Planning for Recovery, Part Five: ADDRESSING THE NEEDS OF THE POOR

July 17, 2020 by David Nitkin | Categories: Healthcare Series Two: Futures | Tags: class, poverty

What form does recovery take? What is the right strategy for government, companies, and our families as we begin to reopen but the virus is still on the loose? When and where do we citizens under lockdown regulation get a chance to engage in shaping societal decision choices whose efficacy is a matter of debate? This blog article is one in a series of recovery choice reviews that looks at some of the lessons learned from the first months of the COVID-19 pandemic and examines what immediate term alternatives exist about how Canada might move forward with various aspects of recovery.

The Issue

COVID-19 is not an equal opportunity scourge. Opportunistically and cruelly, it has exposed differences between rich and poor, here in Canada and internationally. It threatens to add to the number of the poor in low income, developing countries which lack the health-care infrastructure (ICU hospital beds, medicines, infectious disease specialists, physicians and nurses, and clean water) to treat the infected. Here in the west, the coronavirus preys on the weaknesses, vulnerabilities and condition of certain populations and opportunistically infected the disadvantaged (also called the poor or the vulnerable).

This blog answers three questions:

Do we have evidence about the extent to which the virus disproportionately targets the poor?
Are there remedies to better empower Canada’s poor to cope with COVID?
What recovery changes can we enact as a caring society that would protect the poor, which in the end means less to fear for and from all of us?

Who Exactly (and Why) are the Vulnerable, the Poor, and the Disadvantaged?

Health scientists believe that differences between racial and ethnic groups can result from inequities in living, working, health, and social conditions that have persisted across generations. In public-health emergencies, such as the COVID-19 pandemic, these conditions can also target and isolate people from the resources they need to prepare for and respond to outbreaks.

Our vulnerable population includes:

(a) those living in crowded conditions (high-density housing, prisons, nursing homes, homeless shelters, prisons, and multi-generational households);
(b) those working in physically crowded conditions (abattoirs, farm and agri-food production facilities, nursing homes, and hospitals)
(c) those who are more recent immigrants to this country;
(d) visible minorities like aboriginal and Metis First Nations; and
(e) people without the means and opportunity to physically distance and avoid dangerous or unnecessary contact with others.

The virus thrives in an unprotected nursing home, on a multi-generational First Nations reserve, in a boarding house filled with immigrant labourers, fruit and vegetable pickers, abattoir workers, and from there it spreads. COVID-19 is a new disease, and we are just learning more about it and how it affects people every day. Not enough hard data exists on the specific disproportionate health and financial challenges that the underprivileged face as a result of COVID’s stalking the land. Broadly speaking, there are economic, social and health dimensions to the question of virus risks:

Economic: The economic lockdown triggered by COVID-19 has led to disproportionate employment losses among lower-paid and young workers. Anti-poverty and immigrant rights workers speculate that the adverse effects include:

(a) increased risk of getting COVID or experiencing severe illness, regardless of age;
(b) higher job loss or reduced work hours since the onset of the pandemic;
(c) strongly or moderately impacted financially stress;
(d) more difficulty to apply for and receive federal income support;
(e) higher rates in disruption of scheduled non-COVID health-care services; and
(f) more incidents of food insecurity.

In Canada, some of these ideas are accurate; others [like (d)] disproven.

Social: Some members of certain visible minority, racial and ethnic minority groups are at increased risk of getting COVID-19 or experiencing severe illness, regardless of age. Sociologists and economists believe systemic social and environmental factors are at work. While everyone is at risk of getting COVID-19, some people (related to variables such as their race, immigrant status, or size of extended family) may be more likely to get COVID-19 or experience severe illness. Identifiable minorities may not receive care because of distrust of the health-care system, language barriers, or the cost of missing work.

Most visible minorities in Canada are more likely to live in poverty than the White population. Among the population aged 15 and over, the poverty rate was 9.6% among the White population in the 2016 Census. In comparison, among Korean, Arab, and West-Asian Canadians, the poverty rate ranged from 27% to 32%. Among Black and Chinese-Canadians, the poverty rate reached 20%. Filipinos were the only visible minority group that had a lower poverty rate.

Health: Two EthicScan blogs “Why are we failing health-care workers” (April 22) and “Choices to protect Canadian lives and jobs” (June 18) make the point that Canada and many other countries squashed the curve in order to avoid rationing, triage, and swamping available ICU beds. One effect was that thousands of non-COVID disease procedures were postponed. In a majority (94%) of countries surveyed, ministry of health staff were partially or fully reassigned to support COVID-19. In Canada, thousands of COVID-designated ICU beds went unused and 200,000 procedures were cancelled.

