The deep and persistent inequalities in health among Ontarians have been all but ignored in the 2009 Ontario budget. Over three times as many low-income adults report their health to be only fair or poor as high-income; over 50% more low income adult men have two or more chronic conditions than high-income. While the budget notes that Ontario spends 43 cents out of every dollar on health, it’s not just the size of the spending that matters, it’s also whether the government is making smart investments.
Sick and Tired powerful new research from the Wellesley Institute, shows the deep and persistent gaps in health between poor and rich Ontarians. Along with a huge amount of other research evidence, it shows that low-income people, racialized communities and other groups pushed to the margin are experiencing a heavier burden of illness and premature death. This means that the most important health investments are outside the health system, in reducing poverty and inequality.
But equity must be addressed within the health system as well. In our pre-budget submission, the Wellesley Institute called for health investments targeted to reducing barriers to equitable access and providing high-quality care to populations most in need: including additional funding for peer health ambassadors providing health promotion, system navigation assistance and outreach support in under-served communities, language services and community-based front-line innovation delivered through the Local Health Integration Networks across the province. We also called for additional investments in primary health care and dental care. The total spending tag was modest ($120 million out of a total health care budget of $42.6 billion), but the benefits would be substantial.
“There are a growing number of promising practices at the local level, collaborations among health care providers and community groups, that are delivering real results,” says Bob Gardner, the Wellesley Institute’s Director of Policy and Research. . One with great potential is locating primary health care and related social services in one-stop hub-type community centres. “Just ramping up spending without funding initiatives directed specifically at reducing disparities and innovative community-based collaborations is neglecting an important opportunity to tackle the health inequities that are plaguing Ontarians.”
Most health spending in the provincial budget is on acute care, such as emergency rooms and new hospitals. “People who get sick need to know that there are facilities and services available to help them recover,” says Gardner. “But we also have to expand our primary care services and up-stream investment in health promotion and preventative care, and, most fundamentally, invest in reducing the social and economic inequalities that are making people sick in the first place.”
The Ontario government is increasing the number of Family Health Teams over the next two years, a proposal endorsed by the Wellesley Institute. And the province is also committed to creating another 22 nurse-practitioner-led clinics to deliver good quality health services. “These are welcome investments, but to have a significant equity impact they must be located in the most health disadvantaged communities and combined with interpretation services, multi-disciplinary care, community outreach and local partnerships ,” says Gardner.