The Disproportionate Impact of COVID-19 on Immigrants and Refugees with Chronic Illnesses
This community-based research project delved into the compounded effects of the COVID-19 pandemic on immigrants and refugees living with cancer, and mental health and addiction disorders. The study, a collaboration including Access Alliance, sought to understand the challenges faced by individuals at the intersection of social and clinical disadvantage during a public health crisis. The central question guiding the research was: What happens to those who are at the intersection of social and clinical disadvantage during a pandemic?
The project aimed to identify systemic barriers to equitable healthcare access during pandemics, co-develop actionable solutions with stakeholders to address disparities, and inform policy and programming to protect vulnerable populations in future crises. The insights gained from this research offer actionable recommendations to address the unique needs of these populations in future public health crises.
The study provides a roadmap for building crisis-resistant health systems that centre equity, creating lasting protection for Canada’s most vulnerable communities by addressing both clinical needs and social determinants.
Why This Research Matters
The COVID-19 pandemic did not impact all segments of the population equally. Immigrants, despite representing only a quarter of Ontario’s population, accounted for almost half of the province’s COVID-19 cases. This disproportionate impact highlights the structural inequities that immigrants and refugees face, such as unemployment and crowded housing, which heightened their vulnerability to the virus.
Even before the pandemic, immigrants and refugees encountered challenges in accessing primary care, navigating language barriers, and trusting healthcare systems. Systemic issues, including the exclusion of foreign-trained healthcare providers, inadequate mental health resources, and fragmented social services, further exacerbated these difficulties. The pandemic intensified these disparities through service closures, misinformation, and reduced preventive care, such as cancer screenings.
Chronic conditions like cancer, mental health and addiction amplify these vulnerabilities. This project addressed gaps in understanding how COVID-19 exacerbated disparities for clinically and socially marginalized groups, providing evidence to inform equity-centred policies.
The findings revealed alarming disparities: immigrants with cancer were three times more likely to be hospitalized and four times more likely to die from COVID-19 than non-immigrants without cancer. Similarly, immigrants with mental health and addiction disorders faced 52% higher COVID-19 diagnosis rates and 65% higher mortality rates compared to non-immigrants without such conditions. Systemic issues such as language barriers, lack of culturally safe care, and workforce shortages were identified as contributing factors.
Key Research Questions and Methodology
The research was guided by three key questions:
- How did COVID-19 disproportionately affect immigrants and refugees with cancer or mental health and addiction disorders?
- What structural barriers limited access to cancer/mental health and addiction services during the pandemic?
- What community-driven strategies can improve crisis responsiveness?
Researchers conducted a population-based retrospective cohort study using linked Ontario healthcare administrative databases. The study period spanned from March 31, 2020, to December 31, 2021, corresponding to COVID-19 waves 1-4 and the first 16 days of wave 5.
This study was the first in Ontario to analyze COVID-19 outcomes through both clinical and social lenses, combining population-level health data with community wisdom gathered through Think Tanks. It also prioritized solutions co-created by patients, providers, and policymakers through direct community consultations. Visit the project website for more details on the methods and recommendations from Think Tanks, community reports and other publications.
On May 14, 2025, Dr. Vahabi provided an overview of the project. View the recording:
Key Findings
The research underscores how systemic inequities rooted in racism, socioeconomic status, and geography were exacerbated by COVID-19. Racialized groups already faced lower screening rates and higher cancer mortality before the pandemic, and pandemic-related disruptions deepened these gaps.
Lower-income neighborhoods and newer immigrants experienced significantly reduced access to essential services, leading to delayed screenings. Mental health challenges surged, with 67% of patients reporting heightened anxiety and 63% citing increased stress.
Immigrants with cancer faced delays in diagnosis and treatment due to a lack of family doctors and systemic navigation support. Solutions prioritized leveraging foreign-trained providers as “health ambassadors” and connecting newcomers to care upon arrival.
Participant quote: “I had no OHIP, no family doctor, and didn’t know how to access care after my cancer diagnosis”.
The combination of immigration status and pre-existing mental health and addiction issues significantly influenced adverse COVID-19 outcomes. Pandemic isolation worsened mental health, particularly for youth and seniors, while virtual care excluded those with limited tech literacy.
Participant quote: “Lockdowns felt like imprisonment… we had no guidance on managing stress”.
