positive COVID-testers. We need a community response to COVID. When there is a problem in the community then the community needs to be involved in the response. Community members need to be involved and they should be involved. The community health centre was going out for outreach for the mobile clinic testing center and they noticed that people were scared to get tested (they think it is going to be painful, they are scared because they think they will possibly be other people who may have COVID, they are scared because they are misunderstanding.) When community members can support each other and inform them, they can go a long way. It is important to engage the community leaders so that the community can be involved and the right information can spread (people can converse with each other and help each other). We have community members actually doing outreach, people who are comfortable with each other are spreading awareness.

Answer from a GTA Community Health Centre Executive:

Right now seeing that a lot of people lost their jobs and unable to come back. Large amounts are not eligible for CERB. Affordability is a huge issue in the community. Another thing is how to self-isolate properly in crowded conditions. There may be a second wave, important to learn from this experience and be better equipped to get testing, and so on. In the beginning, testing was hard because it was confusing about who is eligible to get tested, and so on. So, fixing that and making sure it is accessible to people, and we need to also provide wrap-around services. We conducted a community meeting and found that people are afraid to test. They would rather not get tested because if they were positive, they would worry about who would support their family and pay their rent. So, if you are going to have testing available then you need wrap-around services to help support. These are things we would put in place. Food is also a significant issue, don’t think it will change for a while. Lastly, technology needs to be provided. 

 

ANSWER FROM another COMMUNITY HEALTH Centre Executive:

Technology, because we’re switching a lot to virtual communication on the assumption that people have WIFI at home and technology that can adapt to the different programs, and that’s not necessarily the case. There is a level of trauma that people are experiencing that goes beyond COVID. There are concerns facing the statistics your particular racial group, that is people of African descent, inside of that COVID experience. There are concerns about the pandemic and also ones about racial experiences. There is, also a rising awareness about anti-black racism. All of this is a mix of trauma and emotional impact. It affects their motivation, access. Many of the jobs in the nursing homes where the pandemic hit hardest were worked by black female PSWs, so they’re taking those infections home to their families. There is a correlation between low-income jobs and COVID-19. They work multiple jobs because they have no benefits in one part-time job, so they go to the other one. This is how the issue became intense within homes. That has a relation to the statistics in the black community as well. Employment at the PSW level needs to be addressed and if we’re going to enforce that if your work in a job serving seniors, you can only work in that situation and not have two jobs. This requires us to pay those folks with living wages and benefits. In general, the trauma as a black person makes you more susceptible to all these diseases. If you have chronic stress, high bp, asthma, etc. then you are more susceptible to COVID infections, we’re seeing that impact as well. Racism, trauma, unemployment, economic isolation, and exclusion all have physical health outcomes and that’s what black statistics look like.

WHAT RESOURCES ARE BEING USED THE MOST DURING THIS TIME THROUGHOUT THE COMMUNITY?

Answer from a GTA Community Centre Senior Analyst – Planning, Quality, and Risk:

There is a lot of great stuff happening. We have been doing a lot of emergency food programs. Food insecurity is a very prevalent issue in our community. We have been able to get donations from sponsors (restaurants and food companies). Every Tuesday and Friday we have been able to distribute food (people can pick up meals, produce, hot meals, and much more). Our community has also been provided with hygiene kits. The food response has been huge because the demand is so high. Individuals and families that were infected weren’t able to go out and get food, and that’s why this has been in such high demand. Another thing that has been a good resource is helping residents in the community with the CERB benefits. Individuals who don’t have English as their first language, it is difficult for them to fill out these applications. The system is hard to navigate and that is why this community center is trying to provide aid for seniors and immigrants who need help with this. Helping with the application for various benefits. We have also been engaging with our clients through virtual care (we have had to reduce the number of in-person interactions). We have been doing one on one interview appointments. Some clients don’t have access to technology to stay connected (everything is practically online and some do not have access to this). We have gotten funding from the government, and we are going to provide tablets to our seniors so they can use it to interact with the health centre virtually. They can use it to stay connected with their family and with their community. Virtual care is part of the norm and that is why we need to provide technology and the internet in this community because it is a real barrier for them.

Answer from a GTA Community Health Centre Executive:

Can speak on local. We have a response table from the city of Toronto and some other group that helped connecting community members to different services. Whether about food or checking in on people that are self-isolating. On a community level, we knew whom to check in on. A lot of us struggled with virtual care as well because as a not for profit organization we do not have a big budget to equip everyone with laptops and so on, so that was a shift we had to do. We were fortunate to access technology that were donated or refurbished. We were provided with internet sticks from Telus. We got everyone to collaborate and address the issue in the community. Food is a major resource that is used of course. Also, counseling and mental health resources is another big one. How do people access primary care, have to call in but if there are language barriers how do they do that? How do you know services that are virtual are accessible to everyone?  Employment also, not sure what the government recovery plan is, but they need to create opportunities for people to be trained so they can seek other employment. A lot of people have lost their jobs and they aren’t coming back soon at least not all. The notion of whether the school is open or not will limit their ability to work because can’t work from home or vacation or other things. 

