Video - Structural Economic and Lasting Social Changes: Enduring Impact of COVID-19 on the Health of Canadians

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Structural Economic and Lasting Social Changes: Enduring Impact of COVID-19 on the Health of Canadians - Video transcript

(The Statistics Canada symbol and Canada wordmark appear on screen with the title: "Structural Economic and Lasting Social Changes: Enduring Impact of COVID-19 on the Health of Canadians. A proposed framework to track an evolving health landscape in Canada. Statistics Canada - December 2022")

The COVID-19 pandemic has caused many structural, economic and lasting social changes. In the presentation today we're going to talk about the enduring impact of the COVID-19 pandemic on the health of Canadians.

The COVID-19 pandemic has caused a shift in the way we think about health data and analysis at Statistics Canada.

This presentation will discuss three points: 1) Tracking the impact of the pandemic on health requires short and long-term thinking.

2) In this presentation, you will learn about how Statistics Canada has been responsive to evolving health data needs through the identification of research priorities, development of new survey content, making projections into the future and producing new dissemination products to reach more Canadians.

3) Finally, this presentation will discuss next steps for Statistics Canada.

It goes without saying that a lot has changed in the past 2 years. This slide captures only a few examples:

We have seen changes to health care including a pivot to telemedicine, challenges in the long-term care sector and health care worker burnout.

The pandemic has been a challenging time for Canadians and declines in mental health have been observed. As of March 2022, the percentage of Canadians reporting very good or excellent mental health has still not returned to pre-pandemic levels. Further, mental health difficulties are not solved overnight and we expect to see lingering effects of the pandemic on mental health for years to come.

The COVID-19 pandemic caused a temporary shift to teleworking for many Canadians. Some Canadians have since returned to the office while others will continue to work from home into the future. This shift in work location led to some migration out of urban areas. It is unclear how these trends will evolve in the future.

The pandemic has put a spotlight on inequalities in society. Specific groups were impacted more during the pandemic because of the type of job they had, where they lived, whether they had kids at home, their income, education, ethnicity/race or Indigenous identity.

Throughout the pandemic, Canadians faced a constant stream of information related to the virus, vaccines and public health restrictions. Filtering such a large volume of information is and will continue to be a challenge for all Canadians.

Teleworking is an example of how a change in the way we work impacts so many different aspects of our lives.

Where we work impacts many things: how much we use public transit, how often we eat at restaurants, how active we are and our likelihood to need or want to buy cars and fancy clothes to go to the office. We cannot ignore the red arrows here as everyone responds differently to these new ways of living and working.

Onscreen: (red arrows are showing both up and down directions).

But the key point here is a need to understand how these decisions will ultimately impact our health, the economy, the environment and how we connect with one another.

This was posted to Twitter by Dr.Victor Tseng? in March 2020 with the goal of projecting the possible health footprint of the pandemic from 2020 and 2022.

Onscreen: (The x-axis along the bottom depicts time in years from 2020 to 2022).

As we near the end of 2022 we can see that this projection made early in the pandemic was quite accurate. The health footprint can be thought of as the impact of the pandemic on the health care system as well as on the lives of Canadians.

Onscreen: (The health footprint and is depicted on the y-axis (vertical axis). There is no value on health footprint as it is simply a conceptual graph figure).

Onscreen: (A purple line spikes high on the health footprint scale in early 2020, drops quickly but then has a smaller spike in late 2020).

The purple line depicts the immediate morbidity and mortality at the onset of the pandemic in 2020. The additional bump you see later on reflects the reality that many people who ended up in the ICU with COVID required follow-up care later on.

Onscreen: (A green line spikes about halfway up the health footprint scale in late 2020).

The green line depicts the challenges faced by those with non-COVID health conditions when so many healthcare resources were re-directed to COVID-19 patients.

Onscreen: (A blue line spikes about a quarter of the way up the health footprint scale in early 2021).

Similarly, the blue line depicts issues faced by Canadians with long-term or chronic conditions who did not receive the ongoing care they needed.

Onscreen: (A red line rises early in 2020 to the top of the health footprint scale and plateaus at this high level into 2022 and beyond).

Finally, you will notice the red line has a large footprint and does not seem to come back down over time like the other lines. This line represents the long-term and lingering mental health impacts of the pandemic. Related issues include job loss, financial stress, burnout etc.

In addition to the health footprint of the red line, we are facing new and ongoing global challenges that will compound the mental health impact for Canadians into the future. For example:

War and global conflict. New variants of concern may emerge in the future. And Climate change remains an ongoing source of stress for Canadians.

