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Ontario health care reform success depends on social assistance system
Published on 13/03/2019
The Ontario government’s recent announcement on the future of the province’s health care system was significant. But we need to think even bigger.
As the debate continues on the right path for health care, we cannot lose sight of the fact that the announcement was both instructive for, and dependent on, the changes coming to Ontario’s social assistance system.
Many of the problems being raised with regard to our health care system — the silos, patients falling through the cracks — will sound familiar to those who have followed the discussions on social assistance in Ontario. Replace “health care” with “social assistance” and “patients” with “people” in the government’s announcement, and you will see that the structural issues pervading health care also affect our social assistance system.
Ultimately, the government’s vision is that health care services will “wrap-around” the patient so that they can navigate a more harmonized health care system that effectively provides them care. To make this happen, new Ontario health teams will develop seamless links between different local health care providers.
A similar model is envisioned for social assistance. As Minister Lisa MacLeod said late last year, “We will embrace a true wrap-around model that is customized to meet the need of the individual — training, job placement, mental health and addiction, child care, housing or life skills support.”
The fact that these visions are so similar is a good thing. The ultimate success of health care reform depends on the success of Ontario’s social assistance system.
Countless research studies have demonstrated the relationship between income, social cohesion, and housing — among other “social determinants” — and health outcomes. For example, as demonstrated in Income and Health: Opportunities to achieve health equity in Ontario, 23.5 per cent of those with the lowest incomes in Ontario report having multiple chronic conditions, compared with 12.4 per cent of those with the highest incomes, and as compared to 16.2 per cent for the broader Ontario population.
Put plainly, those with the lowest incomes in Ontario are nearly twice as likely as those with the highest incomes to report having multiple chronic conditions. Further, the hospitalization rate for conditions that could be addressed outside the hospital among people living in the poorest neighbourhoods in Ontario is almost 2.5 times that of people living in the richest neighbourhoods.
While most prevention measures in health care focus on genetic predisposition and individual health behaviour, economic and social factors play a tremendous role in who gets sick, and who ends up in our health care system.
This is why effective social assistance transformation is so critical to the success of health care reform in Ontario.
Don’t just take my word for it. Hallway Healthcare: A System Under Strain, the first interim report delivered from the premier’s Council on Improving Healthcare and Ending Hallway Medicine, noted the importance of the social determinants of health. Although the report, and the government’s plan for social assistance reform, disappointingly do not address the importance of adequate incomes, they recognize that investments in supports like supportive housing and community mental health and addictions services are required.
We need to break the cycle of low-income Ontarians ending up in our health care system because other supports and services, that could and should have better addressed their needs, failed to do so. By investing in, and strengthening Ontario’s social assistance system, we can ensure that low-income Ontarians receive the supports they need to improve their health and well-being.
As we develop seamless links within health care teams and social assistance program providers, we need to cultivate effective links between both systems.
To develop strong wrap-around supports in health care, social assistance service managers (the entities that broadly administer social assistance in municipalities) should be identified as partners for Ontario Health Teams. Luckily, the draft legislation tabled by Minister Christine Elliott could provide the space to make these types of connections through funding for “non-health” services that support the provision of health care — but it is incumbent on us to ensure that this remains the case. This way, if health care providers see that a patient can also be served through the social assistance system, they can connect them with the service providers that can best serve their needs.
Many skeptics will contend that the inclusion of service managers in Ontario health teams could create challenges for funding administration and place burdens on some health care providers to develop an understanding of social services (which may not be a part of their duties today). While these challenges are important to work through, they are not impossible to overcome.
The provincial government’s goal of transforming health care and social assistance is a challenging undertaking. If the government has truly taken to putting people at the centre of reform, this is a unique opportunity where changes in social assistance and health care could be complementary, not contradictory.
Originally posted on HuffPost.