Looking at the demographic data for the neighbourhoods of Humbermede, Black Creek, Glenfield-Jane Heights, Downsview-Roding-CFB, and York University Heights provides a useful lens into the dynamics of the area. Before contemplating the results of the COVID-19 case rates or Toronto’s budgeting activities, the data from the latest 2016 Canadian Census paints a picture of a cluster of neighbourhoods in Toronto’s northwest that live below the median income for Canada’s largest city, are predominately made up of visible minorities, and are more likely to live in unsuitable housing and with larger household sizes compared to the city’s average. From our analysis of historic trends in public health and the information we know about social determinants of health, we find that the neighbourhoods in northwest Toronto are home to a population that is vulnerable to significant disruption from any number of potential crises, let alone a global pandemic.
Looking first at housing data, the average household size for all five neighbourhoods was greater than the city’s average. Additionally, all five neighbourhoods had a higher percentage of multiple families living within one household, ranging from 4% to 7%, compared to the city’s average of 3% (Statistics Canada, 2016). These larger-than-average household sizes, as well as the greater likelihood of multi-family or multigenerational households, leads one to infer that the residents in these northwest neighbourhoods are more likely to live in crowded settings. Given that all five neighbourhoods have a higher percentage of residents living in unsuitable or inadequate housing compared to the city’s average, it is reasonable to conclude that housing may be a critical factor in the spread of the infectious respiratory disease of COVID-19. The blanket mandate and public health precaution prescribed to everyone during the pandemic was to stay home, avoid crowds, and social distance from others. This prescription becomes increasingly difficult to adhere to when one’s home is crowded, unsuitable, or inadequate. Although the funding for the Shelter, Support & Housing Administration had steadily been increasing year over year between 2016 and 2020, there was an accelerated spike of 53% between 2020 and 2021. There are myriad reasons why this may have increased; however, Toronto has seen average rent costs increase every year since at least 2012 (which is the furthest back the data goes on the city’s website) (City of Toronto, 2021b). This increase in rental costs and the unaffordability of home ownership in the city pushes more and more people to find cheaper housing outside of the desirable downtown core and into the outskirts of the city. This could explain why new Canadians and low-income households settle in the northwest neighbourhoods of Toronto where housing is more affordable compared to the condos that dominate downtown. Rental costs for condo units which are common to downtown Toronto are considerably higher than the average rent for all rental apartments in the city. For example, the average rental cost of a two bedroom condo unit in 2020 was $2,440 versus $1,635 for an average apartment rental (Canada Mortgage and Housing Corporation, 2021). As Toronto’s housing market is characterized by a supply which generally fails to keep pace with demand, low-income populations will likely continue to settle in outlying areas of the city that unfortunately have a higher-than-average percentage of unsuitable and inadequate housing.
The dispersal of general healthcare services across the city of Toronto are geographically uneven and it is unclear to us how the locations of healthcare services are determined. However, despite the greater COVID-19 case numbers in the northwest region of Toronto, there are only two COVID-19 assessment centres within the northwest corner of the city, and only one within the borders of the five neighbourhoods discussed here. In comparison, there are four COVID-19 assessment centres within the city’s downtown core, all within walking distance (<3km) of each other (Infectious Disease Working Group, 2020). It is notable that each of these COVID-19 assessment centres is within a major Toronto hospital. Hospitals, of course, require substantial investment and planning. However, mobile testing centres can be procured relatively quickly and dispatched to the areas that require testing services the most. According to reporting in the Toronto Star in late June 2020, months after the initial cases of COVID-19 were detected in the city, mobile testing centres had yet to materialize in the city’s northwest neighbourhoods, despite public awareness that this corner of the city was hard hit by the virus (Yang et al., 2020). This delay may be a matter of resources and the nature of bureaucracy, issues perhaps city officials attempted to rectify in proposing their 2021 budget. COVID-19 is still very much a material issue in 2021 and Toronto Public Health will require a boost in resources to help steer the city towards recovery. However, after seeing the stratification of healthcare services across neighbourhoods, one issue that Toronto Public Health will need to address in planning for the future is how best to dispatch preventative care so that resiliency is built into neighbourhoods at greatest risk of disease.
Median household incomes across the five neighbourhoods are all lower than the median Toronto household income. Poverty and low-income proportions across four of the five studied neighbourhoods are also higher than city average. These metrics suggest a trend of lower earning potential and economic opportunities in the area. As income is one of the fundamental drivers of disease (Link & Phalen, 1995), this difference in income levels across the area compared to the rest of the city could contribute to COVID-19 propensity in the area. Toronto Public Health’s data on income groups and COVID-19 case rates revealed a clear division between the wealthiest Torontonians and the lower-income households in Toronto. The COVID-19 rate was disproportionate among households that earned less than $69,999 (Toronto Public Health, 2021). This data combined with the COVID-19 case rate map as well as the census data for the northwest neighbourhoods all tell the same story.
