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Canada’s health-care crisis is gendered: How the burden of care falls to women

Not only is the health sector feminized, but women — particularly racialized women — are more likely to be in jobs at the low end of the pay scale,…

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5 months ago

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Women — particularly racialized women — are more likely to be in positions at the lower end of the health sector's pay scale, that also require close and prolonged contact with patients. (Shutterstock)

As we enter cold, flu and COVID season, Canada is continuing to experience a health-care crisis. One in six Canadians don’t have a family doctor and less than 50 per cent are able to see a primary care provider on the same or next day. Both the B.C. Nurses Union and Hospital Employees Union report over one-third of their members are considering quitting, largely due to burnout.

Because women make up 75 per cent of the health-care workforce — and are responsible for the majority of care work in the community and at home — women bear the brunt of this crisis, much as they did during the COVID-19 pandemic.

Book cover 'Conscripted to Care: Women on the frontlines of the COVID-19 response'
‘Conscripted to Care: Women on the frontlines of the COVID-19 response’ compiles the stories of nearly 200 women. (McGill-Queen's University Press)

In 2020 and 2021, as co-lead of the Gender and COVID-19 Project based at Simon Fraser University, I spoke with nearly 200 women working on the frontlines of the COVID-19 response.

Their stories, compiled in my book Conscripted to Care, range from well-paid physicians to those making minimum wage cleaning rooms in long-term care (LTC) facilities, with participants identifying along a range of social positions related to factors including race, ethnicity and sexuality. Their combined experiences illustrate the cracks within our health system created by gender inequality.

Health care is built on women’s labour

A woman in personal protective equipment removing a face mask looking exhausted
Both the B.C. Nurses Union and Hospital Employees Union report over one-third of their members are considering quitting, largely due to burnout. (Shutterstock)

Not only is the health sector feminized, but women — particularly racialized women — are more likely to be in positions at the lower end of the pay scale, that also require close and prolonged contact with patients. When space, equipment and staff are scarce, these frontline workers are left to fill intractable gaps.

An LTC care aid described working under conditions so short staffed that some residents had missed several baths in a row:

“You feel bad because there are people, and this is their homes and their lives potentially, right. And they’re not getting the care that they need and so how I mean it always ends up coming back on us is we have to eventually just have to stop and find the energy or find the time — it eventually just catches up to us. The work just doesn’t disappear, we just don’t do it for that day.”

Such circumstances can lead to moral distress, the experience of being unable to provide ethically required care due to structural constraints. In a recent study we found 57 per cent of LTC workers surveyed were considering leaving their profession due to moral distress.

The care economy depends on women’s labour

A woman in scrubs and a face mask looking out a window with a furrowed brow
One physician described how, due to a nanny having to self-isolate, she was called away from surgery by her child’s school when he was ill. (Shutterstock)

The care economy is the paid and unpaid labour related to caregiving such as childcare, elder care and domestic chores.

Like health care, the care economy is primarily staffed by women. For example, in Canada, over 96 per cent of early childhood educators (ECEs) are women.

Jobs in the care economy tend to be poorly paid and valued. ECEs felt this distinction during the pandemic, noting they were rarely mentioned in celebrations of essential workers:

“You know, they’re clapping for the nurses, they’re clapping for all the essential workers, but they never mention us. Like, we’re taking care of your children and yet nobody’s clapping for us.”

The pandemic demonstrated how essential childcare was to a strong health-care workforce. A nurse I spoke to described how lack of access to childcare forced her to reduce her hours by 50 per cent, and a physician described how, due to a nanny having to self-isolate, she was called away from surgery by her child’s school when he was ill. Midwives describe leaving the field due to lack of childcare corresponding to shiftwork hours.

How the burden of care falls on women

Due to gender norms and roles, in Canada, women do 1.5 times more unpaid care work than men. This means that when formal health and care systems fails, the burden is most likely to fall on women.

A woman with her hand on a sick child's forehead
When formal health and care systems fails, the burden is most likely to fall on women. (Shutterstock)

For example, in 2020, a mother who had recently immigrated to Canada explained how her child suffered from severe anxiety, due to past experiences of violence, but had been receiving support at her daycare.

When the daycare closed due to COVID the child’s health deteriorated to the point she was vomiting due to stress. The mother called the nurses’ line and was told to keep her child home due to fear of COVID infection at the hospital, and so was left to care for her sick and distressed child alone.

