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Dear Hon. Deputy Minister Menard, Dr. Huyer and Mr. Anderson,

We write to you to highlight the urgent need for a broad province-wide strategy to protect the health of migrant agricultural workers during the COVID-19 crisis. A growing number of outbreaks in the migrant worker communities and two deaths in the Windsor-Essex area have made it clear that this group is one of the most at-risk in Ontario.

Several Alliance for Healthier Communities members serve migrant farm workers in multiple regions, including Norfolk, Windsor-Essex, Chatham Kent, Harrow, Brantford, St Catharine’s, Brock, Port Hope and other communities in between and are familiar with the barriers these workers face. We also work closely with the Occupational Health Clinic for Ontario Workers.

Since the beginning of the COVID-19 pandemic, the Alliance, among other advocate groups, have been calling for additional supports to prevent the outbreaks, including proactive surveillance testing, access to educational and health promotion materials in multiple languages, adequate infection control measures, prioritizing public health and Ministry of Labour coordination. Please see links to our letter to Minister Elliott and Minister MacNaughton sent on March 24 and our letter to Deputy Minister Helen Angus and Ontario Health CEO Matt Anderson sent on April 7. In both letters, we outlined our concerns along with specific recommendations and offered help developing solutions.

While there have been some positive developments, like the expansion of OHIP and the Guidance for Temporary Foreign Workers (TFWs), a lot of our questions and concerns remain unanswered. There is still no province-wide proactive surveillance testing strategy or transparent outbreak reporting. We don’t have clarity about who’s responsible for migrant agricultural workers strategy. In the absence of a coordinated strategy, the work has fallen to individual public health units, and the growing number of outbreaks demonstrates that the measures currently in place are not sufficient.

We urge you to implement the following measures as soon as possible to manage and to prevent future COVID-19 cases, outbreaks and deaths, and ensure food security.

• Broad proactive surveillance testing strategy for all migrant agricultural workers. During the Ministry of Health briefing on Protecting Ontarians through Enhanced Testing delivered on May 29, proactive surveillance testing was presented as part of the strategy, and agri-food business was at the top of the list of essential workers. Migrant agricultural workers should be prioritized for targeted testing considering their living and working conditions often make physical distancing challenging and put them at a higher risk of COVID-19. We know some regions are already moving ahead with broad testing of all migrant workers in their area. Proactive surveillance testing needs to be implemented across the province to prevent future outbreaks.
• Transparent and timely reporting on the number of cases and outbreaks among migrant agricultural workers. During our meeting on May 29 with the Ministry of Children, Community and Social Services regarding action and reporting on the provincial action plan for vulnerable people and congregate settings, we were told seasonal farm workers were on their list. However, the outbreaks are still not being reported in a separate category, similar to the cases in long-term care settings.
• Analysis of investigation into outbreaks by both the Ministry of Health (via Public Health) and the Ministry of Labour, Training and Skills Development and transparent reporting of the results. This would help identify root causes of the outbreaks, e.g. lack of compliance with the guidelines; inadequacy of directives or poor/insufficient communications of directives; inability to comply with directives; unrealistic expectations of farmers; lack of personal protective equipment (PPE); non-reporting of symptoms or conditions by workers due to fear; lack of COVID-19 related information or confidential health care contact information; language challenges preventing workers to report symptoms in a timely manner; or employers not being able to perform adequately the multiple roles that are now expected of them as public health educators, health assessors and infection control officers. Access to this information would help apply what is learned and adjust strategy as needed.
• Enhanced culturally safe supports for workers who are sick and self-isolating. Bonifacio Eugenio-Romero, a worker in the Windsor-Essex area, was self-isolating in a hotel room when he developed difficulty breathing and died within 30 minutes of calling the EMS.  While the measures were put in place to do daily phone check-ins, with an in-person follow-up if necessary, for workers in self-isolation, closer monitoring is required. Lack of supportive networks compounded by language and cultural barriers puts migrant workers in a precarious position. Beyond physical needs there are mental health needs. Being in isolation is being alone and the stress of no one to talk to, uncertainty regarding income continuity and the inability to reach their families is incredibly stressful for these workers. As the Windsor-Essex public health officials are reviewing and enhancing their response plan right now, it is an important learning opportunity for other regions with a large concentration of migrant workers. There are promising practices already in place that need to be replicated in other areas, like the COVID-19 task force  that includes a nurse practitioner, an EMS worker, a Spanish interpreter and a registered nurse checking in on workers in self-isolation in the Windsor-Essex area, performing on-site testing, providing infection control advice and answering questions.
• Adequate resources for translation services. Migrant workers in the hospital, those in quarantine, and workers who have health concerns and don’t know who to call need access to care and supports in their languages. In some instances, workers have been known to connect with Spanish-speaking support services in other provinces as they do not know who to contact in close proximity to them here in Ontario. Public health units are sometimes scrambling to find translation support for investigation and intervention. Often they are relying on Alliance members and community volunteers. Without adequate resources, this is unsustainable and insufficient to provide proper care, outbreak management and prevention.

