Reflections on public health & health equity during COVID-19

Sitting at my desk in my apartment in Toronto, I can recall hearing mentions of the newly identified coronavirus in the beginning days of 2020. Like any other keen student passionate about population health and health equity, I follow a number of public health professionals and news outlets on social media and COVID-19 quickly began to dominate more and more of my social media timeline. Perhaps naïve, it felt almost impossible to imagine the level of worry, disruption, and death that would be caused by this virus at that time.

As news came about the severe interruptions, high incidence of illness and deaths caused by COVID-19 in China, Iran and Italy; my winter academic semester began as normal despite the growing rates of infection and control measures governments around the world were beginning to implement.

 In late January 2020, I watched the weekend press conference where provincial health officials announced that the first person with COVID-19 had been identified in Canada. Among other speakers,  Dr. Eileen de Villa, the Medical Officer of Health for the City of Toronto, assured Toronto residents that public health officials were doing everything possible to control the risk of infection. It had been just a few months earlier, in September, when I was sitting in a packed lecture hall during my Master of Public Health orientation with Dr. de Villa welcoming all of us in the incoming MPH cohort to a career in public health.

In her address, Dr. de Villa spoke about the public health response during the 2003 SARS epidemic in Toronto – the last time, she said, that public health officials had regularly been in the media spotlight. Emergencies, such as outbreaks and pandemics, make visible the critical role that public health plays within our communities. It is this “prevention paradox” – the false understanding that prevention efforts have little impact because effective implementation results in a non-event – that limits the visibility and therefore appreciation of public health as a critical public good. Writing in May 2020, I had no idea just how clear that paradox would become to me as public health faced critical funding cuts just ahead of a major global public health emergency.

Dr. de Villa cautioned us that the public often prefers to forget about the role of public health until it is needed, at which point the best defences of prevention are unavailable. I am concerned that too often it is more convenient to respond to crises than to prevent their occurrences. 

I did not imagine that only a few months later, I would witness and monitor the rolling out of extreme public health policies and emergency measures, like the Canadian Emergency Response Benefit (CERB), in the midst of a global medical and public health emergency. This moment is unprecedented, as a student struggling to navigate a graduate degree in the midst of changing circumstances, and as an individual committed to health equity and healthy public policy. I am witnessing the ways by which public health professionals are relied upon to solve the ongoing and systemic disparities that have existed for generations within our societies now torn open by this pandemic.

As a community organizer and a public health student, I know that I will not be able to ‘fix’ anything by myself. I don’t want to. My role is to listen to communities and do what I can to support them in bringing their needs forward. We need healthy public policies that are rooted in the principles of social, environmental, and economic justice. Community groups have been advocating for decades for policies such as: livable wage, safe housing, status for all, paid sick days, an end to militarized policing, a safe drug supply, mental health programs that do not involve criminalization. These are only a few of the many brilliant policy changes being advocated for by communities directly.  Public health professionals’ role seems clear – to actively listen to communities and ask “how can I help?”, while coordinating with various sectors to bring about this change. 

This pandemic is not the only emergency currently unfolding across the Canadian public health landscape. The COVID-19 pandemic is taking place in the midst of an ongoing opioid crisis fueled by a tainted supply of drugs, a homeless epidemic across multiple Canadian cities including Toronto and Vancouver, and a lack of adequate action and policies to address healthcare access and funding for Indigenous communities, including the high number of water advisories for First Nation communities despite promises by the federal government to address them. Many of these emergencies are well documented and yet, the existing public health responses to the COVID-19 pandemic may serve to exacerbate many of them through responses such as the criminalization of homeless people avoiding densely-populated shelters at this time, and closures of food banks and supervised consumption sites during the pandemic.

Many of us may be navigating challenging circumstances and working from home, but the extent to which we are able to remain flexible and adapt to changing circumstances will, in many ways, be dictated by our privilege and access to resources.

The instinct to self-isolate and look out for oneself is understandable and sometimes appropriate but public health policy responses must centre on the needs of those made most vulnerable as a result of ongoing health disparities. 

In a world where COVID-19 is not expected to go away, we need to innovate public policies that listen to community leaders and advocates and implement upstream solutions to addressing the existing and deepening health disparities created by systemic discrimination.


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