In his in his review of the potential health impacts of Toronto’s Core Service Review, Toronto’s Medical Officer of Health, Dr. David McKeown, has cautioned that some City of Toronto cost-cutting proposals will have a serious health impact on the city’s most vulnerable populations.
In his report, Dr. McKeown warns that implementing a number of the ‘opportunities’ identified by KPMG (the consultants hired by the city to perform the review of services) to significantly alter the provision and delivery of services, will have “adverse consequences on the health and social outcomes of at-risk populations.” He details the implications of severe cuts to or elimination of a number of of Toronto’s HIV/AIDS and illicit drug misuse prevention programs, cuts to Student Nutrition Programs, the dental health program, and the Investing in Families initiative. Dr. McKeown notes that all of the programs have proven to be both effective in meeting their objectives and very cost-effective and cautions that cuts in these areas will not only have serious health impacts, but serious financial impacts as well.
This week, Toronto’s City Manager made a number of recommendations to the City of Toronto’s Executive Committee for actions related to the opportunities KPMG identified. These included recommendations that the Dental Health and Investing in Families programs be considered for elimination or for service level reductions.
As Dr. McKeown notes, the dental health program, “a last resort program for eligible children, youth, perinatal mothers, and seniors who do not have access to dental care for financial reasons and have urgent and other conditions requiring treatment,” helps approximate 26,000 low-income people across the city who would otherwise not be able to access critical dental care. He states that, “dental disease has been shown to increase the severity and complications of other chronic diseases such as diabetes, heart and lung diseases, as well as contributing to premature births,” and that “people without access to care may resort to taking care of the symptoms themselves or to obtaining care from unsafe, unlicensed, and unregulated dental providers.”
Dr. McKeown also notes that the Investing in Families initiative is an evidence-based, City-wide program that offers “wrap-around” support to families who have children under the age of 17 years and are receiving Social Assistance. Through this program, Toronto Public Health provides assessment, counselling support, referral and service co-ordinaton for approximately 1,000 families per year. Many of these families are experiencing mental health problems and unhealthy family dynamics. The program helps to improve the health and parenting capacity of these families and increase their job readiness and employability. The program has demonstrated significant benefits for both parent and child participants–improving timely access to community mental health services and community programming and improving both their physical health and well-being. Dr. McKeown states that, “the program has demonstrated that as a parent’s physical and mental health improves their capacity to more effectively parent and provide a healthy environment for their children does too. Without this evidence-based partnership program, approximately 1,000 families who are currently receiving social services will fail to realize these benefits.”
While Dr. McKeown identifies a number of programs that would have severe health implications for Torontonians if service levels were significantly reduced or eliminated in his report, he unfortunately overlooks the significant health implications of a large number of programs and services that the City Manager has recommended be cut or eliminated. Cuts to the development of new affordable housing, housing assistance, subsidized childcare, the Riverdale Farm, community and neighbourhood development activities, environmental services, the Hardship Fund, neighbourhood and community program funding, library services (which includes ESL and employment programs), the TTC’s Blue Night Network service, childcare programs, Long-Term Care Homes, and EMS community medicine services all have serious health implications for Toronto residents, and the City’s disadvantaged and vulnerable in particular.
Toronto Public Health’s 2008 report, The Unequal City, draws the strong links between poverty and poor health, and notes that 1,100 Torontonians suffer premature deaths annually due to poverty and income inequality. Cuts that negatively impact Torontians’ health will serve to drive up the costs to the health care system, negating the intended financial benefit. It’s a lose-lose situation for everyone.