Thank you so much.
Good afternoon. I'm a family doctor, a professor at the University of Toronto and a senior fellow with the Wellesley Institute. I have experience in social policy development as a member of Ontario's income security reform working group.
Over the past year, I have spent most of my working hours on the medical frontlines of the pandemic in my clinics at St. Michael's Hospital and the Good Shepherd homeless shelter, in a COVID-19 homeless recovery site and recently at a COVID-19 vaccination centre for indigenous people in Toronto.
This infectious disease pandemic has been challenging, but every day I battle social pandemics. I work with communities that are disproportionately affected by adverse social conditions, including poverty, homelessness and systemic injustices caused by racist and colonial social structures and policies. The scientific evidence is powerful. These social pressures have a massive impact on health, including higher rates of chronic and acute illness, adverse childhood outcomes and death.
In COVID-19, the communities I work with have faced greater hardship than most. This infectious disease pandemic, placed on top of the long-standing social pandemic, has created what is termed a “syndemic”, a synergistic pandemic in which the spark of COVID-19 has ignited the tinderbox of social inequity built into the structures, policies and institutions of our society.
We have known since the first months of the COVID-19 crisis that the people getting sick and dying live in poverty and without adequate housing, work in high-risk frontline jobs without adequate employment protections and are racialized, disabled, women, indigenous, and, more often than not, impacted by intersections of multiple identities.
I ask you to urgently call for health, public health, and social resources to be redirected to neighbourhoods and communities with the highest burden of illness and with the fewest protections. This includes extending emergency income benefits, guaranteeing employment supports like paid sick days and facilitating access to health supports such as a safe supply of opioids.
Deeper structural changes to our health and social systems will be required to prevent this situation from recurring, and I have three recommendations for this committee.
First, strengthen social support programs to provide a foundation for health. This week's promise of a national child care program is an important step. I suggest that this committee examine income support programs to ensure that all Canadians have access to an adequate income to attain and maintain good health. This could include extending basic income programs beyond those currently in place for seniors and children, with particular attention to the needs of people living with disabilities, indigenous people and others who face historical and structural barriers to living above the poverty line. I also suggest that this committee call for a commitment to end homelessness through increased funding for affordable and supportive housing and housing first programs.
Second, collect data to make social pandemics visible. We must improve social disease surveillance systems. To properly understand health and social outcomes, we require access to disaggregated data on race, ethnicity, income, disability, housing status and other key determinants of social inequity. Public institutions and community agencies should be directed and supported to gather, analyze and report on social data on a community and individual level. I suggest that this committee demand specific health and social outcomes targets for those who have been socially marginalized, with regular reporting and accountability to those targets.
Third, empower those who have been most impacted by adverse social conditions to lead these changes. I have been giving vaccinations at the Auduzhe Mino Nesewinong clinic, a program created and governed by indigenous people. Using their knowledge and community connections, they have provided extensive services to an urban indigenous community that has long been hidden from view.
I suggest that this committee advocate for this approach, which is often called “nothing about us without us”, to be replicated for other projects and other communities, putting those who are most impacted by inequitable social policies in the driver's seat of efforts to redress those inequities. These changes will set the foundation for a recovery that aims to address the disastrous inequities that have characterized the COVID syndemic.
Thank you.