The pandemic exposed Montreal's inequalities, and residents say it's time to tackle root causes

What was long suspected was quietly confirmed last month: Montrealers who live in the city's poorest neighbourhoods were more likely to die from COVID-19 at the height of the pandemic.

Now community organizers and experts are turning to how to best address the underlying issues that contributed to the disproportionate impact of the pandemic on the city's lower income, more racialized neighbourhoods.

"It really sheds light on the fact that social inequalities here since long before the pandemic are still here and need to be addressed," said Véronique Nadeau-Grenier, the lead researcher on the study conducted by Montreal public health.

The study, released Oct. 13, found a clear correlation between a neighbourhood's material advantages — a metric which includes education and income levels — and COVID-19 mortality rates.

The public health agency recommended a multitude of changes to address the underlying disparity in the city.

Some of them can be addressed by the City of Montreal, which is set to hold its municipal election Nov. 6 and 7, and others are more complex issues that involve several levels of government.

They include an increase in pay for low-wage workers and the fostering of more stable workplaces (movement between healthcare workplaces was an early contributor to the spread of COVID-19 in Quebec), increase to the availability of affordable quality housing and improved access to social and health services in disadvantaged areas.  

The findings underscore those laid out in a CBC News analysis last year after the city's first wave. 

Vulnerable populations, such as people living in low-income households, with precarious employment and in underprivileged neighbourhoods, represented both the most cases and deaths linked to COVID-19.

On average, underprivileged neighbourhoods had twice the number of cases and deaths than more affluent ones. 

Marjorie Villefranche, the head of Maison d'Haiti, a community organization in Montréal-Nord, said the numbers confirm what she has been saying for more than a year. 

"We kept saying it and no one was listening," she said. Villefranche said the pandemic highlighted the lack of services in the area. 

Montréal-Nord, the report found, has the highest mortality rate of any sector: three times higher than some parts of the West Island. 

The borough also has the highest per capita case count in the city: 12,079 cases per 100,000 people, as of Oct. 28.

Parole d'excluEs and Hoodstock, both of which have been calling for more research on pandemic impacts, released their own survey of residents. The report found a gap in health and mental health services, and the need for improved communication with residents.

"What all this highlights is that there needs to be a massive investment for community-based organizations in these poorer neighbourhoods that would lead to better access to health care and social services," said Olivier Bonnet, head of Parole d'excluEs.

Mabel Carabali, an assistant professor in the department of social and preventative medicine at University of Montreal, who holds adjunct position at the Dalla Lana School of Public Health at the University of Toronto, said such dynamics are visible in many cities. 

She said the underlying issues have been "neglected for too long" and they need to be put under the microscope long after the municipal election cycle. 

In Montreal, the disparity played out during the first three waves of COVID-19. By the summer of 2021, according to the report, the disparity had subsided with the spread of COVID-19 on the decline.

Nicholas King, a professor at McGill University who conducts research in public health ethics and policy, said it would be useful to dig deeper into the causes of that levelling off.

"That may give us some clues for us intervening in the future to try to reduce inequalities in health," he said. 

In the meantime, he said the government should commit to more quickly and consistently reporting on health and social inequality.

King touted community groups in the province for stepping up and into the breach by producing the data themselves when they noticed the lag.

He said while experts and governments rely on public health authorities to understand what should be done next, community groups can benefit from the data themselves. 

"Often some of the most effective interventions against inequalities are bottom up."