Canada has significant health inequities. Wellesley Institute research has shown that social factors such as housing, income, education, discrimination, and access to social supports, are vital for individual and community health as well as Canada’s economic growth. To build back better, to establish a new normal, inequities in the social determinants of health must be our most important issue.
In a country as diverse as Canada, for a sustainable recovery that will deliver growth for all, inequities in the social determinants of health must be our most important issue.
The COVID-19 virus thrived and spread where we have failed collectively to address social determinants of health. If we want to be prepared for the next crisis, inequities in the social determinants of health must be our most important issue.
All political parties, with different emphases and to various extents, have made statements recognizing that the pandemic has made things worse – on income inequality, gender inequity, racism, poverty, housing, mental health, and other social determinants.
But none of these harmful realities have ever been adequately addressed. Budgets, legislation, regulations, funding programs, policy proposals, and platforms must all live up to rhetoric about addressing inequities.
Now is the time for a serious equity strategy for Canada. This 2022 Budget Submission will outline what needs to go into a national Health Equity Plan, then illustrate how that Plan should work in four crucial areas for equitable progress – child care, mental health, housing, poverty and job creation.
A Health Equity Plan For Canada
The federal government must commit to developing an all-of-government strategy on equity. This means involving equity-seeking communities and outside experts, consulting with provinces, territories, and municipalities, and funding and providing both political and bureaucratic central, departmental, and agency support and commitment. It means reviewing all existing and new policies and programs to address unintended health equity impacts.
The plan must include specific disaggregated targets for preventable health disparities for different equity-seeking population groups. It must identify, through consultation with those groups, which social determinants of health should be targeted first to achieve better health. It must identify which steps for each year will be undertaken. It must clarify what the targets for each year are, and how it will monitor progress, and legislate those targets. And it must include a commitment to reviewing and renewing progress and goals.
The government must immediately move to finally ensure that the sociodemographic data necessary to support the strategy over time is responsibly collected, analyzed, reported on, and used to inform action. We have seen enormous equity failures through this COVID-19 pandemic but we have only been able to sketch the outlines of this problem because governments have failed to collect the data needed.
This budget must commit to a government-wide health equity impact assessment and action plan, and hard-wire equity across government.
With child care, the government is moving forward with significant improvements to reduce the financial burden on all Canadian families, improve quality, increase access, and better support early childhood educators across Canada. All of these changes have the potential to improve health equity – they will help low-income families get closer to a Thriving Income (in which they have enough income and supports to live a healthy life), give all children a step up towards a better, fairer educated future, and help a predominantly female and racialized workforce of early childhood educators improve their lives through decent wages and working conditions.
The government’s short-term goal of reducing child care fees by 50 per cent must be met by ensuring that all low-income families can access free or truly affordable, high quality child care as soon as possible – this program should, in time, become universal and barrier-free for all, and those who need help the most must get it first.
The federal commitment to measurable standards should include a clear focus on ensuring in particular that low-income families have the same access to quality care as high income families, and Black and other racialized families are able to access care of excellent quality.
The federal government must ensure that their agreements with the provinces are robust, integrate equity, and that they are followed. Federal money must not flow to provinces that do not intend to, do not have meaningful plans to, or fail to, address equity in all aspects of their child care efforts. If provincial governments are hesitant to do what is needed, the federal government should directly fund municipalities and civil society who are ready and willing to step up and deliver.
In mental health, we and many partners have called for a new social contract for mental health – a ten-year plan co-developed by governments, business, and civil society to reduce the rate of pre-pandemic emotional distress by half, decrease the number of children exposed to adverse childhood experiences by half, and reduce the suicide rate by half. The plan must ensure that those goals are measured, and reached equitably, for all groups. This means, among others, specific investments in the mental health and well-being of youth, Black and other racialized persons, and Indigenous communities.
In its 2021 budget, the government definitively accepted that the social determinants of health must be addressed in order to improve mental health and wellness. The federal government in this next budget should build on, and make real, its commitment to national standards by taking a leadership role in bringing our provinces and territories, municipalities, businesses, and civil society together. We need a ten-year plan to achieve measurable outcomes, and take clear steps, that everyone in Canada can come together to achieve. It is time for federal leadership to build a future with much better mental health and well-being for everyone in Canada.
