The effects of COVID-19 have been felt by people across the globe. Whether it be contracting the illness itself, job loss, mental illness, financial stress, or lack of access to community support and resources, it’s safe to say that everyone has been adversely impacted by the pandemic in some way or another.
For communities that have been historically oppressed and marginalized for generations, the effects of COVID-19 have been far more devastating. We asked Dr. OmiSoore Dryden, the James R. Johnston Chair in Black Canadian Studies at Dal, to explain the impacts of COVID-19 on these communities and to identify some solutions for addressing them.
Can you identify some of the challenges that are unique to marginalized and historically oppressed communities due to COVID-19?
People in marginalized and historically oppressed communities tend to be employed in low-paying and highly feminized jobs such as janitorial staff, orderlies, nursing assistants and clerical positions. During COVID-19 these are the very jobs that have become essential services; these are mostly part-time positions requiring people to work at multiple jobs across multiple locations. These are the jobs that people cannot do at home; they are unable to work from home during this pandemic. Because of this, marginalized and historically oppressed people are placed in even greater vulnerable positions with a greater likelihood of contracting COVID-19.
Folks in these communities also do not have the same access to government supports like CERB and other programs which would allow them to shelter in place. As a result, they must continue to work outside home, travel to their jobs, perhaps by public transit, during a global pandemic. This mean they are less able to physically distance or less likely afforded the opportunity to wash their hands often, or have access to personal protective equipment.
Depending on class privileges, not everyone has the ability to work from home, shelter in place and physically distance. Not everyone has access to clean water in order to frequently wash their hands. We see these realities discussed in the documentary There’s Something in the Water and understand that environmental racism is also a chronic condition that must be taken into account during this pandemic. What does it mean to wash your hands frequently if you don’t have access to clean water?
Many marginal and historically oppressed families also live in multi-generational families, where you have young children and elders in the same household, and those adults in the middle are out working multiple jobs. The systems in place that create these conditions are the perfect storm for transmission. This is not the fault of the people who contract COVID-19, it is the outcome of the system.
What are the systemic barriers that have led to these challenges?
When I think about systemic barriers, I really like to focus on the social determinants of health (SDH). These are helpful because SDH refer to the social and political realities that impact our lives, including our health. SDH includes the social conditions of gender, sex, sexual orientation, education, employment, income, disability, living in a rural or urban spaces, living arrangements, access to health care, immigration status and racialization. The reason why we have social determinants of health is that it helps us think through how these various aspects of our lives impact our personal health, levels of community health and, of course, access to health care and services.
An example would be in Nova Scotia where many people are without a primary care physician, which may be further exacerbated if you are living rurally. Systemic barriers such as precarious employment might mean that you can’t necessarily take time off work to go wait in line at a walk-in clinic or emergency room to have your diabetes, hypertension or heart disease taken care of because when you leave work, it means you don’t get paid. When your income is taking care of your family who may live in multiple locations, how do you decide to take time off work to seek health care? Can you really risk not working that day? This has tremendous consequences during a pandemic. Already limited access is even more limited. Who is missed when this occurs?
We have research that identifies how systemic racism negatively impacts people seeking access to care, and outlines the experiences if they receive care. We also hear people recount their experiences of being racially profiled, accused of being drug seeking, instead of having their pain taken seriously and medicated properly. We have the examples of people not having their symptoms taken seriously.
Just recently in the United States, Rana Zoe Mungin died as a result of complications from COVID-19. A Black woman, Ms. Mungin was denied COVID-19 testing twice, even though exhibiting various symptoms of the virus. Systemic racism manifests when the symptoms one must display, are being displayed but dismissed as attention seeking behavior.
These kinds of systemic barriers don’t go away simply because we wish them to. It’s one of the reasons why there has been a greater demand to have disaggregated race-based data collected so that we can assess differential access to care and then effectively respond to the health disparities that are then made evident.
What are groups within these communities doing to address these issues and how can elected officials and governments support them?
I have to say that the African Nova Scotian communities that have established COVID-19 Response teams, which came together very quickly, is the kind of action Black communities have had to take over and over again for generations. Black communities have had to come together in times of crisis to provide immediate care for themselves. And at the same time, demand effective responses from government and health agencies. African Nova Scotian community response teams have been stellar!
Having taken notice to the reports of coronavirus in January and February, African Nova Scotian community members came together to say, “What do we need?” and then advocated on behalf of the community to make sure the appropriate services were put into place. They were able to have an on-site clinic open up, have provincial supports for that clinic, make sure that testing was happening regularly, and they were able to ensure that there was culturally appropriate pandemic health information distributed. Things you think would be simple are often what gets missed. Images and text used in health promotion, like during a pandemic, must be reflective of the community — it must be diverse, including racially diverse. It also means working collaboratively with community members to ensure that information on pandemic protocols are shared effectively amongst the community. As educators, we know that people have distinct learning styles. This must also be taken into account when sharing information on pandemics that are intended to protect all members of our community. One size does not fit all. One form of communicating does not work for 100 per cent of the population. Understanding this from the beginning means that we have greater success with adherence to the protocols.
There was another community group based in the HRM that was concerned with how the police where given responsibilities within the pandemic. Policing the pandemic is never a good idea. This community group established an online system to make sure that people knew of other more effective responses to managing the pandemic protocols instead of calling the police. That it is better work with neighbours, while maintaining physical distancing. They were able to point out that what we needed to do is physically distancing while maintaining our social connections.
I think in some ways the province has responded effectively, while in other important ways the province has more work to do. The province has said repeatedly that they care for all members of Nova Scotia — and one of the ways to demonstrate that care is to actively address health inequities right now. Now is the time to begin collection of disaggregated race-based data. As of May 1, the chief public health officer in Manitoba and the province started to collect race-based data from people who tested positive for COVID-19. Toronto has already begun to do this. I’m hearing that Hamilton will also begin to collect this data. Now is the time for Nova Scotia to follow these leads and work with African Nova Scotian and Indigenous communities to start collecting that data immediately. Only with that information can we ensure we are effectively able to address health disparities, not only during the pandemic but long after.