When we think of Canadian healthcare, words like “free,” and “accessible” may come to mind. Many, both within the country, and internationally, may see Canadian healthcare as without barriers - yet, Canadian healthcare is often based on socioeconomic status. Further, not only are poorer patients adversely affected by systemic healthcare inequities, but they are also more likely to have a lower quality of health, compared to the average person. Health and social class are deeply interwoven, even in developed nations like Canada. The persistent and cyclical correlation between class and health has been highlighted by COVID-19, as supporting marginalized communities has often been overlooked.
The first facet in which the poorest and most vulnerable are detrimentally impacted by health inequities is through the worsened social health factors in communities. Social determinants of health are classified as factors that contribute to health, such as access to healthcare, lack of education, stigma, and the necessity to work (often in multiple jobs). Health Quality Ontario, the province’s advisor on healthcare quality found, in 2016, that the poorest people in Ontario were 23.5% likely to report having a chronic health condition. This is compared to the 12.4% reported within the wealthiest communities - nearly half of the former group. This statistic elucidates a growing concern regarding poor communities in Ontario. This is a result of many factors, some of which are difficult to address. For instance, someone working for a standard 9-5-hour day would likely have more time to shop for healthy foods, exercise, and go to the doctor compared to someone working multiple jobs. Within poorer communities, these types of sacrifices are a necessity, which highlights a key issue in Canadian healthcare. Some goals that could be worked towards include increasing accessibility for healthcare, as well as healthier foods. While there is a long road ahead in addressing these concerns, the challenges facing lower-class and vulnerable communities are detrimental and should be addressed.
Next, there is less access to medical care (ex. hospitals or clinics) in poorer and less developed regions. This means that an individual who has, for instance, contracted an illness or developed a disease will be less likely to have immediate access to medical attention if they are less wealthy. A statistic that highlights this challenge comes from the aforementioned report from HQ Ontario, which states that “Nearly half (49.7%) of people living in the poorest urban neighbourhoods are overdue for colorectal cancer screening, compared with just over one-third (34.9%) of people living in the richest urban neighbourhoods.” This discrepancy of 15% is a clear issue, especially since the most vulnerable people are often those in poor neighborhoods. Reading these statistics, it may be easy for data to become just that - statistics. However, it is imperative to keep in mind that these statistics are based on our own communities, and those in our lives are affected by them. In lower-class communities, health can seem like a luxury, especially when a fraction of people are receiving healthcare.
Furthermore, a chart by the HQ Ontario report (right) details the percentage of people with prescription medication insurance in Ontario, by income level. While almost 9/10 people in the richest regions have this insurance - that ensures that medication is available and covered - only 58% of people have medication insurance in the poorest regions. Even middle-class households often don’t have this insurance, which clearly displays a recurring issue within the Canadian healthcare system.
Finally, to compound these issues within Ontario communities, the COVID-19 pandemic has detrimentally impacted many Ontarians. As an article by the CBC writes, we are living in “One country, but two pandemics.” Initial hopes of unity and solidarity from March of 2020 have largely dissipated, with those in the most vulnerable situations disregarded. An example of this is in Toronto, a city often seen as a developed and thriving urban area. From May to July 2020, individuals from lower-income households - earning less than $50, 000 per year - were disproportionately affected in COVID-19 cases- making up over half of all positive cases, while only representing around 33% of the city’s population. Lower-income neighborhoods often contend with systemic issues that require them to work and be potentially exposed to COVID-19, despite the virus’s contagiousness.
The challenges explored in this article are not new ones, although they have been amplified by the impacts of the COVID-19 pandemic. From small businesses to hospitals, all aspects of our society have been transformed over the past 16 months. As we recover from the pandemic and begin to move forward, it is imperative to ensure that the most vulnerable people are not forgotten. Last year, Dr. Isaac Bogoch, a physician in Toronto, said to CBC, "It's hard to find a silver lining in a pandemic. But if there is a silver lining in this pandemic, [it's that] this has highlighted some of the inequalities that we see and has highlighted many of the needs of marginalized populations."
If we are to take action through this silver lining, it is essential that including the most vulnerable people as we recover from COVID-19 is not simply a narrative, but a policy. We are at a pivotal point in which we, as a province and a country, are recovering from the COVID-19 pandemic. Now is the time to make a change at a large scale, to make healthcare accessible for all communities. We may be living through two pandemics in Canada - the pandemic of the richest, and the pandemic of the poorest - but we have the opportunity to move forward with one, unified recovery.
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