ANSWER FROM another COMMUNITY HEALTH Centre Executive:

For us, food provision has been everything. A close second has been the provision of mental health support, trying to keep people motivated and to help people deal with the forced isolation and what that does to family dynamics. Moving programs to virtual platforms as much as possible to engage people. We do security check-ins so that people have human contact with someone outside of their household. COVID crisis line was created so people could call if they had any questions. Housing continues to be the main concern, it’s not over yet as a major concern for these communities. The feedback we’re getting is that people in their homes.  There was a case where the landlord and the tenants were complaining because of the relationship becoming more intense in the household and they’re hearing the fighting. Also heard from people that people’s kids were going crazy because they weren’t able to go out and interact with friends and not understanding why. We haven’t really heard of anything regarding overcrowding per se.

Do you feel the Canadian Government's response to COVID, such as CERB/CESB, has been affective? Is the length of time support will be given adequate, or too short? 

Answer from a GTA Community Centre Senior Analyst – Planning, Quality, and Risk:

I’m happy to see that things are continually being extended and that is beneficial to a lot of people. Overall it is truly a blanket approach. The financial assistance programs have shown us that the government has the resources to provide resources to individuals. They have the ability to provide a basic income to people. We can see that the black community does not get paid as equitably as other communities. They are further behind in income. There is an income disparity between black communities and white communities This needs to be addressed. There should be an equitable response. There needs to be a special equitable response to address the distribution of financial resources. COVID-19 is hitting the black community very differently, because of a history of systemic oppression. There have been decades of abuse through the criminal justice system, the employment system, the education system, and the healthcare system, unfortunately. There needs to be something put in place to help with reparation for those communities. They haven’t had the same opportunities (the system needs to change). 

Answer from a GTA Community Health Centre Executive:

I think overall the 3 levels of government are on the same page, which is a good thing. CERB helped some folks out, confusion at the beginning about who is eligible and who is not. Other support for students and stuff did help. When you look at communities of colour and anti-black racism, look at the kind of jobs people have. If you had gig employment, CERB would not have been eligible to you, these are people without stable employment or gig economy employment. When looking at not for profit organizations, the government has given support for businesses but not for the community not for profit organizations to stabilize their funding. We need to look to stabilize these organizations. No recognition as of now that this is an area that needs to be addressed.  A lot of charities rely on donations for funding and COVID has significantly impacted this. There have been 9-15 million lost nationally I believe. Locally, the impact of the notion that police has access to people’s health information. Not sure how I feel about that, health measures need to be in place but privacy and confidentiality are a big component of people’s rights and expectations. So, need to ensure this because it can cause problems especially when looking in black communities. The government could have done more on recognizing early on race-based data, now they have, city and provincial are now. We need to collect data in a confidential way, how will the info be used and inform public policy, and so on.

 

ANSWER FROM another COMMUNITY HEALTH Centre Executive:

As far as my experience from it, it has been effective in reaching members of the community, my personal experiences I have good reports of it from people, I haven’t had any negatives. In terms of the length of it, there is a lot of speculation and worry. What are people going to do after it ends. A long-term strategy is what people are anxious about. There has been some talk about moving to a guaranteed income. That’s a direction that is worth exploring. There was a test case in a community in Hamilton where they provided a basic income as opposed to giving social assistance to families, and what they found was that it was expensive, and it created some stability for the families.

How long after a vaccine is produced and the disease is eradicated do you think things will “go back to normal?” 

Answer from a GTA Community Centre Senior Analyst – Planning, Quality, and Risk:

Our community is getting a lot of attention regarding COVID-19 cases because of the high rates. It is important to get attention so that resources that are needed get distributed in the community. But I worry that this attention leads to more people getting screened (there may be further stigmatization of the community). Jane and Finch is called “the worse place to live in Toronto” (It is called violent) and there are many other negative stereotypes about it, and now it is called COVID central. This is going to have an impact on the community, being further stigmatized. The community and all of us need to change that narrative. The new normal right now is Physical distancing. Kids aren’t going to school and what kind of impact does that have on our community. People aren’t able to get together because of COVID. This is a community that gets together physically. Also, masks, everyone has to wear a mask, and wearing a mask may lead to further criminalization for people of colour. The other normal is advocating for change and we can see that it took a pandemic to highlight inequities within the communities. This is constantly being talked about. We can see in the states all these things are coming together in a perfect storm and change is trying to be made.

Answer from a GTA Community Health Centre Executive:

We all have to adjust to a new normal, not specific to the black community. Fear is though that the new normal will have a much different impact on the black community because the starting point was different. As we adjust to the new normal need to ask questions about who is left behind and who is left behind further as we adapt. The new normal may be to continue to have these public health measures in place until 2021 at least, so what does that mean for the black community. We know that they have low paying jobs with no benefits, likely to be front-facing, no ability to safely self-isolate, unsure about how long CERB will be around, food insecurity. Need to look at these things, and these all existed before COVID, they are not new, COVID has just highlighted it. Not going back to the old but to new normal, how do we make sure these communities are not further impacted. 

