Across the U.S. researchers are struggling to understand why COVID-19 is taking a much greater toll in Black communities.
But in B.C. and across Canada, health officials aren’t even gathering data on the pandemic’s impact on racialized communities, crippling the system’s ability to protect a diverse population.
It’s not just the U.S. Around the world scientists are discovering COVID-19’s risks may be linked to race and ethnicity.
In Canada, the lack of data means public health officials are flying blind, said June Francis, director of the Institute for Diaspora Research and Engagement at Simon Fraser University.
“I think there’s a political and intentional colour-blindness because we don’t want to accept that some people are being mistreated,” said Francis.
“The pandemic has put a magnifying glass on how the lack of race-based data has caused us to be so inadequate in our responses and to target these responses in appropriate ways to address the specific needs of vulnerable communities.”
Racial biases and language barriers permeate health care at every level and can have drastic impacts on health outcomes for racialized patients.
Black and Indigenous people seeking treatment for pain may be assumed to be drug-seeking and not taken seriously, Francis said, or their reports of pain may simply be discounted.
And a lack of research on underlying health issues specific to racialized people and how they interact with COVID-19 hurts the chances for effective treatment.
Most research, Francis said, focuses on the white Eurocentric population. There has been little research, she noted, on the interaction of underlying conditions like sickle cell anemia and hypertension — more prevalent in Black individuals — with COVID-19.
Even standard indicators used by health professionals to assess people — like a change in facial colour as an indicator of breathing difficulty — don’t apply to many racialized individuals, said Francis.
“Where our needs are not targeted, other people’s needs are privileged over ours,” she said.
Francis said that once when she was in hospital it took 10 different people to put an IV into a vein. She asked a nurse why, and was shocked.
“She said, ‘Because you’re Black, and we don’t train to find veins in Black skin,’” said Francis, noting she felt like she was being butchered. “I was sitting there thinking, when people ask me why systemic racism ends up in the service we get, and why our outcomes are not as good, these [gaps] are all factors, they all culminate.”
The problem isn’t just that racialized individuals have a hard time accessing targeted care.
They’re also among the most likely to contract COVID-19 due to the concentration of many racialized workers in essential work that involves dealing with the public.
In B.C., about half of workers in hard-hit long-term care facilities are racialized.
Many of the workers are Filipinx, which led Vancouver’s Tulayan Filipino Diaspora Society to call on the B.C. government today to begin collecting this kind of data.
“We need to know whether and how these pre-existing vulnerabilities are affecting instances and recovery and hospitalization of people who are exposed to COVID-19,” said John Paul Catungal, an assistant professor at the University of British Columbia’s Social Justice Institute who is co-spearheading the call to action.
Racialized people are also more likely to experience homelessness and do precarious work like food delivery that puts them in closer contact with the public.
“The big determinants of health are how much money and how much power you have,” said Farah Shroff, a global public health expert at UBC. “And health status is a way of measuring equity.”
Race plays a large role in these upstream determinants of health — what people do for work, where they live and income — that determine how illness, including COVID-19, affect people, Shroff said.
Information is important, but B.C. isn’t collecting it
B.C. currently collects federally mandated health data on individuals who self-identify to health providers as First Nations, Métis and Indigenous.
But it hasn’t released any data publicly on how those groups are being affected by the pandemic.
Provincial health officer Dr. Bonnie Henry says the province is considering how race-based data for other communities may be collected, but no plan is in place.
“We know it can be an incredibly important marker... and part of that is around challenges to access health care,” said Henry last week. “We’re thinking about how we can do that for sure.”
Race is also important when thinking about why certain communities might more easily adhere to public health guidelines, and how to build culturally-sensitive public health initiatives.
For many Chinese Canadians, wearing a mask is a sign of respect for others’ health even under normal circumstances, so many started wearing masks early in the pandemic.
Meanwhile many white Canadians felt they were alarmist and not necessary.
“Cultural misreads, cultural miscommunications, it all comes into play,” said Andy Yan, a city planning expert and instructor at UBC and Simon Fraser University.
On the other hand the criminalization of many racialized communities means many Black and Indigenous people worry that covering their faces may make them more vulnerable to police suspicion and action.
“For Black people, it’s not as simple as just wearing a mask,” said Francis. “We know Black people are dying at a greater rate, and yet our own officials can’t tell us what we need to do because they assume wearing a mask is safe for everyone.”
Not visiting elderly family members is also more difficult for racialized communities, particularly South Asian and Filipinx families, who tend to live more often in multi-generational homes, Catungal said.
Challenges in gathering data
Getting the needed data is not as simple as asking people their race.
There is a long history of race-based data being weaponized against communities or used to stigmatize them.
Francis says community members and leaders need to be involved from the start to ensure public health is asking the right questions and that the information is used to build culturally sensitive and community-led responses.
“This data should not be collected about us, it should be collected with us at the centre of it,” said Francis. “We are fearful of a system that doesn't make sure that we are part of that solution at every level.”
Collecting this kind of data would be a step towards a better recognition of the role race plays in cities, said Yan, particularly in Vancouver where he feels the conversations are lacking.
“Race has been with us since the start,” he said. “It’s been an underlying foundation of the city. And yet over the last couple of decades, certain people have shied away from talking about it.”
Yan thinks that race is often used to avoid conversations about privilege and power in Vancouver — like in the debate around the foreign buyers tax.
The lack of initiatives to gather race-based pandemic data is just another example, he said.
But talking about race is not the end of the conversation.
Catungal stressed that it is important to open the conversation about race now so the long-term health and economic impacts on racialized communities can be addressed when all is said and done.
If collected and made public, such data will also shed light on the economic and social inequality that harms certain populations.
“The important conversation is about that understanding of why this is happening,” said Yan.