FROM OCTOBER 2020 ISSUE OF WEST END PHOENIX

In Toronto’s northwest corner, a web of systemic factors—from poverty to employment patterns—put the neighbourhood’s most vulnerable residents at higher risk for contracting the novel coronavirus

In April 2020, months after COVID-19 had gained a foothold in this province, Ontario Medical Officer of Health David Williams told the public that his agency doesn’t collect race-based data because the WHO didn’t think it was necessary. “All [groups are] priorities to us, regardless of race, ethnic or other backgrounds,” he said. “They’re all equally important to us.”

But Dr. Onye Nnorom wasn’t having it. On Twitter, she wrote back in response: “The collection of demographic data to determine who is at risk is standard practice during an outbreak. I’m a Canadian public health doc. The refusal to collect race-based data when Black Americans have been identified as a high risk for COVID-19 is institutional racism.”

Nnorom wasn’t alone in her frustration over Williams’s comments. Representatives from other health organizations, including the Toronto-based Wellesley Institute and Ottawa’s Somerset West Community Health Centre, also spoke out. “It’s really concerning. It’s almost like there wasn’t an acknowledgment of existing health disparities,” Suzanne Obiorah, the director of primary care at Somerset West, told CBC.

The City of Toronto didn’t release a map of the city’s neighbourhood infection rates until late May, but when they did it confirmed what many already knew: Black neighbourhoods were being hit the hardest by COVID-19.

Humber Heights–Westmount (1,507 cases per 100,000 people), Weston (1,023 per 100,000 cases), York University Heights (906 cases per 100,000) and Mount Dennis (890 cases per 100,000), all in the city’s northwest corner, accounted for the highest COVID-19 rates in the city, at numbers nearly 10 times higher than other Toronto neighbourhoods. These areas are predominantly inhabited by people of colour, newcomers and Black people and face the largest socio-economic disadvantages in the city.

The disparity doesn’t just exist in these neighbourhoods, of course. According to Toronto Public Health’s data for July, Black people make up 21 per cent of reported cases in the city, even though they only represent nine per cent of the population. That aligns with Montreal’s data, as well as what’s happening in the U.S., where Black people are three times more likely to die of COVID-19 than white people. But what is happening in the city’s northwest, and especially Weston, is, unfortunately, an excellent case study in systemic racism.

Researchers and advocates say the difference in COVID-19 rates is due to disparities in both healthcare and health crisis planning. That’s certainly true in Weston. It is one of the city’s 13 “priority neighbourhoods” – meaning it needs additional investments to help with specific issues, such as high crime rates, poverty and a shortage of services. But despite it being designated as such, the city has continued to disrupt the area with gentrification and massive infrastructure projects: an affordable housing project for seniors that was still unaffordable; Black-owned businesses torn down to make room for new condos being geared to and purchased by homeowners from outside the area; and Metrolinx’s plans (thwarted in the end) to build a gas plant for the Eglinton LRT in the nearby residential neighbourhood of Mount Dennis. The area is also dealing with extreme poverty and the highest eviction rates in the city – both of which have been exacerbated by COVID-19, and will likely get worse now that CERB has run out and Ontario has passed the controversial Bill 184, which makes it easier to evict tenants.

Weston’s infection rates tell the story of a community long forgotten and rejected by the rest of Toronto. But the Weston community is so much more than that. From healthcare workers to outreach coordinators, residents aren’t shying away from the racial – and racist – factors that play a role in Weston’s high rates and they’re willing to do what it takes to help their neighbours get through the pandemic.

Michael Gardam, an infectious disease physician at Women’s College Hospital and previously at Humber River Hospital, says the social determinants of health – the conditions in which people grow, work and live – play a key role in who is likely to get COVID-19. These include income, employment, housing, health services, food insecurity, gender, race and ability.