Several system-related findings emerged, including:
- System Fragmentation: Virtual care excluded a significant portion of immigrants with limited digital literacy, and silos between health, housing, and immigration policies left families struggling to meet basic needs.
- Cultural Inequities: Lower vaccination uptake among Black and Latin American immigrants was linked to historical mistrust.
- Social Inequities: A significant proportion of immigrants with cancer resided in ethnically concentrated, high-deprivation areas.
- Clinical Inequities: More immigrants lacked a primary care provider and had higher rates of comorbidities.
Key Recommendations
Stakeholders emphasized the need for urgent policy reforms, such as targeted outreach, programs co-designed with affected communities, and infrastructure investments to ensure equitable care during crises. Recommendations include:
- Improving access to health, social, and economic resources for immigrants and refugees and fostering intersectoral collaboration across services.
- Prioritizing proactive primary care connections for immigrants and refugees and increasing both health and digital literacy.
- Enhancing service access through community engagement, including culturally specific outreach and care.
- Ensuring culturally competent service delivery and tailored programs for local needs, including leveraging internationally educated health professionals as community health ambassadors.
How the Research Can Be Used
Access Alliance can use this research to advocate for OHIP coverage for language interpreter services, champion peer-led navigation programs, and partner with settlement agencies to integrate health promotion and awareness. Policymakers can use the findings to fast-track licensure for internationally educated health professionals and mandate cultural safety training in accreditation standards. Healthcare providers can work with community organizations to implement health connection protocols throughout the immigration and settlement process, while community organizations can train community health workers in trauma-informed health support and establish pop-up vaccination clinics in faith centres.
The study uniquely centres stakeholder engagement through surveys, focus groups, and roundtables with healthcare providers, patients, and policymakers to highlight actionable solutions, connecting fragmented care during the pandemic to broader structural issues.
Knowledge Mobilization Activities
A project website was created that includes more information about research methods and recommendations from Think Tank consultations, community reports and publications.
Compounded Impacts of COVID-19 on Immigrants Living with Mental Health & Addiction Disorders
Compounded Impacts of COVID-19 on Immigrants Living with Cancer
Webinar reflection – Bridging Gaps in Care – Reimagining Ontario’s Health System for Immigrants and Refugees
On May 27th Access Alliance ran an engaging and solutions-focused conversation with a mixed group of health system administrators, health and settlement service providers, researchers, health system patients, and a policy maker. Together we re-imagined how Ontario’s healthcare system can be more accessible, equitable, and responsive for immigrants and refugees. We explored how to ensure these communities are not only included in system improvements, but also meaningfully connected to primary care and vital social supports.
Participants underscored that research findings accurately capture systemic barriers, and that lived experiences add nuance to the data. They also highlighted system challenges (IEHP licensing hurdles, language gaps, funding shortfalls) and innovative solutions (peer networks, social-media outreach). Participants discussed a system that, while well-intentioned, contains structural barriers that systematically disadvantages newcomers to Canada. The themes identified suggest that meaningful improvement requires coordinated action across multiple levels – from policy reform to service delivery redesign to better community supports. Participants have clear, actionable insights about what needs to change. View/download the full session report.
Bridging Gaps in Care: Reimagining Ontario’s Health System for Immigrants and Refugees – Community Consultation Feedback
In June we conducted four in-person consultations to re-imagine how Ontario’s healthcare system can be more accessible, equitable, and responsive for immigrants and refugees. These sessions provided engaging and solutions-focused conversations with groups of community members, the vast majority identifying as patients/caregivers in the healthcare system. We explored how to ensure their communities are not only included in system improvements, but also meaningfully connected to primary care and vital social supports. These sessions provide valuable validation and expansion of the main project themes and those identified in the previous webinar analysis. In this document we provide an overview of feedback from four additional community consultation sessions.
Our webinar discussions, enhanced by additional detailed comments and community consultation feedback, reveal a healthcare system that systematically disadvantages newcomers through structural barriers, but also demonstrate remarkable sophistication in community understanding of both problems and solutions. These consultations strongly reinforce the project’s research findings and action items.
Advancing Health Equity: A Collaborative Consultation on Practice and Progress
On July 31, 2025, we led a virtual discussion with Ontario-based healthcare professionals to explore how organizations can put health equity and cultural safety into practice, and foster welcoming, inclusive environments for all stakeholders. Participants were invited to reflect on the meaning of health equity in relation to their roles and organizations as well as what effective health equity training is for them.
