In this week’s blog, the Wellesley Institute’s Steve Barnes reflects on what we heard at a recent roundtable that we hosted with the Equity MAgIC group to discuss how to use measurement to drive equity into action in health care. The blog identifies ten guiding themes and recommendations that came out of roundtable working groups, including the importance of having clear starting points, sharing the data that we have, and looking for opportunities to act.

The previous blog in this series was from long-time Wellesley collaborator Sanjeev Sridharan on the challenges in evaluating equity and other complex evaluations. Earlier in the series, the Wellesley Institute’s Bob Gardner blogged about setting out an overall health equity roadmap.

Michael Shapcott, the Wellesley Institute’s Director of Housing and Innovation, delivered a keynote presentation to the annual meeting of the Association of Community Legal Clinics of Ontario that set out the challenges and opportunities of taking action in complex and dynamic social policy areas – and the particular issues facing  Ontarians who are precariously housed in an increasingly unequal province. He outlined two key strategic actions:
First, community legal clinics are uniquely positioned to identify both the housing and other social issues in their communities and to identify practical strategies for action; and, second, community legal clinics have the expertise and training to adopt rights-based approaches to housing and social issues.

A significant amount of the research and policy work of the Wellesley Institute focuses on housing and income issues. Our formal submission to the Special Rapporteur noted that hunger and food insecurity loom large for people who are homeless, precariously housed and those with low-incomes. While Canada has signed onto numerous international legal instruments that recognize the right to food, the right to adequate housing and an overall adequate standard of living, these international obligations have not been fully incorporated into domestic law or properly realized in Canadian policies and programs.

Among other recommendations, the Wellesley Institute is calling on the Special Rapporteur to add his support for Bill C-400, a private member’s bill in front of Canada’s Parliament, which would require the federal government to develop a national housing plan in consultation with other orders of government, the community, Aboriginal groups and the private sector. The high cost of housing is the single biggest expense for most low, moderate and middle-income Canadian households, and for many, the high cost of housing leaves less money for food, medicine, transportation and other necessities for both personal and population health.

Links and resources:

The formal Wellesley Institute submission to the Special Rapporteur

The Wellesley Institute presentation at the meeting with the Special Rapporteur

Wellesley Institute’s Precarious Housing in Canada 2010

United Nation’s Special Rapporteur on Right to Housing – final report on fact-finding mission to Canada

United Nation’s Human Rights Council – Universal Period Review of Canada: Working Group report

Government of Canada formal response to UN Universal Periodic Review – June 2009

Affidavit of Michael Shapcott, Director Affordable Housing and Social Innovation-Wellesley Institute

Street Health report 2007 – health status of homeless people

Work and health – Wellesley Institute research report

Canada’s Colour-Coded Labour Market

OECD Growing Unequal – Canada report

OECD Divided We Stand – Canada report

Bill C-400 – draft legislation for a national housing plan

In from Margins – Senate report on poverty, housing and homelessness

The mental health strategy offers some promising directions for achieving good mental health and well-being for all Canadians. Acting on the social determinants of health was identified as a priority area. The Commission rightly argued that different populations face different barriers to good mental health and that interventions must be targeted to ensure that the right kinds of support are available and that supports meet each individual’s needs. This means that efforts to address social determinants must be coordinated across all levels of government and must include a broad range of social services, not just health care.

Also promising is the recommendation that health equity lenses be used to ensure that new mental health policies and programs reduce disparities while improving mental health for the population as a whole. The Commission referenced Ontario’s Health Equity Impact Assessment and argued that collecting better data, particularly for key sub-populations, on mental health inequities is critical to making progress.

The Wellesley Institute has previously worked with the Ontario branch of the Canadian Mental Health Association (CMHA-O) to create an equity-focused report on Ontario’s Mental Health and Addictions Strategy, and last year Bob Gardner spoke to CMHA-O about integrating and operationalizing equity into mental health.

Attention will now turn to the federal government as they decide what their next steps are in implementing the mental health strategy. Mental health problems are complex and the solutions need to reflect this complexity. We congratulate the Mental Health Commission for taking an important step forward.

Richard Wilkinson, Toronto May 4, 2012

Many of us today at the Wellesley Institute were fortunate to catch Richard Wilkinson’s lecture, courtesy of MASS LBP and the Dalla Lana School of Public Health at the University of Toronto. It reminded us of several things, including why the project of solving income inequality is so important, not only socially and economically, but also for our health.

