How will COVID-19 change us as a global society? Will equity lose ground?

“Cockroach infestations, residents left to wallow in soiled diapers, COVID-19 patients allowed to wander around, forceful feeding of the elderly and a ‘culture of fear to use supplies because those cost money.’” This horrific vision, published in the Toronto Star (May 20, 2020), described what the Canadian Armed Forces encountered at five Ontario nursing homes.

Most Canadians were astounded by this, but not Faculty of Health Professor Tamara Daly. She’s been studying long-term care (LTC) for 20 years.

“These revelations were shocking, but not a surprise. This has been happening for years, and this information is readily available in critical incident reports publicly posted on government websites. The COVID-19 pandemic has exposed the fault lines in this system," she says.

Tamara Daly on making long-term care a priority

Daly, also director of York’s Centre for Aging Research and Education, notes that the challenges in LTC are linked to society’s failure to appreciate women’s work and the aging population.

“We undervalue what we consider to be women’s work and we undervalue older people. Most personal care workers (PSWs) are women. PSWs are not well paid, have few benefits and their work is often temporary.

“We do see exceptions. In Nordic countries, there are better workplace protections and working conditions. Long-term care facilities aren’t understaffed in the same way they are in Ontario.”

She points to an aphorism in the LTC field: “Good working conditions create good caring conditions.”

“Combine the poor working conditions LTC workers have with our ageist assumptions about older people and what they deserve at the end of their lives... When you put those two factors together, we tend to forget LTC. But as people continue to live longer, most of us will face the challenge of living in an LTC setting. We must make improved care and working conditions in LTC a priority.”

Kelly Pike on how COVID-19 affects the supply chain

Professor Kelly Pike (Faculty of Liberal Arts & Professional Studies) considers COVID-19-based equity issues in a different way. Her research focuses on garment workers in sub-Saharan Africa, specifically those in Lesotho, a small, landlocked kingdom encircled by South Africa. It’s a poor nation that relies heavily on the garment industry, the largest private employer. This industry fits into the global supply chain by securing the raw materials, such as buttons and zippers, from other countries; then its factory workers assemble jeans, t-shirts and underwear for external markets including the United States.

The corporations purchasing the garments are supposed to send auditors to the Lesotho plants to ensure that health and safety conditions for the workers are upheld. But historically this has been met with non-compliance by garment factory owners.

The situation improved in 2010-11, when the International Labour Organization launched the Better Work program to encourage buyers, suppliers, union and government to improve compliance. But the 2016 withdrawal of the program undid some progress. Pike worries that COVID-19 could further exacerbate the issue for workers.

“With global supply chains, the impact of the pandemic is affecting everyone, even the big clothing companies. Sourcing is a problem. Lesotho sources raw materials from China and, with COVID-19, it can’t get raw materials. In turn, retail stores aren’t selling because they’re not getting new product and consumers aren’t buying because they’re losing jobs.”

Pike emphasizes that the impact of COVID-19 is most painfully felt in a developing country like Lesotho, and in a certain segment of the population: women, who represent the majority of the labour force. “Before the pandemic, there were existing problems, like high unemployment, poverty, health issues and lack of work alternatives. As COVID-19 paralyzes the supply chain, workers in Lesotho, primarily women, are losing their jobs and may be forced to turn to more dangerous forms of work, like selling their bodies.”

Nazilla Khanlou on how COVID-19 has created a “syndemic”

With millions out of work or locked down in their homes to halt the spread of the virus, other issues are exacerbated. One of them, notes Professor Nazilla Khanlou (Faculty of Health), is gender-based violence (GBV).

“Early in the pandemic, reports came out about how violence against women had increased due to lockdown measures. Families were spending more time together, but it was also creating a situation where victims of abuse were not able to access services they needed, like shelters,” she explains. “The nature of this pandemic has increased the risk of violence for those women who are in difficult situations to begin with, and created new settings where they may be more at risk of violence.”

Khanlou, who holds the Women’s Health Research Chair in Mental Health, points to an emerging “syndemic” – the combination of COVID-19 with two other pandemics – that of racism and GBV. Together, they form what she identifies as the 2020 Syndemic of COVID-19, GBV and racism. She notes that “gendered health disparities pathways result in synergistic health disadvantage for certain segments of the population, including racialized women at risk of gender-based violence during COVID-19 pandemic’s response and recovery phases.”

Through their recent knowledge synthesis project, funded by the Canadian Institutes of Health Research, Khanlou and her team are producing knowledge outputs to help inform mental health support for racialized women at risk of GBV. One example is their publicly accessible Information Sheet that addresses risk factors and systemic challenges, and offers suggestions for service providers. It was co-written with academic and community partners on the project.

Roojin Habibi on the value of solidarity

What can governments do to address COVID-19 and inequity? The big problem, says Osgoode Hall Law School PhD student Roojin Habibi, is that when faced with a crisis, governments tend to lose sight of global solidarity.

“There’s a certain wisdom we often repeat in global health – that the world is only as healthy as its weakest health system,” says Habibi, a research Fellow in Global Health Law at York’s Global Strategy Lab.

“Rattled by SARS in 2007, the World Health Organization (WHO) revised the International Health Regulations, an international legal agreement that governs how countries cooperate and coordinate to mount an effective global response to diseases that spread internationally. Despite high hopes to do better post-SARS, it’s alarming how in this COVID-19 crisis, knee-jerk reactions kick in and promises that were agreed to in the Regulations are suddenly ‘nice to do, but we’ll focus on our own country for now – or indefinitely.’”

Habibi, also a consultant to the Joint United Nations Program on HIV/AIDs, believes there’s no more stinging example of a country rebuking solidarity with others than when the President of the United States (U.S.) announced U.S. withdrawal from the WHO. “The fact that a state could contemplate this course of action amid an unprecedented pandemic was shocking.”

She’s also concerned about global cohesion when a vaccine is ready. “We need a vaccine that everyone in the world will be able to access. To truly overcome this pandemic, we need everyone, everywhere, to be protected. But as individual countries start cutting deals behind closed doors with specific private manufacturers, we drift further from that ideal.”

Can positive next steps be taken to lessen these inequities?

Daly calls for more oversight: “Public accountability and transparency are critical in long-term care. We need more eyes on this, so that advocacy organizations and researchers can examine data and see when things are wrong.”

Pike believes it’s time to stand up: “The world’s now realizing how important the supply chain is. Everyone along the supply chain is affected negatively, but the people at the bottom are affected a thousand-fold. Now’s the time for buyers to stand up, pay up and help these people who may die if they don’t have better conditions.”

Khanlou calls for improved and more universal access to mental health resources: “The pandemic has shown us how important it is to have a robust public health system. We need to expand that to a public mental health system, where access to a range of mental health promotion programs, and to mental illness and addictions prevention and rehabilitation services, are available universally to all Canadians.”

Habibi advocates learning from the best policy responses: “There will be other pandemics, so scholars and governments need to publish our collective thinking and make it available. There’s a proliferation of databases coming out now synthesizing the effectiveness of COVID-19 laws and policies. With this information in hand, we will be able to compare countries’ responses to the pandemic and find out which policies were the most successful at improving people’s well-being.”