How to support systemic change for an equitable recovery

Across Ontario over the last ten months, we’ve seen how vital community-based responses are for ensuring people can stay safe and healthy during the pandemic. We’ve seen neighbours checking in on each other, people volunteering to deliver food and other essentials, and service providers supporting isolated and vulnerable people. We’ve also seen innovation, including technology used in new ways to ensure people can stay connected and get services and support virtually.

At the same time, the pandemic has exposed and amplified the gaps and inequities across the province, resulting in disproportionately higher infection rates in communities that are predominantly Black, racialized, and people living on low incomes. It’s also meant increased risks for Indigenous people, both those living in remote or rural communities, and urban Indigenous populations, as well as people, especially seniors, isolated by COVID-19 public health measures that cannot be avoided. But these inequities aren’t COVID-19-specific problems; these are long-standing health disparities rooted in racism, poverty, and barriers to access that we can no longer ignore.

Addressing COVID-19 requires doing things differently. Community-based organizations across the province are leading the innovation we need. What enables this local leadership are partnerships, relationships, and, most importantly, trust cultivated and built over time.

We’ve seen community members, volunteers, staff at community health centres, and local community agencies step up to deliver tailored and targeted responses to the pandemic, including COVID-19 testing, outreach, and addressing isolation; these community level interventions are making sure that those who are most marginalized in Ontario have access to what they need to stay healthy and safe.

As the Chief Public Health Officer of Canada pointed to in her annual report that focused on health equity and building community resilience, we need to address long-standing systemic barriers.

Here are five areas where we think systemic change is long overdue:

1. Make community-based comprehensive primary health care more accessible to the people who need it most

We need government leaders at all levels to look to communities for innovation in reaching people with essential health and wellbeing resources, and support agencies at the local level that make it happen. Across Ontario, Community Health Centres, Aboriginal Health Access Centres, Community Family Health Teams, and Nurse Practitioner-Led Clinics are leading the way on community testing, tracing cases, and ensuring local supports for food and housing are available to the people most at risk. This leadership is guided by the Model of Health and Wellbeing. For Indigenous-led organizations, it is guided by the members of the Indigenous Primary Health Care Council and the Model of Wholistic Health and Wellbeing.

But this work should not and cannot be left to community agencies to support on their own: it needs to be supported by all levels of government. By laying a strong foundation for a community-governed and community-driven health and wellbeing strategy, governments of all stripes can ensure every community has a strong backbone of local support for people who face health inequities.

2. Scale up and co-design community-led interventions to reach people with public health messages

One size does not fit all when it comes to responding to a deadly pandemic. Whether it’s to communicate about a COVID-19 vaccine, or to increase access to mental health supports, chronic disease management, or other preventative health care, top-down messages are neither equitable nor effective. We need systems-level approaches that will support scaling up community-led interventions to disrupt diseases and social inequities like racism, poverty, and homelessness.

The only way to do this effectively is by listening to what works locally, and working directly with people to support their designs and ideas for supporting community members’ health and wellbeing. The most effective messages and interventions will be the ones rooted in trusted relationships, and that means systems and Ministry-level planners must find ways to leverage the local.

3. Address housing as a primary determinant of health

Access to safe and affordable housing is a core determinant of who is getting sick during COVID-19 and who isn’t. Simply put, many people do not have access to a place where they can isolate, work or attend school, or access virtual services. A house with a yard and access to high speed internet is not the same as a one-bedroom apartment with multiple families living in it.

We must shift away from the endless dead-end loops of tax credits for home buyers, piecemeal funding for developers and municipalities, and the incomplete fixes of shelters, hotels, and other forms of temporary housing.

In November, Alliance for Healthier Communities members voted unanimously to support a resolution calling for the full adoption of Housing as a Human Right in Canada, as supported by federal legislation (National Housing Strategy Act, 2019), and international human rights law (Universal Declaration of Human Rights, 1948).

While these ideas aren’t new, our approach to them must be. We need governments to implement national, provincial, and local strategies for affordable rent-geared-to-income housing that address the unique needs of various geographic communities in urban, rural, remote and Northern areas, and put the needs of people and communities’ health ahead of developers’ priorities and shareholders.

4. Root decision-making in well-collected local data

Pandemic data have made it clear that people facing barriers due to systemic racism, poverty, language, and isolation have fared worse than others. We’ve seen the population data on where COVID-19 hotspots are, and we know they align with higher concentrations of racialized people and people experiencing poverty. This has led to strong, broad support for collecting (and transparently sharing) race-based and sociodemographic data to better understand what’s happening in communities, and where disparities are.

But these data also have to be a call to action to allocate more resources in the areas with increased needs and where a lot of local work had to be done (and is still being done) without coordination or additional resources or funding.

We know that things won’t magically improve in these areas once the pandemic ends – that’s why we need a strategy to address health equity at the community level that is driven by data. It’s a strategy that’s overdue across Ontario, since we know health inequities exist in every region and community of our province.

We need to learn as much as we can about these gaps to better understand how to close them. Collection of race-based and socio-demographic data in health and social services should be mandatory, so that decision-makers have the information they need about disparities to take action.

5. Create opportunities for the real representation of community voices, knowledge, and experience

Our final idea for creating more systemic change could have easily been the first one on this list. Local voices representing communities at key tables, now and in recovery, are essential to scale up community-led interventions.

Ontario needs to listen deeply to racialized people, to people living on low incomes, to isolated seniors, to newcomers, to LGBTQ+ populations, and other marginalized populations. We also need to create new ways for people to meaningfully co-design and partner in interventions to improve community health and wellbeing in ways that make sense locally.

Communities are on the frontlines of interventions that work to address high chronic disease rates, food deserts and insecurity, and homelessness. Creating and promoting space for marginalized voices and leaders to scale up these interventions and shape new systems needs to be on the agendas of leaders in health and social services at all levels of government. Community needs seats at existing tables, and tables of its own, to ensure ideas are being understood and shared up.

We’ve seen in the last few months the importance of listening to community, the positive results that can come from it, and the difficulty, pain, and tragedy that result when community voices go unheard.

The pandemic and our collective response to it marks a unique and precious opportunity to create a new, more equitable normal, instead of going back to the old normal that was making so many people sick, leaving so many without the support they need, leaving so many out in the cold.

We must learn from the actions communities are taking to address health disparities, now. We must break away from systems and policies rooted in systemic racism and colonialism. We must build a healthier, more resilient society.

To do this, we need to commit to change for marginalized people in the province. Because only by addressing health inequities and barriers faced by some people can we create a more inclusive, equitable, and just Ontario for all.