All of these realities increase the everyday stress of Canadians in a variety of ways. For example:

  • Supply chain disruptions.
  • The cost of living is increasing and may shift many Canadians into a precarious financial situation in the months and years to come.
  • The recent protests against pandemic restrictions suggest growing division among Canadians.

In 2021, the Health Analysis Division at Statistics Canada worked with the Innovation Secretariat to put a COVID-19 lens on a traditional health research framework.

The COVID-19 pandemic caused immediate negative and positive impacts on the lives of Canadians. While some Canadians faced job loss or stressful working conditions, other Canadians found themselves with improved work-life balance. The pandemic did not affect everyone the same.

The blue box in the middle depicts the initial and longer-term impacts on health. COVID-19 infections have transitioned into long COVID for some. What was experienced as fear, grief and boredom in the early days of the pandemic may have evolved into longer-term mental health challenges. Restricted access to healthcare means that some conditions were not caught when they normally would have been, such as cancer. Canadians also changed their health behaviours. For example, physical activity dropped among youth yet remained stable among adults. Isolation at home meant that some Canadians were exposed to more violence within the home. Some Canadians changed how much they use substances such as alcohol, cannabis opioids and tobacco.

Health researchers are interested in tracking how these initial and longer-term health impacts relate to future well-being, physical and mental health and mortality. This is depicted in the blue box at the far right.

The COVID-19 pandemic has undoubtedly changed the lives of Canadians in many ways, such as how we work, how we go to school and how we interact with the health care system. Further, the pandemic has changed the way we think about economic stability and the environment. An important question right now is what, if any, of these changes are here to stay? What are the structural or enduring changes caused by the pandemic? And how will these changes impact the health of Canadians?

Importantly, the yellow boxes found throughout the diagram highlight that the pandemic, the enduring changes caused by the pandemic and the impacts on health were not experienced in the same way by all Canadians.

Onscreen: (The yellow boxes contain the text “Social class, gender, ethnicity (racism), age, etc.” and are placed next to every list of impacts.)

In late 2020, the annual report from the Chief Public Health Officer of Canada focused on taking a health equity approach to the COVID-19 recovery. This schematic from the report does a good job of summarizing the immediate response to the pandemic and how this has shifted over time into new ways of living and working.

Onscreen: (The schematic has the title COVID-19 pandemic with an arrow pointing down to the a blue box.)

Onscreen: (The blue box is titled “Crisis Response” and contains the text, “Rapid innovations to existing systems, policies and programs”, and “Deployment of new actions”.)

Onscreen: (The blue box has an arrow pointing to a yellow box that says “Changing awareness; shifts in values and attitudes.”)

Onscreen: (The yellow box has an arrow pointing an orange box.)

Onscreen: (The orange box is titled “New ways of living and working”. Within it there are two boxes titled “Focus on high impact areas of action” and “Strengthening infrastructure”. There are arrows on both directions connecting these two boxes.)

Onscreen: (The “Focus on high impact areas of action” box contains four boxes titled: Economic security and employment conditions; Stable housing and healthy built environment; Health, social service and education systems; and Environmental sustainability.)

Onscreen: (The “Strengthening infrastructure” box contains three boxes titled: Data systems (e.g., collection, analyses, visualization); Governance (e.g., cross sectoral; active community engagement); and Communication)e.g., coordination; countering misinformation). Across the bottom of all three boxes is a white box with the text “Reducing stigma and discrimination”.)

The key questions asked are 1) How is life going to change in Canada?, and 2) What, if any, of these changes are going to stick around and create new ways of living and working?

Four areas of action were identified that are of interest to health researchers:

1) How we work 2) Where we live,

3) Health, social service 4) Education systems and Environmental sustainability.

At the bottom of the slide, the importance of strengthening infrastructure is noted. An important piece for Statistics Canada is the inclusion of data systems. Having adequate data systems in place is necessary to support relevant and timely health research. Early identification of data gaps is a key step in this process.

Beyond a framework and call to modernize our data systems is the more practical issue of what are the research questions we can and should focus on and how will this evolve over time? Three areas of action are identified on this slide and will be discussed further in subsequent slides.

1. Consultation with internal and external partners is key to prioritizing resources.

2. The pandemic inspired Statistics Canada to collect data and acquire information in new ways.

3. The pandemic also inspired Statistics Canada to develop new dissemination vehicles in order to reach more Canadians.

A timeline is useful to demonstrate how we have transitioned over time from pre-COVID, during-COVID, living with COVID and hopefully someday entering a post-COVID time.