On housing, in many areas including Toronto, all levels of government have public commitments to ending chronic homelessness, which is a crucial social determinant of health, a key driver of poverty, and a daily crisis that disproportionately damages the health of equity-seeking groups in Canada.
But governments cannot solve problems they do not measure, and they will never solve them through inputs – dollars and numbers of new units – alone. All levels of government must produce and publicize plans, together or separately, that will measurably eliminate homelessness. All levels must, at a bare minimum, demonstrate how they will meet their share of ending the crisis over each of the next ten years. These plans must also ensure chronic homelessness is eliminated fairly for all equity-seeking groups.
Our federal, provincial/territorial, and municipal governments each bear joint and individual responsibility to end our homelessness pandemic, which has been greatly exacerbated by the COVID-19 pandemic. After developing its own plan, the federal government should ensure Canada Social Transfer funding requires provinces to have meaningful targets to increase the number of affordable units and take other steps to decrease homelessness.
Urgently, all levels of government must ensure COVID-19 and the associated recession evictions are prevented through income supports, rent subsidies, arrears relief or forgiveness, and landlord-tenant policy reform. Failure to do so would financially devastate those who have managed to keep their homes through the pandemic, damage their health, and stunt the economic recovery for all.
Poverty must be eliminated. The economic damage from COVID-19 has disproportionately fallen on racialized individuals, females, newcomers, and low-income workers, their families, and their communities, as they lost income, jobs, homes, and loved ones. The 2021 budget included wise investments into areas including the Old Age Security pension, the Canada Workers Benefit (CWB), housing, and child care, and for proposing to raise the minimum wage for federally regulated workers to $15. The current government has already moved many Canadians out of poverty, and every step counts.
However, the measures announced in the budget will not end poverty, and that is the goal we must all be committed to and must achieve together. All governments must heed the call of the National Advisory Council on Poverty to ensure a coordinated robust social safety net in Canada by ensuring they collectively provide income support that is at least above the level of Canada’s official poverty line.
Further, the government should take a fresh look at where its anti-poverty dollars are going. The increase to the CWB is a positive step, but workers should not be forced to rely on it long-term due to poverty wages. If the government fights for better work standards, including higher wages, in all jurisdictions, not just for federally regulated entities, investments in the CWB and other programs could be reduced by addressing need. If provinces are not taking steps within their jurisdiction to reduce the need for social services, they are taking advantage of federal transfer funding to subsidize their own refusal to act.
Ending poverty must be seen as our first step towards ensuring everyone in Canada has the ability to thrive. We need all levels of government to commit to achieving a Thriving Income, one in which wages, benefits, and social supports are all adequate for good health. It is not enough to improve the devastating health impacts of impoverishment. Everyone in Canada deserves a healthy life, and we can achieve it.
Job creation is a key commitment for the government, as along with their national political competitors, it has committed to creating one million new jobs. These must be good jobs. Bad jobs harm our individual health (which our society cannot afford) and enabling and allowing bad jobs to proliferate will hinder our pandemic recovery. Everyone in Canada needs a Thriving Income, a safe and healthy workplace, a workplace that supports good mental health, anti-racism and anti-discrimination, control over their working lives, and decent benefits.
Our public dollars must not go towards bad jobs – jobs that do not meet a real, reasonable standard for income and workers’ rights. This should include all direct government funding and procurement. It should cover government funding for child care, and long-term care, health and social transfers – the entire care economy. It must include tax expenditures and grants and loans.
All governments must track where their investments and tax expenditures go and ensure that we are building a society we can be proud of. They must ensure that the economy created by their rules and their investments on our behalf is one that prioritizes health and equity.
There are of course many other areas that must be addressed (as every department puts forward their own plans to achieve health equity), including but not limited to immigration and resettlement, Pharmacare, Employment Insurance, tax reform, and gender equity. It is also essential that the government continues to fully commit to action on Indigenous Reconciliation and listen and follow the advice of Indigenous voices.
To progress towards the society we want, Canada must commit itself – in action, legislation, planning, funding, staffing, and all other aspects of government – to ensure health equity for everyone in Canada. We have seen all too clearly that we must all be in this together, as failures to address health inequities meant the pandemic was worse than it could have been if governments had acted sooner, with better information, and with clear purpose.
Canada needs, and can deliver, a national Health Equity Plan. Child care, mental health, housing, poverty, and good jobs are all crucial areas to move this Plan forward.
Delivering an all-of-government health equity plan will build a stronger future for us all.