Disproportionate Rates of COVID-19 Among Black Canadian Communities: Lessons from a Cross-Sectional Study in the First Year of the Pandemic.

BACKGROUND: Racialized communities, including Black Canadians, have disproportionately higher COVID-19 cases. We examined the extent to which SARS-CoV-2 infection has affected the Black Canadian community and the factors associated with the infection. METHODS: We conducted a cross-sectional survey in an area of Ontario (northwest Toronto/Peel Region) with a high proportion of Black residents along with 2 areas that have lower proportions of Black residents (Oakville and London, Ontario). SARS-CoV-2 IgG antibodies were determined using the EUROIMMUN assay. The study was conducted between August 15, 2020, and December 15, 2020. RESULTS: Among 387 evaluable subjects, the majority, 273 (70.5%), were enrolled from northwest Toronto and adjoining suburban areas of Peel, Ontario. The seropositivity values for Oakville and London were comparable (3.3% (2/60; 95% CI 0.4-11.5) and 3.9% (2/51; 95% CI 0.5-13.5), respectively). Relative to these areas, the seropositivity was higher for the northwest Toronto/Peel area at 12.1% (33/273), relative risk (RR) 3.35 (1.22-9.25). Persons 19 years of age or less had the highest seropositivity (10/50; 20.0%, 95% CI 10.3-33.7%), RR 2.27 (1.23-3.59). There was a trend for an interaction effect between race and location of residence as this relates to the relative risk of seropositivity. INTERPRETATION: During the early phases of the pandemic, the seropositivity within a COVID-19 high-prevalence zone was threefold greater than lower prevalence areas of Ontario. Black individuals were among those with the highest seroprevalence of SARS-CoV-2.

Exploring the COVID-19 Knowledge, Attitudes, and Practices (KAPs) in the Black Community: a Scoping Review.

INTRODUCTION AND BACKGROUND: Racial minorities have been the focal point of media coverage, attributing the disproportionate impact of COVID-19 to their individual actions; however, the ability to engage in preventative practices can also depend on one's social determinants of health. Individual actions can include knowledge, attitudes, and practices (KAPs). Since Black communities are among those disproportionately affected by COVID-19, this scoping review explores what is known about COVID-19 KAPs among Black populations. METHODS: A comprehensive literature search was conducted in 2020 for articles written in English from the Medline, Embase, and PsycInfo databases. Reviews, experimental research, and observational studies were included if they investigated at least one of COVID-19 KAP in relation to the pandemic and Black communities in OECD peer countries including Canada, the United States, and the United Kingdom. RESULTS AND ANALYSIS: Thirty-one articles were included for analysis, and all employed observational designs were from the United States. The following KAPs were examined: 6 (18.8%) knowledge, 21 (65.6%) attitudes, and 22 (68.8%) practices. Black communities demonstrated high levels of adherence to preventative measures (e.g., lockdowns) and practices (e.g., mask wearing), despite a strong proportion of participants believing they were less likely to become infected with the virus, and having lower levels of COVID-19 knowledge, than other racial groups. CONCLUSIONS AND IMPLICATIONS: The findings from this review support that Black communities highly engage in COVID-19 preventative practices within their realm of control such as mask-wearing and hand washing and suggest that low knowledge does not predict low practice scores among this population.

Anti-Black Racism in the Canadian Healthcare System: A Reckoning.

Canada is often held out by scholars as the exception to a disheartening global pattern that suggests that high levels of racial diversity in a society are incompatible with support for generous social policies (Banting et al. 2006). The explanation for this pattern is that it is a real phenomenon (rather than an artefactual one) and it can be chalked up to racist motivations that cause powerful racial groups (whites and those non-white people who ally with whites) from endorsing policies that will benefit Black and other non-white groups (Alesina et al. 2001). One of the social policies that we are most often lauded for maintaining is the Canada Health Act (1985), which mandates that the vast majority of physician and hospital services are accessible free of charge. The prevailing discourse in Canada has been that the Canada Health Act (1985) ensures equal access to healthcare among all Canadians. In addition, polling data suggest that the vast majority of Canadians believe racism is a terrible thing (Bricker and Chhim 2020). However, cases such as that of Joyce Echaquan (Nerestant 2021) who died at a hospital in Saint-Charles-Borromée, QC, as nurses looked on and mocked and demeaned her with their words, or Leonard Rodriques (Allen 2020) who was turned away from an emergency room in Toronto during the COVID-19 pandemic and died shortly after, call into serious question the narratives of an egalitarian and benevolent system, in the context of a society that publicly endorses anti-racism.