Richard Wilkinson and Kate Pickett ignited the conversation that economic inequality harms societies three years ago with their book The Spirit Level: Why Equality Is Better For Everyone. The difference from previous decades, Wilkinson says, about income inequality and its harmful effects on society is that now we have the research to prove the links between income and health. Wilkinson and Pickett brought this conversation to the forefront when people still weren’t linking income inequality to the kinds of social and health problems we’re seeing across societies today. And, they certainly weren’t talking about it.

While high income doesn’t necessarily equal good health, low income almost certainly equals poor health, says a study by the Wellesley Institute in 2011, Poverty is Making Us Sick. We know that poor health is linked to poverty in Ontario and that the causes of the causes of bad health can be traced back to our housing, the condition of our neighbourhoods, our access to healthy food, whether we belong to healthy communities, have strong social circles, have access to a high quality education, and many other factors.

As Dr. Arlene King, Ontario’s Chief Medical Officer of Health and a panel respondent in today’s discussion noted, poor health is often a social disease with a medical element.

In The Spirit Level, Wilkinson and Pickett highlight that not only are there jarring differences in life expectancy between rich poor countries across the globe, but these differences also exist within the so-called rich developed nations.

A great example from Wilkinson’s presentation was social mobility within nations. He demonstrated that social mobility – a critical measure of whether people with low income are able to move up the social ladder – is lowest in the United States and highest in Denmark. As a result, Wilkinson joked, to achieve the American Dream, US citizens should go to Denmark.

Sick and Tired, a report funded in part by the Wellesley Institute, which came out in 2009, revealed that people on social assistance and the working poor in Ontario have much higher rates of chronic illness, up to seven times, than their non-poor counterparts. Our ongoing work about reforming the social assistance system includes a focus on ensuring that people on social assistance have adequate incomes.

One important message from Wilkinson’s presentation was that addressing inequality does not have a single simple fix. Wilkinson noted that Sweden and Japan – two rich countries that have low levels of income inequality – took widely divergent paths. Sweden favours a strong welfare state and higher taxes to create less income inequality after tax, while Japan has lower taxes and less income inequality between those at the top and those at the bottom before tax.

This is a message to keep in mind while addressing inequality in Canada. We know that the gap between the richest and poorest is growing and we can look to what has worked in more equal societies for cues to reverse this trend. Wilkinson ended his presentation by arguing that we’ve known about this problem for decades – now it’s time for us to act.

Working with a number of partners, the Wellesley Institute put forward a suite of policies to support the creation of good jobs Ontario. Better protection for migrant workers was a big piece of that project.

The rapid growth of migrant worker programs has resulted in the expansion of a workforce in Canada that is considered cheap and disposable. Migrant workers have fewer rights than other Canadian workers and they often work in industries that are exempt from protections and rights under the Employment Standards Act and Labour Relations Act.

Armine Yalnizyan was on Metro Morning on May 1st talking about the impact these changes will have on inequality. Tom Walkom wrote in the Toronto Star about the impact on the labour market, saying that it will drive wages down for everyone. He says “it is a solution that threatens to bring with it the kind of agitation now seen in countries like France, Holland and Greece — where the racist right is on the rise and where far too many workers view immigrants as mortal enemies out to steal their jobs.”

There are clear links between labour market policies, employment and working conditions, and health inequities. Increasing precarious employment for migrant workers increases the risk of occupational injuries, diseases, death, social exclusion, lack of health and safety training, fear of reprisal for demanding better working conditions, linguistic and cultural barriers that minimize the effectiveness of training, and difficulty accessing care and compensation when injured.

Temporary foreign workers should enjoy the same rights and protections as other workers in Canada. Taking a two-tiered approach will have long-term impacts on the health of migrant workers and other vulnerable workers in Canada.

Listen to Armine Yalnizyan on Metro Morning

Watch this piece on Global about disposable labour

Read 6 Good Ideas About Jobs

• Ontario has the lowest rate of public funding for dental care in Canada.
•  71% of Ontarians visited a dentist in 2005. Among Ontarians with lower income and less education, as well as those with no insurance, only half made such a visit.
• Ontarians with lower income, less education, as well as those with no insurance and those over the age of 65, are more likely to only visit the dentist in cases of emergency.
• Among Ontarians who did not visit a dentist in the past three years, one in five cited cost as a barrier.
• Lower income Ontarians are the most likely to report mouth conditions that cause them to avoid social interactions such as conversation, laughing or smiling.
• 68% of Ontarians report having dental insurance. However, among older Ontarians and those with lower income and less education, there is a significant drop in coverage rates (36%, 40%, and 41% respectively).