We’ve yet to recover. To date, more than half (53%) of the countries surveyed by WHO epidemiologists have partially or completely disrupted services for hypertension treatment; 49% for treatment for diabetes and diabetes-related complications; 42% for cancer treatment, and 31% for cardiovascular emergencies. Likewise, rehabilitation services have been disrupted in almost two-thirds (63%) of countries, even though rehabilitation is key to a healthy recovery following severe illness from COVID-19. Among countries reporting health-care service disruptions to WHO, globally 58% of countries are now using telemedicine (advice by telephone or online means) to replace in-person consultations; in low-income countries this figure is 42%.

Direct and Indirect Impacts of Trends in COVID-Care for the Poor

Here are some direct pandemic impact trend data noted by physicians and health scientists:

The poor report higher job loss and reduced work hours as a result of lockdowns
In Canada, essentially all federal income relief support applicants (95%) received support, regardless of race, geography or poverty level
The more recent the immigrant, the more reported economic difficulties during COVID
According to the World Health Organization, people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment (which is higher among vulnerable population) is interrupted.
In Canada, the COVID-19 pandemic generally had a stronger impact on visible minority participants’ ability to meet financial obligations or essential needs than for White participants, even after taking into account group differences in job loss, immigration status, pre-COVID employment status, education, and other demographic characteristics
In the USA, among some racial and ethnic minority groups, including non-Hispanic black persons, Hispanics and Latinos, and American Indians/Alaska Natives, evidence points to higher rates of hospitalization or death from COVID-19 than among non-Hispanic white persons. As of June 12, 2020, age-adjusted hospitalization rates are highest among non-Hispanic American Indian or Alaska Native and non-Hispanic black persons, followed by Hispanic or Latino persons
The economic impacts of the coronavirus pandemic sweeping the world could lead to 580 million people ― 8% of humanity ― being pushed into poverty. This would be an increase in global poverty for the first time since 1990.

COVID-19 has had an impact not only on those directly infected but also on society as a whole, including school closures, physical distancing, and also, for many, increased financial and food insecurity, as well as increased risks of abuse, all of which are likely to have very real impacts on adult and child mental health. COVID-19 patients who recover display high levels of Post Traumatic Stress Syndrome (PTSS) and increased levels of depression. Patients with pre-existing psychiatric disorders reported worsening of psychiatric symptoms. Higher levels of psychiatric symptoms were found among front-line health-care workers. A decrease in psychological well-being was observed in the general public.

Specific Recovery Strategies to Protect or Empower the Poor

1. Institution building: History shows that severe illness and death rates tend to be higher for racial and ethnic minority populations during public-health emergencies than for other populations. Addressing the needs of these populations in emergencies includes improving day-to-day life circumstances and harnessing the strengths of these groups. Shared faith, family, and cultural institutions are recognized, effective and common sources of mutual social support. These institutions can empower and encourage individuals and communities to take action to prevent the spread of COVID-19, care for those who become sick, and help community members cope with stress.

2. Guaranteed annual income: According to a 2019 Federal Reserve study, 40% of Americans could not come up with $400 to cover an emergency. Lacking resources to prepare and protect against the COVID-19, many such individuals face a higher risk of contracting—and subsequently spreading—the virus. As noted in EthicScan Blog, “Renewal choice-planning: economic renewal” (July 10), the virus has resulted in trillions of dollars of direct relief monies being printed by governments. The amounts are such that as notions of vulnerability change, as noted in EthicScan Blog “The D eserving Poor” (April 13) that countries like Sweden, Finland and South Korea are exploring various forms of progressive “financial safety net” programs like minimum wage, living wage, and guaranteed annual income support for citizens.

3. Digital device and high speed internet service empowerment: The EthicScan Blog, “Distance education: a huge COVID bump” (May 29) discusses the explosion in distance education, the growth of automation, and their unequal implications for employability and education among different socio-economic groups. One remedy involves giving or gifting economically disadvantaged (low income) students, parents, group-home residents, and workers access to devices, apps and digital technology products, training and services to help them overcome these remediable “techno-peasant” disadvantages.

4. Maintain the option of cash transactions: In many countries, consumers have flocked to low-contactless payment options in preference to paying by cash in order to help avoid person-to-person contact disease transmission. The use of cash is currently at risk of being phased out or restricted in certain countries, a move that disproportionately impacts on the poor who have much less access to credit. This use of cash option should be protected as a means of payment for the disadvantaged, many of whom have lower credit ratings and difficulty accessing digital financial services.

