Ontario’s next provincial election is fast approaching on February 27. As the election candidates roll out their platforms, they must keep health equity – fairness – at the forefront. Our previous piece in our Ontario election series provided recommendations for provincial candidates on thriving — policies that will help ensure people have what they need to live a healthy life. Below, we discuss how the province can work towards improving health system equity.
Ontario’s healthcare system is in crisis. Severe underfunding and fragmentation of care structures have led to shortages in the health workforce, barriers to primary care, hallway medicine, long surgical wait times and widespread ER closures. This is directly impacting health outcomes of Ontarians, particularly those who are low-income, Black, Indigenous or racialized, living in rural communities and/or living with disabilities. Evidence shows these equity-deserving groups face lower life expectancy, higher rates of chronic health conditions such as diabetes, and worse mental health.
Ontario can reduce these inequities and improve health outcomes for all by developing and implementing a healthcare strategy that focuses on illness prevention and health promotion rather than short-term, piecemeal solutions. Expanding the scope of practice for pharmacists and nurse practitioners and increasing the role of private delivery for public services such as MRI and CT scans may improve access to healthcare services for some, but will likely only exacerbate existing inequities.
There are no immediate solutions to the healthcare crisis. Building an equitable health system will require systemic change and active support from all levels of government, community and individuals. The first step towards this could be to finally act upon the 1986 Ottawa Charter, which was a landmark document that covered issues such as building healthy public policy, strengthening community action on health and re-orienting health services to promote wellness. The next provincial leader should commit to bringing together relevant miniatures, agencies, experts, and communities to create a new vision and strategy for healthcare in Ontario based on the Ottawa Charter. This should include focusing on action on the social determinants of health, such as housing and income, along with improving access to services.
There are also a number of things the next provincial leader can do in the coming months.
First, Ontario should require all healthcare service providers collect race-based data. The province already mandates the collection of standardized race-based data through the Anti-Racism Act for some public sector organizations (PSOs), including child and youth services, education and correctional services. The healthcare system should not be exempt from this, as evidence clearly shows it is an effective tool to identify and understand health inequities and can power action on solutions.
Wellesley Institute’s recent work on understanding barriers to accessing primary care also highlights that there is much more work to be done in making primary care equitable, beyond just connecting everyone to a provider. For example, our research showed that healthcare professionals need improved training on the social and cultural factors of health, which greatly influences the care experiences of those from equity-deserving groups including low-income, racialized and 2SLGBTQ+ communities.
The next government of Ontario should, in consultation with community and experts, develop a broader strategy to address inequities in primary care. While that work takes place, the province should increase provincial funding for language translation services and targeted disease prevention programs and require mandatory cultural competency training for healthcare providers and staff. In addition, community-based organizations should be expanded and receive funding that allows them to meet the needs of their clients, including Community Health Centres.
Finally, healthcare service providers, healthcare organizations, policy makers and others who create policies and programs that impact people’s health also have a responsibility to identify and mitigate health inequities. Ontario’s next leader should require and publicize the results of the use of the Health Equity Impact Assessment tool, which helps to identify unintended potential health impacts of a policy, program or initiative on equity-deserving populations and supports the development of equity-based improvements to ensure positive impact.
Although there is much work to be done to achieve a truly equitable healthcare system that adequately supports all Ontarians, the next Premier of Ontario must commit to getting the process started.