Anser Daud is a medical student at the University of Toronto who writes about health advocacy and human-rights issues.
It may not feel like it, but we remain in the early days of the coronavirus outbreak. In Canada, more than 30 new cases have emerged in March alone; in the world, there have been more than 110,000 people diagnosed with it, with more than 3,800 deaths. There is much that scientists still don’t know about COVID-19, including whether or not a vaccination is possible; it may take a year, if not more, before such a preventative measure could even be developed and distributed.
But while new research continues to expand experts’ understanding of the epidemic, there is a lesson that is more obvious if we take the time to notice it: Humanity’s health is collective, because humanity is so connected. The coronavirus has demonstrated that everyone’s well-being relies, at least to some extent, on everyone else’s; our health is only as safe as the worst cared-for, most vulnerable individuals in our society.
Viruses are not contained by geographic, social, economic or cultural borders; they travel freely through humanity. The most medically vulnerable among us – those with weakened immune systems, those with cancer, transplant patients, or the elderly – are at greatest risk, and we must work together to protect them. Because of this fact, only a truly comprehensive public health-care system can be an effective shield. This is, after all, the core concept of herd immunity, which undergirds the reasons we vaccinate: we cannot all be immune unless we all participate in the effort together.
It is essential that the world’s health systems and our social attitudes reflect this reality. In the New England Journal of Medicine, billionaire Bill Gates highlighted the fact that helping low- and middle-income countries in Africa and South Asia will slow the global circulation of coronavirus and save lives everywhere. He says vaccines and antivirals, when developed, must be available and affordable for people who are at the heart of such outbreaks. “Not only is such distribution the right thing to do," Mr. Gates writes, “it’s also the right strategy for short-circuiting transmission and preventing future pandemics.”
Take the example of a Miami man who returned from China and, feeling unwell, visited a hospital to get himself checked for the coronavirus. It turned out he did not have it – he had the flu – but he was subsequently billed US$3,270 for what was classified as a high-severity ER visit. It is not inconceivable that an uninsured individual would consider skipping a visit to the hospital to avoid such unbearable costs. The young and healthy may survive an infection from the coronavirus, but they might carry it to someone who wouldn’t.
In Canada, our system of universal health care makes such a scenario seem inconceivable. But truly universal health coverage isn’t quite what we have here. Under the Canada Health Act, our publicly-funded system is meant to be based on the principles of comprehensiveness (that necessary health services are insured), universality (that everyone is insured to the same level), portability (that a resident has coverage between provinces) and accessibility (that all persons have reasonable access to health-care services and facilities).
Yet, there are many factions of our population that are far behind in the standards of health care that they receive. Consider the Indigenous peoples in Canada, who are affected by major health problems at rates that are much higher than non-Indigenous populations. The disparities range from high rates of infant and maternal sickness, diabetes and hypertension, to diseases related to substance abuse, environmental contamination and heavy burdens around infectious disease.
And while Health Minister Patty Hajdu recently encouraged Canadians to stockpile food and medication in case they end up quarantined, that’s not meaningfully achievable for many. By some estimates, nearly 20 per cent of Canadians do not have adequate drug coverage and as a result cannot afford to stock up on medicine. Universal drug coverage may yet be on the way, but it is a glaringly missing piece in our universal health-care system; Canada remains the only high-income country with a universal health-care system that does not provide coverage of medically necessary prescription drugs.
For some people, the challenges extend beyond just inadequate access to care. Long have refugees and immigrants faced marginalization due to language and cultural differences. COVID-19 has yet again provided an opportunity for hate-mongers and racists to sow fear and divisiveness against those who look different from us, with the victims this time being Chinese and East Asian Canadians.
While neither health-insurance status nor positive social attitudes would prevent the spread of COVID-19, our interconnected health is eminently vulnerable to the spread of disease – which knows no class, culture, race or creed. Regardless of whether or not coronavirus persists, when it comes to health, we must understand that we’re greater than the sum of our individual parts – but less than we could be, if we ignore our weakest ones.
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