And in Weston, these factors need improvement. According to city data, 31 per cent of people in the area – and 40 per cent of children – live in poverty. The neighbourhood has more unsuitable and inadequate housing than the average Toronto neighbourhood, with 43 per cent living in homes they can’t afford. Those homes are often highrise apartments or crowded housing spaces, which make it impossible to self-isolate if you do have COVID-19. And residents are more likely to have to rely on public transit and often do high-risk, essential work. It is the perfect storm for high rates of infection.

But it’s not just about poverty. Weston is also 61 per cent visible minority and 33 per cent Black, the second-highest ratio in the city. Racialized people in Canada are more likely to experience poverty, but race itself is also a social determinant of health. A recent report by the Government of Canada acknowledged anti-Black racism is a determinant of health: “Inequities in access to education, income, employment, housing, and food security can drive inequities in health and well-being,” it said.

That’s because racism is considered a “chronic stressor.” For Black people in particular, being exposed to racism, microaggressions or even simply anticipating discrimination can lead to a higher risk of the common cold, hypertension, diabetes, cardiovascular diseases, depression, anxiety, inflammation and even an earlier death. They also experience trauma, rapid aging and poor health as a result of experiencing or witnessing police brutality, which is relevant because Black people in Toronto are 20 times more likely than white people to be shot by police despite only making up nine per cent of Toronto’s demographic. Police carding disproportionately affects the Weston-Mount Dennis area, and in July 2019, immigration officers from the Canadian Border Services Agency (CBSA) were conducting ID checks in the Lawrence Ave. and Weston Rd. area – a practice Ontario banned in 2017 – around the same time that ICE launched its targeted raids against migrant families in the U.S. All of this works together to ensure that Black people in Canada have one of the worst health profiles in the country. (Indigenous people also face “appalling” barriers to healthcare, according to a 2012 report by the Wellesley Institute, which went on to say that “the health status of [Indigenous] people in Canada falls far below that of other marginalized groups.”)

This means racialized people aren’t just more likely to contract COVID-19. “Once you catch COVID-19, there’s pretty good evidence that if you’re a person of colour, you’re more likely to get sicker with it, which is even more worrisome,” Gardam says.

It isn’t yet clear why that is the case, but we do know that income plays a role.

“If you look at the map of Toronto, the richer you are – in terms of where you [live] – the less likely you are to catch COVID-19,” Gardam says. “It’s that simple.”

Weston’s infection rate in June, for example, was 12 times higher than in Rosedale, and 18 times higher than in the Beaches.

“Given the size of the houses there, given the work they’re able to do, they’re able to better physically distance themselves. To be blunt: If you have money, it’s easier to deal with COVID-19 than if you don’t,” he says.

But there are things the city can do to mitigate these factors. Faisal Hassan, NDP MPP for York South–Weston, says it’s been a very “difficult and trying” time for the community. “Since March, we’ve been fighting to have permanent and pop-up testing locations so that the community can get them,” he says, adding that they finally had their first one-day pop-up testing centre on Sept. 15. “The line-up was huge. But we need more of them to deal with the many cases in the community,” he says. “Right now, if people need tests or have symptoms, they have to travel to get tested.” (Ontario Health says additional testing access in specific neighbourhoods will be available in coming the weeks, including in York South–Weston.)

In the meantime, the community is rallying to support its members, from checking in on seniors and delivering hot meals to helping at food banks.

Arts organizations are also doing their part. When COVID-19 hit, Shakespeare in Action, a culturally diverse theatre company in the Weston area, pivoted to help bring arts – which research has shown can improve life outcomes, health and safety for low-income communities – to Weston during a particularly difficult time.

“A lot of people are complaining that they can’t have their Aperol spritz on Queen West the way they used to, but for a lot of people in the Weston area, the implications of COVID-19 have been way more severe, and the downtown sector is not in touch with that,” says Matt Nethersole, the company’s community programming coordinator.

He organizes in-person events with stringent social distancing measures. “Our intention was to do everything live because internet and computer access are privileges,” he says. “People who don’t have access to these shouldn’t have to worry about not getting to participate.”