Work as a social determinant of health in high-income countries: past, present, and future.

This paper, the first in a three-part Series on work and health, provides a narrative review of research into work as a social determinant of health over the past 25 years, the key emerging challenges in this field, and the implications of these challenges for future research. By use of a conceptual framework for work as a social determinant of health, we identified six emerging challenges: (1) the influence of technology on the nature of work in high-income countries, culminating in the sudden shift to telework during the COVID-19 pandemic; (2) the intersectionality of work with gender, sexual orientation, age, race, ethnicity, migrant status, and socioeconomic status as codeterminants of health disparities; (3) the arrival in many Organisation for Economic Co-operation and Development countries of large migrant labour workforces, who are often subject to adverse working conditions and social exclusion; (4) the development of precarious employment as a feature of many national labour markets; (5) the phenomenon of working long and irregular hours with potential health consequences; and (6) the looming threat of climate change's effects on work. We conclude that profound changes in the nature and availability of work over the past few decades have led to widespread new psychosocial and physical exposures that are associated with adverse health outcomes and contribute to increasing disparities in health. These new exposures at work will require novel and creative methods of data collection for monitoring of their potential health impacts to protect the workforce, and for new research into better means of occupational health promotion and protection. There is also an urgent need for a better integration of occupational health within public health, medicine, the life sciences, and the social sciences, with the work environment explicitly conceptualised as a major social determinant of health.

Income inequality and 'hospitalisations of despair' in Canada: a study on longitudinal, population-based data.

BACKGROUND: Rates of drug overdoses, alcohol-related liver disease and suicide attempts represent a major public health burden in Canada. While the existing literature does highlight some evidence of association between income inequality and mental health and deaths of despair, no existing research has investigated more intermediate events. As such, the objective of the current study is to investigate the association between income inequality and hospitalisations of despair over time. METHODS: Data from the 2006 Canadian Census, the 2007/2008 Canadian Community Health Survey and the 2007-2018 Discharge Abstract Database were linked. Data were analysed using Cox proportional hazards modelling accounting for robust standard errors at the area level to investigate associations between income inequality at baseline and hazards for hospitalisations of despair, hospitalisations attributable to drug overdose, alcohol-related liver disease and suicide attempts, and all-cause hospitalisations, while controlling for sociodemographics characteristics (including income) and relevant area-level variables. RESULTS: The results highlighted statistically significant associations between income inequality and hazard of hospitalisations of despair (HR 1.38, 95% CI 1.06 to 1.80), hospitalisations related to drug overdose (HR 1.51, 95% CI 1.07 to 2.13) and all-cause hospitalisations (HR 1.17, 95% CI 1.05 to 1.30). The association between income inequality and hospitalisations related to alcohol-related liver disease and suicide attempts/self-harm were not statistically significant. CONCLUSION: Overall, the results showed evidence of associations between income inequality and hospitalisations of despair, drug overdose-related hospitalisations and all-cause hospitalisations. These findings are applicable to upstream policy discussion regarding reducing income inequality and identify potential points of intervention for prevention of drug overdose, alcohol-related liver disease and suicide attempts/self-harm.

Racial and Ethnic Inequities in the Return-to-Work of Workers Experiencing Injury or Illness: A Systematic Review.

