STRUCTURAL RACISM AND INCOME-RELATED HEALTH INEQUITIES IN THE ONTARIO GOVERNMENT AND ITS PUBLIC HEALTH UNITS' RESPONSE TO THE COVID-19 PANDEMIC

Early reports in Canada indicated that the health impacts of COVID-19 would be disproportionately worse for marginalized groups due to existing health inequities. While the federal, provincial, and territorial governments had extensive emergency powers at their disposal, the bulk of the pandemic response came from the provinces and territories. Despite warnings about the anticipated disparate impact of the pandemic, data from Ontario indicates that racialized populations and individuals in lowerincome households were the worst hit by the pandemic. This paper explores four aspects of the Ontario government and its 34 public health units' emergency response: (1) data collection on COVID-19 and health inequities, (2) administration of COVID-19 testing, (3) the provision of medical services to those with COVID-19, and (4) distribution of COVID-19 vaccines. For each of these four aspects of the Ontario government and its 34 public health units' response, we highlight central areas where structural racism and income-related health inequities were apparent. We acknowledge the significant practical barriers, such as lack of information and severe resource constraints, involved in pursuing health equity goals during the COVID-19 pandemic. However, for each of these areas, we recommend steps that could have been taken by the Ontario government and the public health units, in part through the province's emergency powers, to redress the disparate impact of the pandemic. We suggest that the Ontario government had a moral duty to combat these inequities, as well as a possible legal duty to do so in light of the Canadian Charter of Rights and Freedoms and certain international human rights obligations.