It is challenging to determine exactly what types of jobs residents in Toronto’s northwest hold and how that may impact their exposure to the SARS CoV-2 virus. However, it may be reasonable to assume that lower-income households are less likely to enjoy the option of working from home, and instead are required to be physically present at their place of work, as is the case with grocery store staff, long-term care providers, and personal support workers. Working from home, much like social distancing, is a public health guideline that is prescribed to the public—as long as it is feasible for one’s job. As essential workers leave the house, they increase potential touch points of COVID-19 exposure. This exposure accelerates if the job requires a commute, and the individual does not own a personal vehicle and must take public transit. The movement of individuals between work and home is one of the likely modes of transmission of COVID-19, despite the government-mandated lockdown of non-essential services (Shaw et al., 2021).
Public health experts have long recommended that individuals sick with an infectious disease should stay home to reduce the spread of the infection. However, with rising economic inequality and 27% of all 193 UN member states not providing guaranteed paid sick leave from the first day of illness (Heymann et al., 2020), it is difficult to choose between preventing further disease spread and making ends meet. Without a guaranteed paid sick leave policy, workers—especially those working in low-wage labour markets and part-time or self-employed/gig economy workers, are less likely to take time off compared to those with stable employment (DeRigne, Stoddard-Dare, & Quinn, 2016). In Ontario, there is no provincially mandated paid sick leave (Government of Ontario, 2021). The province mandates employers provide employees with three days of unpaid sick leave; however, this trade-off places the burden on an individual to decide if the opportunity cost of lost wages is less than the cost of contracting an infectious disease. The federal government of Canada passed the Canada Recovery Sickness Benefit (CRSB) and the Canada Recovery Caregiving Benefit (CRCB) at the end of September 2020 (CBC News, 2020). These benefits extended a national paid sick leave benefit to all working Canadians that may contract COVID-19 or those who must care for others, such as young children, and thus cannot work. Although these benefits are welcomed, they only provide $500 (before tax) per week and do not replace full wages. They also require individuals to reapply every week they require the assistance, up to a total of four weeks (Government of Canada, 2021).
The CRSB is likely to be effective in helping to mitigate the spread of COVID-19. However, the CRSB should be implemented in concert with several other government interventions that incentivize Canadians to stay home, such as expanded employment insurance and a reconsideration of a Canada Emergency Response Benefit (CERB) extension. It is critical that the conversation regarding the necessity of paid sick leave continues and should lead to greater scrutiny of economic inequality. In the long term, paid sick leave should be paired with genuine policy considerations for basic income, targeted minimum wage standards, and a general economic analysis on the rising cost of living. The COVID-19 pandemic will eventually begin to dissipate, but the socioeconomic inequalities that were exposed during this time of crisis will remain. Considering that the demographics that are most likely to not have access to paid sick leave intersect with the demographics that are more likely to work in low-wage jobs in hospitality, retail, and healthcare, that are now widely celebrated as “essential work,” it is integral for the sustainability of our social and economic systems that these workers receive the support they need.
Despite the high percentage of individuals living in poverty or designated as low-income in Toronto’s northwest, the city budget has consecutively decreased funding to the Toronto Employment & Social Services (TESS) since at least 2016. TESS is focused on providing employment services, financial assistance, and social supports to Toronto residents with the goal of strengthening socioeconomic wellbeing in communities (City of Toronto, 2020). Although Toronto’s employment and social services is touted as the third largest social assistance delivery system in Canada, it is notable that the SSHS budget is nearly ten times that of TESS. This begs the question if Toronto is truly targeting the root causes of inequality. Funding to provide socioeconomic wellbeing and opportunity has the potential to assist individuals seeking access to adequate housing. Toronto certainly must address the immediate needs of its unhoused population; however, this should not come at the (albeit, likely indirect) expense of services that have the potential to create a multiplying effect through economic opportunity.
