I often hear friends and family say, “I can’t wait until we go back to normal.” Although I understand the sentiment behind this very popular phrase being used at the moment, it has me thinking, “What was normal to begin with?”

This past year has been challenging to say the least, but it has also forced me to reflect on the state of our society prior to the pandemic. On the surface, one could say that COVID-19 has forced everyone to change the manner in which they go about their daily lives. 

However, this pandemic has not only elicited lifestyle changes. It has also further reinforced what many scholars and academics have been expressing for so long: the need to directly address the social conditions that determine health outcomes. 

I am a Master of Public Health (MPH) student at the Dalla Lana School of Public Health and a member of the Infectious Disease Working Group, a coalition of MPH graduates and students working to explain COVID-19-related research. In the past year, my colleagues and I have seen far too many examples of how social inequities can increase vulnerability to COVID-19.

When we wish for things to go back to normal, we have to recognize that for many people, ‘normal’ was never good enough. 

Why social determinants of health matter 

Not everything that impacts our health is biological. So-called social determinants of health — comprising all the environmental and socioeconomic factors that shape the way we live, like income and education — play a large role in our overall health. 

Upstream public health policies directly aim at these factors and try to improve them, as opposed to downstream policies, which aim to mitigate social determinants without necessarily fixing them. 

Throughout the pandemic, many academics and health care professionals have continued to push for upstream solutions when developing policies and methods of deterring the spread of COVID-19. 

The argument for upstream solutions was already well-established. Even in the 1990s, researchers were aware of the crucial need to shift focus from individualistic causes of disease to the overarching social determinants of health in order to attain health reform to its fullest capacity.  

Epidemiologist Arjumand Siddiqi has exhibited through her work the various ways in which health inequities have continued to grow — despite the existence of various public health promotion programs. Writing in the Toronto Star, she called this a consequence of the failure to address the social conditions that make people vulnerable to disease.

The clear boundary lines of disease

One social determinant that we see consistently in the spread of COVID-19 is socioeconomic status.

The connection between income and disease burden has been both well-studied and documented. And yet, there has been a lack of efforts made to protect individuals with a low-income background from the risk of COVID-19, illustrating the numerous ways in which we continue to fail in establishing effective interventions and policies. 

Research continues to illustrate the differential manner through which COVID-19 impacts low-income communities that were already struggling with inequities prior to the pandemic. 

In Toronto, the most impacted neighbourhoods include Humbermede, Humber Summit, and Scarborough Village. Many of the most impacted neighborhoods also happen to be designated Neighborhood Improvement Areas. Evidently, this pandemic continues to highlight the ways in which our current system fails to counter the effects of health inequities. It continues to showcase the ways in which income contributes to the differential spread of disease.

It is no shock that those most impacted by COVID-19 are individuals from a lower income background. Research has shown trends of a growing association between socioeconomic status and premature mortality — trends that will continue with Canada’s increasing wealth disparity.

We need a new normal 

Inequities exist not only in the spread of COVID-19 but also in terms of who can truly adhere to the public health guidelines. For many individuals living in multigenerational homes, those experiencing homelessness, those living in communities with boiling water advisories, and those in various other situations that prevent them from being able to protect themselves and their family members, being able to follow certain public health guidelines is a privilege. 

For example, one can only wash their hands and abide by these guidelines if they are privileged with access to clean water, which many Indigenous communities have not had during this pandemic. 

In the end, I don’t think we have the option of ever going back to ‘normal’ because it is clear that the normal that existed prior to this pandemic was never good enough to begin with.

Although I don’t wish to chastise anyone for wishing so, I do hope that — with the information and knowledge surrounding the impact of COVID-19 — people begin to ask questions about how we let this happen.

How did we know that social inequities drive disease spread yet fail those who were already anticipated to be the most affected? How can we facilitate effective change going forward?