A single mother and community health worker explained how she struggled to balance the needs of those she cared for at work and at home during the pandemic.

“I’m a single mom. This is how I show up in the world, it’s a huge part of how I identify. There’s a lot of things that have to be done because there is no other choice. I have tiny humans to keep alive and try to keep their mental health OK through a pretty earth-shaking experience. I mean if nobody else is going to show up, you can pretty much count on the mom. She will show up and that is beautiful and wonderful, but also heavily fucking exploited.”

Addressing gender inequality

Health-care workers pushing a gurner in a hospital corridor
The crisis is felt most acutely by frontline staff, the majority of whom are women. (Shutterstock)

While pandemic restrictions exacerbated weaknesses within the health and care system, the knock-on effects continue with the current crisis and are felt most acutely by frontline staff — the majority of whom are women. This leads to increased risk of moral distress and burnout, which in turn fuels the crisis.

Policy responses can interrupt this vicious cycle through increased investments in the care economy and increasing mental health services for those providing care.

Improved working conditions — including flexibility, pay and benefits — in feminized health and care sectors would empower those providing care to be able do their best. After all, it is these women we all rely upon.

The Conversation

Julia Smith receives funding from Health Research BC and the Canadian Institutes for Health Research

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Mathematicians use AI to identify emerging COVID-19 variants

Scientists at The Universities of Manchester and Oxford have developed an AI framework that can identify and track new and concerning COVID-19 variants…

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2 hours ago

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March 11, 2024

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Scientists at The Universities of Manchester and Oxford have developed an AI framework that can identify and track new and concerning COVID-19 variants and could help with other infections in the future.

Credit: source: https://phil.cdc.gov/Details.aspx?pid=23312

Scientists at The Universities of Manchester and Oxford have developed an AI framework that can identify and track new and concerning COVID-19 variants and could help with other infections in the future.

The framework combines dimension reduction techniques and a new explainable clustering algorithm called CLASSIX, developed by mathematicians at The University of Manchester. This enables the quick identification of groups of viral genomes that might present a risk in the future from huge volumes of data.

The study, presented this week in the journal PNAS, could support traditional methods of tracking viral evolution, such as phylogenetic analysis, which currently require extensive manual curation.

Roberto Cahuantzi, a researcher at The University of Manchester and first and corresponding author of the paper, said: “Since the emergence of COVID-19, we have seen multiple waves of new variants, heightened transmissibility, evasion of immune responses, and increased severity of illness.

“Scientists are now intensifying efforts to pinpoint these worrying new variants, such as alpha, delta and omicron, at the earliest stages of their emergence. If we can find a way to do this quickly and efficiently, it will enable us to be more proactive in our response, such as tailored vaccine development and may even enable us to eliminate the variants before they become established.”

Like many other RNA viruses, COVID-19 has a high mutation rate and short time between generations meaning it evolves extremely rapidly. This means identifying new strains that are likely to be problematic in the future requires considerable effort.

Currently, there are almost 16 million sequences available on the GISAID database (the Global Initiative on Sharing All Influenza Data), which provides access to genomic data of influenza viruses.

Mapping the evolution and history of all COVID-19 genomes from this data is currently done using extremely large amounts of computer and human time.

The described method allows automation of such tasks. The researchers processed 5.7 million high-coverage sequences in only one to two days on a standard modern laptop; this would not be possible for existing methods, putting identification of concerning pathogen strains in the hands of more researchers due to reduced resource needs.

Thomas House, Professor of Mathematical Sciences at The University of Manchester, said: “The unprecedented amount of genetic data generated during the pandemic demands improvements to our methods to analyse it thoroughly. The data is continuing to grow rapidly but without showing a benefit to curating this data, there is a risk that it will be removed or deleted.

“We know that human expert time is limited, so our approach should not replace the work of humans all together but work alongside them to enable the job to be done much quicker and free our experts for other vital developments.”

The proposed method works by breaking down genetic sequences of the COVID-19 virus into smaller “words” (called 3-mers) represented as numbers by counting them. Then, it groups similar sequences together based on their word patterns using machine learning techniques.

Stefan Güttel, Professor of Applied Mathematics at the University of Manchester, said: “The clustering algorithm CLASSIX we developed is much less computationally demanding than traditional methods and is fully explainable, meaning that it provides textual and visual explanations of the computed clusters.”

