Over the last couple of weeks I’ve been blogging about the submission to the Commission for the Review of Social Assistance in Ontario that the Wellesley Institute wrote as part of a collaboration of health leaders. So far, I’ve blogged about the submission itself and about how the social assistance system causes poor health. This blog highlights the solution to this problem – building a social assistance system that enables good health for all.
For the social assistance system to support good health and well-being, health-enabling components must be identified and ingrained as cornerstones of system reform. In Ontario, the Excellent Care for All Act sets out the pre-conditions for a high-performing health system. This idea of identifying the key features and drivers of a high performing system should also be applied to social assistance policy. Excellent Care for All-type principles of person-centred, effective and integrated services; paying attention to program impact on the population as a whole and on particularly vulnerable communities; setting out clear deliverables and objectives, and measuring performance and delivery against them; and building quality, sustainability and effectiveness are just as relevant for social assistance reforms as they are for health reform.
A high performing social assistance system that enables good health would be:
- Adequate: so that people on social assistance can maintain a healthy standard of living;
- Flexible: with a range of responsive supports to help people get out of poverty – recognizing that there are very different pathways into and out of poverty;
- Person-centred: so services and requirements are responsive to individual and family needs and situations, are delivered in a respectful manner that does not undermine dignity, and so people can be empowered to achieve more control over their lives;
- Health-enabling: so that people’s opportunities for better health are enhanced, not constantly eroded.
One of the primary goals of social assistance is to provide basic protection against loss of income or employment. However, income security is only one aspect of well-being – policy makers must be continually aware of the health impact of poverty and insecurity. Therefore, in addition to providing basic income security, social assistance should also provide basic health security. This means:
- Ensuring housing, food, living conditions, support and other factors that enable good health;
- Enhancing access to primary care and other critical health and social services that will ameliorate the impact of health inequities;
- Contributing to reducing the impact of wider poverty, income inequality, social exclusion and other social determinants of health.
To enable this, our first recommendation to the Commission is that they should develop a vision of how a high performing social assistance system for Ontario will enable good health. We argue that the vision should articulate equity in health and well-being as a basic value of Ontario society and recognize the provision of adequate supports for people who lose their income or employment, or who are injured, sick, or disabled.
While a vision alone will not create a health-enabling social assistance system, it sets out at a very fundamental level the purposes and responsibilities of the system. It is from this base that the components of the social assistance system should be built. Upcoming blogs will discuss some of these components, including establishing a basket of essential supports.