 

ANSWER FROM another COMMUNITY HEALTH Centre Executive:

I’m hopeful that now the pandemic has highlighted that there are disproportionate impacts experienced in the black and indigenous communities. More programming and focus will be placed on the social determinants of health and economic wellbeing and inclusion to those two communities in particular. The idea to paint everyone with one brush and approach the idea of providing services and support according to a perceived norm is not having a positive outcome for these communities. I’m hoping to see us ask more critical questions and how we can tailor our approaches to those communities. This can only be done in consultation with the leadership of the communities. Culturally specific approaches are what we need. The trusts have been broken with traditional services (health, education, children’s aid, justice banking, food security). The impacts and experiences of African and ingenious people, they aren’t having any success navigating as a group. 

What are some lessons we can learn from what is happening South of the border (US)? 

Answer from a GTA Community Centre Senior Analyst – Planning, Quality, and Risk:

We need to listen to our medical experts as they have the best evidence. Florida is what Italy was 6 weeks ago. We need to safely open through stages. In order to safely open we need to wear masks in indoor spaces. In the states, there are a lot of challenges in being tested and I am grateful that we have access over here to get tested. Testing needs to be more accessible. We should look at countries overseas (look at how they have tackled COVID). Countries that have gotten out of COVID are good examples of how to tackle COVID. We are going to have some kind of the second wave, and we have to plan and prepare.

Answer from a GTA Community Health Centre Executive:

The whole notion that Canada is different when it comes to anti-black racism. We are different but honestly how black racism impacts these communities in Canada. Every perimeter, whether it be health, education, blacks are at the bottom. Health outcomes, with the exceptions of first nations and indigenous people, they are the next lowest. Education, grad rates, they are not doing as well as everyone else in society. Same with employment. Look at the criminal justice system, look at % of black people in the overall community compared to % of black in correctional facilities, it is overwhelming. We have similar concerns, but we need to overcome the notion that black racism does not exist the same way in Canada. It exists and it is systemic, needs to be addressed. Doesn't help when we don't take a stand that this is something that is unacceptable in Canadian society and not admitting it. Admitting it is the first step and then we can do something about this.

Questions From Podcasts

Podcast #1

Can you give your perspectives on why mobile testing was available weeks ago in less burdened neighbourhoods, but was not offered in the neighbourhoods that have the highest proportions of inadequate housing and poor access to healthcare? Also, how does this speak to the systemic discrimination the black community continues to face within the healthcare system? 

Answer from Dr. Nida Mustafa:

These are questions that need to be asked and I think it comes back to the value and needs to collect race-based data in general. The reason why these communities are hit hardest is because there is no prior knowledge of the needs of the community, and what health outcomes are already present in the community, collecting race-based data is so necessary even prior to something, like a pandemic, in order to be prepared. If we knew the health concerns, what resources are needed, even before the pandemic hit there could have been resources allocated to these areas. It does point to systemic discrimination, neglect, and not prioritizing these communities that need it the most. 

I know the virus has affected many of us psychologically, as we take extra precautions when we go outside to go shopping, and even if we come down with a sore throat one day, we become anxious and worried. Being at an increased risk due to working essential jobs, living in inadequate housing conditions, and still not having testing readily available to these communities, how big of a psychological impact do you think COVID-19 has and continues to have on the black community? 

Answer from Dr. Nida Mustafa:

I do think it’s going to have a strong impact, maybe not right now because people are just trying to get through their days, so it's kind of non-stop and on the go. In the next year or so, this will have a strong profound impact on the psychological health of marginalized communities. There are already issues of access to mental health support. If a community is going through these things, there needs to be access to mental health services. I’ve heard stories of individuals from these communities, they don’t have the luxury of staying home. If they are living with other vulnerable family members, they have to send them to other members' houses to reduce the spread. It is an accumulating effect.

In your opinion, what resources do you feel are currently needed that communities do not have access to? As well as what other resources do you feel are being used the most during this time throughout communities? 

Answer from Dr. Nida Mustafa:

I think one of the most important points in terms of getting the appropriate resources they need is timing. It does make you wonder why these testing centres and PPE weren’t allocated to these areas beforehand, if we had these resources beforehand, the burden on these communities would have been reduced. The other point I wanted to touch on was the technology which I think is very useful, and it makes me think about individuals who need technology to work at home and students who are in school. Because they're not COVID related like testing centres they are also needed in these communities. I think the CERB resource offered by the government is widely used and it does give a certain amount of money per month to individuals per month which are very important. However, going back to the point of lived experiences, individuals have unique needs and families, and the amount and where you live, it's all-important, and having those blanket approaches and giving everyone the same amount may not be enough for certain communities based on their needs. 