Roberto Cahuantzi added: “Our analysis serves as a proof of concept, demonstrating the potential use of machine learning methods as an alert tool for the early discovery of emerging major variants without relying on the need to generate phylogenies.

“Whilst phylogenetics remains the ‘gold standard’ for understanding the viral ancestry, these machine learning methods can accommodate several orders of magnitude more sequences than the current phylogenetic methods and at a low computational cost.”

Journal

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2317284121

Article Title

Unsupervised identification of significant lineages of SARS-CoV-2 through scalable machine learning methods

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There will soon be one million seats on this popular Amtrak route

“More people are taking the train than ever before,” says Amtrak’s Executive Vice President.

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March 11, 2024

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While the size of the United States makes it hard for it to compete with the inter-city train access available in places like Japan and many European countries, Amtrak trains are a very popular transportation option in certain pockets of the country — so much so that the country’s national railway company is expanding its Northeast Corridor by more than one million seats.

Related: This is what it's like to take a 19-hour train from New York to Chicago

Running from Boston all the way south to Washington, D.C., the route is one of the most popular as it passes through the most densely populated part of the country and serves as a commuter train for those who need to go between East Coast cities such as New York and Philadelphia for business.

Veronika Bondarenko captured this photo of New York’s Moynihan Train Hall. 

Veronika Bondarenko

Amtrak launches new routes, promises travelers ‘additional travel options’

Earlier this month, Amtrak announced that it was adding four additional Northeastern routes to its schedule — two more routes between New York’s Penn Station and Union Station in Washington, D.C. on the weekend, a new early-morning weekday route between New York and Philadelphia’s William H. Gray III 30th Street Station and a weekend route between Philadelphia and Boston’s South Station.

More Travel:

According to Amtrak, these additions will increase Northeast Corridor’s service by 20% on the weekdays and 10% on the weekends for a total of one million additional seats when counted by how many will ride the corridor over the year.

“More people are taking the train than ever before and we’re proud to offer our customers additional travel options when they ride with us on the Northeast Regional,” Amtrak Executive Vice President and Chief Commercial Officer Eliot Hamlisch said in a statement on the new routes. “The Northeast Regional gets you where you want to go comfortably, conveniently and sustainably as you breeze past traffic on I-95 for a more enjoyable travel experience.”

Here are some of the other Amtrak changes you can expect to see

Amtrak also said that, in the 2023 financial year, the Northeast Corridor had nearly 9.2 million riders — 8% more than it had pre-pandemic and a 29% increase from 2022. The higher demand, particularly during both off-peak hours and the time when many business travelers use to get to work, is pushing Amtrak to invest into this corridor in particular.

To reach more customers, Amtrak has also made several changes to both its routes and pricing system. In the fall of 2023, it introduced a type of new “Night Owl Fare” — if traveling during very late or very early hours, one can go between cities like New York and Philadelphia or Philadelphia and Washington. D.C. for $5 to $15.

As travel on the same routes during peak hours can reach as much as $300, this was a deliberate move to reach those who have the flexibility of time and might have otherwise preferred more affordable methods of transportation such as the bus. After seeing strong uptake, Amtrak added this type of fare to more Boston routes.

The largest distances, such as the ones between Boston and New York or New York and Washington, are available at the lowest rate for $20.

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International

The next pandemic? It’s already here for Earth’s wildlife

Bird flu is decimating species already threatened by climate change and habitat loss.

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3 hours ago

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March 11, 2024

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I am a conservation biologist who studies emerging infectious diseases. When people ask me what I think the next pandemic will be I often say that we are in the midst of one – it’s just afflicting a great many species more than ours.

I am referring to the highly pathogenic strain of avian influenza H5N1 (HPAI H5N1), otherwise known as bird flu, which has killed millions of birds and unknown numbers of mammals, particularly during the past three years.

This is the strain that emerged in domestic geese in China in 1997 and quickly jumped to humans in south-east Asia with a mortality rate of around 40-50%. My research group encountered the virus when it killed a mammal, an endangered Owston’s palm civet, in a captive breeding programme in Cuc Phuong National Park Vietnam in 2005.

How these animals caught bird flu was never confirmed. Their diet is mainly earthworms, so they had not been infected by eating diseased poultry like many captive tigers in the region.

