Moving to Vancouver from Edmonton, one of my first impressions was about the obvious divide between rich and poor. One only has to walk from Yaletown to the downtown eastside to register this disparity. Researchers who have studied rising neighbourhood inequality over time in Canada find there has been a significant rise in inequality in Vancouver over time (as in Toronto and other major cities). The percentage of low-income individuals (more than 20% below average) in Vancouver grew from 10% in 1970 to 29% in 2015.[1] Over the same period, the percentage of high-income individuals grew from 12% to 20%. At the same time, low-income people are being displaced, with middle-class gentrification “nibbling around the edges of the traditionally low-income inner city neighbourhoods, including the downtown eastside, Gastown, Chinatown, Strathcona, Grandview-Woodland and Mount Pleasant.”[2]
In Vancouver’s downtown eastside (DTES), the COVID-19 crisis is layered on top of an overdose epidemic that has been going on for years. More than 5,000 people in BC died as a result of illicit drug toxicity between 2016 and 2019.[3] Addiction is a health emergency, and is related to other social vulnerability factors.
The level of homelessness and insecure housing in the DTES community has required quick action with the arrival of the pandemic. As Richardson writes, “How can you wash your hands frequently if you don’t have access to a sink in your room or don’t have shelter at all? How do you stay two metres away from people when you live in extremely close quarters?”[4]
The city responded by converting Coal Harbour Community Centre and Roundhouse Community Centres into housing for homeless people. Meanwhile, the province has committed to moving people in Oppenheimer Park into temporary housing by May 9th.[5] It remains to be seen whether this is sufficient to address both crises.
Advocates hope that low income residents in the DTES and other parts of Vancouver will be eligible for federal COVID-19 benefits, and the provincial government has announced an increase in income assistance for individuals not eligible for these benefits. But lack of digital access to information and help with completing applications (e.g., from librarians, adult English Second Language and literacy educators, and settlement workers whose offices are now closed) introduces additional barriers for low-income people.[6] The loss of Chinatown businesses in the downtown eastside between 2009 and 2015 partly because of gentrification[7] may also be exacerbated by COVID-19.
The pandemic has shone a spotlight on “wicked” issues that are longstanding—poverty, racism, homelessness, and addiction. How does Canada compare with other countries in terms of income inequality? The Gini coefficient is a statistical measure of the distribution of income or wealth within a population. Comparisons of this measure across OECD countries for 2014-15 suggest Canada is below Nordic and Western European countries, and is slightly above the OECD average in terms of income inequality.[8]
So, what is to be done? Interestingly, the pandemic has opened up conversations about guaranteed income support and basic income. NDP leader Jagmeet Singh recently called for Universal Basic Income program to be introduced, and researchers like Diane Pohler (University of Toronto) have proposed a Targeted Basic Income program.[9] In a recent article, Pohler and colleagues write,
“A targeted basic income is a feasible, efficient, and equitable option for addressing income precarity during the ongoing health pandemic. It would provide a direct economic stimulus by putting money into the hands of the people most likely to spend it, and more importantly, into the hands of those most likely to need it. And once the pandemic is over, we can discuss how to make the policy permanent. As Canadians will increasingly come to understand, people can fall into poverty through no fault of their own.”[10]
A different approach to drug use is also necessary. If addiction is seen as an illness, then access to health services, access to safe supply, and decriminalization of drugs for personal use are all part of this new approach. The people most affected by this health crisis are doubtless in the best position to contribute to solutions, like many social problems. [11]
Questions related to the displacement of low-income residents and Chinese seniors in the downtown eastside are also important to keep on the table as the effects of the pandemic reside. If we don’t want a return to a society where some members are seen as disposable, actions need to be taken now.
[11] For more information about the opioid crisis from the perspective of drug users, see podcast “Crackdown” about drugs, drug policy and the drug war led by drug user activists in Vancouver: https://crackdownpod.com/
As we enter the second month of social-distancing and self-isolation, and as curves ‘flatten’ in some parts of Canada, there’s speculation about how our communities will ‘get back to normal.’ It’s a good time, therefore, to reflect on what parts of ‘normal’ life are not worth reviving post-COVID 19 and what issues in higher education give pause for thought.
