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On: Feb. 3, 2012 When do we talk about health? Ontario’s option paper needs to build a stronger vision of a health-enabling social assistance system

Today the Commission for the Review of Social Assistance in Ontario released it’s much anticipated options paper. The paper sets out some interesting ideas and poses some challenging questions that will help to shape the debate around social assistance in the coming months.

In our submission to the Commission, we started by arguing that the cornerstone of reform is starting from a vision of a high-performing social assistance system. We argued that such a system should be:

  • Adequate: so that people on social assistance can maintain a healthy standard of living;
  • Flexible: with a range of responsive supports to help people get out of poverty – recognizing that there are very different pathways into and out of poverty;
  • Person-centred: so services and requirements are responsive to individual and family needs and situations, are delivered in a respectful manner that does not undermine dignity, and so people can be empowered to achieve more control over their lives; and
  • Health-enabling: so that people’s opportunities for better health are enhanced, not constantly eroded.

In the options paper released today, a vision is set out of “a 21st century income security system that enables Ontarians to live with dignity, participate in their communities, and contribute to a prospering economy.”

While this is a good start, the vision is not embedded in the document. The vision does not identify the components of a high-performing social assistance system and, as a result, the Commission has not articulated a clear vision in their ideas for reform. In their introductory note, the Commissioners argue that “we need to transform the social assistance system; small fixes will not be enough.” We agree, and to do this a more comprehensive vision needs to be built into reforming the system.

A cornerstone of our advice to the Commission was that the social assistance system needs to be health-enabling. The measure of a health-enabling system is not whether people on social assistance have access to health care when they’re sick – although this is important – but rather whether the system can prevent people from getting sick to begin with. This means providing health benefits, but also ensuring that social assistance rates and supports are sufficient to cover essential items that enable good health like housing, nutritious food, and child care.

Unfortunately, the Commission’s report frames health very narrowly as a question of whether people on social assistance can get health care when they need it – they did not fully recognize that health and well being are affected by other social and economic factors. The Commission rightly identified that exiting social assistance is difficult when the employment that people move into does not offer health benefits and other essential supports like child care or housing and that this can create a situation where people are forced to remain on social assistance. But they did not make the connections between enhancing these kinds of supports and building good health. Our submission set out the nature of this problem and explained how disincentives to exiting social assistance can be reduced or eliminated by providing more flexible supports and building a system that recognizes that individual needs are different and change over time.

The Commission also did not adequately address how a broad range of wider social determinants affect health: issues like the barriers that immigrants face in entering employment, income inequality, and the lack of affordable housing are only addressed as examples of areas of intergovernmental tension, not as factors that have significant population health impacts.

Throughout their report, the Commission talks about the need for social assistance to be fair to everyone. They argue that it is unfair for a low-wage worker to not receive health benefits while a person exiting social assistance who works alongside them retains their benefits. The Commission is right – this isn’t fair. But the reason that it isn’t fair is because the low-wage worker doesn’t have benefits, not because the person exiting social assistance does. We cannot penalize people on social assistance for the labour market’s failures.

This is why we argued for a system based on equity rather than just an abstract notion of fairness. Equity is about addressing differences in outcomes that are avoidable, unfair and systematically related to social inequality and disadvantage. Equity means that people with different needs are supported in different ways. The Commission needs to avoid taking benefits away from people who need them in the interest of rigid uniformity in the name of fairness.

We’ll be digging deeper into the Commission’s report over the coming days and will continue to blog our analysis. In the meantime, we encourage you to review our recent work on social assistance, including our blogs on creating a vision of a high-performing social assistance system, building a basket of essential supports, supporting people on social assistance into training and employment, building on health promotion and primary care initiatives, and collaborative solutions to fixing social assistance.

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On: Feb. 1, 2012 Colour Coded Health Care: The Impact of Race and Racism on Canadians’ Health

Canada’s universal health care system is often understood as a central pillar of a national commitment to social equity and social justice. Such an understanding makes it difficult to raise the issue of racial inequalities within the context of the Canadian health care system. Indeed, far too little research has been conducted in Canada on racial inequality in heath and heath care.