PURPOSE: Non-White workers face more frequent, severe, and disabling occupational and non-occupational injuries and illnesses when compared to White workers. It is unclear whether the return-to-work (RTW) process following injury or illness differs according to race or ethnicity. OBJECTIVE: To determine racial and ethnic differences in the RTW process of workers with an occupational or non-occupational injury or illness. METHODS: A systematic review was conducted. Eight academic databases - Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, ASSIA, ABI Inform, and Econ lit - were searched. Titles/abstracts and full texts of articles were reviewed for eligibility; relevant articles were appraised for methodological quality. A best evidence synthesis was applied to determine key findings and generate recommendations based on an assessment of the quality, quantity, and consistency of evidence. RESULTS: 15,289 articles were identified from which 19 studies met eligibility criteria and were appraised as medium-to-high methodological quality. Fifteen studies focused on workers with a non-occupational injury or illness and only four focused on workers with an occupational injury or illness. There was strong evidence indicating that non-White and racial/ethnic minority workers were less likely to RTW following a non-occupational injury or illness when compared to White or racial/ethnic majority workers. CONCLUSIONS: Policy and programmatic attention should be directed towards addressing racism and discrimination faced by non-White and racial/ethnic minority workers in the RTW process. Our research also underscores the importance of enhancing the measurement and examination of race and ethnicity in the field of work disability management.

Perceived status threat and health among White Americans: A scoping review.

Previous research on pre-COVID-19 pandemic rising White mortality in the United States suggests that White Americans' perceived decline in relative group status may have influenced worsening mortality. In conjunction with other social and economic indicators, social status threat is one determinant of this population-level health shift, yet it is unclear how perceptions of status threat shape individual health outcomes. Because of this, we sought to identify and synthesize research studies across disciplines that broadly explored how perceived threats to White Americans' social status affect their health. Our research objectives were to (1) examine how status threat (and related constructs) have been measured across the health and social sciences, (2) determine which health outcomes and behaviors are related to status threat, and (3) identify gaps in the existing knowledge base. We systematically searched six multidisciplinary databases. Only 12 studies met inclusion criteria, suggesting that status threat and Whites' health is an understudied topic that warrants continued investigation. Furthermore, there was inconsistency in how threats to status were measured and conceptualized across disciplines. Threat-related indicators evaluated changes in Democratic or Republican vote share, perceived racial treatment, financial status, personal identification with political party affiliation, perceptions of hypothetical "majority-minority" population shifts, racial awareness, and subjective social status. Studies primarily relied on self-rated measures of overall health, mental health status, and social determinants of health. Consequently, there is a gap in the literature concerning which specific health outcomes (besides mortality) are directly affected by status threat. Overall, included studies demonstrated that Whites' can experience negative health effects when they perceive threats in societal conditions, within their interpersonal social experiences, or related to their individual social standing. Moving forward, researchers should consider how Whites' beliefs about their position within social hierarchies potentially affect individual and group-level health outcomes.

Probing key informants' views of health equity within the World Health Organization's Urban HEART initiative.

To date, no studies have assessed how those involved in the World Health Organization's (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, "how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?", with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as "unnecessary"; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms "health inequity" and "health inequality" were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.

A comparison of health and socioeconomic gradients in health between the United States and Canada.

Data from the early 2000s indicated worse overall health and larger socioeconomic (SES) health inequalities in the U.S. than in Canada. Yet, sociopolitical contexts, health levels, and SES-health inequalities have changed in both countries during the intervening two decades. Drawing on new data, we update the comparison of health levels and SES-health gradients between the two countries. Analyses, focused on self-rated health, are based on two complementary sets of data sources: Resilience and Recovery (RR) data, a harmonized U.S.-Canada survey of social conditions collected in 2020 (N = 3743); and a pair of leading nationally representative health data sources from each country: the National Health Interview Surveys (NHIS, N = 104,027) and the Canadian Community Health Survey (CCHS, N = 97,605), both collected in 2017-2018. Health levels and disparities, net of demographic and socioeconomic covariates, were estimated using modified Poisson models for relative comparisons; descriptives and predicted levels of fair/poor health show the comparisons from absolute perspective. Both data sources show that U.S. adults continue to have significantly worse health than Canadians; the disadvantage may be due to SES differences between the two populations. However, the two data sources yield conflicting findings on SES-health inequalities: the RR data indicate no difference between the two countries in socioeconomic health gradients, while the NHIS/CCHS data show a significantly steeper gradient in the U.S. than in Canada for both education and income. Canadian adults continue to report better health than their U.S. peers, but it is unclear whether health inequalities remain smaller as well. We discuss potential reasons for the conflicting findings and call for a large new cross-national data collection, which will enable scholars and policymakers to better understand health and wellbeing in the U.S. and Canadian contexts.