Onscreen: (There is a timeline with four points. The first one is before 2020. The second one is COVID 2020 to 2022. The third one is living with COVID 2022 to 2025. The fourth one is Long-Term Post-COVID 2026 and beyond.)

As we move across this timeline, the priorities for health research have evolved and will continue to evolve in the future. During COVID, there was a focus on COVID cases, excess mortality from COVID, impact on health behaviours and coping strategies such as alcohol consumption, nutrition and physical activity As we move into a living with COVID time, the focus is shifting towards understanding the unintended consequences of the pandemic on other health conditions such as cancer, cardiovascular disease and diabetes. For example, what is the impact of interruptions in screening and routine surgeries? Thinking into the future, it is important to remember that many health impacts can take a long time to emerge. It will be important to continue to examine excess deaths and longer-term consequences of interruptions in non-COVID healthcare as well as changes in how people eat, how active they are and their overall mental health and wellbeing.

There are many strategies to help identify and prioritize health research topics. Some examples include consultation with expert advisory committees, consultation with internal subject-matter experts and strategic foresight.

The same timeline is also useful to demonstrate how data collection mechanisms have changed over time.

Crowdsourcing and the web-panel surveys offered quick turnaround mechanisms to get a handle on how Canadians were doing in the early days of the pandemic.

New surveys on focused topics are being developed by the Centre for Population Health Data at Statistics Canada. These surveys allow us to take a closer look at key sectors and issues that emerged during the pandemic, such as health care access, health care worker burnout, long COVID, maternal health, youth mental health etc.

Statistics Canada has many ongoing and established health surveys, including the Canadian Community Health Survey, the Canadian Health Measures Survey and the Canadian Health Survey on Children and Youth. These established surveys offer a unique advantage in that they provide important historical context and often have consistent content over time to allow us to properly track changes over time. The Census and a range of administrative data assets are also important data sources to support health research.

Finally, data projections and data modelling allow us to use existing data to project possible future impacts of the pandemic on the health of Canadians.

This slide provides only some examples of the range of data acquisition mechanisms recently implemented at Statistics Canada to address the evolving data needs resultant from the pandemic. This includes new tools, new focused surveys, the leveraging of existing programs and planning for future topics of interest.

New data collection vehicles were put in place to gather information quickly early in the pandemic including the Canadian Perspective Survey Series and Crowdsourcing surveys on a variety of topics.

Onscreen: (The topics listed are: Impacts of COVID-19, Monitoring the effects of COVID-19, Mental Health, Nicotine and Tobacco, and Experiences with COVID-19 tests.)

New focused surveys are targeting hot topics that have emerged during the pandemic. Some examples include COVID antibodies, the experience of health care workers, access to health care and pharmaceuticals, mental health and the nursing and residential care sector.

Leveraging existing programs is another strategy used to gather more data and information. For example, COVID-19 content was added to the 2020 and 2021 Canadian Community Health Survey. Monitoring of COVID-19 was achieved via the Canadian Wastewater Survey. Administrative databases, such as vital statistics, cancer, hospitalizations, will be key to understanding the impact of the pandemic on short- and long-term morbidity and mortality.

Survey development takes times and some topics on the horizon for future surveys include sexual and reproductive health, a second cycle of the Canadian Health Survey on Children and Youth, a survey on access to mental health care and Canadians’ experience with health care access.

A common thread throughout the various data acquisition mechanisms is mental health. One unintended consequence of the pandemic is the mental health challenge experienced by canadians especially our youth. Understanding the extent and distribution of this impact in the youth population will be important in the recovery from the pandemic.

Integrating data from multiple sources and striving to disaggregate data to understand the unique experiences of various groups are high priorities at Statistics Canada.

This slide walks through an alternative mechanism to acquire new information. Analytical techniques and modelling can be used to make projections about the long-term impact of the pandemic. The advantage here of course being the ability to put out information now that could be extremely relevant and useful to those working in health care planning and those wanting to project potential health care costs of the future.

The steps involved are taking an observed finding from the pandemic, develop a range of plausible scenarios from that finding, and project potential impacts.

Let’s walk through an example.

A paper was published in February 2021 that examined the impact of disruptions in colorectal screening programmes in Canada, the Netherlands and Australia.

This paper noted that ‘Although the projected effect of short-term disruption to colorectal cancer screening is modest, such disruption will have a marked impact on colorectal incidence anddeaths between 2020 and 2050 attributable to missed screening’.

