Backgrounder: The Chief Public Health Officer of Canada’s Report on the State of Public Health in Canada, From Risk to Resilience: An Equity Approach to COVID-19

October 28, 2020

“The COVID-19 pandemic has jolted our collective consciousness into recognizing that equity is vital for ensuring health security.”
– Dr. Theresa Tam, Canada’s Chief Public Health Officer

The Report

This year’s annual report describes the heavy toll that the COVID-19 pandemic has had on Canadian society, both directly and indirectly. Through this challenging time, there has been incredible collaboration across sectors and between individuals, community organizations, businesses, governments and scientists. The aim of this report is to offer evidence-based opportunities to build on this collaboration to strengthen Canada’s preparedness for future public health emergencies.

The Broader Consequences of COVID-19

The severity of COVID-19 outcomes among Canadians has been influenced by their susceptibility and exposure to the virus, as well as access to treatment. Risk factors that increase susceptibility after being exposed to COVID-19 include age and underlying health issues, such as heart disease and diabetes, as well as health behaviours, such as smoking or living with obesity.

The amount of exposure Canadians have had to the virus is associated with their living and economic conditions, which can affect the ability to maintain physical distancing. This includes employment conditions, such as the inability to work from home, access to sick leave benefits and job security. Reliance on childcare outside of the home, crowded housing conditions and the use of shared transportation also influence the risk of exposure to the virus.

Lastly, the severity of illness to COVID-19 may also be influenced by access to quality health and social services. This can be influenced by a number of factors including the availability of services in communities, experiences of discrimination when seeking services, as well as logistical obstacles such as transportation and access to the Internet.

The 2020 CPHO report reviews the Canadian data available from January to the end of August 2020 across these three areas.

Quick Facts

• Residents of long-term care facilities (LTC) have been hit the hardest in this pandemic, accounting for approximately 80% of COVID-19 related deaths in Canada, as of August 2020. This is one of the highest fatality rates of residents when compared to other OECD countries.
• People who work in essential services experience higher risks of viral exposure in their work environment or while commuting to and from work. Healthcare workers accounted for 19% of national cases by mid- August. Also, there were 23 outbreaks across Canada in agricultural workplace settings during the same time period.
• Research demonstrates the major impact of COVID-19 on workers with the least bargaining power, such as non-union, low-wage, female or hourly paid workers.
• First Nations, Inuit and Metis peoples have shown leadership, resilience and community collaboration in responding to COVID-19. First Nations populations, for example, had lower rates of hospitalization among persons with COVID-19 than the general population (8.4% compared to 13.4%) and lower rates of death (1.4% compared to 7.1%) by the end of August 2020.
• Confined group working and living conditions can create situations where physical distancing, good hygiene, and sanitary standards are difficult to maintain, which can promote the spread of the COVID-19 virus.
• Opioid-related overdose deaths have increased significantly in Canada during the pandemic, reversing the previously observed positive downward trend.
• Stigma and discrimination are important factors that can drive and exacerbate negative health outcomes in the context of a pandemic.  This may be reflected in the disproportionately higher rates of COVID-19 infection in racialized communities, seniors and other marginalized groups.

The Way Forward

In the report, Dr. Tam describes key actions for moving forward:

• Sustain leadership and governance at all levels for structural change across health, social and economic sectors. Practically, this means that data needs to be stratified to understand the multiple needs (e.g. housing, safety and employment) of people. Pandemic plans that are multi-sectoral need to be tested on a regular basis. And, the progress of subsequent collaborative actions need to be measured and adjusted until inequities are eliminated.
• Harness the power of social cohesion as a key ingredient to controlling and minimizing the negative impacts of this pandemic. Communities and countries that have strong norms of taking care of each other can better prevent and control resurgences. Everyone has a role to play to make this happen. Public health leaders, media and political leaders all need to share evidence, stories and demonstrate willingness to work together on the ongoing response to the pandemic. These actions can provide Canadians with the information and the confidence to take daily public health action and to call for supports for others who are most at risk.
• Strengthen public health capacity to ensure that Canada has a health system that is able to surge and adapt during a crisis while maintaining capacity to address on-going critical issues. Usually, public health efforts are invisible to the general population. A pandemic makes obvious the need for a robust and agile public health system that has the workforce and tools needed to tackle emergencies and inequities. It offers an opportunity to re- evaluate what sustained investments and the future of public health would look like.

How the 2020 report was developed

As with previous CPHO reports, the 2020 report was developed using the best available evidence at the time based on research findings, subject-matter expertise, and living experiences.

Due to the rapidly evolving nature of the evidence around COVID-19, a wide variety of sources were considered throughout the process of writing this report, including scientific literature, epidemiological case data, federal and expert advice from researchers, policy-makers, non-governmental organizations and community leaders.

The report was written with the knowledge that the story of this pandemic is continuing to change every day.

Background and Previous Reports

Canada’s Chief Public Health Officer is mandated under the Public Health Agency of Canada Act to provide the Minister of Health with an independent report on the state of public health in Canada each year. The Act mandates that the Minister of Health table the report in parliament and that it be accessible to Canadians. CPHO annual reports are required to be submitted to the Minister of Health six months after the end of the fiscal year and tabled in parliament within 15 sitting days after submission.

The CPHO reports are intended to create awareness and stimulate action, ultimately seeking to improve and protect the health of Canadians.

Previous annual reports from Canada’s Chief Public Health Officers are available online and have called attention to public health issues such as stigma in the health system, substance use among youth, and the elimination of tuberculosis.