Do you feel the Canadian Government's response to COVID, such as CERB/CESB, has been effective? Is the length of time support will be given adequate, or too short? 

Answer from Dr. Nida Mustafa:

It's a good resource and it's being highly utilized, however, I feel like there should be more compensation and more resources available to certain marginalized communities in order for the response to be equitable, otherwise, it's just equal, and that's the difference between equality and equity. Some may need more, and they should get more. Another point in regard to CERB, a lot of individuals in these communities have jobs where there is a higher risk of contracting the virus. If someone contracts the virus in this type of employment, they have to be off work for 2 weeks. They may not be getting their regular paid income and they won’t qualify for CERB. There are pockets of individuals who fall through these cracks, you have to go to individual needs and not look at the population.

How long after a vaccine is produced and the disease is eradicated, do you think things will “go back to normal?” 

Answer from Dr. Nida Mustafa:

The new normal is something that will affect everybody. There is constantly going to be that distance between individuals and waiting outside stores, all of these changes are going to be the new norm for everyone. And again, As I mentioned it will affect different communities based on things such as housing and employment. If you’re living in an apartment building, for example, you will have to use the elevator, and this is where germs can be confined. This is adding more time and stress to your life. Although things are going back to normal. Those changes in your everyday living space will impact you psychologically and just impact your everyday life. I do feel like everyone's life has changed, but those individuals in those communities who are most vulnerable, their fires are going to be changed for longer. If these communities are disproportionately affected, then the virus will affect them for a longer period of time than other areas that have become virus-free, they will be dealing with these effects for longer just because those populations have been hit harder.

What are some lessons we can learn from what is happening South of the border (US)? 

Answer from Dr. Nida Mustafa:

In the US, wherein certain areas the numbers are increasing. I do feel like Canada is doing a good job in terms of reopening things, it's a gradual reopening and they’re doing it pocket by pocket rather than province by province. I'm not sure if that's what is happening in the US, but I've heard the areas hit hardest are opening simultaneously. I do commend the government for staying focused on the numbers and how to reopen. In the US, I feel like the emphasis on wearing masks and socially distancing is being said but it may not be as followed. I do feel like Canadians are being more vigilant in terms of social distancing and wearing masks, just speaking from my experiences of going out and seeing how people interact with one another. I think this is all needed. It's not just a tip down approach from the government, but the community should take those responsibilities and do those things. I'm not sure if they're doing this south of the border, but these may be the reasons for the increase in cases. 

Podcast #2

How important is it that our leaders understand that a one size fits all approach is not an effective solution to this pandemic, as certain communities do not have the luxury to follow the measures that are put in place?

Answer from Executive Director of LAMP Community Health Centre Keddone Dias:

You know this is great that we’re actually discussing all of this now. it's not a new issue it's something that I'm seeing a lot and we have to acknowledge that there are differences between the communities all across the province and all across the country and ignoring those differences means that we are perpetuating the inequities that exist within our systemic structures and it would never work because we are all very different, our communities experience things very differently and when you look at the disproportionate impact of the COVID- 19 virus on black communities we’ve seen data out of the United States, we have recently, as of yesterday, seen data from the city of Toronto because they started collecting the data. This situation is also true here as it is in the states. Does it not make perfect sense to say hey this is happening over here, it's impacting us in communities, what do we do to support the health and well-being of a community that’s impacted in that way supports everyone self. It's not like COVID is going to just remain in that community, we’re all out and about, with restrictions right now anyway, but we're all out interacting with each other and so the differences and the inequity in some communities are putting everyone at risk. I just understand that there's strength in acknowledging where there are differences within our communities using the knowledge of those differences about the help and support of the health of our overall general population. That's a good thing, it's not a bad thing, you know, where we can make improvements and how our Healthcare dollars are spent. 

What are the ways in which people from these communities can protect themselves and their families with the resources they have available to them? How can they stay safe while working, using public transportation, and being unable to self-isolate? 

Answer from Executive Director of LAMP Community Health Centre Keddone Dias:

We can do things within our control following public health advice like handwashing, the use of masks where possible, distancing, and ensuring we're keeping interaction with people outside of your circle to a minimum, and those things are within our control. With communities that are marginalized and vulnerable, as you mentioned, getting access to a mask may be something that isn't easily done. There are organizations out there that help people have access to masks, so they can take advantage of that. When it comes to transit, being on the TTC, the anxiety it has on people is real. When going to work, you don't have an option but to take TTC, which is something that a lot of people living in marginalized situations are dealing with. I don't know that I have any advice around how to get around that, poverty is real, and people are dealing with their economic situations and it's not as easy as saying “get a car”, which would be an easy solution to this. Also saying “isolate from your family when you feel you have been exposed” isn't an option to those living in multigenerational homes, there's only so much you can do to separate yourself from your family when you share rooms. While there are general public health lines that people can follow, there are real systemic issues and some factors that are not easily in the control of some of the people who are really most impacted by this. In terms of that, I would say follow public health advice as much as possible, but we have to be real and acknowledge that there are challenges there for some communities in following public health advice. Social determinants of health and how they impact people's life play a pivotal role in how they are able to practice some of these things and we can't simply pass out advice and ignore that there are challenges for some people in doing some of these things. And for the leaders implementing a one-size-fits-all approach, we need to understand that we don't all share a similar paycheck, similar access to education, similar access to having a place to live. If we're really going to look at protecting and supporting the health of our community we need to take all of these things into consideration and understand that there is no one-size-fits-all approach that will work and there are those in communities that are struggling to even practice the advice of public health, and what are we going to do about that. 