But as popular as these community events are, Hassan says they’re not enough.

“If the data shows that this is a hotspot area, then we need more testing facilities, more support, more resources and investments so that the community feels that the government is working for them, but unfortunately it hasn’t been working for them,” he says. “And this is because of systemic barriers that exist in the infrastructure that exists in the decision-making of this government.”

Faisal says in the two years since he’s been elected, he’s seen the community fight for their issues to be recognized, but they are never addressed. “And what is happening is neglect that has lasted 30 years in this community.”

And that speaks to Ontario’s, and Canada’s, systemic failures.

“There were a couple of hundred preventable deaths that we didn’t prevent because we didn’t look at Black or low-income populations, and we didn’t say that our strategies were not working for those populations,” says Kwame McKenzie, CEO of the Wellesley Institute. “So, we should have been collecting data right away, and we also should have been looking at data we already had.” One example is an Ontario report that found that during the H1N1 pandemic in Ontario, the Black population was 10 times more likely to be infected. (South Asians were six times more likely and Southeast Asians were three times more likely.)

However, McKenzie notes that data was published years after H1N1, and did nothing to create urgency in collecting data during the current pandemic. “I think it’s reasonable to say that we have a public health response that is fit for only some of the population,” he says. “Though Canada spends a lot of its time explaining how we’re so much better than America, sadly, I think, the Black population in Canada is too often an afterthought when thinking about health, and definitely an afterthought when thinking about pandemic strategy.”

McKenzie says that even with clear race-based data [in Ontario] he’s only seen Toronto – in particular Toronto Public Health – step up to create self-isolation units, meet with community members and organize mobile testing. (Quebec, for example won’t even release its data).

“I’m incredibly angry and disappointed by the lack of urgency of this. And if we are treated like this in this situation when we’ve now got the data, it makes me worry about what the kind of ‘diversity is our strength’ type of words actually mean,” he says. “There’s been systematic failure to protect the Black population, and we really need urgent action.”

In more recent years, the healthcare system has been more forthcoming about its own pitfalls when it comes to racism. Studies have shown that doctors are less likely to believe Black patients about their symptoms, and see Black patients as biologically less susceptible to pain. Triage nurses are also more likely to score Black patients lower, hiking their ER wait times up higher. During COVID-19, a number of Black people in America were denied tests, then died of the virus.

Gardam also says that people in Weston face unique barriers to accessing care. “There’s a fair number of people who may not have permanent resident status or may not be in Canada legally, who may be reluctant to go seek healthcare out of fear,” he says. “There’s also people who are working two jobs to make ends meet who don’t have time to seek healthcare. There’s not an overabundance of family doctors in that region, and it’s also more difficult to see a family doctor right now because of fears about spreading COVID-19.”

But all of that speaks to the need for creative healthcare solutions in Weston. Gardam cites Thorncliffe Park as an example of a neighbourhood that has a similar demographic makeup to Weston but that has implemented mobile testing to make it more accessible to the community. “There’s a lot of things that we can’t fix quickly, but at least access to testing is one that can make it easier,” he says.

Adapting the current pandemic strategy by consulting with the community could also save lives. “It includes sitting down with communities and understanding the things that the data can’t tell you – the pressures that people have and the choices they have to make,” McKenzie says. “And then you have to put the specialists and communities together to see how they can make this strategy work.”

For Tamara Freeman, the artists and outreach coordinator at Shakespeare in Action, Weston also needs communal support from the rest of the city.

“It’s like people either don’t know about Weston or see it as not part of Toronto. And when they do have information, it’s all negative,” she says. “And there is so much joy in this area. I love the community so much, so to feel as though [it’s] not a part of our city is very heartbreaking.”

She wants people to see the Weston she knows through the work that SIA does. “As somebody who lives in Toronto, I need to do better, and we all do. We all need to see that here in Toronto, Weston is our neighbour.”