Income inequality and population health: a political-economic research agenda.

There is more than 30 years of research on relationships between income inequality and population health. In this article, we propose a research agenda with five recommendations for future research to refine existing knowledge and examine new questions. First, we recommend that future research prioritise analyses with broader time horizons, exploring multiple temporal aspects of the relationship. Second, we recommend expanding research on the effect of public expenditures on the inequality-health relationship. Third, we introduce a new area of inquiry focused on interactions between social mobility, income inequality and population health. Fourth, we argue the need to examine new perspectives on 21st century capitalism, specifically the population health impacts of inequality in income from capital (especially housing), in contrast to inequality in income from labour. Finally, we propose that this research broaden beyond all-cause mortality, to cause-specific mortality, avoidable mortality and subcategories thereof. We believe that such a research agenda is important for policy to respond to the changes following the COVID-19 pandemic.

Social determinants of ethno-racial inequalities in substance use: a decomposition of national survey data.

BACKGROUND: Similar to the US, mortality due to suicide and the use of opioids, alcohol, and other substances (so-called "Deaths of Despair"), is rising in Canada and has been disproportionately observed among Whites compared to other racial and ethnic groups. This study aimed to assess the determinants of the ethno-racial differences in the use of substances that underlie these deaths. METHODS: Using nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles), a decomposition analysis was performed to estimate the contribution of psychosocial determinants, including age, sex, marital status, immigration, education, income, rurality, and affective health on inequalities between White and non-White populations in illicit substance, opioid, and problematic alcohol use and combined use (≥ 2) of substances. RESULTS: Overall, White respondents reported higher levels (by 5% to 10%) of substance use than non-White peers. Over 30% of the ethno-racial inequalities in illicit substance, problematic alcohol, and polysubstance use are explained by the protective role of immigration among those who are not White, whose low levels of substance use lower the prevalence in the non-White population overall. Among those born in Canada, no ethno-racial differences in substance use were observed. CONCLUSION: Social determinants, particularly immigrant status, explain a substantial proportion of ethno-racial inequalities in substance use in Canada. The jump in substance use between racialized populations who immigrated to Canada and those Canadian-born highlights the importance of exploring within-group variability in deaths of despair risk and considering how intersecting forces including systemic racism shape substance use patterns across generations.

Looking back and moving forward: Addressing health inequities after COVID-19.

We will likely look back on 2020 as a turning point. The pandemic put a spotlight on existing societal issues, accelerated the pace of change in others, and created some new ones too. For example, concerns about inequalities in health by income and race are not new, but they became more apparent to a larger number of people during 2020. The speed and starkness of broadening societal conversation, including beyond the direct effects of COVID-19, create an opportunity and motivation to reassess our understanding of health. Perhaps more importantly, it is an opportunity to reduce inequities in who has access to, who uses, and who benefits from the resources that promote health and well-being. To this end, we offer three questions to guide thinking about health and health inequities after 2020: (1) what do we mean by "health" and "health inequality and inequity"? (2) what are the structures and policies we put in place to support or promote health, and how effective are they? And (3) who has the power to shape structures and policies, and whose interests do those structures and policies serve?

Cash transfer programs and child health and family economic outcomes: a systematic review.

OBJECTIVES: Family income is an important determinant of child and parental health. In Canada, cash transfer programs to families with children have existed since 1945. This systematic review aimed to examine the association between cash transfer programs to families with children and health outcomes in Canadian children (ages 0 to 18) as well as family economic outcomes. METHODS: We reviewed academic and grey literature published up to November 2021. Additional studies were identified through reference review. We included any study that examined children 0-18 years old and/or their parents, took place in Canada and reported Canada-specific data, and reported child, youth and/or parental health outcomes, as well as family economic outcomes. Risk of bias was assessed by two reviewers using a modified Newcastle-Ottawa Scale. SYNTHESIS: Our search yielded 23 studies meeting the inclusion criteria out of 7052 identified. Eight studies in total measured child health outcomes, including birth outcomes, child overall health, and developmental and behavioural outcomes, and four directly addressed parental health, including mental health, injuries, and obesity. Most studies reported generally positive associations, though some findings were specific to certain subgroups. Some studies also examined fertility and labour force participation outcomes, which described varying effects. CONCLUSION: Cash transfer programs to families with children in Canada are associated with better child and parental health outcomes. Additional research is needed to evaluate the mechanisms of effects, and to identify which types and levels of government transfers are most effective, and target populations, to optimize the positive effects of these benefits.