Doug Ford recently stated that anti-black racism is not as serious compared to the US. With our leaders constantly neglecting the seriousness of anti-black racism in Canada, what lessons can they take on how racism has played a huge role in driving the devastating effects of COVID-19 on the black community? 

Answer from Executive Director of LAMP Community Health Centre Keddone Dias:

This statement about anti-black racism not being as serious as compared to the US, in terms of healthcare, which is the lens we are in every day, I think that that statement is misinformed because say what we want about the US but when it comes to data, they know they have data on the impacts of the COVID-19 virus on black communities as they've been collecting this data for long time, so making a comparison, well, we’re not doing that with good information as Canada has not been collecting race based data in healthcare, so as much as the US we say that Canada has a universal healthcare system vs us we are behind the ball in those respects, in terms of understanding how certain things impact the black community as were not collecting that data and the lessons we can take on how racism has played a huge role in COVID, just look at the rate of people who are dying from COVID in the US, and look at rates in the city of Toronto in their recent data collection, I believe it's 80% of people affected by COVID are black or racialized, so we don't need to look far to see that we need to pay attention to the anti-black racism story related to COVID because if we do not, it perpetuates this situation where the black community will continue to be disproportionately impacted and I guess the difficulty is that, I liken it to putting our heads in the sand. We don't want to see it so we don't go looking for the data that will confirm what we already know, and we have lots of anecdotal stories from community providers, organizations, and people who are experiencing the system on an individual level. Anecdotal information is not readily accepted as data, it's just not, so why not collect the appropriate data that will tell us the story because we already know how black communities are impacted and we now need the government and our health system leaders and political leaders to put some weight behind this issue and say “yes, I hear you, that this is happening, let's collect the data to really have the information we need and let's use this data” as it's not enough to just collect it, we need to use the data to support the positive health outcomes of the communities impacted. So, in short, it's misinformed as we don’t even collect the data to make an informed comparison there. 

With your unique insight, what are some of the common concerns you have heard from the people you have interacted with in your community in regards to COVID-19, and from these concerns what would you advise to the government to help address the concerns of people whose voices otherwise would not reach their ears? 

Answer from Executive Director of LAMP Community Health Centre Keddone Dias:

When the whole COVID-19 pandemic was first declared and we had the widespread cancel of different services like schools and daycares, we saw an increase in the number of people who needed support in food security and other ways to help their families, and other necessities that are everyday things that you would think “you should have food, you should have shelter” we had some of our clients that are homeless, who were shut down. We had people who were marginalized and vulnerable, and with many of our programs moving online we saw that it also perpetuated inequities as not everyone had access to virtual tools to participate, show that your doctor is closed physically but doing virtual appointments and you don't have access to a phone or to a computer to participate, you don't get access to healthcare. For education, for people who have more than 1 child at home but only 1 computer, or people who don't have a computer at all nor internet access, they are shut off from education. We saw many families that had to choose which child could access school which day with virtual education. We have to look at the situations that different communities are facing otherwise we will never be able to address the health inequities. And that's what I would say to our health leaders, we need to know our communities on a local level as community health centres, we are very much connected to our communities. And hearing from the community and understanding the needs people have and not designing things to meet the needs of people who have, let's try to design things for people who are most marginalized, because if they are able to have access, then everyone else who are not as marginalized as them would have access as well, so you should be able to get everyone that way. So my advice or plea to our government is that we need to do everything we can to support the health of our most marginalized to ensure that we are using the best information possible to make decisions that include understanding who’s being hurt by this, where are those pockets of people that are benignly affected by this and really tailoring our response to addressing the biggest need and not sticking out head in the sand as all that does encourage the current situation to continue. 

By seeing the impact COVID-19 has on surrounding black communities in the Greater Toronto Area and the disadvantages these communities face on a daily basis, what policies can be put in place that you believe has the ability to lessen social inequities that the Black communities are facing, in order to decrease the impact that COVID-19 has on these people? 

