Health Equity & Social Determinants of Health

health-equity-social-determinants-of-health, science-brief

| June 21, 2022

The Impact of Physical Activity on Mental Health Outcomes during the COVID-19 Pandemic

Increasing physical activity and decreasing sedentary behaviour have positive effects on mental well-being and are associated with reduced symptoms of depression and anxiety. These effects were well-established prior to the COVID-19 pandemic. Overall, movement behaviours and mental health status worsened among Canadians during the COVID-19 pandemic. Physical activity in some groups, including children, has been disproportionately affected during the pandemic by measures such as school and recreation closures. Further, a lack of safe, accessible physical activity opportunities for some populations will persist past the pandemic due to structural inequities such as inequities in access to indoor or outdoor recreation spaces, as well as built environment features, which may ultimately negatively impact mental health. Promoting physical activity can help optimize both physical and mental health among Ontarians during and beyond the COVID-19 pandemic. Maintaining and improving emotional well-being through engagement in physical activity may be facilitated by providing publicly accessible and proportionally distributed indoor and outdoor recreation spaces, as well as supporting policies which address the relationship between the built environment and physical activity.

health-equity-social-determinants-of-health, science-brief

| October 7, 2021

Burnout in Hospital-Based Healthcare Workers during COVID-19

Burnout is an occupational hazard in healthcare, which harms the healthcare system, patients, and healthcare workers. In the COVID-19 pandemic, burnout has increased to levels that pose a threat to maintaining a functioning healthcare workforce. Elevated burnout and other indicators of stress are anticipated to persist long after the pandemic. The COVID-19 pandemic has created a cycle of understaffing alongside difficult work conditions which can drive burnout. Robust interventions to bolster individuals, improve work environments and address health system drivers of burnout are important to maintain and support hospital-based healthcare workers. Interventions need to target those most at risk and affected by burnout: nurses, intensive care unit and emergency department staff, women, recent graduates and trainees. Interventions to reduce burnout need to be implemented at organizational and structural level of healthcare systems, complemented by intervention at the individual level. Further, leadership is a vital enabler to address burnout from organizational leaders and managers as well as policymakers. Organizations need to ensure adequate staffing through ongoing evaluation of workload including mitigation of data entry and administrative burdens, efforts to reduce overtime and avoid long shifts, and staff deployment in areas where they lack training. Approaches to mitigate, reduce and address burnout should be multi-faceted and include interventions to improve workplace conditions by fostering a supportive culture, relationships and leadership, as well as individual-level interventions (e.g., education, stress reduction tools, access support for moral distress).

health-equity-social-determinants-of-health, science-brief

| July 16, 2021

Ontario’s Community-Dwelling Older Adults Who Remain Unvaccinated Against COVID-19

COVID-19 vaccination rates among community-dwelling Ontarians aged 65 years and older are lowest in neighbourhoods at highest risk of SARS-CoV-2 infection, those that have the highest material deprivation, and those that are most ethnically diverse. Lower rates of vaccination were most pronounced among older adults who had no regular contact with a primary care physician. Between April 26, 2021 and June 7, 2021, Ontarians aged 80 years and older had the lowest increase in first dose vaccination among all eligible older adults in Ontario, suggesting that vaccination rates in this age group may have plateaued. Community-dwelling older adults remain at disproportionately high risk of hospitalization and death due to COVID-19, and efforts should be made to maximize vaccination in this population.

