Eliminating health disparities is a complex challenge. But not all of it: some solutions are quick and immediate. Ontario denies access to OHIP for new immigrants for three months. This is discriminatory and dangerous to a vulnerable population – and easily fixable. I am supporting the Right to Health Care Coalition’s demand to remove the three month wait for OHIP eligibility.
A crucial health and social problem facing the people and government of Ontario is pervasive and systemic health disparities. Whether measured by overall health outcomes or for specific conditions such as diabetes or mental health, the better off consistently have far better health than the less advantaged. There is a systematic social gradient of health along income, education, race and other dimensions of social inequality and exclusion. This inequality has a significant impact on people’s lives – from far higher infant mortality in poorer neighbourhoods and in Aboriginal and other marginalized communities, through life expectancy that is years lower for low income people, and to immigrants’ health steadily deteriorating after they come to Canada.
The roots of these health inequalities lie in wider structures of social and economic inequality, and the solutions needed to address these social determinants of health are the responsibility of all levels of government and the public, private and community sectors working together. The provincial government has a key role to play in these wider changes, and policies such as poverty reduction can be an important contribution.
But there are also significant inequities in access to and quality of health care that are the responsibility of the provincial government. The recent Excellent Care for All Act, 2010 enshrines equity and population health among the essential dimensions of the provincial health system. It is especially unconscionable for the province to deploy policies that directly – and knowingly – make health inequities worse. Requiring new immigrants and others to wait three months for OHIP coverage is just such a policy. It has a damaging and inequitable impact on vulnerable people, damage that is entirely avoidable.
Recent data presented at a research conference at Women’s College Hospital in Toronto confirmed a pattern long identified by front-line health care providers: denying new immigrants access to OHIP coverage has significant impact on their health. People without health coverage delayed seeking treatment, increasing the danger of adverse outcomes and conditions worsening; when seeking care, they received differential and inequitable treatment within health care institutions; and they had virtually no access to primary care and other services that promote health and prevent illness. These inequities are worse for women, and their children: the medical danger of arriving at hospital giving birth without having received pre-natal care has been well established.
I add my voice to many researchers, health professionals and other community organizations in supporting the Right to Health Care Coalition recommendation to eliminate the three-month wait for public health insurance. In addition to eliminating a glaring social inequity, their business case demonstrates that the relatively low cost is easily affordable (the highest estimate of costs amounts to 0.18% of health expenditures); will be balanced by savings from the preventable costs of having to delay treatment; will have significant immediate and long-term benefit for the health of vulnerable populations; and will enhance the equity of Ontario’s health system.