Answer from Executive Director of LAMP Community Health Centre Keddone Dias:

This issue is so much bigger than this COVID-19 moment because COVID-19 has highlighted the inequities that have existed for a long time. So, in terms of policies that would lessen the impact on black communities, I think that's a very big piece to dissect. I would say in terms of the COVID-19 moment, we need to look at the data, we need to start using the data and now we know that the disproportionate impact on black and indigenous people, and people of colour generally, now that we have data attached to that, let's use that to make decisions around our response to COVID-19 in terms of giving testing, for instance. If there are pockets of the city or province where we are seeing a high prevalence of the virus, let's ask ourselves why and look at the data and target our response to address those issues in a substantive way. Let's be responsive and wherever possible, let's be proactive. I think right now the targeted testing and support for those communities would be a great place for us to start and i know that a few weeks ago the heat chart of the city showing the different pockets of COVID-19 impacts highlighted some communities that we could have guessed, having a high population of people of colour, black people, and we saw a prevalence of COVID-19 impact there so let's use that data, let's get into those communities and be responsive because it means taking care of that community but also taking care of everyone else at the same time. In terms of policies, we’ve heard a lot about policies and let’s review policies and come up with new ones in response to COVID-19 or even just anti-black racism and like the collection of race-based data, these policies are just words on paper if they're not actually being lived in our structural forms and real and meaningful way. Many of our institutions already have policies in place, what do those policies actually translate to in a practical sense, how are we living those policies. And that question that we need to examine individually and as an organization and systems and structures, how are we living these policies, and do they actually hold any weight in how we practice our everyday business. 

Just yesterday Dr. Eileen de Villa spoke about race-based data in Toronto and how black communities and people of colour make up 83% of COVID-19 cases. She also mentioned short-term measures such as target testing and access to employment that need to be addressed. The impact on these communities has been seen since the beginning of this pandemic. Does it seem that these measures should have been put in place earlier on to avoid the high percentage of COVID-19 cases from black people and people of colour? 

Answer from Executive Director of LAMP Community Health Centre Keddone Dias:

In short, yes. But in terms of what should've been done and how soon it should've been done, the inequities are based by black people and people of colour in our healthcare systems are long-standing and have been present and impacting people long before COVID-19 came about so the time is now to address these things. If we didn't do it yesterday, today is the next best thing, so let's not put it off anymore, let's not make excuses, let’s not just talk, let’s see some action. The city of Toronto has declared anti-black racism a public health crisis/issue over the last few weeks and in terms of that piece, the question now is, so what are we going do about it? In all of our systems and structures, what are we going to do about it beyond the declaration and the collection of data in the Peel region and in Toronto is a great start and now we have to figure out, what is our response going to be knowing that 80% of COVID-19 are made up of black people and those of colour. It's great that the collection has started, but this is not the end of the story. Wouldn't it be great if right across the country in our healthcare system we were collecting this type of data, whether it be COVID-19 or some other issue that will inevitably come, we don’t know what’s next, it would be great to be able to look at our data and identify who is most impacted, identify what's contributing to the cases that do come up, and to identify ways that can mitigate some of that. That would be a great improvement in our healthcare system and a step closer to health equity. An example for other institutions. Let’s not ignore what we know is happening, let's try to get in front of it because right now it would've been nice to have this data collected on COVID-19 from the very beginning, but we collected it now, which is great. For the next thing that is going to come don’t have to make that same mistake, we could be better prepared to desegregate data and look at where we're having a disproportionate impact. If we take action now and not just use COVID at this moment, we can take the lessons and really use them to make some good changes within our systems. 

Podcast #3

What are some similarities in low-income US communities (e.g. New York communities) that you have noticed in the low-income communities in Toronto, and how important is it that the collection of race-based data should have been conducted earlier on? 

Answer from the Executive Director of TAIBU Community Health Centre Liben Gebremikael

When we started getting info from the US, it was very clear that certain communities were disproportionately affected. These were black and racialized communities, people who are living in low-income communities. We know from previous information that black, racialized, and low-income neighborhoods are disproportionately affected by the health crisis and the SDOH. A few black health leaders in the city of Toronto really started advocating for the collection of race-based data. The collection of race-based data overall for health and measuring social and health outcomes has been there and we’ve been advocating for that because it doesn’t happen a lot in Canada compared to the US and UK. through the advocacy of black health leaders, the city of Toronto agreed to collect race-based COVID-19 data. With the report that has come out recently, we can really see how disproportionate the impact of COVID is on low income and racialized neighbourhoods. It's not different, it's the same and what that tells us there is an underlying systemic issue that leads racialized communities like the black or indigenous communities, and communities living in low-income neighbourhoods are impacted by this, and we call this anti-black racism. Because the system has not developed a fork around equity, any health or social status will impact certain communities more than others. 

Specifically, how has Canada’s government response to COVID-19 (e.g. opening in stages, closing borders. Limiting access to stores..etc.) impacted the Black community? 

