Surviving influenza: lived experiences of health inequity and pandemic disease in Canada – CMAJ

June 22, 2020

Historically, infectious disease outbreaks have exposed social inequalities. It is clear that coronavirus disease 2019 (COVID-19) is doing the same and, even though historians shy away from looking into the crystal ball, it seems that the global experience with the virus will be shaped by inequities. Like the influenza outbreak in 1918–1920, COVID-19 is not a democratic disease.

History shows that lived experience during an epidemic is influenced by factors such as trust in and access to health care, the availability of financial and social supports that are equitable and based in social justice, and the fulfillment of basic human needs, such as clean, running water and safe workplaces.

Several historians have documented social differentials during the 1918 influenza outbreak in Canada. In urban centres, death rates per population varied considerably by socioeconomic status, ethnicity and race. Poorer neighbourhoods, including those with families that had recently immigrated to Canada, had higher mortality rates in cities like Winnipeg and Hamilton.1,2 Deaths among Indigenous people were higher than among non-Indigenous people: 6.2 out of every 1000 non-Indigenous Canadians died of influenza, whereas known death rates among Indigenous people living on reserves ranged from 10.3 per 1000 population in Prince Edward Island to 61 per 1000 in Alberta.3

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