Colour Coded Health Care, a new literature review by Sheryl Nestel, offers a survey of relevant academic and community-based research on racial disparities in the health of Canadians appearing between 1990-2010. In addition to surveying the research on mortality and morbidity by racialized groups in Canada, it surveys the evidence of bias, discrimination and stereotyping in health care delivery.

Download the flip sheet here: Colour Coded Health Care

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On: Jan. 31, 2012 Building Equity Into Ontario’s New Health Care Action Plan

The Minister of Health and Long-Term Care today launched an ambitious plan to transform Ontario’s health care system. It identifies key drivers of change to improve access, quality and value; all underlain by improved system coordination and coherence, and by service and quality innovation. These are positive directions, but the opportunity must not be lost to ensure that this transformation also contributes to reducing pervasive and damaging inequities in health in the province – we need to build equity into these reforms from the outset.

The Minister emphasizes the high proportion of costs attributed to preventable illness. The Action Plan should also stress that health inequities are a major cause of avoidable illness and system costs. There is an overwhelming body of evidence demonstrating the impact of wider social determinants of health and of structured social and economic inequality on shaping population health. All of the particular challenges noted on the Action Plan – chronic conditions, emergency room use, navigation – are worse for lower income people, immigrants and others facing social exclusion.

Similarly, the solutions proposed – from increasing access to community-based services, through ensuring seniors can stay in their homes longer, through improved health promotion – can only succeed if people’s living conditions and community context and are taken into account. Children cannot be expected to exercise more if there are no safe parks in their neighbourhood or if recreation programs have user fees. What if poor housing is the real problem underlying some senior’s ill health? How can health information and support be provided in the different languages and cultures of our diverse communities?

Equity must also be built into the specific reforms identified. For example, the more comprehensive and integrated care that can be provided by Family Health Teams has great potential, but this potential may not be available equitably – existing data indicates that FHTs have tended to serve the better off and healthier. This also shows how one success condition to this Action Plan is paying attention to incentives: for FHTs and other practice models paid per patient, there is an incentive to take on the healthiest (and easiest) people to serve and to locate in wealthier and healthier neighbourhoods. Ensuring any new patient-based funding does not have such unintended and inequitable consequences, and that funding models take account of the greater burden and risk of ill health in disadvantaged populations will be crucial.

There are many levers within the Action Plan that can be used to improve health equity:
• Hospital Quality Improvement Plans can be required to include equity indicators;
• Initiatives to reduce hospital readmissions should collect data to monitor if there are differences by income, neighbourhood, or region, and should be expected to reduce any inequitable differences they find;
• As LHINs shift resources where need is greatest they must take equity into account – focussing on those neighbourhoods and populations who have the greatest burden of ill health and have traditionally had less equitable access to services;
• Every LHIN should make an explicit strategic commitment to reduce health inequities within its area; and
• The Ministry of Health and Long Term Care should apply its own very useful Health Equity Impact Assessment tool within the elaboration of its seniors’ strategy.
By building equity into the Action Plan, these reforms can help to provide quality care to all Ontarians, including the most vulnerable, and deliver better value for the health care system.

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On: Jan. 24, 2012 Drawing Out Links: Health Equity, Social Determinants of Health, and Social Policy

The Wellesley Institute engages in policy development and advocacy to advance population health. Our work also sees us working with researchers and community groups to help develop policy capacity, and we often speak on how to maximize the policy influence of research and knowledge exchange.

Earlier this week, we spoke to a graduate-level social work class at the University of Toronto about why policy matters to the social problems they address. We highlighted parallels between the kinds of policy changes needed to address social determinants of health and health equity and those needed to address the structural foundations of social inequality and exclusion. We set out some key ways to develop effective policy recommendations. The slides from Bob’s presentation are below.

We also often speak on knowledge exchange with policy impact: including recently to a major national KE conference and a CIHR research conference (here is the audio of that speech).