health-equity-social-determinants-of-health, science-brief

| June 8, 2021

COVID-19 Vaccination for People with Disabilities

Internationally, people with disabilities have been disproportionately impacted by COVID-19, accounting for nearly 60% of COVID-19 deaths in the UK and overall higher mortality rates based on social, clinical, and demographic factors. Ontario has prioritized people with disabilities across the three phases of its COVID-19 vaccination program, but there is a difference between availability and accessibility of vaccination. Ontario’s 34 public health units are responsible for leading the local distribution and administration of COVID-19 vaccines, and their public facing websites serve as entry points for information on the accessibility of vaccination. On average, these websites contain information about 5 of 18 key accessibility features, across three domains: accessible communication, physical accessibility, and accessible social and sensory environments. Ontario needs a multi-pronged strategy to reach all people with disabilities that includes improving information about communication accessibility, physical accessibility, and social and sensory environment accessibility throughout the COVID-19 vaccination journey. Ontario’s progress on vaccinating people with disabilities needs to also be measured through enhanced data monitoring efforts.

health-equity-social-determinants-of-health, science-brief

| April 23, 2021

A Vaccination Strategy for Ontario COVID-19 Hotspots and Essential Workers

Ontario’s initial mass COVID-19 vaccination strategy in place until April 8, 2021 was based on per-capita regional allocation of vaccines with subsequent distribution – in order of relative priority – by age, chronic health conditions and high-risk congregate care settings, COVID-19 hotspots, and essential worker status. Early analysis of Ontario’s COVID-19 vaccine rollout reveals inequities in vaccine coverage across the province, with residents of higher risk neighbourhoods being least likely get vaccinated. Accelerating the vaccination of COVID-19 hotspots and essential workers will prevent considerably more SARS-CoV-2 infections and COVID-19 hospitalizations, ICU admissions and deaths as compared with Ontario’s initial mass vaccination strategy (Figure 1).

health-equity-social-determinants-of-health, science-brief

| March 31, 2021

Mobile In-Home COVID-19 Vaccination of Ontario Homebound Older Adults by Neighbourhood Risk

Homebound individuals face substantial barriers to receiving COVID-19 vaccines as they cannot or rarely leave their homes because of medical, psychiatric, cognitive, functional, transportation-related and social reasons. There are at least 75,000 Ontarians aged 65 years and above who are homebound, with the majority being women and people aged 85 years and above. Much of this older homebound population requires mobile in-home COVID-19 vaccination, which could be prioritized by residence in high SARS-CoV-2 risk neighbourhoods.

health-equity-social-determinants-of-health, science-brief

| March 17, 2021

Mobile On-Site COVID-19 Vaccination of Naturally Occurring Retirement Communities by Neighbourhood Risk in Toronto

Naturally occurring retirement communities (NORCs) are apartment, condo, co-op and social housing buildings that while not purpose-built for older adults, have become home to a high number of them. In Toronto, there are 489 residential buildings that are NORCs. Of these, 256 are located in neighbourhoods with the highest cumulative incidence of SARS-CoV-2, and are home to 40,955 older adults 65 years of age and above, including 18,144 older adults 80 years of age and above. Prioritizing COVID-19 vaccination by both age and neighbourhood of residence is an effective strategy to minimize deaths, morbidity, and hospitalization. Targeting people living in NORCs in high-risk neighbourhoods for early vaccination is a practical application of that strategy, which will also address barriers to vaccination in this population.

health-equity-social-determinants-of-health, science-brief

| February 26, 2021

A Strategy for the Mass Distribution of COVID-19 Vaccines in Ontario Based on Age and Neighbourhood

SARS-CoV-2 infection has taken a disproportionate toll on Ontario older adults, and on residents of disadvantaged and racialized urban neighbourhoods throughout the province. Prioritizing and implementing vaccine distribution for Ontarians based on both age and neighbourhood of residence could ensure that those at the highest risk of SARS-CoV-2 infection, and hospitalization, ICU admission or death from COVID-19 will be among the first to receive vaccines. This vaccine strategy will maximize the prevention of deaths and long-term morbidity, and best maintain health care system capacity by reducing hospitalizations and ICU admissions due to COVID-19 as compared with a strategy that prioritizes vaccination based on age alone (Figure 1). The strategy would not interfere with the ongoing and future vaccination of any specific high-risk population, as it is intended to guide the mass distribution of vaccines to the general Ontario population.