Last week, the Ontario government sent out a news release “celebrating local agri-food heroes.” Migrant agricultural workers were not mentioned even though their contribution to the food supply chain is indisputable. Over the past few months, we have read numerous media stories about farmers scrambling with food production because the numbers of migrant workers arriving this year have been impacted by COVID-19. Farmers keep saying that these workers have the skills and experience that cannot be easily replaced with local workforce. Yet, again and again we fail to treat them with the dignity and respect they deserve and they remain invisible and expandable.

We need to act now to keep migrant agricultural workers safe, prevent future outbreaks and deaths, and maintain food supply.

We look forward to seeing these recommendations implemented and are ready to discuss them in more details.

Regards,

Sincerely,

Adrianna Tetley CEO, Alliance for Healthier Communities

Madame la solliciteure générale,

Nous vous écrivons pour exprimer nos préoccupations relativement à l’accès limité à des soins de santé pour les personnes incarcérées, celles qui ont récemment été libérées d’établissements correctionnels, ou celles, qui de façon générale, ont des démêlés avec la justice.  

Le Canada est signataire des déclarations des Nations-Unies engageant à offrir des services de santé adéquats pour les personnes incarcérées, sans discrimination. Au cours de la pandémie de la COVID-19, l’accès à des soins de santé pour les personnes détenues dans les établissements correctionnels et celles récemment libérées n’est pas équitable comparativement à celle de la population en général. Au contraire, les risques pour la santé pour ces populations vulnérables sont maintenant plus élevés. Nous exhortons le ministère à combler ces lacunes en matière de soins.

Les organismes communautaires de soins de santé fournissent des soins primaires à des gens de partout dans la province qui ont des démêlés avec la justice. Nos organismes sont très conscients que les personnes incarcérées ont un risque élevé de contracter la COVID-19 étant donné le surpeuplement des établissements correctionnels qui rend inévitables les contacts proches. Les personnes incarcérées n’ont pas accès « sur demande » à des ressources de prévention comme la population en général. Ces facteurs accroissent la susceptibilité de contracter la COVID-19. Compte tenu de ce contexte, les organismes communautaires de la santé ont accueilli favorablement les mesures prises pour accélérer la libération des individus admissibles. Pour la sécurité de cette population et de celle de l’ensemble de la population de l’Ontario, il faut offrir des ressources adéquates et des soins de santé complets aux personnes récemment libérées dans la lutte contre la COVID-19.

Nos organismes s’inquiètent quant aux protocoles inadéquats pour la planification des libérations. Malgré le risque élevé d’exposition à la COVID-19 dans les milieux carcéraux, la province n’a pas présenté de stratégie concernant cette population dans son Plan d’action COVID-19 : protection des Ontariens vulnérables. Des rapports indiquent que plus de 1000 personnes ont été libérées d’établissements correctionnels au cours de la présente pandémie. Les individus récemment libérés sont susceptibles d’avoir des problèmes de santé. Sans interventions adaptées, plusieurs restent coupés des soins de santé primaires et des services sociaux essentiels. Les données montrent que plusieurs personnes qui quittent les établissements correctionnels en Ontario sont plus susceptibles de vivre dans la pauvreté et dans l’itinérance et d’avoir un mauvais état de santé; la crise de la COVID-19 exacerbe ces préoccupations. L’absence de plans de transition clairs et de stratégies exhaustives de libération amplifie les risques pour les personnes vulnérables. Les conséquences qui en découlent sont tout à fait évitables.  

Nous pouvons aider. Nos secteurs possèdent le savoir-faire et la capacité pour éliminer ces lacunes. Les centres de santé communautaire (CSC) et les centres d’accès aux services de santé pour les Autochtones (CASSA) ont créé une liste d’établissements de soins de santé primaires à proximité des établissements correctionnels pour le bureau de la solliciteure générale. Ces établissements de soins de santé sont prêts à établir des liens formels avec des établissements à proximité. Des organismes fournissant des services sociaux (réunis sous la Correctional Reform Coalition – coalition pour la réforme du système correctionnel) ont offert à la province de l’aider à élaborer de rigoureux plans flexibles de libération pour réduire l’isolement social et la vulnérabilité des personnes qui quittent les établissements correctionnels. Nous exhortons la province à inviter les acteurs de ces secteurs à se réunir pour établir des protocoles exhaustifs de libération.   

