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. It 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, including 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.
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 B.C. Liberal premier Gordon Campbell, who slashed health workers' wages in the 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. It 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. It promotes the social determinants of health like income equality, it supports public health measures like staying home when sick, and it encourages 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.
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