5. Basic financial services rights guarantees for all citizens: Many European countries are implementing and strengthening new requirements that financial institutions provide a mandatory set (or minimum basket) of basic necessary financial services (payments, savings, insurance and pensions) for both residents and landed immigrants. Among these “basic rights” would be access to:

(a) a basic payment account;
(b) a savings account;
(c) a safe third pillar pension product with attractive conditions;
(d) credit insurance;
(e) affordable, responsible and tailor-made, non-usury consumer credit terms for credit-worthy customers; and
(f) affordable motor, health, home and personal/ family liability insurance.

6. Implement new revenue collection treatment standards for low wage, low esteem, essential workers: Some types of work and workplace policies can put workers at increased risk of getting COVID-19. Members of some racial and ethnic minority groups are more likely to work in more hazardous, essential industries such as health care, meat-packing, grocery stores, food processing, warehousing, and transport. These workers must be at the job site despite outbreaks in their communities, and many may need to continue working in these jobs because of their immigration, language and economic circumstances—even if they feel or fear they have symptoms.

New income and revenue treatment standards could include:

(a) sick leave, because workers without paid sick leave may be more likely to keep working when they are sick and the majority of low-income jobs don’t offer paid sick days.

(b) hero pay supplements for low-income front line worker jobs—line-cooks, nurse’s aides, grocery store clerks, staple goods delivery staff, and nannies—which mostly can’t be done remotely.

(c) extended health insurance: Low-income people are disproportionately more likely to be uninsured or underinsured for medical, dental and prescription care, and for many, even stocking up the pantry can be an impossible financial hurdle.

(d) tax rules protective of underserved populations: As provincial and community health departments scramble to address COVID-19, they have shut down schools, created containment zones, and enforced quarantines—moves that often have outsized, if unintended, downstream effects on poorer people—including free and reduced school breakfasts and lunches, affordable child care when their school age kids are suddenly home all day, and extended term layoffs. Remedial, progressive, flexible deadline filing, rebate and processing rules could be introduced because many of these wage and income changes can show up in individual and business tax returns.

7. Targeting relief for Indigenous Peoples: Many First Nations communities lack access to clean water and inadequate funding for on-reserve housing has led to severe overcrowding, making social distancing difficult. In urban settings, Indigenous people are also overrepresented in populations at heightened risk of COVID-19– including populations experiencing homelessness, prison incarceration, living in poverty, high rates of TB, and discrimination in accessing health-care services. In remote Northern communities, many nursing stations are ill-equipped and understaffed. Travel to medical centers is expensive and challenging due to current travel restrictions. Current solutions could include programs like:

(a) travel subsidies;
(b) adequate necessary supplies of personal protective equipment (PPE);
(c) suicide prevention programs; and
(d) needed mental health training and counselling. This does not even begin to cover the mental health impacts these communities will face moving forward.

8. Assess the needs of visible minorities: Most visible minorities had higher poverty rates prior to the virus. The pandemic’s precise impact on visible minorities is not well studied or currently well known. Since visible minorities often have lower incomes and more precarious employment than the White population, their ability to buffer the income losses due to work interruptions is likely more limited. This needs more large scale study and, if appropriate, remedial action.

9. Recent immigrants: Recent immigrants are much more likely to be in poverty than long-term immigrants and the Canadian born.The large gaps in Canada’s poverty rates between visible minority groups and the White population reflect and are partly related to citizenship and immigration status. About one-third of Koreans, Arabs, and West Asians and one-fifth to one-quarter of Chinese, Blacks, and South Asians are recent immigrants. When group differences in immigration status, official language knowledge, education, employment status, and other demographic characteristics are taken into account, the gaps in the poverty rate between visible minorities and the White population decrease, but still remain large. Local municipality efforts addressing specific sub-groups are necessary in order to seek communal dialogue and discussion about how best to deal with these discrepancies and issues.

Conclusion

Canada’s poor are getting access to COVID emergency financial relief programs much as are the rich. The latter have more resources, language skills and experience to take advantage of economic recovery, as the economy opens. A number of renewal and mediation steps — several of which are being addressed globally — have been summarized here. Your personal and professional comments are welcome.

The Issue

Who Exactly (and Why) are the Vulnerable, the Poor, and the Disadvantaged?

Direct and Indirect Impacts of Trends in COVID-Care for the Poor

Specific Recovery Strategies to Protect or Empower the Poor

Conclusion

Further Reading