Minorities are more likely to be impacted by COVID-19

While everyone is affected by the COVID-19 outbreak in one way or another, some have been put into more dire circumstances than others. Those who were already facing economic hardships or felt marginalized prior to shutdowns are in positions to be more at risk of infection or of losing their means of income, according to gender inequality experts. "In most cases, and especially when we're talking about economics and general livelihood, we can see that women experience inequalities compared to men and, of course, that's a big generalization," said Julia Smith, a research associate at Simon Fraser University. "We see with these outbreaks who are most impacted, not necessarily just in terms of their biological impacts but the social, economic impacts will usually differ by gender, because different sectors of the economy tend to be dominated by women or men. Because services provided might be designed primarily by men, all of that can affect health outcomes and the outcomes of an epidemic, and how people experience an outbreak." Responses to crises, she said, can also exacerbate inequality. "It can make things worse for those groups of people who are already experiencing equities," she said. "So, for example, the Ebola outbreak in West Africa — a lot of people there, specifically women, don't have access to essential health services. Then during the outbreak, the little resources that are available for maternity care are diverted to the outbreak response. So, women have less access to care and you see rates for maternal mortality going up." Smith added that including gender analysis makes outbreak responses more effective because it includes a more complete picture of how people are being affected and how they are responding to the crises. As the number of sick people increases during an epidemic, the need for a caregiver will also increase and historically, that role has been filled by women. Additionally, Smith said that the majority of health care workers are women, meaning there is an already increased risk of exposure due to their professions. This leads to a disproportionate burden on women, who are the most likely to conduct care in homes to people who are sick, elderly or children, she said. As a result, women may have less time to engage in things like other income-generating activities, schooling or self-care. Even so, Smith said that in response to COVID-19, she has seen increased attention to gender than she has in past outbreaks. "There is more attention being paid to gender," she said. "Gender-based analysis is being called for by global institutions, by activists, some policymakers, and that's encouraging. I don't think it's sufficient yet, but it's encouraging. I think we do need to increase our attention to other inequities — you know, the response and economic impacts of the response of different races and ethnicities, of indigenous or American Indian people. These are all questions that need to be asked more often." Black women Beverly Bain, a professor of women and gender studies at the University of Toronto, said to understand how black communities are at higher risk, a historical context is important. Similarly to America, Canada has a history of slavery, which brought enslaved people of color into the country. This shaped black women as best suited to jobs that involved a form of servitude. Once slavery was abolished, many American slaves sought freedom in Canada through the Underground Railroad. In the 1960s, black women came to Canada or the U.S. as domestic workers, usually caring for the children and homes of white families. "Once they had fulfilled their obligation, many of them were deported. Canada wanted to erase all evidence of blackness by making it difficult for black people to migrate here and form communities," Bain said. She added that black, Filipino and Asian women have all been positioned in a state of passivity, having jobs at "the lowest rung of the ladder." Even now, Bain said, black women are primarily in jobs that are about taking care of others, such as support workers, nurse assistants, cleaners and grocery workers. The irony to her is that jobs that have always been seen as precarious and disposable to some are now considered essential during the pandemic. "They are jobs that put these women at risk of being infected or dying," she said. People working those essential jobs cannot stay home, which means they are at a higher risk of infection, and there is still a lack of personal protective equipment for frontline workers. Bain said black and Latino women are positioned in vulnerable places, and poverty, homelessness and other pre-existing conditions are keeping them there. She then added that she believes people of color are still not involved enough in the conversations that decide their fate. "We know our situation better because we live it," she said. "We should be in charge of race-based health data collection. We must be the leader in creating and defining the strategies that the governments need to follow. The state has a job to do as well which is to provide adequate socio-economic and health supports to black, indigenous and racialized communities to ensure their liveability." The transgender community Going to the hospital can be scary to some, but for those in the transgender community, visiting a health care provider can be terrifying. Mara Keisling, executive director of the National Center for Transgender Equality, explained in an interview recently that most trans people have experienced a doctor not knowing how to treat them. "There's actually a thing we call trans broken arm syndrome," she said. "They will go into an emergency room or urgent care with a very obvious problem, like a broken arm, and a health care provider will say, 'Oh, I don't know how to treat you as a trans person,' and meanwhile you're like, 'My arm is broken.' Just imagine some 18-year-old kid whose first time ever trying to get health care, and that happens to them. They may never go to the doctor again." During the pandemic, already marginalized people are more likely to be in dire situations, she said, adding that some of the areas with the largest infections are prisons and homeless shelters. For those who identify as transgender, they are already twice as likely to be unemployed said Keisling, meaning they are less likely to have health insurance in the first place. In a study from 2015, Keisling said greater than 30 percent of trans people said they did not seek out medical treatment when necessary because they could not afford it. More than 20 percent of those in the survey said they needed to see a health care provider, but they didn't because of a fear of being disrespected. In response to COVID-19, many elective or nonessential surgeries have been postponed, though some trans people may have had scheduled gender-confirming surgery that was canceled. "Some people are interpreting that rule as saying that our health care isn't essential, and that's not really what they're trying to say," she said. "A lot of folks are losing the health insurance that they thought would pay for some or all of it. I don't think we know exactly how that's going to play out in the long run. We have a lot of people who have taken scheduled time off and they have jobs where you can't just reclaim that. "As much as there are particular aspects of being trans that lead to additional mental health challenges," she concluded, "those are exacerbated now, but it's also true that everybody's facing some of that."