The paper proposed a range of screening catch-up strategies to demonstrate how this impact could be mitigated.

The researchers examined the impact of a 3-, 6- and 12-month disruption in colorectal screening.

The researchers used a Statistics Canada microsimulation model called OncoSim to project how cancer diagnoses and deaths may be impacted by the various mitigation strategies.

Onscreen: (For diagnoses and deaths between 2020 and 2050, a 3-month disruption is projected to increase diagnoses by 1,671 and deaths by 799. A 6-month disruption is projected to increase diagnoses by 2,844 and deaths by 1,319. A 12-month disruption is projected to increase diagnoses by 5,212 and deaths by 2,366.)

Let’s walk through another example of how microsimulation models can be used to make projections about the long-term health impacts of the pandemic.

A paper published in September 2021 noted that youth, but not adults, reported less physical activity during the COVID-19 pandemic.

The percentage of youth meeting the physical activity recommendation dropped from 51% to 37% between the fall of 2018 and the fall of 2020. The percentage of adults meeting the recommendation remained stable while the percentage among older adults increased slightly.

The drop among youth is attributable to marked decreases in recreation- and school-based physical activity. This finding makes sense given that school closures and interruptions in organized sports were common in the fall of 2020.

It is possible that adults were better able to pivot during the pandemic to alternative forms of activity including home-based exercise and outdoor walking.

In fact, Canadians spent an estimated 211.4 million dollars on exercise equipment at retail stores in the fall of 2020 – an increase of 24% from the 4th quarter of 2018.

Two questions emerge from this finding: 1) What if more youth enter adulthood overweight?, and 2) What if older adults maintain their new found love of physical activity?

The Population Health Microsimulation Model (also known as POHEM) could be used to project how an increased prevalence of obesity in early adulthood would impact future incidence of type 2 diabetes, cardiovascular disease and healthcare system strain.

Similarly, POHEM could be used to project how different levels of physical activity in older adulthood would impact future incidence of type 2 diabetes, cardiovascular disease and healthcare system strain.

Onscreen: (A red arrow pointing up is depicting an increase in Diabetes, Cardiovascular disease and Healthcare strain as a potential impacts of more youth entering adulthood overweight.)

Onscreen: (A green arrow pointing down is depicting a decrease in Diabetes, Cardiovascular disease and Healthcare strain as a potential impacts of adults maintaining their newfound love of physical activity.)

Modernization combined with the pandemic have led to many new and innovative ways of talking to Canadians about data.

For those seeking quick information, there are now infographics, focused web portals and smartphone apps being published regularly.

For those wanting more interaction with the data, there are many new interactive tools available on the StatCan website. For example, a collaboration between Children First Canada and the StatCan Census team led to interactive tool on the impact of school closures. During the pandemic, an excess mortality dashboard was created. COVID Insights was a new publication vehicle started during the pandemic that allowed for quick turnaround papers to be published.

For those wanting to take a deeper dive on a focused health topic, Statistics Canada has a peer-reviewed scientific health journal. Health Reports is our flagship health publication at Statistics Canada and is one of the leading products for the agency when it comes to page views and downloads. With an impact factor of 4.796, this journal is competitive with the Canadian Journal of Public Health (Impact factor of 2.448),the Canadian Medical Association Journal (Impact factor of 5.941) and Preventive Medicine (Impact factor of 3.45).

This final slide includes 3 important quotes to summarize the path forward for health research at Statistics Canada.

As noted in Statcan’s two-year update on the pandemic (March 2022), ‘The unintended health impacts of COVID-19 restrictions, along with the impacts of post COVID-19 condition, will be felt for years and will continue to strain health care resources’.

As noted in the Chief Public Health Officer’s Report in late 2020, ‘In order to understand and address inequities, it is essential to collect, link, and disaggregate data related to socio-demographic factors, including geography, income, education, Indigenous status, racial and/or ethnic background, sex and gender, sexual orientation, age, disability status, occupation and migratory status.’

  • The Disaggregated Data Action Plan (DDAP) at Statistics Canada demonstrates the effort underway to address the need to examine groups within the Canadian population to better understand inequities.

Also in the Chief Public Health Officer’s Report in late 2020, ‘These efforts rely on the ability to integrate intersectional data from various sources, such as self-reported survey data with administrative data, which requires adequate expertise, technology and infrastructure.’

Statistics Canada is committed to continue its efforts to track and report on the short-, medium- and long-term impacts of the COVID-19 pandemic on the lives of Canadians.

(The Canada wordmark is on screen.)