La province peut agir rapidement pour venir en aide à ces populations grâce aux mesures suivantes :

1. L’établissement de liens à des soins de santé offerts par des organismes de soins de santé primaires dirigés par les communautés. Les CSC et les CASSA ont la capacité d’aider les personnes récemment libérées. Ils aident aussi les communautés très marginalisées et sont bien adaptés pour satisfaire aux besoins complexes des individus récemment libérés des établissements correctionnels.
2. L’élaboration de stratégies de libération en temps de pandémie en collaboration avec des organismes de services sociaux. La province doit inclure des leaders du secteur dans l’élaboration de lignes directrices, de protocoles de gestion de cas et de politiques de libération qui assureront des liens à des services sociaux.
3. La mise en place de protocoles de libération en temps de pandémie pour les personnes en détention provisoire qui correspondent aux protocoles utilisés dans la planification de la libération des personnes condamnées. Le fait que des protocoles existent pour un groupe et non pour l’autre engendre des inégalités en matière de soins.
4. La publication de données sur la proportion des personnes condamnées et détenues de façon provisoire qui ont été libérées pour renseigner le secteur dans la planification des libérations. Nous exhortons la province de faire rapport avec transparence en ce qui concerne la COVID-19 afin de lutter efficacement contre cette crise.
5. L’établissement de liens formels avec les organismes communautaires et les organismes de services sociaux afin d’aider les personnes libérées.   
6. L’élargissement des mesures concernant la suspension des renouvellements de documents d’identification pour inclure les personnes libérées pendant la pandémie de la COVID-19, et l’élimination des exigences pour des documents d’identification admissibles pour l’accès à des soins de santé et des services sociaux.
7. L’adoption de mesures pour lutter contre les facteurs contribuant au départ du personnel dans les établissements en accordant la priorité à l’accès à de l’ÉPI et à des primes de risque pour ces travailleurs essentiels. La province doit s’assurer que les établissements ont suffisamment d’effectifs et demeurent en mesure d’offrir des soins complets.    

Il s’agit d’une crise exceptionnelle qui nécessite des mesures extraordinaires. Nos secteurs sont prêts à appuyer la province dans l’élaboration de programmes de soutien pour les groupes marginalisés.

Adrianna Tetley, directrice générale, Alliance pour des communautés en santé

Over the past week – and the weeks, months and years before this – we at the Alliance for Healthier Communities have seen the impact of historical and present-day racism, inequity, violence and inaction on our member organizations and the communities they serve.

Anti-Black racism is a public health crisis that manifests in many different forms, including police violence in Ontario and around the world. Black people are routinely denied access to the healthcare services that are a basic human right. Black children are given lower levels of pain management as white children. Black women receive cervical cancer screening at lower rates than any other population group. People suffering from sickle cell anemia are treated as drug seekers. People living with mental health conditions are turned away or offered culturally unsafe healthcare, leading to increased rates of suicide and suffering.

At the same time, Black communities bear the disproportionate burdens of racism and discrimination in housing and labour markets, placing them at higher risk of both communicable diseases like COVID-19 (at work as personal support workers and other essential service workers, and at home in close or unsafe living conditions), and chronic conditions like diabetes, hypertension and mental health conditions caused by inequitable living conditions and the daily stresses of living under the macro and micro conditions of structural, systemic and individual racism. In the life and death of Black Personal Support Worker Leonard Rodriques, who died from COVID-19 after being repeatedly turned away from personal protective equipment and healthcare, we witness one example of the real-time collision of the determinants of health and healthcare services for Black people in this province.

The strengths of Black communities – amongst other things, in mutual support, organizing, and creating and sustaining community-led health and social care – are what has seen them through crisis after crisis. These strengths and the solidarity of immense, intersectional leadership are being shown in the current moment, too. Black-led community health centres within the Alliance are providing visionary, steadfast and culturally safe healthcare and systems leadership at community, provincial and national levels.

Racism, inequity and dehumanization are deeply embedded in our social structures, daily lives, neighbourhoods and healthcare organizations. This affects every single person in our province and the world – unequal societies have worse health outcomes for all people than more equal ones. The work of confronting anti-Black racism is the work of advancing health and wellbeing for all. To be allies, we continue to have major work to do to remove the barriers that structures, systems and our own actions put in the way of these strengths.

At the Alliance for Healthier Communities, we are in the midst of updating our Health Equity Charter to ensure it sets out clear guidance and principles to which we will be held accountable, including a strong stand against white supremacy and anti-Black racism. Our work in progress includes working to ensure we are appropriately devoting staff time and resources to the work of Black Health and the support of Black Health leadership in comprehensive primary health care organizations throughout Ontario; ensuring our Board of Directors includes intersectional health equity leadership including directors from Ontario’s Black communities; working to support all our members to appropriately collect and use race-based and sociodemographic data; and advocating for policies and practices that hold our governments and health systems accountable for health equity.

