Doug Ford campaigned on a promise to end
hallway medicine, but this can’t be done by implementing corporate demands to
scrap Bill 148, along with further healthcare cuts. From a higher minimum wage
and equal pay, to paid sick days and fair scheduling, to easier unionization,
Bill 148 has many health implications—and is part of the process of rebuilding
public healthcare and ending hallway medicine.
$15/hr minimum wage
and equal pay
To end hallway medicine we need to prevent
illness in the first place. As Juha Mikkonen and Dennis Raphael explain in Social Determinants
of Health: the Canadian Facts, “Income is perhaps the most important social
determinant of health. Level of income shapes overall living conditions, affects
psychological functioning, and influences health-related behaviours such as
quality of diet, extent of physical activity, tobacco use, and excessive alcohol
use. In Canada, income determines the quality of other social determinants of
health such as food security, housing, and other basic prerequisites of health…Increasing
the minimum wage and boosting assistance levels for those unable to work would
provide immediate health benefits for the most disadvantaged Canadians.”
But the minimum wage in Ontario was frozen
for 12 of the 20 years between 1995 and 2015, and many have been denied equal
pay for equal work—from temp agency workers to contract faculty. This undermines
health and disproportionately impacts those concentrated in jobs that pay poverty
wages and deny equal pay: Indigenous, migrant and racialized workers,
especially women. By raising the minimum wage to $14/hr this year and 15 in
2019, and promoting equal pay for equal work, Bill 148 is an important step
towards reducing income inequality and promoting health equity, which keeps
people out of hospital. As the Canadian
Centre for Policy Alternatives explained, “the minimum wage hike
will produce a particularly large benefit for First Nations women in the
workforce, 36% of whom will get a raise on January 1, 2019…The effect is
similar to the strong impact a $15 minimum wage will have on the incomes of
immigrant women, 42% of whom will get a raise.”
Paid sick days and
fair scheduling
In order to help relieve overcrowded
hospitals, we need to make it easier for people to access primary care, stay
home when sick, and work in a healthy environment. Until this year, workplaces in
Ontario with less than 50 workers could fire an employee for taking a personal
emergency day, and many more workers would lose wages for staying home sick. Without
paid sick days, workers are forced to go to work sick, which spreads infection
to others. As the Canadian Medical Association
Journal summarized, “The Public Health
Agency of Canada, the World Health Organization and every major public health
body recommend that people stay home from work when they have influenza.
Leading medical and public health associations also recommend that people who
handle food not go to work when they have gastroenteritis or other contagious
diseases. However, many employees cannot follow these recommendations if it
means forgoing their wages or risking their jobs… Employees who have access to
paid sick leave are more likely to stay home when advised to do so by a
physician; employees with no sick leave are more likely to go to work and
expose others to infection.”
The lack of paid sick days encourages
hallway medicine by making it more difficult to workers access preventive
health like vaccinations and cancer screens, and more likely they
will rely on off hours visits to the emergency department (ED) rather than
their primary health providers during the work day. Which is why the American
Journal of Emergency Medicine concluded that “to reduce ED
utilization, health policymakers should consider alternative reforms including
paid sick leave.”
Unpredictable schedules also make it
difficult to keep medical appointments, and are a source of stress that undermines
mental and physical health. As a World
Health Organization report on psychosocial work hazards explained,
“stress at work is associated with heart disease, depression, and
musculoskeletal disorders and there is consistent evidence that high job
demands, low control, and effort-reward imbalance are risk factors for mental
and physical health problems, thereby leading to further strain on public
spending for increased costs on healthcare.” These are exactly the sort of precarious
jobs that have increased in recent years, especially temp agencies that combine
low pay, unequal pay, erratic schedules and no paid sick days: a prescription
for injuries and illness, which worsen hallway medicine.
Bill 148 provides 10 personal emergency
leave days, the first two of which are paid, and fair scheduling. These are
essential to provide a basic level of stability to reduce workplace stress, and
to encourage workers to stay home when sick—which allows a faster recovery,
prevents the spread of infection in the workplace and to the public, and makes
it easier for workers to see their primary health providers rather than relying
on the emergency department. As with a minimum wage increase and equal pay
provisions, paid sick days especially benefit women—who disproportionately
provide child care—and parents with
paid sick days are more likely to keep their sick child at home
rather than send them to school, which helps prevent infection.
Unionization
Unions have played important roles in supporting
healthy wages, promoting environmental and workplace safety legislation that
prevents injuries and illnesses, and defending public health systems like
Medicare. That’s why governments intent on privatizing healthcare have attacked
unions—from Ontario Premier Mike Harris who went after unions in his campaign
to close hospitals in the 1990s, to BC Liberal premier Gordon
Campbell who slashed wages of health workers in 2000s. As Mikkonen and Raphael
explain, “a greater degree of unionized workplaces would most likely reduce
income and wealth inequalities in Canada. Unionization helps to set limits of
the extent of profit-making that comes at the expense of employees’ health and
wellbeing.”
Bill 148 makes it easier for workers to
join unions, which helps workers defend healthy wages and working conditions,
and contribute to campaigns to defend public healthcare. Recently Gordon
Campbell called for privatizing healthcare based on the claim
that “health costs relentlessly escalate faster than population growth and far
faster than economic growth.” But as the Ontario
Council for Hospital Unions explained in their report Hallway Medicine: it Can
Be Fixed, “in 2017, real funding per person was still less than in 2008—although
the Ontario economy was about 17% larger than it was in 2008 in real terms. The
hysteria about runaway health care costs is just that—hysteria. Two-thirds of
this dollar cut came from cuts to hospital funding. Between 2010/2011 and
2017/2018 real provincial hospital expenditures were cut 8.3%” It is these cuts
that created hallway medicine, combined with broader policies like income
inequality, and Ford was elected on a promise to help the situation, not
bring further harm.
Defend Bill 148
But the big business lobby Ontario wants
to tear up Bill 148 and all of its health benefits. They want to freeze the
minimum wage and reverse equal pay provisions—which would maintain poverty wages
and income inequality, undermining a key social determinant of health. They
want to revoke paid sick day and fair scheduling—which would force sick workers
into their workplaces and sick kids into schools to spread infection, and divert
patients into overcrowded hospitals rather than primary healthcare. They want
to make it more difficult for workers to unionize—which would make it easier to
cutback and privatize public services. All of these policies will worsen
hallway medicine, under
the guidance of Gordon Campbell, just as we head into flu season—and
will disproportionately impact Indigenous, migrant and racialized people,
especially women.
Bill 148 won’t end hallway medicine on its
own, but it is part of broader efforts towards that goal—by promoting the
social determinants of health like income equality, supporting public health
measures like staying home when sick, and encouraging safe workplaces and
public healthcare. If Ford wants to maintain his promises of ending hallway
medicine and being premier for the people, then he should listen to the
people—from the large majority in the polls who support $15 minimum wage, to
the more than 50 actions on October
15 in support of Bill 148, to the rally for public healthcare October 23.
Contact the Premier and
your MPP to support $15 and Fairness, and join the October
23 rally for public healthcar
