Social Policy in Ontario

The cost of poverty in Ontario is an estimated $32-to-38-billion per year. As physicians, we know that biology accounts for only a small portion of what makes people sick and that income is perhaps the most important social factor contributing to health.

One of the reasons poverty is expensive is because people living in poverty have higher rates of chronic disease, including diabetes, cancer and heart disease. Children in low-income families are at higher risk of diagnosed mental health problems, nutritional deficiencies, asthma and injury.

In Ontario, poverty is addressed through the income security system that largely consists of the Ontario Disability Support Program (ODSP) and Ontario Works (OW), but also includes a variety of programs, such as Employment Insurance (EI), Canada Pension Plan (CPP), and child tax benefits.

In 2015, there were 900,000 Ontarians (654,000 adults and 253,000 children) relying on OW and ODSP. This is only a portion of those who are considered low-income by Statistics Canada, an estimated 14.4 per cent of residents in Ontario. Despite the magnitude of the problem, Ontario’s income security program has remained stagnant and requires major reforms.

The health impacts of poverty are clear, yet our social assistance programs leave Ontarians in poverty. In 2014, a single adult on ODSP received on average $14,028 per year; that is $6,783 below the poverty line. A couple with one child on OW received only $25,936 per year, which is $15,686 below the poverty line.

Aside from being inadequate, our social assistance programs are dysfunctional. In our practices, we see users struggling to navigate its complex system. Application forms are hard copies that have to be physically picked up and dropped off to assigned locations. How do we expect our patients with little to no income and mobility limitations to afford and physically navigate this outdated system?

Why is it that our patients have to utilize unnecessary resources to appeal a rejected application for disability support that we, as their physicians, spent tireless efforts preparing and deeming appropriate? And why is there such a barrier to communication between health care providers, social assistance workers, and our patients?

These are the frustrations that we face as we watch our patients’ health decline as a result of an inadequate, barrier-filled system, and their continued poverty.

In 2016, the Income Security Reform Working Group was formed and assigned the daunting task of providing recommendations to the provincial government to transform the income security system. On Nov. 2, the group released its recommendations in the form of a 10-year road map that, if implemented, could make Ontario a world-leader in income security policy.

Among the many thoughtful recommendations made, highlights include adopting a minimum income standard, expanding and extending universal health benefits for all low-income persons, and transforming the culture of the social assistance program.

The group suggests Ontario set a minimum income standard so users of the income security system are able to live at or above the poverty line. They hope for this to be achieved in the next 10 years by implementing a combination of supports across the system.

The group recommends introducing core health benefits to all low-income adults (not just those on OW or ODSP), starting with adding prescription drug coverage for persons aged of 25 to 65, as well as expanding coverage for those on social assistance to include more services.

In addition to increasing funding and resources, it outlines a transformation of the culture of the social assistance program from one that is penalizing and barrier-filled to one that is streamlined and founded on trust, collaboration, and problem-solving — one that truly supports its users.

With the cost of poverty at more than $32 billion per year in Ontario, we can’t afford to continue with the same flawed system, nor can we as health care providers tolerate the toll it is taking on our patients, and on society.

We applaud the Ministry of Social and Community Services for commissioning this report. We expect the Wynne government to use these recommendations as a framework for building legislation, and for other political parties to collaborate in support of this document.

Additionally, we call on the government to clearly outline how funds will be allocated for this transformation, preferably involving a policy of progressive taxation.

In implementing the recommendations of the Income Security Reform Working Group, we are hopeful that Ontario can have a world-leading, people-friendly income security system that will promote a more healthy and equitable society.

Alissa Tedesco and Katie Boone are resident physicians at the University of Toronto. Chetan Mehta is physician who practices family and addictions medicine at Parkdale-Queen West Community Health Centre and Women’s College Hospital. Jim Deutsch is a child psychiatrist who also practices in Toronto. All authors are members of Health Providers Against Poverty (HPAP), a collaboration of health care providers and trainees from across disciplines committed to addressing poverty as a health issue.

https://www.thestar.com/opinion/commentary/2017/11/14/there-is-a-prescription-for-povertys-punishing-impact-on-health-in-ontario.html