This is not enough. As an organization and as a network of organizations committed to anti-racism and anti-oppression, we at the Alliance must continue to search ourselves, as individuals and organizations, to identify, name and directly confront our own silence and inaction. In solidarity with Black Health leadership across the Alliance, and with Black communities across Ontario, Canada and the world, here is what we commit to today to further walk our talk on anti-racism, health equity and community wellbeing.

We commit to:

• Supporting anti-racism and anti-oppression training for all member boards and staff at the Alliance and in member organizations.
• Reviewing all existing projects and initiatives, including human resources policies, Board policies and internal procedures, to ensure an up-to-date, explicit and accountable focus on anti-Black racism
• Transparency and accountability for our actions that includes mechanisms for regularly reporting our progress and supporting Alliance members to do the same
• Collaborating with the Black Health Committee to explore opportunities for funding and resourcing the design, implementation, and modifying of new and existing sector-wide initiatives that advance Black health and wellbeing in Ontario
• Standing with Black communities in their work to advance structural change and using our voice to support their calls to action for a more equitable, just and inclusive Ontario

Signed,

Adrianna Tetley, CEO

Claudia den Boer, Board Chair

Dear Solicitor General,

We write to express concerns about limited access to healthcare for people who are currently incarcerated, have recently been released from correctional facilities, or are otherwise involved with justice.

Canada is a signatory to United Nations declarations committing to the provision of adequate health services for imprisoned people, without discrimination. During the ongoing COVID-19 pandemic, healthcare access for people held in correctional facilities and those recently discharged has not been equitable to mainstream populations. On the contrary, health risks to these vulnerable populations have been elevated. We urge the ministry to close these gaps to care.

Community led healthcare organizations provide primary care to people involved with justice across the province. Our organizations are acutely aware that incarcerated people are at elevated risk of harms linked to COVID-19 due to overcrowded conditions in correctional facilities that make close contact inevitable. Incarcerated people do not have “on demand” access to prevention resources in the same way that mainstream populations do. These factors increase susceptibility to COVID-19. In light of these contextual factors, community led health organizations have welcomed recent actions to accelerate release for eligible individuals. For the safety of these populations and the wider population of Ontario, a core component of this COVID-19 response must be to provide adequate supports and comprehensive healthcare for recently released individuals.

Our organizations are concerned about inadequate discharge planning protocols currently in place. Despite the elevated risk to COVID-19 exposure, the province has not released a strategy for corrections and incarcerated populations under the COVID-19 Action plan for vulnerable populations. Reports indicate that over 1000 people have been released from correctional facilities in the midst of the ongoing pandemic. Recently released people are susceptible to poor health outcomes. Without tailored interventions, many remain disconnected from primary healthcare and disconnected from vital social service supports. Evidence shows that many people leaving correctional facilities in Ontario are at higher risk of poverty, homelessness and poor health. COVID-19 exacerbates these concerns. The lack of clear transition plans and comprehensive discharge strategies puts vulnerable people at risk. These outcomes are entirely preventable.

We can help. Our sectors have the expertise and the capacity to eliminate these gaps. Community Health Centres (CHCs) and Aboriginal Health Access Centres (AHACs) have made a list of primary healthcare facilities in close proximity to correctional facilities available to the Solicitor General’s office. These healthcare facilities are prepared to establish formal linkages with facilities in close proximity. Social service organizations, (convening as the Correctional Reform Coalition), have offered the province support in developing robust and nimble discharge plans that decrease social isolation and vulnerability for individuals leaving corrections. We urge the province to invite stakeholders from these sectors to the table to develop comprehensive discharge protocols. 

The province can act swiftly to support these populations by:

1. Developing linkages to healthcare through community led primary healthcare organizations. CHCs and AHACs are well positioned to support recently released populations. They already support communities experiencing high levels of marginalization and are well suited to respond to the complex needs of individuals recently discharged from corrections.
2. Developing pandemic discharge strategies in collaboration with social services organizations. The province must include sector leaders in the development of guidelines, case management protocols and discharge policies that will ensure linkages to social services.
3. Mandating pandemic discharge protocols for remanded populations that match protocols used in discharge planning for the release of individuals who have been sentenced. The presence of protocols for one group which are not required for the other creates inequities in care.
4. Releasing data on the proportion of sentenced and remanded individuals released to inform sector discharge planning. We urge the province to report transparently about COVID-19 to effectively address this crisis.
5. Formalizing links to community and social service organizations supporting discharged individuals.
6. Expanding temporary hold on identification document renewal for recently discharged populations during COVID-19 and eliminate requirements for valid I.D to access health and social services.
7. Addressing factors contributing to mass staff walkouts in facilities by prioritizing access to PPE and hazard pay to these essential workers. The province must ensure that facilities remain well-staffed and able to provide comprehensive care.

This is an exceptional crisis requiring responses that surpass the ordinary. Our sectors are prepared to support the province in developing supportive programs for marginalized population groups.

Adrianna Tetley, CEO, Alliance for Healthier Communities