Answer from the Executive Director of TAIBU Community Health Centre Liben Gebremikael

To start, looking at the general response of the Canadian, provincial, and municipal government, the measures taken are to be commended as we have seen how the COVID curve compares to other cities in America, so all forms of government should be commended for the quick and strict response, such as the social distancing laws, closing borders, and opening in stages, which I feel has played a large role in limiting the impact of COVID in general. I think that's one piece we need to commend all levels of government for. And within that, it would also show that that kind of prevention and protection has helped racialized and black communities. I feel the gap is in not having community-specific responses, which is where the question of equity comes in. You can’t treat everyone the same way as not everyone is at the same level with opportunities, privileges, access, and things like that. So, I think that if there could have been more community-specific responses included in that, we would have not seen the number of cases, for example, in the black community which is higher than any other race. The last resort, for example, showed that the cases in the black community were 21% compared to their 9% population in Toronto. If there were specific plans and strategies put in place for them, indigenous, and low-income communities, we would have had a better outcome. This is an issue of equity, not just COVID, we need a specific plan of action or even resources. For example, when you look at the numbers of deaths from COVID or the number of employees impacted by it, you will find it disproportionately higher for black and racialized communities. Why? Because it's the kind of employment they’re engaged in. Perhaps its poverty, or the need to go to work and not be able to work from home. For example, one of the measures taken by the government was to limit the number of people in offices and let them work from home, which is a good plan. People began to work from home which resulted in less travel, less contact, which gave social distancing. However, many of the marginalized communities, including the black community, are in employment that doesn't allow them to work from home, whether it be social services, hospitality, healthcare, so they can work from home and have to go to work, and if they can’t drive they have to take public transport, which exposes them to all the risks the government is trying to reduce. So, when there's a plan it's important to ask, where is everybody, who are the most impacted, who are the most at risk, and what kind of protection or plan do we need. That would be something that would be very comprehensive in terms of a strategy or plan to address situations like this.

Has the governmental aid system been beneficial to the black communities? What would you want to change about the procedures taken when providing aid (CESB, CERB)? How could the government have provided a more equitable response? 

Answer from the Executive Director of TAIBU Community Health Centre Liben Gebremikael

Not everyone can access information in the same way. When there are supports like this, we have to make sure that that kind of support is meeting the needs of the most marginalized because if you plan things with the most marginalized in mind, the response that you develop would be ok for everybody because you would have covered the economy from bottom up. With regard to the assistance provided by the government, I think this is commendable. But is everybody able to access this assistance at the right time in the right way would be a question? How you access support/services are different for different communities. There should be a specific plan or access routes for those marginalized communities. We have a lot of racialized and marginalized communities in low income that their employment situation is so precarious that it wouldn't allow them to access this kind of financial assistance. If you’re in a situation, you won’t have access, so what happens to those people? And they’re already at the bottom of all kinds of challenges, so with the appropriate resources and assistance, they would be impacted even more. When a plan is designed, we should pay attention to the most marginalized, the ones that don’t access information or services in the traditional way. If you don't have the internet, how can you do that. You would need somebody to help you, even if you’re qualified for assistance, with school being closed and education moving to an online platform, not everyone was able to follow this appropriately. If you don’t have good enough internet access or computers, it’s very limited to what they can do. Low-income communities, newcomers would have a challenge in accessing those services.

Do you feel that there is a common complaint or prevalent issue in the community you are involved in that hasn’t been addressed by the government yet? 

Answer from the Executive Director of TAIBU Community Health Centre Liben Gebremikael

I think the government has been listening. There are some things that aren't at the forefront of discussion, such as housing, which is a difficult situation for marginalized communities. It was only later on that people started talking about housing and what kind of assistance is required. But housing is a big issue as many people are impacted by homelessness, so the COVID situation has made that worse, so I don't think there was a strong plan to address that issue. Another issue that did not have high enough attention was the migrant workers who do a lot of the agricultural workers who don't have much access and connections to systems and have been impacted more by the COVID situation. There hasn't been a lot of discussion surrounding them. Also, the prison population should have gotten better and quicker attention, both in terms of management and more importantly in terms of prevention. And we know that the prison population is disproportionately represented by the black and indigenous communities. I think there are pockets of areas where not enough attention was given and I think it started afterward but there was a lag, which is because of COVID  hitting suddenly, and if you didn't have any plan in place, like closing the borders and shutting down, which really helped with the situation, however, there was a lag with many other issues which impacted many people. If we had an equity plan overall where we believe and have evidence that certain racialized, marginalized or low-income communities are always at the bottom, whether its health, social, education, employment, or criminal justice. When you look at all stats, these communities are at the bottom. If we knew that and we really worked with that frame of mind, when a pandemic comes, we would start our plan in those communities which we don't have in Canada yet. Maybe the pandemic situation has highlighted and amplified it showing people the impact of it, so perhaps moving forwards we can improve in how we are developing plans. Somebody once said that COVID is like an x-ray, we might know something is wrong, but the x-ray (COVID) shows exactly how it's broken, allowing us to implement the appropriate intervention. So hopefully, with this experience of COVID, perhaps there are some lessons that are learned that will teach us how to do things differently next time. 

