City Council will be considering recommendations from the Toronto Board of Health regarding health care for uninsured residents of Toronto. We and a number of progressive health care providers and researchers had appeared before the Board to support a Toronto Public Health Report.
Uninsured populations currently face serious and damaging barriers to good health and access to health care.
- The Board of Health heard about ground-breaking research regarding:
- the mental health crises, injuries and other serious problems that bring uninsured people to hospital emergency departments;
- how the uninsured are more likely to be seriously ill when they come to a hospital;
- and the inequitable care they receive – the uninsured are more than twice as likely to leave without receiving care.
- The Toronto Public Health Report reviews available evidence, outlines the underlying causes and drivers of the inequitable health faced by uninsured residents, and identifies particularly vulnerable groups such as women giving birth without adequate pre-natal care, children, people facing mental health challenges, those requiring emergency or urgent care, those with chronic conditions that will worsen without adequate care, and people with communicable diseases.
- Toronto has also seen how committed front-line service providers can make a huge difference through the many innovative services that have been developed locally by the Scarborough Volunteer Clinic, Community Health Centres, midwives, physicians, and other providers. This base of innovation and experience should be built upon.
These barriers and their inequitable health impact can be addressed through better policy. Here’s how:
- Council should approve the Board of Health’s recommendations.
- The City should build on its Access Without Fear policies for undocumented immigrants; Toronto Public Health should proactively implement its report’s recommendation to work with health sector colleagues and authorities to ensure Access Without Fear policies are consistently in place in facilities across the city.
- The Report’s recommendations include working with local, provincial and federal governments to address the access barriers identified and advocate for the changes proposed. Toronto Public Health can undertake this collaboration from a position of considerable strength; being widely recognized as a research-based, credible and influential champion for population health. TPH should monitor relevant policy changes and debate and proactively ensure that its strong population health approach is influential in ongoing policy development regarding immigrant health.
- Toronto Public Health has a long and effective history of local health leadership and collaboration. It should build on this tradition by continuing to work in ground-level front-line service innovations and local coordinating networks to improve care for uninsured residents. It should also collaborate with LHINs, service providers, researchers and appropriate networks to monitor the health of uninsured populations, assess the impact of policy and program changes made to improve access to health care, and identify service gaps and access barriers.
- Senior staff should also work with public health leaders across the province and country, both to help develop creative local solutions to challenges uninsured face in different communities and to forge a strong public health voice on the systemic policy changes needed to ensure health equity for all, including the uninsured.
And, of course, action needs to be taken by other levels of government. Starting points that would make a huge difference would be for Ontario to remove the three-month wait period for OHIP for new immigrants and for the federal government to rescind its very damaging cuts to refugee health care.