Over the past couple of weeks we’ve seen a lot of discussion around Toronto about the value of a range of services that the City provides and how we should pay for them. As an organization dedicated to advancing urban health, the Wellesley Institute is always interested in participating in these types of discussions about what makes our city tick. However, we’re also interested in making sure that policy decisions are made after sober and informed thought.
The Wellesley Institute made a formal deputation to the Executive Committee where we set out our concerns about the rushed policy process for this year’s budget discussions and how this will negatively affect health equity in Toronto. We argued that many of the items identified in the KPMG report will serve to worsen the health of many Torontonians and that vulnerable populations will be the most severely affected. If we fail to consider how possible cuts to city services will affect these populations the result will be deteriorating health in already disadvantaged groups which will adversely affect quality of life in our city and will lead to greater need for costly health services in the future.
Dental health is a perfect example of how disadvantage compounds to lead to poor health. Periodontal disease can lead to diabetes and lung disease. This is on top of oral pain that affects individuals’ ability to carry out day-to-day tasks like eating or going to work. Research on homelessness in Toronto conducted by Street Health and supported by the Wellesley Institute found evidence of homeless people attempting to extract their own teeth because they could not access dental services. This led to distressing, unnecessary, and costly visits to hospital emergency departments.
We all know how expensive even routine or preventative dental care is, so it’s not surprising that having dental insurance is a major factor in determining how likely individuals are to visit a dentist. The Toronto Dental Coalition reports that adults in Canada who have dental insurance are 2.7 times more likely than non-insured adults to report visiting a dentist in the last year. Insured children are 2.5 times more likely to receive dental care than non-insured children.
Statistics Canada reports that only 62 percent of Canadians have private dental insurance and only 6 percent are covered by publicly funded programs. This leaves 32 percent of Canadians with no dental insurance. These uninsured Canadians come disproportionately from the most vulnerable populations – Torontonians who are precariously employed are less likely to have any benefits, let alone dental insurance.
The City’s Dental Health Program provides dental services to Torontonians who are unable to afford to pay for a dentist, including 13,000 seniors in long-term care homes and over 7,500 children and youth annually. This program was identified as a possible area to be reduced or eliminated in the KPMG report to the Executive Committee. However, in the rushed policy process no thought has been given to how this would create greater health inequities amongst Torontonians.
In our deputation, the Wellesley Institute urged the Executive Committee to ensure that the City undertake a rapid assessment of all key budget decisions to determine if the proposed changes would have a differential and inequitable health impact on residents, and whether and how these impacts would specifically affect priority neighbourhoods and disadvantaged communities. We asked that if the analysis determined that an adverse and differential outcome was possible, then a Health Equity Impact Assessment should be conducted.
We at the Wellesley Institute agree that it is important to have discussions about what works and what doesn’t work in our city. However, it is essential that we take the time to properly consider the impacts of policy decisions and that we ensure that we reduce health inequities between Torontonians.