Canada has significant health inequities. Wellesley Institute research has shown that social factors such as housing, income, education, discrimination, and access to social supports are vital for individual health, community health, and Canada’s economic growth. To build back better, to establish a new normal, inequities in the social determinants of health are our most important issue.
In a country as diverse as Canada, for a sustainable future that will deliver growth for all, inequities in the social determinants of health are our most important issue.
The COVID-19 virus thrives and spreads where we have failed collectively to address social determinants of health. If we want to get through this ongoing crisis and be prepared for the next crisis, inequities in the social determinants of health are our most important issue.
Now is the time for a health equity strategy for Canada.
This 2023 Budget Submission, as did our submission last year, will outline what needs to go into a national Health Equity Plan, then illustrate how that Plan should work in four crucial areas for equitable progress. We will address pandemic management, mental health, housing, poverty, and combatting the harms of inflation.
A Health Equity Plan For Canada
The federal government must commit to developing an all-of-government strategy on equity. This means involving structurally disadvantaged communities and outside experts, consulting with provinces, territories, and municipalities, and funding and providing both political and bureaucratic central, departmental, and agency support and commitment. It means reviewing all existing and new policies and programs to address unintended health equity impacts.
The plan must include specific disaggregated targets for preventable health disparities for different equity-seeking population groups. It must identify, through consultation with those groups, which social determinants of health should be targeted first to achieve better health. It must identify which steps for each year will be undertaken. It must clarify what the targets for each year are, and how it will monitor progress, and legislate those targets. And it must include a commitment to reviewing and renewing progress and goals.
The government must immediately move to ensure that the sociodemographic data necessary to support the strategy over time is responsibly collected, analyzed, reported on, and used to inform action. We have seen enormous equity failures throughout the COVID-19 pandemic but we have only been able to sketch the outlines of this problem because governments have failed to collect the data needed.
This budget must commit to a government-wide health equity impact assessment and action plan, and hard-wire equity across government.
The COVID-19 Pandemic continues to take a shocking toll but tragically governments, public officials, experts, and the public seem to be “moving on” from the fight.
We will continue to live with the health and economic devastation of the pandemic unless we combat it with reasonable measures and by committing to taking care of one another. The burden of the pandemic will continue to disproportionately fall on those whom it has always fallen: Indigenous, Black, racialized persons, persons with disabilities, and those struggling with low-incomes. But it will not fall on them alone.
A National Health Equity Plan would recognize the enormous ongoing impacts and ensure that communications, protections, and funding go where they are needed. The government must also put in the work to re-build the consensus we need to combat, rather than capitulate to, the COVID-19 virus. This should include efforts to pressure provinces to act and to ensure that federal funding sent to the provinces is distributed, and distributed equitably. We continue to need income supports, paid sick days, and significant investments in research focused on the virus, long COVID, and their inequitable impacts. We need straightforward protections that can benefit us all. This includes a renewed focus on vaccination, non-pharmaceutical interventions where reasonable, and most importantly a renewed commitment to keeping each other safe.
In mental health we and many partners have called for a new social contract for mental health—a ten-year plan co-developed by governments, business, and civil society to reduce the rate of pre-pandemic emotional distress by half, decrease the number of children exposed to adverse childhood experiences by half, and reduce the suicide rate by half. The plan must ensure that those goals are measured, and reached equitably, for all groups. This means, among others, specific investments in the mental health and well-being of youth, Black and other racialized persons, and Indigenous communities.
The federal government should build on, and make real, its commitment to national standards by taking a leadership role in bringing our provinces and territories, municipalities, businesses, and civil society together. We need a long term plan to achieve measurable outcomes, and take clear steps, that everyone in Canada can come together to achieve. It’s time for federal leadership to build a future with much better mental health and well-being for everyone in Canada.
On housing, in many areas including Toronto, all levels of government have public commitments to ending chronic homelessness, which is a crucial social determinant of health, a key driver of poverty, and a daily crisis that disproportionately damages the health of equity-seeking groups in Canada.
But governments cannot solve problems they do not measure, and they will never solve them through inputs—dollars and numbers of new units—alone. All levels of government must produce and publicize plans, together or separately, that will measurably eliminate homelessness. All levels must, at a bare minimum, demonstrate how they will meet their share of ending the crisis over each of the next 10 years. These plans must also ensure chronic homelessness is eliminated fairly for all equity seeking groups.
Our federal, provincial/territorial, and municipal governments each bear joint and individual responsibility to end our homelessness pandemic, which has been greatly exacerbated by the COVID-19 pandemic.
After developing its own plan, the federal government should ensure Canada Social Transfer funding requires provinces have meaningful targets to increase the number of affordable units and take other steps to decrease homelessness.
Poverty must be eliminated. The ongoing economic damage from COVID-19 has disproportionately fallen on racialized individuals, women, newcomers, low-income workers and their families and communities. They’ve lost income, jobs, homes, and loved ones. The current government has already moved many Canadians out of poverty, and every step counts. However, measures announced so far will not end poverty, and that is the goal we must all be committed to and must achieve together. All governments must heed the call of the National Advisory Council on Poverty to ensure a coordinated robust social safety net in Canada by ensuring they collectively provide income support that is at least above the level of Canada’s official poverty line.
Ending poverty must be seen as our first step towards ensuring everyone in Canada has the ability to thrive. We need all levels of government to commit to achieving a Thriving Income, one in which wages, benefits, and social supports are all adequate for good health. It is not enough to improve the devastating health impacts of impoverishment. Everyone in Canada deserves a healthy life, and we can achieve it.
Inflation is understandably and correctly of great concern to many. We recognize the government has taken important steps to ameliorate some of the harms of inflation, including through enhancing HST credits and beginning down the path to national dental care.
Incorporating these steps into a national Health Equity Plan, however, would mean more efforts to support those who are most affected by increasing prices without increasing wages or income supports. Before that, however, it would mean identifying the issue correctly and providing the public with the government’s goals.
A plan measuring health equity outcomes will find the largest impact is how the rising cost of living affects low-income individuals. Inflation does not affect us all equally, nor will central bank interest rate increases harm us equally. Protecting the already precarious should be centered in the government’s economic response to inflation.
The government should then show the public how it will do so by establishing what an acceptable level of income and benefits is, given this inflationary period, and then how it will arrive at that goal. As mentioned above, the Wellesley Institute advocates for a Thriving Income—a level at which each individual has what they need to live a healthy, meaningful life. Responses to inflation that advance this goal would advance health equity.
There are of course many other areas that must be addressed (as every department puts forward their own plans to achieve health equity) including but not limited to immigration and resettlement, Pharmacare, Employment Insurance, tax reform, and gender equity. It is also essential that the government continue to fully commit to action on Indigenous Reconciliation, and listen and follow the advice of Indigenous voices.
To progress towards the society we want, Canada must commit itself—in action, legislation, planning, funding, staffing, and all other aspects of government—to ensuring health equity for everyone. We’ve seen all too clearly that we must be in this together as failures to address health inequities meant the pandemic was worse than it could have been if governments had acted sooner with better information and a clear purpose.
Canada needs, and can deliver, a national Health Equity Plan. Pandemic protections, mental health, housing, poverty, and combatting the harms of inflation are all crucial areas to move such a Plan forward.
Delivering an all-of-government Health Equity Plan will build a stronger future for us all.