Letter to Premier Ford, Deputy Premier Elliott and Dr. Williams regarding the need to collect and use socio-demographic and race-based data

Dear Premier Ford, Deputy Premier Elliott and Dr Williams,

We are alarmed to hear the CMOH of Canada's most populous and diverse province say there is no need to collect data that tracks race and socio-demographic information.

During this turbulent COVID-19 pandemic, we rely on our leaders to boldly take action and put interventions in place that will limit the harms posed by the crisis. This makes the comments made by CMOH Dr. David Williams, during the April 10 COVID briefing all the more troubling.

The experiences of people and communities across the province demonstrate how unjust and untrue is the CMOH’s assertion that all people are considered “equally important”. In Ontario, key priority populations including Indigenous people, Black people, Francophone populations, 2S&LGBTQ+ communities, people living with disabilities and people who live in poverty do not have the same access as their counterparts to healthcare and resources that promote good health. Structural and systemic discrimination profoundly impact access to care. Ontario, like other provinces and territories in Canada, continues to deal with ongoing legacies of colonization, structural inequality and systemic racism. Responding to COVID-19 with the expectation that all people will experience the pandemic in the same way hurts already marginalized people and communities.

Collecting race and socio-demographic data is an essential component of the work of eliminating inequalities in healthcare. The World Health Organization says to “develop effective prevention strategies, countries need to improve their information.” We cannot address what we cannot measure. Collecting and analyzing data allows systems to measure differential experiences, account for disparities and develop evidence-based interventions. Ontario recognized the importance of data collection in 2017 when all Ministries except health were required to collect and use these data. The health sector has long called for the responsible collection and use of these data and COVID-19 highlights the urgency of this call. All sectors must be mandated to immediately collect data that will allow us to understand who this pandemic impacts and which pathways must be interrupted to stop its escalation. We will not address population health inequities and effectively contain COVID-19 without data that illuminates gaps to care in our system.

Community led primary health care organizations have long collected and used these data, safely and responsibly, to reduce disparities and improve health for people and communities facing discrimination. In the same vein, as early as 2010, organizations and institutions within the Toronto Central LHIN began collecting patient race and socio-demographic data to inform health planning. This crisis is dire. We cannot wait for our leaders and policy makers to catch up to what experts and front facing providers are already telling us. Communities across Ontario are concerned about the absence of strategic and proactive leadership in response to this crisis.

If indeed this province’s leaders say that all people are equally important they must act now to ensure that COVID-19 care is equally accessible to all groups that have so far been left behind in this response, including Indigenous and Black populations, people experiencing homelessness, people living on low incomes, people living with disabilities, those facing the double crisis of COVID-19 and a poisoned drug supply, and people facing the intersections of more than one of these at once.

Ontario’s response to COVID-19 to date has failed the test of health equity. Too many people in marginalized social locations that cause “pre-existing” medical conditions and vulnerabilities have been ignored by a one-size-fits all approach to the province’s public health. Bioethics frameworks mention equity- but do not incorporate Black or Indigenous expertise. Overdose prevention sites close their services due to staff exposures to the coronavirus. Seniors die days after Ontario’s Chief Medical Officer of Health recommends against the use of masks by long term care workers. From front-facing workers in healthcare and essential services working without masks or test kits, to people living without safe shelter or access to digital devices, Ontario’s most marginalized have been forgotten. If indeed everyone is equally important the province must act now to ensure that enhanced care is available for populations who have been so far left behind.

Systemic and structural inequalities govern everyday life for people across Ontario. We cannot effectively contain COVID-19 and mitigate its long term harms without addressing underlying inequalities that facilitate this pandemic’s escalation. We urge our province’s leaders to act boldly now to address this crisis with the urgency and gravity it deserves.

We call on Ontario to implement a health equity approach immediately by:

• Mandating the collection and use of socio-demographic and race-based data in health and social services now as it relates to COVID-19;
• Ensuring diverse and racialized voices on provincial and regional decision-making tables, including bioethics and critical care tables;
• Prioritizing PPE, testing and funding for health services that take an anti-oppressive approach and provide trusted, evidence-driven healthcare to populations facing discrimination; and
• Including regular updates on health equity data and progress in daily COVID-19 press conferences and situation reports

*This letter is endorsed by 192 organizations and 1612 individuals.

Organizational endorsements (total= 192):