While the pandemic’s third wave rages, we focus on the illness around us and the hardships caused by another lockdown. But the infections will clear and we will emerge from this moment into a different society, one in which social rifts have been laid bare. The recovery from the social pandemic will require more work and resources, over a longer time, than the recovery from the infectious disease pandemic. On April 23, I challenged the House of Commons Standing Committee on Health to prioritize the social recovery:
“I have spent most of my working hours over the past year on the medical front lines of the pandemic – in my clinics at St. Michael’s Hospital and the Good Shepherd homeless shelter, in a COVID homeless recovery site, and recently at a COVID vaccination centre for Indigenous people in Toronto.
“This infectious disease pandemic has been challenging, but I have battled social pandemics for as long as I’ve been a doctor. I work with communities that are disproportionately impacted by adverse social conditions, including poverty, homelessness and systemic injustices caused by racist and colonial social structures and policies. The scientific evidence is powerful: These social pressures have a massive impact on health, including higher rates of chronic illness, acute illness, adverse childhood outcomes and death.
“In COVID-19, the communities I work with have faced greater hardship than most. This infectious disease pandemic, placed on top of the longstanding social pandemic, has created what is termed a syndemic – a synergistic pandemic – in which the spark of COVID has ignited the tinderbox of social inequity built into the structures, policies and institutions of our society.
“We have known since the first months of the COVID crisis that the people getting sick and dying live in poverty and without adequate housing, work in high-risk front-line jobs without adequate employment protections, and are racialized, disabled, women, Indigenous, and more often than not impacted by intersections of multiple identities.
“I ask you to urgently call for health, public health and social resources to be redirected to neighbourhoods and communities with the highest burden of illness and with the least protections. This includes extending emergency income benefits, guaranteeing employment supports like paid sick days and facilitating access to health supports such as a safe supply of opioids.
“But deeper structural changes to our health and social systems will be required to prevent this situation from recurring. I have three recommendations:
1) Strengthen social support programs to provide a foundation for health. The federal budget’s promise of a national child-care program is an important step. We must now examine income support programs to ensure all Canadians have access, through federal and provincial benefits, to an income adequate to attain and maintain good health. This could include extending Basic Income programs beyond those currently in place for seniors and children, with particular attention to the needs of people living with disabilities, Indigenous and others who face historical and structural barriers to living above the poverty line. We must also commit to end homelessness now through increased funding for affordable and supportive housing and Housing First programs.
2) Collect data to make social pandemics visible. We must improve social disease surveillance systems. To properly understand health and social outcomes, we require access to disaggregated data on race, ethnicity, income, disability, housing status and other key determinants of social inequity. Public institutions and community agencies should be directed and supported to gather, analyze and report on social data at a community and individual level. The government must set specific health and social outcomes targets for those who have been socially marginalized, with regular reporting and accountability to those targets.
3) Empower those who have been most impacted by adverse social conditions to lead these changes. I have been giving vaccinations at the Auduzhe Mino Nesewinong clinic, a program created and governed by Indigenous people. Using their knowledge and community connections, they have provided extensive services to an urban Indigenous community that has long been hidden from view. The government must advocate for this approach, often called “nothing about us without us,” to be replicated for other projects and other communities, putting those who are most impacted by inequitable social policies in the driver’s seat of efforts to redress those inequities.
“These changes will set the foundation for a recovery that aims to address the disastrous inequities that have characterized the COVID syndemic.”