They addressed the questions: What does health equity mean in your work? What does health equity training look like in your work? They represented a diverse range of roles from front-line healthcare practitioners, academics, settlement professionals to senior leaders across various organizations and sectors. Participants agreed that equitable healthcare access must respect individual identities and that all providers must be equipped with the necessary skills to deliver inclusive care. In this document we provide a summary of the session and participant insights on health equity.
This final report documents the knowledge mobilization (KMb) activities for the research initiative Compounded Effects of the COVID-19 Pandemic on Immigrants and Refugees Living with Cancer, Mental Health and Addiction Disorders Project. The project investigated the impact of COVID-19 on immigrants and refugees with chronic conditions. Access Alliance’s KMb strategy focused on sharing research findings and engaging with diverse stakeholders through multiple channels to identify pathways to systemic change and improve health outcomes for these vulnerable populations.
The Compounded Effects of the COVID-19 Pandemic on Immigrants and Refugees Living with Cancer, Mental Health and Addiction Disorders Project’s knowledge mobilization activities successfully disseminated key findings to diverse stakeholders and facilitated meaningful and collaborative discussions. Access Alliance employed multiple channels and formats to reach healthcare providers, community organizations, and affected populations with actionable information.
The emphasis on structural barriers and system-level solutions has positioned this research to influence policy development and practice change to support better access to adequate health care regardless of specific health conditions among immigrant and refugees in Ontario.
Related Project Articles
Silent Voices of Immigrants and Refugees Battling with Mental Health and Addiction during COVID-19: A Follow- Up Population-Based Cohort Retrospective Study in Ontario, Canada
This article examines the compounded effects of social and clinical disadvantages, specifically focusing on the combined impact of immigration status and pre-existing mental health and addiction, on COVID-19 outcomes (vaccination rates, diagnoses, hospitalizations, ICU admissions, and mortality).
The impact of COVID-19 on Immigrants and Refugees living with Cancer: A Population-Based Cohort Study in Ontario, Canada
This article explores the impact of COVID-19 on immigrants and refugees living with cancer in Ontario, Canada. Immigrants and refugees with active cancer had significantly worse COVID-19 outcomes compared to other groups, particularly non-immigrants without cancer. They were 66% more likely to be diagnosed with COVID-19, 3.3 times more likely to be hospitalized, 3 times more likely to be admitted to ICU, and 4.2 times more likely to die from COVID-19.
Navigating Equitable Access to Cancer and Mental Health Services During Pandemics: Stakeholder Perspectives on COVID-19 Challenges and Community-Based Solutions for Immigrants and Refugees – Proceedings from Think Tank Sessions
This report provides an overview and findings from Think Tank sessions that engaged stakeholders to identify barriers and co-create actionable strategies to safeguard immigrant and refugee health and well-being during current and future crises. The sessions brought together affected community members, service providers, policymakers, and researchers, to discuss challenges and co-develop solutions.
Related Access Alliance Activities
Impact of Social Isolation on Refugee Children and Youth
This project aims to assess the impact of social isolation on refugee youth in Toronto (Canada) as well as their coping mechanisms to overcome the adverse effects on their health and wellbeing. This will be done by conducting a rigorous systematic review of existing literature followed by peer-led facilitated discussion.
Client Perspectives on the Impacts of COVID-19
Recognizing the significant changes and challenges facing the centre and our community a year into the COVID-19 pandemic in Toronto, Access Alliance initiated a strategic planning process in the spring of 2021. To fully understand the situation, we needed to engage directly with our service-users. We conducted seven virtual focus groups between April 8 and 21, 2021 (using the Zoom platform). A total of 64 community members took part, including people of various genders, ages, education levels, sexual orientations, and cultural backgrounds.
Vaccine Engagement Impact Report
Taylor Massey-Oakridge-Victoria Village was one of the least vaccinated neighbourhoods during the summer/fall of 2021. With a coordinated effort between the partners, we raised the vaccination rate above the City’s average and significantly reduced the COVID-19 hospitalization rates during the pandemic peak.
Vaccine hesitancy among Syrian refugee parents in Canada: A multifaceted challenge in public health
This multi-country multi-institute study, housed at Access Alliance, investigates vaccine hesitancy among Syrian refugee parents in Canada. Researchers examined the factors that influence their willingness to accept COVID-19 vaccination.