Although health inequities for immigrants and racialized populations have long existed in high income countries, the COVID-19 pandemic exposed longstanding disparities and generated new health challenges for these groups (Platt and Warwick, 2020; Guadagno, 2020). Studies report higher rates of COVID-19 infection, hospitalization, and death among immigrants and racialized communities compared to white, national born counterparts (Aldridge, et al., 2020; Escobar et al., 2021). Within Canada, COVID-19 was experienced unevenly within the population and across the country. While no federal mandate to collect racial and immigration data on COVID-19 exists, available information highlights higher COVID-19 positive cases, hospitalizations, and COVID-19 deaths for immigrant and racialized groups than non-immigrant and white Canadians (Anand et al., 2022; Government of Canada, 2021) with Ontario's Peel Region being classified as one of Canada's major COVID-19 hotspots (Nasser, 2020; Public Health Ontario, 2023). With only 3.7% of Canada's total population, the Peel Region experienced 7.6% of all lab-confirmed cases and 4.3% of hospitalizations (PHAC, 2021; Region of Peel, 2021a, Region of Peel, 2021b). Provincial reports indicate that COVID-19 infections, hospitalizations, and deaths in the Peel Region were highest among people living in ethno-culturally diverse areas (Public Health Ontario, 2023). In 2020, immigrants and racialized communities were 6–7 times more likely to test positive for COVID-19 and be overrepresented in regional COVID-19 hospitalizations and deaths (Public Health Ontario, 2023).

Explanations for inequities are rooted in a variety of place specific socio-economic, environmental, and structural factors tied to the overrepresentation of immigrant and racialized groups in essential, low paying and precarious employment, less regional access and willingness to receive a vaccine, high-density housing, along with poor emergency preparedness, inadequate lab capacities and disorganized regional and provincial public health care systems (Mental Health Commission of Canada, 2019; Etowa and Hyman, 2021). A Statistics Canada (2020) analysis of COVID-19 mortality reveals the disproportionate burden of COVID-19 cases in Peel is due to converging household and neighbourhood-level poverty, extended and multi-family households, and occupational risk (Subedi et al., 2020). Since “vulnerabilities to disease are not equally experienced across a changing world, but rather filter through existing conditions that are unequal and power laden” (King, 2017; 141), there is pressing need to understand the ways structural racism impacts opportunities to manage health and disease now and into the future (Hudson et al., 2022; Lee et al., 2022).

Although studies highlight the uneven burden of COVID-19 among immigrant and racialized groups, explanations for disparities often lie in accounts of individual behaviours, lifestyle factors, or vaccine hesitancy, thereby decontextualizing intersecting inequities “rooted in social, economic, political and historical contexts, where systemic racism and neglect exploited marginalized communities embedded in the Western context” (Khan et al., 2021; Adhibkari and Cheah, 2021; Larson et al., 2011). Critical gaps remain in understanding how structural racism shapes environments for health and disease among immigrant and racialized groups and the ways in which racism operates through historical and contextual factors to impact health inequities (Hudson et al., 2022; Lee et al., 2022). Likewise, “it is crucial to understand how place-based inequities and structural racism contributed to the COVID-19 racial disparities in incidence and mortality” in order to begin promoting more equitable societies (Estrada et al., 2022; 357). As Bambara (2022; 102761) underscores, “there has been little explicit integration into the geographies of health inequalities … a more intersectional understanding of health inequalities and place – which explores how multiple axes of inequity are experienced simultaneously within – and as part of – a place”.

This paper responds to current gaps in the literature by unpacking the intersecting ways structural racism shapes the place-based experiences of immigrant and racialized individuals and their (in)ability to navigate health and disease. The aim of this paper is to examine how opportunities for health and disease management among immigrant and racialized individuals are shaped through interactions among sociocultural, political, economic, and built landscapes in the Peel Region of Ontario. In so doing, this paper asks, how does structural racism intersect with the landscapes of Peel to shape the ability of immigrant and racialized individuals to access, use and control resources required for health and disease management. We specifically explore the pathways through which structural racism shapes access and control of economic, built, sociocultural, and political environmental resources during the height of the pandemic and how they converge to shape health and disease dynamics. As such, this paper fills important gaps in the literature by challenging individualistic explanations of disease occurrence, uncovering the synergistic impacts of structural racism on health and place, while bringing nuanced attention to the political ecology of COVID-19 by documenting how uneven health risks are situated within multiple intersecting place-based power relations that co-produce health inequities and perpetuate social difference.