RéSUMé: OBJECTIFS: Le revenu familial est un important déterminant de la santé infantile et parentale. Au Canada, des programmes de transferts monétaires aux familles avec enfants existent depuis 1945. Notre revue systématique visait à examiner l'association entre les programmes de transferts monétaires aux familles avec enfants et les résultats cliniques chez les enfants canadiens (0 à 18 ans), ainsi que les résultats économiques familiaux. MéTHODE: Nous avons passé en revue la littérature spécialisée et la littérature grise publiées jusqu'en novembre 2021. D'autres études ont été répertoriées par une revue des références. Nous avons inclus toute étude portant sur les enfants de 0 à 18 ans et/ou leurs parents, menée au Canada, rapportant des données propres au Canada et rapportant les résultats cliniques d'enfants, de jeunes et/ou de parents, ainsi que les résultats économiques de familles. Le risque de biais a été évalué par deux évaluateurs à l'aide d'une échelle de Newcastle-Ottawa modifiée. SYNTHèSE: Sur les 7 052 études repérées dans notre recherche, 23 répondaient aux critères d'inclusion. En tout, huit études mesuraient les résultats cliniques d'enfants, dont les issues de la grossesse, la santé globale des enfants et les résultats développementaux et comportementaux, et quatre études portaient directement sur la santé parentale, dont la santé mentale, les blessures et l'obésité. La plupart des études faisaient généralement état d'associations positives, mais certaines constatations étaient spécifiques à certains sous-groupes. Quelques études portaient aussi sur la fécondité et la participation à la population active et décrivaient une diversité d'effets. CONCLUSION: Les programmes de transferts monétaires aux familles avec enfants au Canada sont associés à de meilleurs résultats cliniques infantiles et parentaux. Il faudrait pousser la recherche pour évaluer les mécanismes des effets constatés et pour déterminer quels sont les types et les niveaux de transferts gouvernementaux qui sont les plus efficaces, ainsi que les populations cibles, pour optimiser les effets positifs de ces prestations.

Advancing the Social Epidemiology Mission of the American Journal of Epidemiology.

Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field.

Social inequalities in protective behaviour uptake at the start of the COVID-19 pandemic: results from a national survey.

OBJECTIVES: We aimed to assess social patterns of handwashing, social distancing, and working from home at the start of the COVID-19 pandemic in Canada, and determine what proportions of the overall prevalence and social inequalities in handwashing and social distancing are related to inequalities in the opportunity to work from home, to guide pandemic preparedness and response. METHODS: Using cross-sectional data from the Canadian Perspectives Survey Series, collected between March 29 and April 3, 2020, among Canadian adults (N=4455), we assessed prevalence of not working from home, social distancing in public, or practicing frequent handwashing, according to age, sex, marital status, immigration, education, chronic disease presence, and source of COVID-19 information. Multivariate regression, population attributable fraction estimation, and generalized product mediation analysis were applied. RESULTS: Absence of frequent handwashing and distancing was more common among those working outside than within the home (prevalence differences of 7% (95% CI: 4, 10) and 7% (95% CI: 3, 10), respectively). Inequalities in handwashing and distancing were observed across education and immigration status. Over 40% of the prevalence of non-uptake of handwashing and distancing was attributable to populations not being able to work from home. If all worked from home, over 40% (95% CI: 8, 70) of education-based inequalities in handwashing and distancing could be eliminated, but differences by immigration status would likely remain. CONCLUSION: For pandemic response, both workplace safety initiatives and mechanisms to address the inequitable distribution of health risks across socio-economic groups are needed to reduce broader inequalities in transmission risk.