How long after a vaccine is produced, and the disease is eradicated do you think things will “go back to normal?” 

Answer from the Executive Director of TAIBU Community Health Centre Liben Gebremikael

I don't think there's going back to normal. I think we have a new normal. It’s going to take a longer period for racialized communities and black communities to get back to a place where at least things are normal and where there isn’t a lot of anxiety. But I think for racialized communities, it will take longer. We were below a certain standard, and now we're further below and then so it's going to take a long time, double effort, to bring the community back to a better place than it was before. One thing that I've been reflecting on a lot is education support for children and young people. When COVID hit, schools got closed and things moved to online. If you're middle class, nothing has changed much except for the location of where you access education. For low income and racialized communities, where you don’t have the capacity and infrastructure, you have a larger family so you’re not able to social distance, and also support for children is a challenge. I'm concerned that there will be a large number of children who have missed out on education support from march up until this term. There has been a huge gap where they haven’t had support We talked about vaccines, and I think vaccines are like any other health services. If the black is already challenged in accessing health service because of various reasons, other challenges are going to exist when the vaccine is going to be available because that's how the system works. If you have not changed how the system works, whether its vaccine, or prevention, or going to the doctors it’s the same thing because you have to come to the health centre because you have to access the vaccine. 

When a vaccine is available, what protocol do you feel the government should apply when delivering the vaccine to low-income neighbourhoods (e.g. should it only be available in major hospitals, should there be clinics made specifically for the vaccines, or should they be available in all health centres)? 

Answer from the Executive Director of TAIBU Community Health Centre Liben Gebremikael

I think about how communities access different services will give us an idea of how to distribute the vaccine. Having closer to the community, having it accessible, where community members are comfortable going will be important to consider. The second thing is we also need to do education in the community and community engagement as there are already much misinformation and myths going around. Plus, we already know that the black community particularly doesn’t trust the system, rightly so as the health system and government have used health services, including clinical trials and vaccines to further racialize, marginalize, and kill members of the black community. If I was the government and I was coming up with a vaccine and a way to distribute it, I need to make them feel comfortable doing so. So, the government needs to undergo many information campaigns and community engagement that needs to be part of the vaccine deployment plan. As we said earlier in our conversation, specifically in certain communities. Specifically, if we use community testing and mobile testing units, then the workers will be going out in communities, meeting, and having a relationship with them, which will be helpful when the vaccine is released as they are trusted individuals in the community that will come to those in the community to make sure it’s available to everyone. Normally, those services are given higher up in the ladder, in institutions and hospitals, however that's not accessible to the communities, so making it very accessible with proper education and awareness and engagement with the community will be critical for the effectiveness of the vaccine. And, the principle of equity says to start building up from the bottom. So, we should first pay attention to those marginalized and disproportionately affected, similar to how we would first focus on healthcare workers when giving vaccines as they are the most impacted. However, at the same time, we should start with racialized communities. We should find communities most impacted by COVID as we will be addressing the most vulnerable first. This shift in planning would make more logical sense and more useful when addressing intervention and prevention. 

What lessons can the Canadian government take from this pandemic. What steps should they take to improve the health outcomes of the black community moving forward? 

Answer from the Executive Director of TAIBU Community Health Centre Liben Gebremikael

This is looking at a high level. I don't know if the Canadian government is collecting race-based data as it relates to COVID. I know the province has agreed they would start, initially that wasn’t the plan. This is one of the lessons everyone should pay attention to. If you really want to change something that isn't working, we need to understand why that problem exists and the extent of the problem. This is what race-based data can be used for, it can tell us who is most affected by this and why. And we know why the black community and realized communities are being impacted by COVID or any other chronic situation, is because of the inequitable disparities that already exists, whether it is housing, income, also known as the SDOH if we can't’ understand that and really know the extent of the problem we wouldn’t be able to start to address the inequities present in the black and racialized communities. I’m hoping that this is a lesson that has come now. Sometimes there is this notion that a lot of investment is put around healthcare in hospitals because that's where we see most of the challenges. The government is always addressing it at the other end of the healthcare spectrum. Therefore, focusing on the outcome or the end result of a problem and not trying to say where is this problem coming from, where is the fire coming from? When you take your first aid course and stuff like that, they always say when you’re putting the extinguisher, aim it at the source of the fire, because if you can eliminate it, then you won’t have any fire. We should say where this is coming from, if we have more issues with community safety and criminal issues, where is this coming from? The solution is that we needed to stop this pipeline, it's where the school system has been racist to them. Why do we have more black people with mental health problems? We have to go back and say where this is coming from. The common denominator is anti-black racism and the system that is generating all of these problems. I’m hoping with this COVID situation and what transpired after the BLM movement, where we have seen a lot of non-black people are listening to this issue, and I think this has given us a good opportunity to think differently and bring about change, and maybe shift the needle towards equity because people are emotionally attached to say this is not fair.

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