Wellesley Institute’s Pre-Budget Written Submission
Canada has significant inequities in the social determinants of health, including housing, income, education, discrimination and access to health and social care.
We also continue to see these inequities played out through the ongoing disproportionate impacts of the COVID-19 pandemic and long COVID on Black, Indigenous and other racialized communities, low-income groups, people with disabilities and 2SLGBTQIA+ people.
Wellesley Institute research shows these social determinants must be urgently and adequately addressed to reduce health disparities and advance health equity for individuals and communities.
A National Health Equity Plan
Our Budget Submissions in recent years proposed the creation of a health equity strategy for Canada. Once again, we would like to reiterate that the federal government should take the lead on developing a national Health Equity Plan that takes an all-of-government approach to advancing equity. This would mean working alongside other levels of government, people from structurally disadvantaged communities and outside experts, and funding and providing both political and bureaucratic central, departmental and agency support and commitment.
To ensure progress and accountability, this plan must include specific disaggregated targets for preventable health disparities for different equity-deserving groups. Through consultation with structurally disadvantaged communities, it must identify which social determinants of health should be targeted first to achieve better health. It must be clear on what targets are set for each year, legislate those targets, state what steps will be undertaken to achieve them, and how it will monitor progress. And finally, it must include a commitment to reviewing and renewing progress and goals.
To support these actions, the federal government must ensure that the sociodemographic data necessary to support the strategy over time is responsibly collected, analyzed, reported on and used to inform action. It is encouraging that the government is continuing to push forward to create a national health data system alongside provinces and territories. We hope the development and application of this data is transparent and informed by appropriate public and stakeholder consultation and governance – and that it is in place as soon as practicable.
Action must be taken to end poverty. While this government has made some progress, the rising cost of living and continued impacts of the pandemic have fallen on racialized people, low-income communities, newcomers and women. It is imperative that all governments adequately invest and work alongside other actors to bring those who are most in need out of poverty by collectively delivering a robust social safety net that provides income support that is at least above the level of Canada’s official poverty line – as called for by the National Advisory Council on Poverty.
The government has taken previous steps to reduce the impacts of increasing inflation for low-income groups, including through temporarily doubling the GST tax credit, providing a top-up to the Canada Housing Benefit Program, and implementing the interim Canada Dental Benefit to eligible households. These measures can and should be incorporated into a public Health Equity Plan so that their impact on health equity outcomes is measured and further efforts can be made to reduce inflationary pressures on households without solely relying on increased wages or income supports.
Additionally, the federal government should centre health equity in its economic response to inflation and its action towards poverty reduction by establishing what an acceptable level of income and benefits is and then publicly laying out the steps required to get there.
Ending poverty is the first step towards making sure everyone living in Canada can Thrive. Wellesley Institute’s Thriving framework sets out a vision where everyone has what they need to live a healthy life. This means that wages, benefits and social supports from all levels of government and all employers move towards a level that gives everyone in Canada what they need to be healthy and live a meaningful life. In the upcoming budget, the federal government should commit to the Thriving vision and take the lead on setting goals and targets to achieve it. But the federal government is not solely responsible for achieving it. Federal leadership in this area in the near term should mean committing to bringing together all levels of government, community, business and the non-profit sector to establish what Thriving must mean in Canada, and then to collaborate to achieve it over time.
Every one of us in Canada has been through a great deal in recent years, and we believe it is time for a new, unifying vision – and that nothing could be more Canadian than making sure that vision centres around health, caring and fairness – around building a Canada where everyone can Thrive.
All levels of government have made public commitments to ending chronic homelessness, which is a vital social determinant of health and a key driver of poverty and poor health outcomes. Despite this, no government has clearly outlined the necessary targets and methods needed to meet their goal.
Wellesley Institute has advocated for all three levels of government to play a role in achieving a vision of healthy housing. As a first step, this means demonstrating how they are achieving their share of the progress we need to end chronic homelessness.
In the upcoming budget, the federal government should lead on this by committing to producing and publicizing a plan that demonstrates how they will meet their share of ending the homelessness crisis over each of the next 10 years. The plan must show how federal initiatives will lift projected numbers of individuals out of chronic homelessness, and how the federal government believes other levels of government can be held accountable for the rest. All levels of government should move from an outdated practice of housing announcements that centre around funding amounts or regulatory and legislative changes that are not comprehensible to voters or anyone else, and rather provide projections of who, and how many, people they will help (as has been done around decreasing childhood poverty).
This must include working with partners to adequately capture sociodemographic data on people experiencing homelessness at the community and national level. This can inform the development of sub-goals on equitable needs, so that those who are disproportionately impacted by homelessness and under-housing, such as racialized communities, low-income households, the 2SLGBTQIA+ community and persons with disabilities are prioritized and protected.
Wellesley Institute and partners have previously called for a new social contract for mental health – a 10-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 those goals are measured, and reached equitably, for all groups. This would have to include specific investments in the mental health and well-being of youth and Black, Indigenous and other racialized communities.
The federal government should take a leadership role in bringing together provinces and territories, municipalities, businesses and civil society to develop a long-term plan with measurable and achievable outcomes.
In the upcoming budget, the federal government should provide direct funding to municipalities to develop and implement sustainable, collective and multi-sectoral mental health and wellbeing strategies that are tailored to unique community needs. For example, the City of Calgary’s Mental Health and Addictions Strategy is a cross-sector, community-based initiative that aims to address issues related to mental health, addictions and public safety through a range of programs and supports. For many cities, obtaining the funding and resources to develop and implement their own strategies in their regions is a significant barrier. Supporting municipalities by providing some level of sustainable funding to help initiate their own community-based strategies would be an important step towards a future with better mental health and well-being for everyone in Canada.
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 by seeking and heeding 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 clearly that we must all be in this together because 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. Poverty, housing and mental health 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.
List of Recommendations
- Recommendation 1: That the government develop, implement, and legislate an all-of-government health equity plan.
- Recommendation 2: That the government establish what an acceptable level of income and benefits is based on the health needs outlined in Wellesley Institute’s Thriving framework and outline measurable targets towards achieving that.
- Recommendation 3: That the government produce and publicize a plan that demonstrates how it will meet its share of ending chronic homelessness over each of the next 10 years.
- Recommendation 4: That the government provide adequate and sustainable funding to municipalities to develop and implement sustainable, collective, and multi-sectoral mental health and well-being strategies.