RéSUMé: OBJECTIFS: Nous avons cherché à évaluer les habitudes sociales en matière d'hygiène des mains, de distanciation physique et de travail à domicile au début de la pandémie de la COVID-19 au Canada, et à déterminer quelles proportions de la prévalence globale et des inégalités sociales en matière d'hygiène des mains et de distanciation physique sont liées aux inégalités dans la possibilité de travailler à domicile (le télétravail), afin de guider la préparation et la réponse à la pandémie. MéTHODES: À l'aide des données transversales de la Série d'enquêtes sur les perspectives canadiennes 1, recueillies entre le 29 mars et le 3 avril 2020 auprès d'adultes canadiens (N=4 455), nous avons évalué la prévalence du travail hors du domicile, de la non-distanciation physique en public et de l'absence de lavage fréquent des mains, en fonction de l'âge, du sexe, de l'état civil, de l'immigration, de l'éducation, de la présence de maladies chroniques et de la principale source déclarée d'information sur la COVID-19. Une régression multivariée, une estimation de la fraction attribuable dans la population et une analyse de médiation par produit généralisé ont été appliquées. RéSULTATS: L'absence de lavage fréquent des mains et de distanciation physique étaient déclarées plus fréquemment chez les personnes travaillant à l'extérieur qu'à l'intérieur du domicile (différences de prévalence de 7 % (IC 95 % : 4, 10) et 7 % (IC 95 % : 3, 10), respectivement). Des inégalités en matière de lavage fréquent des mains et de la pratique de distanciation physique ont été observées en fonction du niveau d'éducation et du statut d'immigration. Plus de 40 % de la prévalence de la non-pratique du lavage fréquent des mains et de la distanciation physique était attribuable au fait que les populations ne pouvaient pas travailler à domicile. Si toutes les personnes travaillaient à domicile, plus de 40 % (IC 95 % : 8, 70) des inégalités liées au niveau d'éducation en matière de lavage des mains et distanciation physique pourraient être éliminées, mais les inégalités au niveau du statut d'immigration en matière de ces deux comportements subsisteraient probablement. CONCLUSION: Pour la répondre à la pandémie, il faut à la fois des initiatives de sécurité au travail, ainsi que des mécanismes visant à remédier à la répartition inéquitable des risques sanitaires entre les groupes socio-économiques pour réduire les inégalités plus larges en matière de risque de transmission.

Race, Flourishing, and All-Cause Mortality in the United States, 1995-2016.

We assessed whether race moderates the association between flourishing and all-cause mortality. We used panel data from the Midlife in the United States Study (MIDUS) (1995-2016; n = 2,851). Approximately 19% of White respondents and 23% of Black respondents in the baseline sample died over the course of the 21-year study period (n = 564). Cox proportional hazard models showed that Blacks had a higher mortality rate relative to Whites and higher levels of flourishing were associated with a lower mortality rate. Furthermore, a significant interaction between flourishing and race in predicting death was observed. Blacks with higher levels of flourishing had a mortality rate that was not significantly different from that of Whites. However, Blacks, but not Whites, with low flourishing scores had a higher mortality rate. As such, health-promotion efforts focused on enhancing flourishing among Black populations may reduce the Black-White gap in mortalityrate.

Scoping review of the World Health Organization's underlying equity discourses: apparent ambiguities, inadequacy, and contradictions.

BACKGROUND AND OBJECTIVE: Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications. ELIGIBILITY CRITERIA: Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded. SOURCES OF EVIDENCE: We focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search. RESULTS: Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice. CONCLUSIONS: Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.

Identifying gaps in COVID-19 health equity data reporting in Canada using a scorecard approach.