Systemic racism is the perpetuation of discrimination through a confluence of intersecting systems of housing, education, income, credit, media, the criminal justice system, among many others (Bailey et al., 2017). Although this form of discrimination is often not explicitly racist, the impact of marginalization through the tools of the system often falls upon the shoulders of people of colour. Nevertheless, marginalized populations are made vulnerable through systemic actions, placing social mobility beyond their reach. Although the COVID-19 virus does not distinguish or discriminate against borders, races, or classes, it does, however, infect those that are most susceptible to exposure. Housing costs are an important factor in deciding where to live. These costs are paramount to an individual or family that has recently migrated to Toronto. As seen through the census data, the proportion of immigrants and visible minorities in all five northwest neighbourhoods is greater than the city’s average. When you break down the neighbourhoods’ population based on residents’ native language, the languages (excluding English) that are predominant in these neighbourhoods are: Vietnamese, Italian, Spanish, Tagalog, Urdu, and Assyrian Neo-Aramaic (Statistics Canada, 2016). Using language as an indicator of diversity within the neighbourhoods and then comparing them to the disproportionate rates of COVID-19 among Arab, Middle Eastern, or West Asian; Latin American; South Asian; and Southeast Asian, the connections between systemic racism and health inequities become clear. Language barriers are often an obstacle between individuals and the healthcare system. The high percentage of immigrants in Toronto’s northwest neighbourhoods should signal to Toronto Public Health the need to strengthen their communications with these neighbourhoods through a variety of multi-language tools.
Across all five neighbourhoods, the highest represented group among visible minorities is the Black population. For example, in the neighbourhood of Black Creek, the neighbourhood with the highest visible minority population at 81%, 29% of the total population are Black. Black Creek also has the highest percentage of renters across the five neighbourhoods and the highest percentage of unsuitable and inadequate housing. Black Creek also has the lowest median income—across all modes of measurement—among the five neighbourhoods. Black Creek also has the highest percentage of residents that fall below the poverty line, have low-incomes, and receive transfer payments from the government. Black Creek has three healthcare services within its borders, but none of them are walk-in clinics—they are all related to community or social services that also provide healthcare services. Black Creek is an example of a neighbourhood that may not always be explicitly discriminated against by the city or the systems that operate within and beyond the city, yet still sees its residents marginalized via the absence of opportunity for social mobility—and thus, social resiliency.
In addition to the implicit perpetuation of systemic racism, the Ontario Human Rights Commission released a report in August 2020 indicating that there is systemic racism in Toronto policing. It should be noted that among the pervasive cases of racial profiling in the report, 32.2% of cases involving a police firearm involve a Black individual (Wortley, 2020). One particular material case that the City of Toronto should immediately advocate for, considering the overwhelming evidence of gun violence, neighbourhood data, and suggested interventions, is the recently abandoned plan by Metrolinx to build a community hub for youth in the Jane and Finch neighbourhood (Westoll, 2020). Although Metrolinx has scrapped their plan to donate the land to the community, worth millions of dollars, the Ontario government and Toronto City Council should consider redirecting their $4.5M of increased police spending to curb gun violence (CBC News, 2019) and put it towards securing the land for construction of the community hub, and direct the operations of the facility to non-profit community organizations. A community hub at the centre of Jane and Finch has the potential to bring people together, dissolve conflict between groups, and provide a central location to distribute educational tools and opportunities for youth in the area to thrive and flourish.
The city of Toronto has increased the Social Development, Finance & Administration budget year over year, a department that is focused on cultivating inclusive and safe communities. In the 2019 budget, the department established the Confronting Anti-Black Racism Unit with a budget of $1.2M (City of Toronto, 2020). The action plan developed by the unit prioritizes culture change within the city, community capacity building, community safety, wellbeing, and alternatives to policing, as well as Black community resiliency (City of Toronto, 2021). This represents a promising start to addressing systemic racism within the city’s operations. Should the city of Toronto seek to engage in meaningful action, this program, along with any other program, existing or proposed, that is working to dismantle white supremacy and provide opportunities for disadvantaged and disenfranchised communities, should be prioritized in the budget.
There are a number of limitations to the present study, foremost of which is the lack of complete data. Demographic data used in this study is five years old and does not perfectly capture the current environment in which the COVID-19 pandemic continues to transpire. Additionally, the rapid rate in which the COVID-19 pandemic has entered and spread throughout the city (and of course, the world) means that data, inevitably, is incomplete and lagging. The case numbers are based on the information and testing that Toronto Public Health make available. However, it is likely that many cases from early in the pandemic were not captured. And as mentioned previously, it is likely that distrust of the healthcare sector could lead to under-reporting of marginalized communities. The greatest limitation to a study such as this one is that it is difficult to isolate causation. There is no concrete way to test variables in a vacuum and declare that one or all social factors is the cause of increased infectious disease transmission. However, we believe that these data and our findings are beneficial to the task of formulating policies intended to reduce public health inequality and build resilience in the system.