This discovery prompted us to collate all confirmed reports of fatal infection with bird flu to assess just how broad a threat to wildlife this virus might pose.

This is how a newly discovered virus in Chinese poultry came to threaten so much of the world’s biodiversity.

H5N1 originated on a Chinese poultry farm in 1997. ChameleonsEye/Shutterstock

The first signs

Until December 2005, most confirmed infections had been found in a few zoos and rescue centres in Thailand and Cambodia. Our analysis in 2006 showed that nearly half (48%) of all the different groups of birds (known to taxonomists as “orders”) contained a species in which a fatal infection of bird flu had been reported. These 13 orders comprised 84% of all bird species.

We reasoned 20 years ago that the strains of H5N1 circulating were probably highly pathogenic to all bird orders. We also showed that the list of confirmed infected species included those that were globally threatened and that important habitats, such as Vietnam’s Mekong delta, lay close to reported poultry outbreaks.

Mammals known to be susceptible to bird flu during the early 2000s included primates, rodents, pigs and rabbits. Large carnivores such as Bengal tigers and clouded leopards were reported to have been killed, as well as domestic cats.

Our 2006 paper showed the ease with which this virus crossed species barriers and suggested it might one day produce a pandemic-scale threat to global biodiversity.

Unfortunately, our warnings were correct.

A roving sickness

Two decades on, bird flu is killing species from the high Arctic to mainland Antarctica.

In the past couple of years, bird flu has spread rapidly across Europe and infiltrated North and South America, killing millions of poultry and a variety of bird and mammal species. A recent paper found that 26 countries have reported at least 48 mammal species that have died from the virus since 2020, when the latest increase in reported infections started.

Not even the ocean is safe. Since 2020, 13 species of aquatic mammal have succumbed, including American sea lions, porpoises and dolphins, often dying in their thousands in South America. A wide range of scavenging and predatory mammals that live on land are now also confirmed to be susceptible, including mountain lions, lynx, brown, black and polar bears.

The UK alone has lost over 75% of its great skuas and seen a 25% decline in northern gannets. Recent declines in sandwich terns (35%) and common terns (42%) were also largely driven by the virus.

Scientists haven’t managed to completely sequence the virus in all affected species. Research and continuous surveillance could tell us how adaptable it ultimately becomes, and whether it can jump to even more species. We know it can already infect humans – one or more genetic mutations may make it more infectious.

At the crossroads

Between January 1 2003 and December 21 2023, 882 cases of human infection with the H5N1 virus were reported from 23 countries, of which 461 (52%) were fatal.

Of these fatal cases, more than half were in Vietnam, China, Cambodia and Laos. Poultry-to-human infections were first recorded in Cambodia in December 2003. Intermittent cases were reported until 2014, followed by a gap until 2023, yielding 41 deaths from 64 cases. The subtype of H5N1 virus responsible has been detected in poultry in Cambodia since 2014. In the early 2000s, the H5N1 virus circulating had a high human mortality rate, so it is worrying that we are now starting to see people dying after contact with poultry again.

It’s not just H5 subtypes of bird flu that concern humans. The H10N1 virus was originally isolated from wild birds in South Korea, but has also been reported in samples from China and Mongolia.

Recent research found that these particular virus subtypes may be able to jump to humans after they were found to be pathogenic in laboratory mice and ferrets. The first person who was confirmed to be infected with H10N5 died in China on January 27 2024, but this patient was also suffering from seasonal flu (H3N2). They had been exposed to live poultry which also tested positive for H10N5.

Species already threatened with extinction are among those which have died due to bird flu in the past three years. The first deaths from the virus in mainland Antarctica have just been confirmed in skuas, highlighting a looming threat to penguin colonies whose eggs and chicks skuas prey on. Humboldt penguins have already been killed by the virus in Chile.

A colony of king penguins.
Remote penguin colonies are already threatened by climate change. AndreAnita/Shutterstock

How can we stem this tsunami of H5N1 and other avian influenzas? Completely overhaul poultry production on a global scale. Make farms self-sufficient in rearing eggs and chicks instead of exporting them internationally. The trend towards megafarms containing over a million birds must be stopped in its tracks.

To prevent the worst outcomes for this virus, we must revisit its primary source: the incubator of intensive poultry farms.

Diana Bell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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