In the City of Toronto’s drive to address the budget deficit, a number of proposals for service cuts have been brought forward. Unfortunately, many of the proposed service cuts have health implications that would disproportionately affect vulnerable populations in Toronto.
An enormous body of research demonstrates that adequate housing, income, child care, social safety nets, living environments, and other social conditions and opportunities are crucial determinants of the overall health of a population. Low incomes, precarious jobs, poverty, unaffordable housing and homelessness, social exclusion, and other forms of disparity underlie pervasive inequities in life expectancy, infant mortality, chronic conditions, and other poor health outcomes.
Policy development can be complex and unintended adverse consequences can easily result. The Wellesley Health Equity Lens is an evidence-based tool designed to help policy makers to assess the impact of proposed policy and program changes on population health and health inequities. The Lens is a high-level Health Equity Impact Assessment that:
• Analyzes whether a proposed policy or program change could have a different or inequitable impact on health within the community;
• Identifies what groups or neighbourhoods would be adversely and inequitably affected, and how; and
• Sets out what can be done to mitigate and avoid these adverse and inequitable effects on population health.
We applied this analytical tool to three key policy and program changes proposed by the city: reducing child care funding and subsidies, eliminating the Hardship Fund, and limiting the development of affordable housing to completing only what has already been approved and funded.
Child Care: The importance of child care and early child development to individual and population level health is well-known, but in Toronto access to child care is currently worse in neighbourhoods with the highest child poverty. If proposed changes make access to child care less accessible, especially to low income families who cannot afford private care, then this will have a negative and inequitable impact on the health of already disadvantaged groups.
Hardship Fund: The Hardship Fund provides emergency short-term support for people with low or precarious incomes and is a vital safety net for the large numbers of working poor in Toronto. Eliminating the program will have an adverse impact on recent immigrants, racialized populations and others in precarious and lower paid jobs. Increasing economic insecurity and poorer living conditions for these groups will increase their already greater risk of poor health.
Affordable Housing: Decent and affordable housing is a crucial determinant of health. Reducing programs to develop affordable housing will adversely affect people with disabilities, racialized populations and others who cannot afford market rents and cannot get past long waiting lists for subsidized housing.
Already in Toronto life expectancy is 4.5 years less for men living in the poorest neighbourhoods versus those from the richer areas, and 2 years for women. Because the proposed reductions in child care, medical support, and affordable housing will have a disproportionate impact on already vulnerable groups, they will make these health inequities worse. If the city pursues the proposed cuts, the current and future health of many vulnerable Torontonians will be compromised, and Toronto will become a more unequal city.
However, these negative and inequitable outcomes can be avoided, as set out in our full analysis. If the City plans to reduce expenses by cutting programs and services, it cannot be done at the expense of the most vulnerable. Applying Health Equity Impact Assessments to budget decisions will provide a window for elected officials, city staff, and Torontonians to see the inequitable effects of the proposed cuts and to build equity into budget decisions.
Download the report here: The Real Cost of City Cuts