Is the Unequal COVID-19 Burden in Canada Due to Unequal Levels of Citizen Discipline across Provinces?

Abstract

The unequal burden of the coronavirus disease 2019 (COVID-19) crisis (e.g., in terms of infection and death rates) across Canadian provinces is important and puzzling. Some have speculated that differences in levels of citizen compliance with public health preventive measures are central to understanding cross-provincial differences in pandemic-related health outcomes. However, no systematic empirical test of this hypothesis has been conducted. In this research, we make use of an exceptionally large dataset that includes 23 survey waves (N = 22,610) fielded in Canada across 12 months (April 2020–April 2021) to answer the question “Is there evidence of substantial cross-provincial differences in citizen compliance with basic public health measures designed to prevent the spread of infection?” We find that regional differences in self-reported behaviour are few and very modest, suggesting that interprovincial differences in COVID-19–related health outcomes have little to do with differences in citizen compliance, at least in the first year of the pandemic. These results have important implications. Although it is crucial that we continue to study regional variations related to the COVID-19 burden, public health agency officials, pundits, and politicians should be cautious when musing about the role of citizen compliance as the primary explanation of interprovincial pandemic health outcomes.