I blogged earlier on how crucial it is to build equity into the new Action Plan for Health Care released by the Minister of Health and Long-Term Care. This is not just to ensure that high-quality patient-centred care is available equitably to all. But reducing pervasive health inequities is crucial to overall system sustainability: these health inequities lead to avoidable death, disability and service use. A more equitable system is fairer, better quality, more efficient and better value.
But these health system reforms are only part of the picture of achieving the Ministry’s goal of “Making Healthy Change Happen.” The really healthy changes will come through addressing the underlying social determinants of health. Affordable housing, access to childcare, equal opportunities to get a good education and decent living environments are all pre-conditions for good health. And precarious work, racism, poverty and income inequality are the underlying foundations of systemic and damaging inequities in health and well-being. Governments need to act in a coherent way across Ministries and program areas to create the foundations of good health for all, including those communities consistently marginalized and left behind within current structures.
The province has a number of opportunities on the immediate horizon to start to address these fundamental determinants of health in a coordinated way. First of all, the Commission to review Ontario’s social assistance system has just released its options paper for discussion and will be continuing its work over the coming months. Wellesley, health practitioners and other health policy leaders set out a vision and series of concrete recommendations to create a health enabling social assistance system.
Similar principles of expanding opportunities and ensuring the living conditions that support good health should drive the provincial poverty reduction strategy. The Minister of Health and Long-Term Care leads this initiative and is in a good position to drive more coordinated cross-government action. Such action could demonstrate the value of more “joined-up” and integrated government efforts to address complex problems like poverty – and health inequities.
A pre-condition for addressing the social determinants of health within governments is developing new ways of developing and implementing policy. Luckily, a good deal of foundational work has been done within the Ontario government. Several years ago a major cross-Ministry initiative to develop a coordinated policy framework around health equity was undertaken, and was well received at the Deputy Minister’s Social Policy Committee. MOHLTC also developed a Health in All Policies approach: the basic idea, being pursued in leading European agencies and jurisdictions (see an example of a Finance-led HiAP lens from New Zealand), is that the population health implications of legislation, policy and programs from non-health ministries and departments are considered as policy is designed. The Ministry has a Health Equity Impact Assessment tool to facilitate this analysis. Health impact assessment is not just better coordination, but it essential to preventing unintended consequences: this common policy term is a bit of a misnomer – that poor urban planning results in food desserts and inadequate access to safe parks, that fiscal and monetary policy underlies income inequality, or that inadequate safety regulation will have adverse health effects may not be intentional, but it is certainly predictable – and avoidable.
We need policy across all spheres – from social assistance reform, through employment support and training, to fiscal policy – that contributes to reducing structured social inequality and enhancing the fundamental conditions for good health for all.