Thread by @RitikaGoelTO

This is a must-read for all who care about equity and #sdoh in Toronto. The hardest hit neighbourhoods by #COVID19 are in the city's northwest, and second to this, in the east. #topoli

These are the same maps we've seen before - where the most poverty is, where the most racialized and particularly Black people are, where the most diabetes is, where the poorest transit access is, and now where the most #COVID19 is. #topoli #sdoh

But what are we in healthcare doing to address this? Previous excellent reporting by @WendyGlauser pointed out that in Toronto, the primary care providers are not where the need is. thelocal.to/why-arent-the-… #sdoh

I have for some time wondered whether our increased focus on catchments and geographical planning (while very important for serving your own community), perversely further marginalizes these communities that are 'healthcare deserts'. #sdoh #topoli

This is topical as we simultaneously in the public realm reckon with #COVID19 and discussions of systemic anti-Black racism. This is the theory in practice. Black neighbourhoods are the ones disproportionately impacted by COVID, and least likely to have health care. #sdoh

As outlined in the Star article, these neighbourhoods are disproportionately home to workers who could not work from home as prevention, stay home if sick or safely self-isolate if infected. #sdoh #COVID19

They also have more people living in poverty, new immigrants to Canada, racialized people and people with precarious immigration status. In summary, people least likely to have good jobs, with benefits, that protect their rights. This is how systemic racism works. #COVID19

We see similar disproportionate impacts of #COVID19 on migrant farm workers who are also racialized, immigrants, with congregate housing and poor jobs that don't protect their right to distance, stay home or isolate. Different realities for different communities. #sdoh

But for us in healthcare in Toronto who care about equity - how do we work to bridge this gap? Most of our large primary care teams, those associated with academic teaching units, are in the well-resourced area of the map. #sdoh #topoli #cdnhealth

If we are truly going to meet the needs of the whole community, we will have to define community more broadly, and bring together partners across the city to take an equity lens to health resources. Or else we only further marginalize the marginalized. #topoli #sdoh

We have to name the privilege among physicians which allows us to choose where we work and live more than most in our society, often further amplifying the existing inequities in services. We need representation from underserved communities who understand the needs. #sdoh #meded

And finally, we need to pay attention to what #COVID19 is showing us - that which has always existed, but now in the frenzy of the global pandemic, when everything in healthcare is about COVID, perhaps we can finally see who needs us most. #cdnhealth #medtwitter #sdoh