An unequal burden: The pandemic experiences of Latin Americans in Toronto

February 7, 2024

It is well documented that the pandemic not only highlighted but exacerbated existing inequalities. Low-income and racialized people bore a greater burden than others, experiencing higher rates of infections, hospitalizations and deaths.

A new study co-led by CMHA Toronto and Wellesley Institute shows that Spanish-speaking Latin Americans were hit particularly hard and had the second highest mortality rate among immigrant communities in Canada. Toronto’s Latin American population – three per cent of the city’s total – represented eight per cent of COVID-19 cases in the first year of the pandemic.

Among other concerning inequities, Latin Americans:

  • had a lower rate of vaccination than non-racialized residents in Ontario,
  • were over-represented in sectors that laid off employees or reduced work hours during the pandemic, and therefore experienced greater financial hardship,
  • were also over-represented in jobs designated as “essential services” (e.g., healthcare and food services, gig work, agriculture) and were at greater risk of contracting the virus,
  • reported poorer mental health than non-racialized Canadians, with significantly worsening self-reported mental health by Latin Americans compared to other racialized groups in Toronto throughout 2021 and into 2022.

The study sheds light on the factors contributing to these health inequities and provides a detailed picture of what supports and services are needed to reduce these disparities.

FOUR KEY THEMES

Assessing Health Inequities: Understanding the Impact of the COVID-19 pandemic on Toronto’s Spanish-Speaking Latin American Population found four significant challenges that the Latin American community in Toronto faced during the pandemic.

1. Caregiving

Caregivers' health and well-being were negatively affected during the pandemic. Caregivers faced increased demands, including greater domestic responsibilities, remote work obligations, and the need to provide emotional and mental health support to family members. These challenges were worsened by limited support and resources.

Physical distancing and lockdown measures took a great toll on caregivers, leading to heightened levels of stress, burnout, and exhaustion, all of which were compounded by feelings of social isolation.

While coping with loss and grief for family and friends who had passed away, many of the study’s participants also described feeling anxious about getting sick themselves, and the difficulties of feeling socially disconnected. One participant said, “It was very hard because during the time that I was taking care of my kids and also the time that I was sick, I was not able to go and see my mom. And I [usually] go see her every day in complex care. Taking care of other family members (my children who were affected by COVID and then myself) greatly impacted my ability to care for someone else.”

Informal, unpaid caregivers described the burden of balancing daily household and work tasks with caring for sick family members: “My tasks and working hours multiplied. Every time one of them used the bathroom, I washed the entire bathroom completely with everything, with disinfectant… and later one by one [they] got sick, first one, then two and three, until all four [were sick].”

The impact on survey participants’ mental health was profound. One participant described that when she went to the supermarket or shopping: “The [anxiety] attack started. I could not even enter the store because I knew I could not breathe. And it was very difficult, because I would [think] ‘I’m going to faint, I’m going to faint.’ I mean, you can’t control your feelings. Well, the truth is, I felt like I was going to die.”

Another said, “[I had] a lot of depression like I had never felt before in my life. Quite severe depression, I mean, suicidal thoughts and from there you can imagine.”

POLICY RECOMMENDATIONS
  • Greater support for caregivers, including financial resources, respite care and counselling services.
  • Address gender and other inequities in caregiving.

2. Online health and mental health services  

Mental health support was in short supply and, even where it was available, it was usually online. Many respondents faced technology, privacy, security, and language barriers when trying to access online mental health services and, for some, the affordability of devices and internet access was a problem.

Latin Americans who had to engage with virtual healthcare for the first time during the pandemic faced significant obstacles in navigating online platforms, and for those with language barriers it was even harder. One service provider explained: "It’s really hard to navigate because when you call a number, you don’t find answers. Then you have to call another place and then you’re just going around and around and it’s not a straightforward referral process. For some, it was really difficult to get access to mental health services... and the language barrier made it even worse.”

Another service provider commented on the lack of affordability or availability of devices for many clients: “Many of the patients did not have access to technology to connect virtually, whether it was a phone with a camera or a computer or a tablet. So, there were access barriers due to economic factors or a lack of knowledge on how to use the devices.”

POLICY RECOMMENDATIONS
  • Greater investment in internet access and digital devices to ensure equitable access to virtual care in underserved communities.
  • Digital equity-focused plans and training for healthcare providers.

3. Spanish-language services

Many Latin Americans found it difficult to access Spanish-language public health information and health services. This meant they had less information about how to better protect themselves from the virus. The lack of Spanish translation or interpretation services and few bilingual health and social service providers also resulted in delays in service access.

A survey respondent said, “I just feel that there was a lag in translating information for the Latin American community; a lot of it at the beginning was very heavily English based. And, if English isn’t your first language and you’re listening to the media, reading newspapers, you’re not getting all of the information or you’re getting it quite delayed or you’re relying on family members to tell you what is happening.”

Another respondent concurred: “People that I know who are Spanish speaking speak English as their second language. It was either they were living in fear because they didn’t think they had the right information or they weren’t abiding by any of the policies [because they didn’t trust the information they were able to get]. There was not really an in between.”

POLICY RECOMMENDATIONS
  • Increase availability of consistent, standardized language interpretation services in the healthcare system to ensure access to lifesaving information and services.
  • Greater investment in community-based networks that already have language capacity to increase access to translated materials and Spanish-language health services.

4. Immigration and insurance status

Latin Americans with precarious immigration status had an increased risk of contracting COVID-19 because many lived in crowded conditions, engaged in in-person work activities (such as those named essential service workers), and lacked paid sick days. Refugees without OHIP coverage were unable to get medical care, testing, and mental health care and for those with precarious immigration status, the fear of deportation or separation from their families created added anxiety that prevented access to life-saving services.

They also faced unique barriers accessing health services, such as a lack of awareness about their eligibility for coverage and a fear of deportation because of a lack of status. Many individuals delayed or avoided seeking medical attention due to these fears.

A survey respondent said, “I told the person who was taking care of me, ‘take me to the doctor’ and he said, ‘I can’t take you to the doctor because you don’t have insurance; how are they going to treat you?’ And I felt short of breath and it was choking me. I was getting weaker.... My only salvation was my roommate; he was the only one who supported me at the time. When I went to the health centre… they told me ‘you can wait at home.’ …I would have liked to attend a medical institution and receive medicine and the attention that I really needed at the time.”

Refugees ran into barriers in accessing healthcare services under the Interim Federal Health Program (IFHP), including being turned away from walk-in clinics and clinics themselves being unaware of their coverage eligibility. A respondent explained that “it’s complicated, because even when we go for an exam, an X-ray, or any procedure, if we show our brown [IFHP] form... [health providers] don’t like it because they tell us ‘you bring one of these forms, it’s more of a process for us… this takes longer.’”

POLICY RECOMMENDATIONS
  • Increase awareness among individuals and healthcare workers about programs and services available to refugees, non-insured residents, and marginalized groups including temporary workers.
  • Reinstate the Physician and Hospital Services for Uninsured Persons Program in Ontario.
  • Increase funding to community health and uninsured clinics serving these populations.
Although the pandemic is no longer in an emergency phase, many groups in Toronto continue to face inequities accessing health care and other social services. The barriers to accessing the social and economic determinants of health for low-income, racialized, and other marginalized groups have long-term consequences, not only on individuals’ own health and well-being but on public health throughout the GTA. It is imperative to address these vulnerabilities and inequities as we emerge from this pandemic – and well before we face another one.

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