It is in any government’s best interest to invest in the health and wellbeing of its population as a matter of social justice on its own, but also to lower the costs and improve the delivery of health care, criminal justice, and infrastructure. Robust public policy is well-defined in the literature however there is
still much debate about the prioritization of the various complex determinants as well as the “palatability” and “worthiness” of social programs. Most solutions require long-term commitment which is difficult to achieve and maintain through changes in power.
In Ontario, the current status of the Social Determinants of Health (SDoH) can be summarized by reviewing the evolution of the Poverty Reduction Strategy (PRS) implemented by the Liberal Party in 2008: Poverty Reduction Strategy: Breaking the Cycle. This strategy was renewed in 2014: Realizing Our Potential that was meant to further target vulnerable populations. Many of the components of the first strategy were simply renewed, continued, or unchanged in the second so the results of the Liberal PRS were underwhelming. Lawlor, Smith-Carrier, & Benbow (2018) outline the reasons why:
There was a lack of real commitment to each program
Unclear program ownership by a specific ministry
Policy “repackaging” (many policies were included in the PRS that already existed)
Piecemeal funding that was tied to external economic conditions
Broad measures of success/failure with few concrete targets and projected effects
Despite these criticisms, many of the programs in the PRS have an evidence base. If we cross-reference the initiatives in the Liberal PRS to the final report by the World Health Organization's (WHO) Commission on Social Determinants of Health (also published in 2008), there are hopeful similarities that would indicate the strategy would lead to meaningful change. Raphael et al. (2020) describe specific policies effective at targeting SDoH in Canada, the following are some of those interventions that were also identified in the Liberal PRS:
Increasing the minimum wage and increasing social assistance benefits – the Liberal PRS increased both however not to a level that would be consistent with a livable wage
Legislation to improve low-wage workers’ rights (i.e., paid sick days, equal pay for temporary workers (Star Editorial Board 2020).)
Education reform and childcare funding: Full-Day Kindergarten, (some) tuition aid, etc.
Employment equality efforts for women, persons with disabilities, and First Nations
Health benefits (dental, medication, assistive devices) for children of low-income families
Programs targeted to serve Aboriginal communities and individuals
Many of these efforts have shown to provide multiple benefits to more than a single SDoH. For example, the Ontario Child Benefit and full-day kindergarten has the potential to alleviate income insecurity, food insecurity, early childhood development, and promote employment for women (Raphael et al 2020).
The Liberal PRS had modest improvement and continuity that barely scratched the surface of what was needed in Ontario. Although progress was slow-moving and miniscule, it was not the giant leap backwards that came in 2018 when the Conservative government took power and conducted its review of the province’s social assistance system and rolled out its social assistance reform PRS (Clarke 2018). This new strategy reflects a departure from evidence-based interventions and a movement towards the harmful (and misguided) ideology that poor people are poor because they do not work hard and deserve to be punished, not supported.
The limited, short-lived progress made for low-wage workers’ rights was undone: no more two-paid sick days for all workers, equal pay for exploited temporary agency workers, or the planned minimum wage increase to $15/hr (Star Editorial Board 2020). Those receiving social assistance benefits through Ontario Works are being “re-evaluated” as ineligible and instead will be asked to identify themselves on a website for predatory employers and funneled into poverty-wage positions with poor workers’ rights (Clarke 2018). Disability benefits are now to be denied unless the disability is “severe and prolonged” so those not meeting the new definition can choose to join the working poor and have their health deteriorate further or apply for Ontario Works and receive slightly less than what would be considered a poverty wage and have their health deteriorate further still (Bloch 2019). The few that are somehow granted assistance will find their benefits significantly lowered (Ritts 2019). Post-Secondary tuition for low-wage families was eliminated making it harder for vulnerable youth to seek higher-income employment and break out of the cycle of poverty (Star Editorial Board 2020). Funding for legal aid for immigrants and refugees, the Toronto Public Health budget, and overdose prevention sites were respectively cancelled, cut, and reduced (Ritts 2019). Then the COVID pandemic struck with rolling lockdowns, economic instability, and crisis at a time when the social safety net was profoundly weakened. This is where we are now.
The excuse that policy to reduce poverty is too expensive needs to be rejected once and for all. For a wealthy nation, Canada performs poorly compared to other wealthy countries in terms of income equality, poverty rates, and support of our most vulnerable (Raphael et al. 2020). We cannot continue to believe that poverty is an individual problem, turning a blind eye to the social determinants of health.
Works Cited
Image by Greg Plominski from Pixabay
Bloch, G. (2019). Changing disability definition a dangerous mistake that will harm thousands | The Star. Toronto Star. https://www.thestar.com/opinion/contributors/2019/04/08/changing-disability-definition-a-dangerous-mistake-that-will-harm-thousands.html
Clarke, J. (2018). Doug Ford’s War on Ontario’s Poor. The Bullet. https://socialistproject.ca/2018/11/doug-fords-war-on-ontarios-poor
Lawlor, A., Smith-Carrier, T., & Benbow, S. (2018). Reducing Delivery by Program Recycling: An Analysis of the Poverty Reduction Strategy in Ontario, Canada. Canadian Review of Social Policy, 78, 81–110.
OECD. (2019). Health At a Glance 2019: OECD INDICATORS. OECD Publishing Paris. https://doi.org/10.1787/4dd50c09-en
Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian Facts.
Ritts, M. (2019, May 22). Ontario cuts reflect idea that people deserve to be poor. Healthy Debate. https://healthydebate.ca/opinions/ontario-cuts
Star Editorial Board. (2020). The Ford government says it’s committed to poverty reduction. That’s hard to believe | The Star. Toronto Star. https://www.thestar.com/opinion/editorials/2020/12/20/the-ford-government-says-its-committed-to-poverty-reduction-thats-hard-to-believe.html
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