At the end of last year Mayor Tory and city council unanimously approved Toronto’s Poverty Reduction Strategy. In it they herald a new vision for the City:
“By 2035, Toronto is a city with opportunities for all: a leader in the collective pursuit of justice, fairness and equity. We want to be renowned as a city where everyone has access to good jobs, adequate income, stable housing, affordable transportation, nutritious food, and supportive services.”
The strategy has three main pillars:
- “Ensure that essential services are effective, well-funded, coordinated, and meet the needs of those living in poverty.”
- Improve the quality of jobs in the city, attract investments to low income areas, and ensure that City programs and services are integrated, client-centered, and focused on early intervention.
- Drive systemic change by creating a more accountable and participatory government, where reducing poverty and inequality is an integral part of day-to-day business.”
Though funding won’t be confirmed until the 2016 budget is passed, the City’s Poverty Reduction Strategy could be the catalyst for a new way of thinking.
The systemic change they are trying to achieve is mobilizing the city to reduce and ultimately end poverty. For this to happen, poverty reduction must be considered in budgets at all levels. All of those who set budgets need to realize that poverty reduction is their business. If poverty is going to decrease, then, at every turn, city staff need to consider whether each decision they make will increase or decrease poverty. If they include poverty reduction in their thinking, then over time we could see a city budget where poverty is systematically decreased by the coordinated efforts of all city departments.
This form of whole government approach to poverty reduction is the same approach we need to improve health and health equity in Toronto. The drivers of disparities in health in Toronto are social factors such as income inequality, poor housing, stress, access to good nutritious food and access to a social safety net that supports us when we experience difficulty. Action on these drivers, or any of the other social determinants of health, cannot be changed by a single policy. The World Health Organization (WHO) calls for health in all policies, where all new government policies are seen through a health lens, and we agree.
In an ideal situation, all new polices would have to undergo a health impact assessment where the positive and negative health impacts would be quantified. Doing this means that when governments adopt or change policies they know whether, for example, changes in speed limits, a new casino, contracting out their staff, tax changes or changes in zoning laws improve the population’s health or make it worse. But, more than this, it allows the public to understand what government is doing, the risks they are taking, and allows us to keep them accountable. Governments make decisions differently when they have all the information, and they know we have all the information as well.
At Wellesley Institute, we would go one step further than the WHO. Rather than being satisfied with health in all policies, Wellesley Institute wants to see “health and health equity in all policies.” All too often new approaches to improving health are taken up by those with time, money and access to information. Health in all policies sometimes has the effect of increasing disparities in health between rich and poor. But, one of the benefits of the health equity approach is that by decreasing disparities it does not only make the poor and marginalized healthier but it also preserves the health of the rich. There are no losers when governments focus on decreasing the day-to-day health risks we face in society.
Health is of course complex. Though the City plays an important role through Toronto Public Health, most health funding is provincial and some money for the social determinants of health, particularly housing, are federal. This means that a health and health equity in all policies approach needs to work at all levels of government for it to be fully effective.
Looking to 2016, the signs that health will be more systematically considered by our governments are good. We have an unprecedented alignment of forward thinking leaders at all levels of government. The City Poverty Reduction Strategy is a great start. Our biggest Local Health Integration Network (Toronto Central LHIN) has launched a health equity roadmap, are linking hospital services to communities through their Health Links and will soon have new powers over primary health care, homecare, and public health. At the provincial level good progress is being made on implementing their second Poverty Reduction Strategy and Health Quality Ontario, which sets standards for health, is developing a health equity strategy too. With the province targeting an end to homelessness and an update to the Long Term Affordable Housing Strategy on its way they are pushing forward on improvements to the social risks for health. The sunny ways promised by the new federal government also supports the impression that initiatives to improve health and health equity are currently “hot.” The federal government will has signalled that there will be stronger links to provincial governments on health and more support for vital infrastructure – which if properly considered could decrease the impact of the social determinants of health.
The City Poverty Reduction Strategy is trying to get to a place where poverty is everyone’s business. We hope to get to a place where the same can be said for the social determinants of health at all levels of government.
There is a long way to go, and I have been caught up in waves of optimism that followed the election of Obama in the US and Blair in the UK. Some would argue that neither quite lived up to their promise. The difference here is that we have people who want to see real change aligned at all level of government. This gives a chance for real gains in some of the fundamental issues that change health and health inequities in Toronto. The focus of 2016 should be to capitalize on these possibilities to build a healthier and more equitable Toronto.