Social policy grad class jan 2012

 

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On: Jan. 24, 2012 TCHC Update: Executive Committee has voted to delay sell-off of affordable homes

Toronto City Council’s Executive Committee has voted to delay consideration of the proposal to sell-off of 675 single-family homes from the Toronto Community Housing Corporation stock until February 13th. Media reports suggest that Mayor Rob Ford was worried he would lose the vote on this matter at City Council due to strong and principled opposition. More info will be posted as the news develops.

Read Wellesley Institute’s submissions to the Executive committee here and recommendations, here.

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On: Jan. 23, 2012 Housing and homelessness: Presentation to Ryerson University students

The Wellesley Institute’s Director of Housing and Innovation delivered a presentation on housing and homelessness to George Brown College students on January 20, 2012. The presentation spanned a range of themes, from housing and homelessness in Toronto to national trends in inequality and their impact on housing, plus an historical survey of housing developments in Canada.

Ryersonjanuary23242012

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On: Jan. 23, 2012 Use new fed/ON housing dollars to invest in permanent, affordable homes: WI submission to Exec

The Wellesley Institute, in its formal submission to Toronto City Council’s Executive Committee on Jan. 24, 2012, commends the City of Toronto as it considers the allocation of $108 million in federal and provincial affordable housing dollars. The Wellesley Institute supports the overall approach proposed by city staff, which is to divide the housing funds among four of the major priorities set out in the City of Toronto’s long-term affordable housing plan, Housing Opportunities Toronto. However, we recommend adjusting the percentages to ensure that more funding goes into long-term and permanent affordable rental housing, and proportionately less into housing allowances paid to tenants who then hand the money over to private landlords.

Read it here: Housing Investment Allocations

UPDATE: http://www.wellesleyinstitute.com/news/tchc-update-executive-committee-has-voted-to-delay-sell-off-of-affordable-homes/

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On: Jan. 23, 2012 Don’t sell-off 740 affordable homes as wait list hits 82,138 households: WI submission to Exec

The Wellesley Institute, in its formal submission to Toronto City Council’s Executive Committee on Jan 24, 2012, joins with four former Mayors of Toronto, leading urban researchers at the University of Toronto and, perhaps most importantly, a great many tenants of Toronto Community Housing in recommending that Executive Committee reject the proposal for the unprecedented sell-off of 740 affordable homes in 675 buildings at a time when Toronto’s affordable housing wait list has set yet another record of 82,138 households. Instead of selling off the desperately-needed affordable homes, we respectfully recommend that the Executive Committee direct Toronto Community Housing Company to convene a multi-sectoral task force, including the TCHC board, staff and tenants, along with housing experts, community leaders and others, to develop a socially and fiscally responsible plan to address the capital repair shortfall in all TCHC housing, including the stand alone portfolio.

Read it here: TCHC Executive Committee Submission Wellesley Institute

UPDATE: http://www.wellesleyinstitute.com/news/tchc-update-executive-committee-has-voted-to-delay-sell-off-of-affordable-homes/

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On: Jan. 23, 2012 CBC Marketplace investigation probes many complaints against big private landlord

A good place to call home is one of the most fundamental determinants of health. Research from the Wellesley Institute and others draw strong links between poor housing and homelessness, and increased illness and early death. CBC Marketplace has investigated numerous complaints from tenants at one of Canada’s largest private landlords – and their powerful report raises many questions about whether negligent practices by some private landlords are making their tenants sick. The Wellesley Institute’s Director of Housing and Innovation, Michael Shapcott, is featured in the Marketplace investigative report.

The full episode here: http://www.cbc.ca/marketplace/2012/troubleforrent/

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On: Jan. 20, 2012 Supportive housing helps

Supportive housing is a proven component of the range of services that can help people facing health challenges to continue to live in the community. But it has occasionally faced local opposition. In 2008, Wellesley Institue funded research on the impact of supportive housing on neighbourhoods as a way to provide answers to people’s questions. Among other key findings, the research shows that there is no evidence that supportive housing buildings have negative impacts on property values or crime rates.

We Are Neighbours: The Impact of Supportive Housing on Community, Social, Economic and Attitude Changes offers an invaluable community-based view of the impact of supportive housing on the surrounding neighbourhood.

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