From the start of the pandemic, the Canadian prime minister Justin Trudeau has urged his citizens to join together in solidarity. “We are all in this together and we are there for you,” Trudeau said on March 18, 2020. But as the pandemic wages on, it has become clear that while we may all be in this together, we are not all in this equally. Emerging statistics on COVID-19 transmission, infection, and death rates have shown that individuals from low-income communities are at a higher risk of both catching the disease and developing fatal complications. This is not only a question of how the virus has disproportionately affected these communities, but it also reveals failings of the Canadian healthcare system to equitably provide for all.
From the first wave of the pandemic, individuals living in Canada’s lowest income neighbourhoods have accounted for 2 times the share of visits to the emergency room, 2.5 times the hospitalizations and 2.9 times more deaths in the hospital due to COVID-19 complications. We can point to many different factors that could be influencing the relationship between COVID-19 related deaths and income including crowded housing, lack of proper nutrition, employment in essential services, inability to take time off work, and lack of social support. The problem is not rooted simply in these individual sets of circumstances, but in structural inequalities in the Canadian health care system.
Income related disparities have existed in Canada’s health care system since before the pandemic struck, but any pre-existing inequalities have only been exacerbated by COVID-19, which put an incredible strain on the system. A recent study by the Commonwealth Fund comparing the healthcare systems of eleven high-income countries ranked Canada’s system 10th overall. Canada ranked second-to last in terms of economic equality in healthcare access. According to the study, one of the main causes of this inequality is the lack of spending on social programs related to health care services.
While socialized healthcare is meant to provide equal medical services to all, people living in low-income neighbourhoods have reported less contact with doctors than those living in wealthier areas as well as lengthier wait times for healthcare services. Other financial barriers can get in the way of necessary treatment, such as lack of transportation, lack of internet access— which has become necessary to book appointments in some cases — and inability to afford childcare. This is all without mentioning wait times for specialized treatment that are extended, or lack of coverage for extra costs associated with these treatments.
Canada’s wealth gap has been growing since the 90s, with the health gap growing steadily along with it. This is apparent when analyzing various health indicators that demonstrate significant inequalities across economic groups. For example, conditions like COPD and poor mental health have continued to worsen for low-income groups while remaining stable or improving for high-income groups.
While there is not currently a concrete answer as to how we can close the health gap, looking to countries that have successfully created equitable healthcare systems can point us in the right direction to creating policy that will produce positive change. For example, Australia was rated first out of the eleven countries compared in the Commonwealth Fund study on the equity scale.
We can look to Australia’s successes to draw inspiration for how to improve Canada’s health care system. Australia’s medicare system provides free or affordable access to most healthcare services. They also have a system in place to lower the price of medicines as well as a safety net to help individuals pay for the services that are not covered by the government.
Despite being one of the leaders in equitable health care, Australia has not been left unscathed by the COVID-19 pandemic. At the beginning of the pandemic, Australia was seen as a model for COVID-19 response. Thanks to strict lockdown and quarantine measures, the country had one of the shortest lockdowns and a relatively quick return to “normal.” However, with an outbreak of the Delta variant in June, Australia has had to reimpose health measures. Because of their success at controlling the virus at the beginning, the government took a less aggressive approach to vaccine rollout, and the country’s vaccine campaign is now lagging behind. In addition, as the government is starting to ease restrictions after an intense lockdown in an effort to prevent a second economic downturn, concerns are being raised about the risks of overwhelmed ICUs. Australians that received monetary government assistance at the beginning of the pandemic are now struggling to get by as the financial aid has trickled out.
While the economic toll of the pandemic might raise some concerns about revolutionizing our healthcare system, this is not only a question of investing more into healthcare. By contrasting our healthcare system with that of other countries, we can see that it is possible to reduce inequality without excessive spending. Rather, policy change in a variety of fields such as education, employment, housing, transportation, as well as reduced administrative burdens can help create better health outcomes without investing into the healthcare system itself. The earlier the interventions, the more health-related complications can be avoided later on, decreasing the strain on the healthcare system. These inequities relate both to material conditions as well as systems of privilege. Social factors that reinforce the wealth gap should be taken into account as they directly contribute to the problem.
By creating more partnerships between the healthcare system and other social sectors, medical services can become more widely accessible across economic groups. Creating an open dialogue about economic barriers in the healthcare system can foster a greater sense of understanding from healthcare workers as well as create engagement from community leaders and help to advocate for and implement policy change. Further research will be important in tracking the efficacy of new policies, as well as to pinpoint differences in quality of treatment so that they can be addressed when they arise.
The widening of the health gap has detrimental consequences not only for Canada’s lowest income groups but for society as a whole. There are multiple spillover effects, namely, the spread of disease. Healthcare inequalities are avoidable as well as solvable, and if Canada can work towards eliminating them, it will be to the benefit of the entire population. The disparities in the Canadian healthcare system may have been brought to light by the 2020 pandemic, but they have existed since long before then and will continue to have harmful effects on Canada’s population and economy unless political and social changes are implemented to create equitable healthcare for all.
Edited by Sofia Idris
Katie is in her first year at McGill, pursuing a double major in Psychology and Political Science. She is particularly interested in topics of feminist and environmental issues as well as sustainable development.