Published October 31, 2023

Ruby Pratka

Local Journalism Initiative reporter

editor@qctonline.com

Residents of poorer neighbourhoods in Quebec City were more vulnerable to COVID-19 infections than their fellow citizens in wealthier areas, a recent study has found.

The study was carried out by researchers from Université Laval and the public health directorate (DSP) of the Centre intégré de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN) and the results were published in English in the journal BMC Public Health. The study explored COVID prevalence within the 1,206 census subdivisions of the Capitale-Nationale region from March 2020 through November 2021.

“The spread of the epidemic was concentrated in the most disadvantaged areas, especial- ly in the densely populated areas. Socioeconomic inequality appeared early and increased with each successive pandemic wave. The models showed that areas with economically dis- advantaged populations were three times more likely to be among the areas at highest risk for COVID-19,” the authors wrote.

Dr. Slim Haddad, one of the study’s lead authors, is a professor in the department of social and preventive medicine at Université Laval and a medical advisor at the regional public health directorate. He explained that researchers wanted to work on a granular level, using the census to di- vide the city’s population into clusters of 500-700 people. “Thanks to the census, we know the level of poverty, the proportion of immigrants, the number of people who spend a significant proportion of their income on housing, in each part of the city. We can evalu- ate their level of [economic] defavorization and make a link with [COVID] transmission. We managed to objectively [show] that transmission was higher in poorer milieus. Our study doesn’t directly answer the question why, but we do have some hypotheses based on our experience of how social in- equality affects public health.”

One hypothesis has to do with housing arrangements. “If you’re in a small dwelling with a large number of other people, you’re close together and there might be less ventilation, less capacity [to self-isolate].” Employment is another probable factor, according to Haddad: “People who are economically disadvantaged often have jobs where they’re directly serving the community – home care aides, people working in the food industry or with delivery services. You can’t work from home when you have a job like that, and you’re often in con- tact with the clientele, more exposed to other people.” Local author Nora Loreto, who began chronicling deaths from COVID in care homes and workplaces early in the pandemic, said the study’s findings “weren’t a shock at all.” “People were advised to isolate in their spare bedrooms [if they had COVID],” she re- called. “That’s great advice if you live in a small apartment. Just under half of Canadians live in a single detached house … but those who didn’t were erased. Politicians aren’t liv- ing in these neighbourhoods where people are most at risk. If we orient policies toward people who are most [at risk], they’re more efficient. ”

Access to information

Haddad said people who are economically disadvantaged are often less able to access or interpret quality health information than their wealthier counterparts.

Marie-Noëlle Béland is the director of L’Engrenage, a civic participation organization in Saint-Roch. According to data released by the city in 2019, the average annual income in Saint-Roch is $10,000 lower than in the city as a whole. One in seven residents is an immi- grant (compared to about one in 14 in the city at large) and one in six has no high school diploma (slightly higher than the city at large).

For Béland, a former literacy educator, the study’s results are a cautionary tale about access to information. She said since the beginning of the pandemic, the organization has gotten creative with its efforts to inform residents, many of whom don’t have reliable Internet access or access to news.

“A lot of people in Lower Town have issues with the digital divide, but also sometimes with reading comprehension,” she said. A hasty flyer cam- paign early in the pandemic gave rise to a community bulletin board, and a “town crier” – Charles-Auguste Lehoux – reads community news bulletins aloud two afternoons a week. Béland also said she hopes to work with community organizations on using more accessible language. “There’s a significant access- to-information issue when most media outlets are aimed at educated people. It takes a lot of translation to be able to take language used by highly educated people and make it accessible to everyone in the population,” she said.

DSP spokesperson Mariane Lajoie said the results will help public health officials prepare for a COVID resurgence or a future epidemic. Ultimately, according to Haddad, COVID is far from the “great equal- izer” that it was portrayed as early in the pandemic. “It’s not a democratic illness [and] it didn’t arrive in a vacuum. It arose in a context of social inequality. It doesn’t affect everyone in the same way, and it won’t affect everyone in the same way in the future.”

This is the second story in an occasional series about the ongoing impact of COVID-19 in Quebec.

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