The pandemic has brought to light, for greater numbers of people,[2] the cracks in our social systems. Notably, it has brought into sharp relief the flaws in societal supports for the elderly and those living in poverty. At the same time, it has diverted public attention from the failure of governments, corporations, and individuals to respond to climate emergency. This 4-part series of blog posts addresses these cracks and what is to be done, before turning to thoughts about higher education stemming from my current research.
The fact that almost three-quarters of the deaths due to COVID-19 in Ontario have been in long term care facilities[3] is unsurprising. For some time, advocates have been calling for change as they document the effects of marketization policies on nursing homes across the country.[4] In 2013, for example, over half of Long-Term Care facilities in Ontario were for-profit.[5] In Vancouver, fees for private long-term care beds are often double those of public beds, based on my investigations. Reliance on private providers means that access to care is increasingly based on income. The number of public beds has not kept up with the demand and wait lists are long. In Ontario, for example, my family waited over two years (mid-2017 to early 2020) for my mother to be offered a bed in a local facility.
Tight provincial funding also means that staffing in nursing homes is bare bones and the staff mix is heavily weighted toward the cheapest staff. Racialized women are over-represented at the bottom of this health care hierarchy, often working as health care aides or personal support workers in challenging working conditions for low wages across different worksites. Because the number of care hours per resident is limited by tight budgets, it’s common for families who can afford it to buy extra help from personal companions.
So, what is to be done? Canadian researchers refer to models from Europe. Norway, Sweden, and Germany which, while also affected by marketization, seem to have been more resistant to the intensification of work in healthcare.[6] This research suggests that staffing levels in nursing homes are higher in Denmark and working conditions for care aides in Nordic countries are better overall.[7] Improved working conditions, in particular, a shared philosophy of care, interdisciplinary support, thoughtfulness about the physical environment, and support from leaders are among the factors likely to improve “person-centred” care[8] in residental care units. Accountability mechanisms that move from task-centred care toward person-centred care are desirable.[9]
Canadian society also needs to reconsider our cultural attitudes towards the elderly, in my opinion.[10] For example, a recent article about end-of- life care in Hong Kong suggests that the institutionalization and medicalization of death have alienated elders and families as they try to serve and care for each other within residential care contexts. Authors call for institutional changes that enable Chinese elders to die with “social dignity.” [11]
Similarly, research with Indigenous elders in First Nations communities on memory loss and memory care highlights the importance of intergenerational relationships and high esteem for Elders in culturally sensitive approaches to care.[12] I think that such research, which is “with” not “on” elderly community members, provides additional models for improving person- and community-centred care.
[1] Writing this series of blog posts provided a welcome opportunity for me to muse on topics related to the personal and political. Comments are welcome.
[2] The cracks were already apparent for many who work in these systems.
[4] See, for example, work by researchers Armstrong et al. Caring for seniors the neoliberal way, in M. Thomas et al. (2019), Change and continuity; Daly (2015), Dancing the two-step in Ontario’s long-term care sector, Studies in Political Economy, 95; MacDonald (2015), Regulating individual charges for long-term residential care in Canada, Studies in Political Economy, 95.
[5] See CIHI. Residential Long-Term Care Financial Data Tables, 2013.
[8] See, for example, Sjögren, K., Lindkvist, M., Sandman, P., Zingmark, K., Edvardsson, D. (2017), Organisational and environmental characteristics of residential aged care units providing highly person-centred care, BMC Nursing, 16(1), 44-9.
[10] See, for example, Sokolovsky, J. (2009) (3rd ed.), The cultural context of aging: worldwide perspectives, Westport: Praeger.
[11] For example, see article about Kong, S. T., Fang, C. M. S., & Lou, V. W. (2017), Organizational capacities for ‘residential care homes for the elderly’ to provide culturally appropriate end-of-life care for Chinese elders and their families. Journal of aging studies, 40, 1-7.
[12] Also, see: Hulko, W., Camille, E., Antifeau, E., Arnouse, M., Bachynski, N., & Taylor, D. (2010), Views of First Nation elders on memory loss and memory care in later life. Journal of Cross-Cultural Gerontology, 25(4), 317-342.
I write this series of blog posts as the Covid-19 pandemic moves into its third month and in response to media stories about “when things get back to normal.” It strikes me that the pandemic has shown us some of the cracks in systems; if taken seriously, it could spark fruitful discussion about what needs to change in our society.
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