Any post-pandemic recovery plan must include society’s most vulnerable

Investments that improve economic and social conditions will help us prepare for future crises — so let’s make sure public-health evidence drives our recovery.

We are starting to see the curve flatten in parts of Canada. Our efforts against COVID-19 are working.

But now we must brace ourselves for the challenges ahead.

The effectiveness of Canada’s response to COVID-19 has been shaped by public-health research, evidence, and leadership. As we start to turn our attention from crisis response to recovery, we cannot lose focus on what public-health guidance tells us.

This guidance goes beyond epidemiology and infectious-disease control. It goes to the heart of what makes a strong and healthy society — what public-health experts call the social determinants of health.

Decades of public-health research confirm what common sense tells us: that good health is greatly influenced by economic and social conditions. What kind of money is the family earning? Can they afford to feed themselves and keep a decent roof over their head? Do the kids have access to a strong public-education system? Are they experiencing chronic stress from trying to make ends meet?

Before the COVID-19 pandemic, we were already experiencing a public-health crisis, but it was silent and invisible to most of us. More than 235,000 Canadians were homeless, 3.2 million were living in poverty, and 4.4 million were suffering from food insecurity. People living in poverty are much more likely to experience poor health outcomes and face an increased risk of hospitalization and even premature death.

Take Ontario, for example. Before the pandemic, among people with the highest incomes, 12 per cent reported multiple chronic conditions. For those with the lowest income, this rate doubles. People living in the poorest neighbourhoods face a hospitalization rate 2.5 times higher than those living in the richest neighbourhoods for conditions that could be managed outside the hospital.

These health inequalities are even more pronounced for women and non-binary people; Black, Indigenous and racialized communities; people with disabilities; members of 2SLGTBQ+ communities; and many more equity-seeking communities.

The pandemic has exposed that we are only as strong as our most vulnerable. Unless we contain (and prevent) outbreaks of the virus in homeless shelters, long-term-care homes, and overcrowded housing, we will all continue to be at risk of infection. Everyone’s health and well-being is interdependent.

So where does this leave us?

Although there have been significant government efforts to protect the most vulnerable during the pandemic, we have to ensure that these responses are not short-lived.

Public-health research demonstrates that, if income-support programs aren’t robust enough, they do little to support the health outcomes of people living in poverty. At the same time, Canadian research also shows that even a small increase in social spending, relative to health-care spending, decreases potentially avoidable deaths and increases life expectancy.

An investment in the social determinants of health is an investment in resiliency that will help prepare us for future public-health crises. Affordable housing. Decent work. Adequate income. Food security. Protections against gender-based violence. Initiatives that counter discrimination in all its forms.

Without these investments, we will return to a normal that sees people living on the streets, skipping meals because they cannot afford food, and working multiple minimum-wage jobs to barely make ends meet. This would be a public-health crisis just as much as a crisis of conscience.

It took a microscopic virus to show us that chronic under-investments in public services are making people sick. We need to make different policy decisions if we are going to come out of the pandemic stronger.

We need our governments, civil society, and industry leaders to focus on a recovery rooted in the full range of what public-health research has to tell us. This includes not only epidemiological models and economic forecasts, but also the social determinants of health.

And the evidence is clear. Investments that improve economic and social conditions prevent disease and improve health outcomes.

Canadians have stepped up and demonstrated immense leadership in everything from doing our part to stay home as much as possible to implementing large-scale, rapid policy changes. It is this exact same leadership we need to forge a new path forward.

We’ve looked to public health to keep us safe during this pandemic. Now let’s look to public health for our roadmap to recovery.

Originally published as an op-ed on TVO.