Definition: Ensure healthy lives and promote well-being for all at all ages
SDG Targets:
- By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
- By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and wellbeing
- Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
- Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
List of Policy Changes and Cuts:
- Introduced legislation to transform the health system
- Proposed funding reductions to Public Health Ontario and decreased provincial funding of public health units
- Reduced funding to Ontario College of Midwives
- Changed conditions of OHIP plus
- Commitment to additional long-term care beds
- Introduced free dental for low income seniors
- Reduced proposed funding for mental health and addictions
- Ended OHIP coverage for Canadians travelling abroad
- Increased access to alcohol
- Removed funding from a gambling research agency
- Reduced funding for e-health
- Reduced funding for health policy and research
- Closures of overdose prevention sites
Analysis:
This Sustainable Development Goal includes a range of policy and funding changes that impact the health and well-being of all Ontarians. Priorities in Ontario have been to address hallway medicine and find more efficient means of providing a continuum of care.
The People’s Health Care Act, 2019 will result in the integration of multiple provincial agencies into a central agency named Ontario Health. It will also result in the establishment of Ontario Health Teams, groups of providers and organizations that are clinically and fiscally accountable for delivering a full and coordinated continuum of care to a defined geographic population. The prospects of this system at maturity are unclear, it is difficult to comment on the benefits or downfalls until actual changes come into effect.
Public Health Ontario (PHO) is undergoing changes to its structure with anticipated funding cuts in the coming year. Currently, PHO’s mandate is prevention, health protection and disease surveillance.
The province has announced that it will decrease its share of funding of Ontario’s public health units by up to 10 per cent. They will also decrease the number of units. The decrease of 35 public health units to 10 regional health boards is intended to reduce health-care bureaucracy and overlapping administration duties. Ontario’s public health units coordinate and deliver many services to address communicable diseases, including vaccination programs, infectious disease outbreak investigations, and restaurant inspections. We cannot yet say what the outcomes of the cuts and consolidation of public health units would be as it has yet to properly take effect. However, reductions of this type could compromise the delivery of public health.
Included in the province’s health care strategy is, commitment of an additional $1.9 billion over 10 years toward mental health and addictions initiatives on top of new payments to be made by the Federal Government The funding is substantial, however it is less than the $2.1 billion over four years that was previously expected. Funding in this area of health care is critical during a time that addictive substances have become more available: alcohol has become more accessible through proactive efforts to extend service hours at the LCBO, decrease prices, make alcohol available at grocery stores, as well as the introduction of legalized marijuana. These factors may undermine the impact of any increase in mental health services funding.
The Ontario government has announced approximately 7, 500 long term care beds in its first year and has committed to providing up 15, 000 beds over the course of five years. With 34,000 Ontarians currently on the waitlist for long-term care, these are positive developments for improving health, as well as reducing stress and wait times in health care settings in Ontario. [i]
Free dental care has been introduced for low income seniors (individual seniors making less than $20, 000 per year). This program is an essential service considering those who do not have or cannot afford insurance for dental services have been shown to have compromised health.
Access to health-related benefits for children and youth has also been the focus of a policy change. The eligibility conditions for OHIP plus have been changed so that children, teens and young adults with private health benefits will no longer be eligible to receive free prescriptions through the program. The change puts many individuals who do not have adequate private health benefits and must pay out of pocket for most of their medication, in a vulnerable position. The original purpose of OHIP plus was to provide near universal access for children and youth; these recent changes are likely to create gaps in coverage, exacerbating health inequities. In fact, a recent report by the Canadian Advisory Council on the implementation of pharmacare has made a strong recommendation to implement a universal single-payer pharmacare system.
E-health Ontario, which works on digital health programs including the building of a private electronic health record system, had their funding reduced this fiscal year. There is also $52 million less for health policy and research, which involved a large cut to the health system research fund that contributes to research relevant to provincial policy. The fund provided financial resources for research projects that investigated a variety of healthcare issues such as de-prescribing and delivery of medication management.
The reduction of funding to overdose prevention sites is another policy decision with clear implications for health. Some sites, including St. Stephen’s Community House in Toronto and the Clarence St injection site in Ottawa, had their funding eliminated, resulting in their possible closure. During the first half of 2918, there were more than 600 opioid-related deaths, up by at least 80 people from the same time the year before. In Toronto, there have been twice as many deaths related to opioid overdoses in the first four months of 2019 compared to the first four months of 2018. Research suggests that supervised consumption sites (SCS) can reduce overdose events and deaths when established in communities where injection drug use is prevalent. For example, when Insite, Canada’s first legally SCS, first opened in Vancouver there was a 35 per cent reduction in overdose deaths in the surrounding vicinity of the site.[ii] The evidence is clear that overdose prevention sites are critical in preventing deaths, decreasing visits to emergency rooms, engaging people into treatment and alleviating costs and strain within the health system. Ontario is facing an opioid crisis and funding supports to address the needs of people living with addiction should be prioritized.
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[i] Health Quality Ontario. (2019). Wait times for long-term care homes. Retrieved July 25, 2019, from https://www.hqontario.ca/System-Performance/Long-Term-Care-Home-Performance/Wait-Times.
[ii] Arkell, C. (2018). Harm reduction in action: Supervised consumption services and overdose prevention sites. Community AIDS Treatment Information Exchange. Retrieved June 27, 2019, from https://www.catie.ca/en/pif/fall-2018/harm-reduction-action-supervised-consumption-services-and-overdose-prevention-sites.