OBJECTIVE: To assess health equity-oriented COVID-19 reporting across Canadian provinces and territories, using a scorecard approach. METHODS: A scan was performed of provincial and territorial reporting of five data elements (cumulative totals of tests, cases, hospitalizations, deaths, and population size) across three units of aggregation (province or territory level, health regions, and local areas) (15 "overall" indicators), and for four vulnerable settings (long-term care and detention facilities, schools, and homeless shelters) and eight social markers (age, sex, immigration status, race/ethnicity, healthcare worker status, occupational sector, income, and education) (180 "equity-related" indicators) as of December 31, 2020. Per indicator, one point was awarded if case-delimited data were released, 0.7 points if only summary statistics were reported, and 0 if neither was provided. Results were presented using a scorecard approach. RESULTS: Overall, information was more complete for cases and deaths than for tests, hospitalizations, and population size denominators needed for rate estimation. Information provided on jurisdictions and their regions, overall, tended to be more available (average score of 58%, "D") than that for equity-related indicators (average score of 17%, "F"). Only British Columbia, Alberta, and Ontario provided case-delimited data, with Ontario and Alberta providing case information for local areas. No jurisdiction reported on outcomes according to patients' immigration status, race/ethnicity, income, or education. Though several provinces reported on cases in long-term care facilities, only Ontario and Quebec provided detailed information for detention facilities and schools, and only Ontario reported on cases within homeless shelters and across occupational sectors. CONCLUSION: One year into the pandemic, socially stratified reporting for COVID-19 outcomes remains sparse in Canada. However, several "best practices" in health equity-oriented reporting were observed and set a relevant precedent for all jurisdictions to follow for this pandemic and future ones.

RéSUMé: OBJECTIF: Évaluer les pratiques de déclaration des données de surveillance de la COVID-19 axée sur l'équité en matière de santé dans les provinces et territoires canadiens, en utilisant une fiche de pointage. MéTHODES: Les sites webs et rapports officiels des provinces et territoires ont été analysés pour identifier la présence de cinq éléments de données sur la COVID-19 (totaux cumulatifs des tests, cas, hospitalisations et décès ainsi que la taille de la population évaluée, nécessaire pour l'estimation de taux), déclarées au niveau de trois unités d'agrégation populationnelle (de la province/du territoire, des régions socio-sanitaires, et des localités/quartiers) (15 indicateurs de données « globales ¼); ainsi qu'au niveau de quatre milieux à risque d'éclosions (les établissements de soins de longue durée et de détention, les écoles, et les refuges pour personnes en situation d'itinérance) et de huit marqueurs sociaux (l'âge, le sexe, le statut d'immigration, la race/ethnicité, le statut de travailleur de santé, le revenu, le niveau d'éducation, et le secteur de travail) (180 indicateurs d'équité en matière de santé) à compter du 31 décembre 2020. Pour chaque indicateur, un point a été attribué si des données délimitées par cas ont été publiées, 0,7 points si seules les statistiques sommaires ont été communiquées, et 0 si aucune information n'a été fournie. Les résultats sont présentés sous la forme d'une fiche de pointage. RéSULTATS: Dans l'ensemble, les informations sur les cas et les décès étaient plus complètes que celles pour les tests, les hospitalisations et les tailles de population. Les éléments de données étaient plus disponibles au niveau global des provinces et territoires et de leurs régions socio-sanitaires (note moyenne de 58 % ou « D ¼) que pour les indicateurs liés à l'équité en matière de santé (note moyenne de 17 % ou « F ¼). Seuls la Colombie-Britannique, l'Alberta et l'Ontario ont fourni des données délimitées par cas, et seuls l'Alberta et l'Ontario ont fourni des données au niveau local. Aucune juridiction n'a fait état de données en fonction du statut d'immigration, de la race/l'ethnicité, du revenu ou du niveau d'éducation des patients. Plusieurs juridictions ont fourni des informations au sujet des cas au sein des établissements de soins de longue durée, mais seuls l'Ontario et le Québec ont fourni des informations détaillées au sujet des établissements de détention et des écoles. L'Ontario était unique en rapportant sur les cas par secteur occupationnel et pour les refuges pour les personnes en situation d'itinérance. CONCLUSION: Un an après le début de la pandémie, la disponibilité des données sur la COVID-19, stratifiées par marqueurs sociaux, reste très limitée au Canada. Cependant, plusieurs « bonnes pratiques ¼ en matière de déclaration axée sur l'équité en matière de santé ont été observées, ce qui constitue un précédent pertinent que les juridictions pourront suivre pendant cette pandémie et celles à venir.