Inequities in COVID-19 Health Outcomes: The Need for Race- and Ethnicity-Based Data

8 December 2020, 8:50 a.m.

(Disponible en français : Inégalités des répercussions en santé de la COVID‑19 : besoin de données sur la race et l’ethnie)

For Indigenous peoples, Black Canadians and other racialized groups, race and racism are important social determinants of health.

Social determinants of health may contribute to negative health outcomes or health inequities, which are differences in health outcomes that could reasonably be avoided among groups, such as racial or ethnic groups. Addressing inequities through inclusive policies and legislation relies on the collection and availability of data disaggregated by various identity factors, such as ethnicity. However, collecting race-based health data remains a challenge in Canada.

Canadian health care stakeholders have identified racism as a public health emergency and emphasized its profound negative effects on Indigenous peoples and racialized groups. The Chief Public Health Officer of Canada’s Report, released in October 2020, asserts that COVID-19 has not affected people in Canada equally. The report recognizes Canada’s history of systemic racism and colonization and the role of social determinants of health in existing health inequities among Canadians.

This HillNote examines the role of race and ethnicity in COVID-19 health outcomes in the United States (U.S.) and the United Kingdom (U.K.), countries that systematically collect race-based health data, as well as initiatives to collect these data in Canada.

Health Inequities and COVID-19 in the United States and United Kingdom

Certain health data disaggregated by ethnic group or race have been collected in the U.S. and U.K. for years. Research in the U.S. indicates that, compared to white Americans, racialized groups tend to face disproportionately elevated risks of COVID-19 diagnosis, hospitalization and death. According to age-adjusted data, Indigenous, Black, Latino, Pacific Islander and Asian Americans face elevated risks of COVID-19 death compared to white Americans.

Number of COVID-19 Deaths per 100,000 population in the United States, adjusted for age by Racial or Ethnic Group, 10 November 2020

The bar graph shows the number of COVID-19 deaths per 100,00 deaths in the United States, adjusted for age, by racial or ethnic group. The various racial and ethnic groups are arranged along the vertical axis in order to highest number of deaths to lowest. Indigenous Americans have the highest number of deaths, at 164.7 per 100,000, closely followed by Black Americans with 153.2 deaths per 100,00. White Americans show the lowest number of deaths, with 50.9 deaths per 100,00.

Source: Figure prepared by author using data from APM Research Lab, “The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S.,” 10 November 2020.

Similar trends have been identified in the UK. For example, data from the first wave of COVID-19 show that members of ethnic minority groups in England died at higher rates than expected, based on their demographics, in contrast to the white population.

Excess Deaths (%) during the pandemic in England by Ethnic Group, 28 April 2020

The bar graph shows the percentage of excess deaths based on expected number of deaths and actual number of deaths based on population structure of racial and ethnic groups. Black, Asian, and Minority Ethnic (BAME) population groups all show a positive excess death percentage, with Black background showing 341% excess deaths. The white population group shows a negative excess death percentage, at -13% excess deaths. The graph concludes that the Black background group is dying at higher rates than the white background group.

Source: Figure prepared by author using data from Abdual Razaq, Dominic Harrison, Sakthi Karunanithi et. al,BAME COVID-19 Deaths – What do we know? Rapid Data & Evidence Review,” Centre for Evidence-Based Medicine University of Oxford, 5 May 2020.
Note: Excess deaths represents the difference in “Observed deaths” and “Expected deaths” for different population groups, based on the size, age and structure of the population.

A study analyzing the results of 50 studies published between December 2019 and August 2020 from the U.S. and U.K. exploring the relationship between ethnicity and clinical outcomes in COVID-19 concluded that individuals from Black, Asian and Hispanic ethnic backgrounds had a higher risk of SARS-CoV-2 infection compared to white individuals. The study highlights underlying inequities that may contribute to the elevated risks for some groups, including structural racism, barriers accessing health care, potential for increased transmission in overcrowded housing, and overrepresentation in essential occupations.

Health Inequities and COVID-19 in Canada

In Canada, COVID-19 data disaggregated by race have not been systematically collected. However, certain provinces, such as Ontario and Manitoba have begun collecting data on race, ethnicity, and in some cases Indigenous identity, for COVID-19 cases. In addition, some municipal public health agencies, such as Toronto, Ottawa and Montreal, have begun collecting and analyzing similar data.

Preliminary data show that in Toronto, while 52% of the population identifies as belonging to a racialized group, as of September 2020, 82% of COVID-19 cases and 71% of hospitalizations were among people belonging to racialized groups. Similarly, data from Ottawa show that members of racialized populations, particularly those who identify as Black, are overrepresented among individuals diagnosed with COVID-19.

Furthermore, during the first wave of the pandemic, Statistics Canada indicated that COVID-19 mortality rates were higher in Canadian neighbourhoods with higher proportions of population groups designated as visible minorities. These analyses suggest that factors such as overcrowded households, “less favourable living conditions,” employment in essential or frontline work, and barriers or discrimination in accessing services, such as those related to health and education, may contribute to the elevated risk for individuals belonging to racialized groups.

Collection of Race, Ethnicity and Indigenous Identity Health Data in Canada

According to health experts, policymakers need disaggregated data to properly understand and meet the needs of specific groups of people. The collection of Canadian health data is a shared responsibility between federal, provincial and territorial governments. Provincial and territorial public health authorities are responsible for reporting data, including COVID-19 case-related data, to the federal government.

At the federal level, the Canadian Institute for Health Information (CIHI) and the Public Health Agency of Canada are responsible for collecting and reporting nationally on health data that have been voluntarily provided by the provinces and territories. Statistics Canada collects various types of socioeconomic survey data that could be used to understand the indirect impacts of COVID-19.

The collection of national race-based health data in Canada is fragmented, with no national approach to date. COVID-19 has reinforced calls for the collection of such data. Some organizations, such as the Canadian Human Rights Commission, have called for a national strategy to improve the collection of Indigeneity and race-based data.

In July 2020, CIHI stated “[t]he lack of race-based data in the health sector in Canada makes it difficult to measure health inequalities and to identify inequities that may stem from racism and discrimination.” In response to the “urgent” need to understand the impact of COVID-19 on racialized communities in Canada, CIHI proposed a pan-Canadian standard in July 2020.

CIHI’s proposed standard, adapted from the Ontario Anti-Racism Directorate’s standards, defines race and ethnicity, and asserts that First Nation, Métis and Inuit people in Canada “have a constitutionally recognized status that is unique” and that Indigenous identity data “merit distinct considerations.” CIHI is currently seeking feedback regarding best practices and approaches to implementing these standards and collecting race-based data.

Racism and discrimination have been identified as significant determinants of health outcomes for racialized groups in general and during the pandemic. The Black Lives Matter movement has drawn global attention to the devastating effects of racism and racial inequality prior to, and during, the pandemic. Experts assert that the collection of race-based health data is integral to the recovery from the COVID-19 pandemic and that this data collection must be followed by action.

Additional Resources

Clare Annett, Robert Mason and Laura Munn-Rivard, Health Outcomes During Pandemics in Different Population Groups in Canada, Library of Parliament, 6 April 2020.

The Lancet, COVID-19 and ethnicity: who will research results apply to?, 12 June 2020.

Department of Sociology, University of Western Ontario, Studying the social determinants of COVID-19 in a data vacuum, 10 May 2020.

Author: Clare Annett, Library of Parliament