By Scott Leon and Laura Anderson
It is budget time again in the City of Toronto and Council is deciding what to cut as it closes the $91 million opening budget gap out of the $10 billion city operating budget. It appears that the budget will be reconciled through a small swathe of cuts to social programs, and canceling planned program expansions like childcare subsidies. These cuts would come at the cost of Torontonians’ health and well-being. The flatlining of funding to community organizations and the cancellation of new affordable childcare spots are two examples of cuts that have consequences for our health. Economic inequality is increasing across Toronto, and Toronto is the child poverty capital of Canada. If we want a healthier city, we need take policy action on the social determinants of health.
It would be a mistake to overshadow the gains of this year with cuts to city programs that ultimately widen social, economic, and health disparities in our city. Among these gains are the two dollar road tolls on the Gardiner and the DVP that will pay for repairs to these roadways, with the reminder funding transit expansion. A 0.5 percent increase in residential property taxes above inflation for a City Building Fund will whittle down the $33 billion capital iceberg of unfunded projects, including transit expansion and the Port Lands flood protection.
The city needs to consider the long-term costs of failing to invest in social determinants of health – like health care for marginalized populations, community programming, and helping homeless youth transition to stable housing. The positive impacts of investing in social programs on population health have been well-documented. If we want a healthier and more equitable city we need to continue to fund and work to improve initiatives that help struggling Torontonians. Investing in social determinants of health means investing in communities and individuals, and working to reduce barriers to income inequality, educational attainment, adequate housing and community involvement, to name a few key determinants of health.
If as a city we want to improve health and health equity, then there are ways in which the budget can do this. Only then will we have a city that is thriving, rather than scraping by. It would not break the budget to include some gains to social programs. If we compare the financial costs of these programs with the equity benefits, we see these programs are worthwhile.
Community grants decrease in real per capita terms to save each household $1.60 per year
The City of Toronto supports roughly 900 community organizations through grants which improve Torontonians’ health, social connectedness, and quality of life. These non-profits deliver a host of services which benefit communities in a myriad of ways. Community grants help support newcomers, immigrants and refugees through health and service agencies like Access Alliance Multicultural Health and Community Services, COSTI Immigrant Services, Polycultural Immigrant and Community Services, and the Canadian Centre for Victims of Torture. Investments are made towards supporting children, youth and families through agencies like SKETCH, Youthlink, Boys and Girls Clubs across the city, and community hubs like the East Scarborough Storefront. Important resources are made available to community members across the city through Distress centres, Meals on Wheels programs, and Community Health Centres. And the city invests in the arts community from gallery spaces to arts collectives, to theatre companies and dance projects. Together these programs each work to address the health and well-being of Torontonians in different and complementary ways through addressing social determinants of health. They build social capital, and social connectedness, support a vibrant arts community, and bring much-needed resources to individuals and families in need.
The funding for these grants, however, is frozen is the current budget, and will not cover inflationary cost increases or the increased Toronto population. This means that in real per capita terms these grants would decrease next year. City of Toronto staff has noted that these effective cuts mean these organizations “may have difficulty maintaining service levels.”
75 low-income childcare spaces canceled to save each household $0.75 per year
Helping low income families afford quality childcare is another way Toronto can improve the health families and children. Toronto has the highest rates of child poverty in the country, and many families cannot afford the $1000 a month in childcare costs. Toronto has the most expensive childcare in Canada. City-run childcare includes subsidies for families living on low incomes, which helps bridge the gap between what families can afford and what quality childcare costs. Subsidizing high-quality childcare allows more mothers and fathers to return to work or school, improving their current and long-term incomes, and improve their children’s chances of higher educational achievements and incomes later in life.
The 2017 budget currently does not expand the childcare system. The 75 new promised childcare spots for low-income families are on the chopping block. While 75 new spots is a drop in the bucket of the 17,000 children currently on the subsidy waiting list, it is a move in the right direction and it sends the right message. Each subsidized spot for a low-income child costs approximately $800/month, but when we average that over the number of households in Toronto, it is roughly only one cent per household per year. To add 75 new spots it would cost each Toronto household $0.75 per year. A low price for an important investment.
It is clear that health equity can be supported in the city budget. The City of Toronto should be proud of its current efforts to improve the health and well-being of its most vulnerable residents, but as we have seen, current trends show increasing health disparities, which suggests we need more, not less investment. Closing the $91 million budget gap does not need to fall on the shoulders of social programs. Rather than cutting programs, we should instead be thinking about ways we can pay for these valuable services that work to improve health and health equity in our city.