COVID-19 revealed stark disparities in our health-care system, with immigrants representing just 25 per cent of Ontario’s population but accounting for nearly 50 per cent of cases. This disproportionate impact wasn’t merely coincidental, it was the predictable outcome of longstanding structural inequities.
Even before the pandemic, immigrants and refugees faced multilayered barriers to health care:
- limited access to primary care
- language obstacles
- systemic distrust
- exclusion of internationally trained health-care professionals
- inadequate mental health resources
- fragmented social services
The pandemic only intensified these challenges through service closures, rampant misinformation and reduced preventive care.
Research led by Toronto Metropolitan University’s Mandana Vahabi during the pandemic uncovered alarming statistics: The prevalence of COVID-19 was significantly higher among immigrants with cancer compared to non-immigrants with cancer. Immigrants with cancer were almost 2.5 times more likely to be diagnosed and two times more likely to be hospitalized from COVID-19 than non-immigrants with cancer. Similarly, immigrants with mental health and addiction disorders were almost twice as likely to be diagnosed with COVID-19 than non-immigrants with such conditions.
The truth is uncomfortable but clear: these findings aren’t new. The research community, health-care providers and community organizations have documented these inequities for decades. What appeared as individual choices during the pandemic – such as vaccine hesitancy – were manifestations of deeper structural barriers.
At Access Alliance, these issues connect directly to our strategic principles of Access, Equity, Engagement and Attachment. We’ve consistently prioritized those made vulnerable by systemic barriers and social determinants of health, particularly newcomers, immigrants, refugees and people without status.
The pandemic taught us valuable lessons about systemic responses. For instance, higher vaccine acceptance rates were linked to better health care access and consistent, culturally sensitive public health messaging. A study of 540 Syrian refugee parents found that those with good mental health, a family doctor and access to interpreters showed significantly less vaccine hesitancy.
The challenge isn’t identifying problems, it’s implementing solutions. Here are key priorities for reimagining Ontario’s health system:
- Revitalize cross-sector collaboration: During the pandemic, we saw unprecedented coordination across health, community and social services. This spirit of collaboration largely has disappeared. We need sustainable funding models that encourage and maintain these intersectoral partnerships to prevent fragmented, siloed approaches.
- Empower communities with tailored approaches: Despite significant impacts on racialized populations, there remains insufficient community-specific research on how different groups navigated pandemic challenges. The research that exists provides clear roadmaps – we need to implement community-led solutions rather than one-size-fits-all approaches.
- Mandate cultural competency training: Health equity curriculum exists but needs to be standardized and customized for service providers at different points of the health equity implementation continuum. This training should be required across all health-care settings.
- Leverage internationally trained health professionals: When residents from diverse linguistic and cultural backgrounds serve as Community Health Ambassadors, vaccination rates rise above municipal averages and hospitalizations decrease during crisis periods. Beyond outreach roles, we must integrate these professionals into the health-care workforce.
- Boost digital and health literacy: Canada lacks a coordinated digital inclusion strategy despite numerous local initiatives. We need systematic approaches to both digital literacy and health promotion, especially for newcomers and vulnerable communities.
- Expand Community Health Centres: Ontario’s Primary Care Action Plan is a start, but more is needed. Research shows that public health authorities rarely prioritize continuity of care for underserved urban populations, focusing instead on infection control. This approach overlooks the interpersonal nature of support needed by vulnerable communities.
- Create a centralized provincial health portal: While some information portals exist, they remain decentralized and disconnected. We should develop an integrated information ecosystem with culturally relevant resources in multiple languages.
- Connect newcomers to health services at entry points: Social determinants and settlement integration significantly influence health outcomes for all newcomers regardless of their pathway or status. Early connection to health services is crucial.
The pandemic didn’t create these inequities, it exposed them. We don’t need more research; we need practice and policy change. The path forward involves bringing researchers, organizations, policymakers, caregivers and community members together to implement these proven solutions.
It’s time to reimagine a health-care system that truly works for everyone, especially those at the intersection of social and clinical disadvantage. Only through collaborative action can we build the inclusive, resilient systems that prioritize access, engagement, and culturally competent care for all Ontario residents.
Join us on May 27, 10 a.m.–11:30 a.m., for a webinar to discuss TMU’s research findings and how they’re connected to a broader discussion about larger health equity questions.
