My last blog about reforming social assistance in Ontario talked about building the vision of a health-enabling social assistance system. This was the cornerstone of our submission to the Commission for the Review of Social Assistance in Ontario, for which we partnered with health leaders in Toronto.
The basic problem is that poor people in Ontario – and especially those on social assistance – do not have sufficient income to afford the housing, food, and other elements of an adequate standard of living. This inequitable access to decent living conditions underlies inequitable and poor health for people with low incomes.
To be effective, the vision of a health-enabling social assistance system must be put into practice through a series of concrete policy and program actions. The first of these is establishing a basket of essential supports that will enable good health for all, including income and associated supports adjusted annually for inflation and reflective of regional costs of living.
The income available to people on social assistance is simply not adequate to afford a standard of living that can maintain good health. Poverty is the fundamental problem: inadequate income leads to inequitable and inadequate access to housing, food and other determinants of health.
The bottom line is that social assistance should provide adequate income support. This must not be reduced by tax benefits, like the child tax benefit. The child tax benefit should be increased so that it accounts for the real cost of raising healthy children in Ontario. This will be a wise investment in future potential and productivity, and will pay off in reduced health care and other costs associated with inequities.
Inadequate housing is directly linked to higher morbidity and mortality. The lack of social housing in Ontario means that many people on social assistance have no choice but to pay market rent, and the limited supply of affordable housing means that people can be forced to accept unsafe accommodation, forego paying for other essential items like healthy food and transportation, or become homeless.
This can be solved by providing a housing benefit reflective of the real cost of appropriate housing at different life stages, for example, families with children, people with disabilities, and senior citizens.
For many people receiving social assistance, regularly getting affordable, fresh and nutritious food is impossible, which leads to ongoing negative health effects. Fresh nutritious food is too expensive for people on a social assistance budget and the cost and limited availability of public transportation in many areas means that significant numbers are not able to travel to grocery stores where healthy food can be purchased. This means that all food has to be purchased within walking distance, which is a particular challenge in food deserts – areas that lack access to sources of healthy, nutritious foods – where no grocery options exist beyond corner stores.
The social assistance system should provide a nutritious food allowance that at minimum covers the regional cost of the Nutritious Food Basket; and provide adequate funding of student nutrition programs that provide healthy food to ensure that school-aged children/youth are well-nourished and ready to learn.
Health and Dental Supports
One quarter of people on social assistance reported unmet health needs: twice that of the working poor and non poor. Improving access to primary care is one of the most effective ways to address the health needs of disadvantaged populations. People with low income have lower rates of screening and other preventative care and have significantly higher rates of visits with medical practitioners and nights in medical facilities. Over half of low-income people had not seen a dentist in the last year. This inequitable access not only reinforces poor health, but also creates an economic cost to the health system. Without preventative care, people’s health deteriorates and requires more expensive hospital and other treatment.
The basket of essential supports should include preventive and emergency dental care for children and adults; a comprehensive drug, assistive medical devices, and eye care benefit that includes over-the-counter medications such as prenatal vitamins and infant vitamin D supplements, prescription drugs and dispensing fees; and appropriate subsidies to enable people to participate in physical activity and recreation programs, including before and after school programs.
Building a basket of essential supports is one important step towards a social assistance system that enables health. The basket recognizes that the structural factors that keep people in poverty cannot be overcome without comprehensive and coordinated supports to lift people up to a level where they can have a fair chance of success.
My next blog in the social assistance series will be about how the social assistance system can enhance opportunities for people to enter the workforce or training.