Should social assistance ensure access to health care services, or keep people from getting sick? Both, actually.

The social assistance system causes poor health. The low levels of income supports combined with inadequate supplementary supports like affordable child care and transportation mean that people on social assistance do not have a fair chance at good health. I’ve blogged about this, and have set out some solutions such as building a basket of essential supports and supporting people on social assistance into training and employment.

This blog talks about how the social assistance system can build upon existing infrastructure to reduce health inequities by facilitating access to primary care and health promotion initiatives.

Primary Care

Extensive health research has found that one of the most effective ways to reduce health inequities is to enhance access to primary care for disadvantaged populations. Effective primary care can stop people from getting sick and can catch and treat illnesses before they become critical. This means greater system efficiency and improved quality of life for patients.

There is, however, more than one way to deliver primary care. In recent years Ontario has focused on family health teams: interdisciplinary teams that work out of a shared location. Depending on your needs, this can be an effective health care option. But the funding incentives have not been well aligned, and family health teams have tended to serve more advantaged and healthier populations.

For disadvantaged populations in particular, community health centres (CHCs) are a proven model. CHCs provide multidisciplinary and person-centred care to disadvantaged populations, connect clients into further services and emphasize health promotion activities to keep people well. This comprehensive model of care means that CHCs deal with issues that reach far beyond health care into individual and family social supports, and community capacity-building and development.

Although direct health care is outside of the scope of the social assistance system, the Commission for the Review of Social Assistance in Ontario should advocate for improved access to primary care and CHCs should be empowered to provide a greater role through their unique grass-roots level infrastructure and specialized knowledge of the community that social services could link into.

Health Promotion

Leading health policy experts and researchers consistently emphasize the importance of health promotion strategies to delay or prevent illness. This is especially important for lower income and more vulnerable populations. Conditions such as asthma, hypertension, diabetes, depression and other chronic conditions are particularly sensitive to social circumstances (for example, one key to preventing and managing diabetes is good diet). Poorer people are at greater risk, yet also tend to have less access to health promotion services.

Social assistance should positively facilitate access to health promoting activities and support. This may include subsidizing user fees and removing other barriers that may prevent people on social assistance from being able to participate in health-promoting activities.

For this to happen, social assistance reform needs to be linked to other spheres; for example, ensuring there are adequate parks and activity opportunities in poorer neighbourhoods, and working with healthy community partnerships to ensure the needs of the poorest and most marginalized are met – more on this in my next blog.