These findings are troubling because poor oral health can lead to serious and ongoing chronic conditions, such as diabetes and lung disease in addition to intense oral pain, and these poor health outcomes are disproportionately felt by low income and vulnerable Ontarians. The 2007 Street Health Report found evidence of homeless people attempting to extract their own teeth because they were unable to access dental care. We have previously blogged about the importance of health equity and oral health.

Currently there are a patchwork of programs designed to increase access to oral health care for low income Ontarians and their children, including the Children in Need of Treatment program and Healthy Smiles Ontario, and some support is available to people on Ontario Works and Ontario Disability Support Program.

The report recommends that the province explore opportunities for better integration and/or alignment of low-income oral health services in Ontario, including integration and/or alignment with the rest of the health care system. We agree with this recommendation and encourage the province to conduct a Health Equity Impact Assessment to ensure that any program changes will improve the health of the most vulnerable Ontarians.

The newly-appointed TCHC board was put in place in a controversial move after the previous board was purged in an unprecedented bid by Mayor Rob Ford and replaced with a political crony. Over the past year, it has been pressing for the sell-off of more than 600 TCHC single family buildings, which provide a home to more than 1,200 tenants and their families. The board points to numbers generated by TCHC which suggest the housing company has a long-term capital repair shortfall of $751 million, largely caused when senior levels of government downloaded social housing to the city without adequate capital reserves.

When a majority of city councilors threatened to block the mayor’s sell-off plans, a political compromise was adopted by Toronto City Council in March. Councillor Ana Bailao, chair of Toronto’s affordable housing committee, was appointed head of a four-person task force to chart a more sustainable future for TCHC. The Wellesley Institute backed plans for the special commission, and has set out seven key priorities for the working group as it moves quickly towards a September deadline for making its recommendations.

Wellesley Institute backgrounder on 2012 wait list numbers, and on the numbers from 2004 to 2011 here.

It’s important to pause for a minute and acknowledge the importance of what Premier McGuinty and Andrea Horwath have accomplished this afternoon. In a political culture that claims voters will not accept tax increases, Ms. Horwath proposed one that will increase progressivity of the tax system. Premier McGuinty had the good judgement to accept this proposal despite the political heat he will take for it. This is a small, but important, first step in addressing the record levels of income inequality in this province and this country.

The Wellesley Institute was profoundly disappointed with the freeze in what are already inadequate social assistance rates that Minister Duncan proposed. We were also disappointed when Ms. Horwath initially proposed an increase only for Ontarians who rely on Ontario Disability Support Payments. This would have left those who rely on Ontario Works, some of the most marginalized and low-income people in the province, even further behind.

While we acknowledge this progress, we must not lose sight of the overall impact of this budget. There will be a real, per capita decrease in program spending.
Ontarians will lose services.

These are services that care for us when we are sick, that keep us safe, and that are essential to our social and economic well-being. Public sector workers will lose their jobs. These are jobs that support families and communities.

Sharing the costs of austerity fairly doesn’t mean expecting the same contributions from everyone. It means that contributions are based on capacity. Today, a small step was made to move in that direction.

Winnie Ng (Ryerson University) and Deena Ladd (Workers Action Centre) will be teaching a new course at Ryerson in May/June this year on community engagement. People who are working in community agencies, immigrant settlement agencies, community projects are encouraged to attend.

The course will be examining models of community engagement from here and the global south, strategies of best practices, strengthening leadership skills, developing critical analysis and reflection on our own practice, understanding how to do this work in the context of inequalities and unequal power dynamics, with lots of opportunities to work on collaborative projects.

“Is this course right for me or one of my staff?” Something to consider:

Ø If you are an executive director or manager  – would you financially support one of your staff to attend this course?

Ø if you are in a leadership position, could you consider arranging a scholarship donation from your organization and sponsor an activist to attend?

Ø If you are a front-line worker  – do you want the space to learn, share strategies and strengthen the work you do with the communities you work with?

Ø If you work in a trade union - do you want to learn, share strategies and understand how to build connections with communities and the work you are doing?

Ø If  you are a community activist - do you want the space to share strategies, learn about best practices and get support for the work you are doing?

 Logistics:

The course will be 42 hours of instruction and fully credited by Ryerson University.  The course is part of a new certificate in Community Engagement, Leadership and Development.

The days of instruction have been organized so that if people are working, they can attend most of the days during work time if they have the support of the organization they work for. Or alternatively, get the course done and only have to take a few days off.

Download the flyer: Certificate in Community Engagement, Leadership, and Development

For more information about The Chang School, or to register for the Certificate in
Community Engagement, Leadership and Development, visit
www.ryerson.ca/ce/community or contact us directly.