This journal article is appearing in a series commissioned by Community Foundations of Canada to accompany the national Vital Signs gender equality reports. The series is being released throughout Fall 2020, and can be accessed here.

There is nothing equitable about the impact of COVID-19 on workers. Who is getting sick, who is dying and how they die tell all tell a story that’s older than this pandemic. It’s a story about power, belonging and systems built to keep others out while letting some in. COVID-19 has exacerbated existing inequalities and brought into sharp focus the systems that fail the most marginalized, those with the least access to power in this country. 

As of October 19, Canada has reported over 200,000 COVID cases to date. By the end of July, almost 20% of these cases were healthcare workers. As primary respondents, healthcare workers face an  increased risk of COVID exposure and infection. A WHO report described a “human tragedy” unfolding among healthcare workers responding to the pandemic globally.

In Canada, workers have raised concerns about barriers in accessing protective equipment, inadequate pay for work carried out under difficult conditions, commonly known as hazard pay, and understaffing. Additionally, the pandemic has taken a heavy psychological toll. Over 1 million people have died world-wide and healthcare workers are on the frontlines of the global response. Health care workers are facing increasing fatigue, burnout, and mental health stress, with less resources available.

We can’t talk about the impact of the pandemic without talking about who these healthcare workers are. Canada’s healthcare labour force is overwhelmingly feminized and racialized.

Furthermore, people who have come to Canada as immigrants, refugees and asylum seekers are over-represented as labourers in the sector. In 2016, one-third of all people employed as nurse aides, orderlies and patient services associates were immigrants. Of this population, over 80% were women. Of all the nurses, orderlies and personal support workers in Canada,  12% of workers in the sector are Black, 11% are Filipino, and 4% are South Asian.

In too many cases, systems have utterly failed to put adequate and appropriate protections for healthcare workers in place. Early in the pandemic in Ontario, delays in providing supports for personal support workers led to an increase in COVID cases within the healthcare sector. It shouldn’t come as a surprise that PSW’s are over-represented among healthcare workers who have died in Ontario.

COVID-19’s impact within the healthcare labour force must be analysed with a critical lens that carefully considers the role race, gender inequality, patriarchy, xenophobia and class have played in driving negative outcomes.

These intersecting factors, layered upon each other, have played an undeniable role in making supports inaccessible for workers. Advocates contend that supports and protections have been slow in reaching these workers precisely because the healthcare labour force is primarily made up of people who are offered little to no care in our society. The disaster unfolding is possible because, even in the midst of a devastating pandemic, the lives of some healthcare workers and their contributions are systematically undervalued. To understand why we must ask what types of workers are visible and how worth is measured.

As the pandemic gained speed, healthcare workers began sounding the alarm on their working conditions. They highlighted low wages, limited benefits, insufficient sick leave, poor decent work standards (for example, the lack of standardization within the long term and home-based care sectors forced PSWs to work multiple part time jobs in order to gain full time hours), insufficient workplace protections and worker safety reporting mechanisms. 

There have indeed been important gains for healthcare workers over the course of the pandemic — such as expedited pathways to permanent residency and immigration security for frontline healthcare workers in Quebec, and wage increases for PSWs in Ontario. However, critical gaps remain.

Across Canada, communities have started thinking about what is needed to ensure a just and equitable recovery from COVID-19. Changing the story we’re telling now, and creating a world where all healthcare workers are valued, particularly racialized women, requires improved working conditions across the sector.

Factors that lead to increased risk for healthcare workers must be addressed. All workers, including PSWs and other workers in supportive roles, must be given equitable protections. The time is now to address systemic and structural factors driving COVID’s escalation. This means clear commitments are required from policy makers and health sector leaders to address gender inequality, racism and systemic inequity.

In the same vein, the philanthropic sector must actively participate in these conversations. The philanthropic sector is well poised to fund interventions that address inequities and, more importantly, to advocate for systemic changes that do not further harm already marginalized communities. To make a just recovery a reality for all, this sector must contend with and address the inequalities exacerbated by COVID-19.

Sané Dube is a policy analyst and storyteller. Her people are the Ndebele of what is now called Zimbabwe. She’s based in Treaty 13/Toronto. Follow her on Twitter @hello_sane