Hamilton is a city of stark inequalities. As the city’s economy booms, many Hamiltonians are swept to the sidelines as a result of a housing crisis and employment insecurity. Compared to other cities in Ontario, Hamilton also has a high proportion of working class people, disabled people and refugees, who are often the first to feel the brunt of these changes.
Health outcomes over the past decade have been bleak, and according to many disability justice and healthcare advocates, show no signs of changing unless bold steps are taken to support Hamilton’s marginalized populations.
In 2010, the Hamilton Spectator released Code Red, a project that mapped the connections between income and health across Hamilton to explore the social determinants of health. Using census and hospital data from 2006 and 2007, the report showed strong disparities in health outcomes between the Hamilton’s wealthiest and poorest neighbourhoods.
The Code Red project shows that social and economic inequalities lead to health inequalities. The lower city, which experiences disproportionately higher rates of poverty, also has significantly poorer health outcomes.
In February 2019, an updated Code Red project was released using data from 2016 and 2017. The updated Code Red project found that in general, health outcomes in Hamilton have declined and inequalities have grown.
Since the first Code Red project in 2010, the average lifespan in parts of the lower city has declined by 1.5 years. Furthermore, the gap in lifespan between Hamilton neighbourhoods has grown from 21 to 23 years.
These results come as no surprise to Sarah Jama, an organizer with the disability justice network of Ontario. According to Jama, given the lack of political change coupled with changes in the city of Hamilton, it was inevitable that poverty would worsen and inequalities would deepen.
Jama notes that health care and social services tend to be compacted into the downtown core, which has tended to have a higher concentration of people who rely on these services.
However, rising costs of living within the downtown core has meant that the people who access these services are being priced out. According to a report by the Hamilton Social Planning and Research Council, eviction rates have skyrocketed in the past decade. As a result, the people who rely on these services have to make compromises about whether to live in a place with supports available close by, or a place that is affordable.
“The more compromises you have to meet with regard to your ability to live freely and safely in the city the harder it is to survive,” said Jama.
Denise Brooks, the executive director for Hamilton Urban Core, works directly with people at the margins of Hamilton’s healthcare system. Brooks noted that the 2010 Code Red project was a wake up call for many.
“For me one of the biggest takeaways [from the first Code Red project] was even greater resolve that this really is a political issue and that it hasn't been looked at and is not being looked at as a crisis,” stated Brooks.
The 2010 Code Red project sparked projects including the Hamilton neighbourhood action strategy and pathways to education program. According to Brooks, while these initiatives were beneficial, more robust policy is needed to substantially address poverty.
“... [C]an we see any change in policy orientation? Did we see a reallocation of resources? Did we see a redistribution of priorities in any way? I would have to say no,” said Brooks.
The updated Code Red project calls for a restructuring of the traditional health care system to include social and economic programs that contribute to people’s overall health.
However, recent political changes have led many health advocates to worry that the coming years will see change for the worse. Matthew Ing, a member of the DJNO research committee, notes that provincial cuts to a slew social assistance programs threaten to further exacerbate the existing inequalities in Hamilton.
In November 2018, the provincial government announced reforms to Ontario Works and the Ontario Disability Support Program that aimed to streamline social assistance and incentivize people to return to work. Among many changes, this includes aligning the definition of disability to align with the more narrow definition used the federal government.
According to Jama, narrowing the eligibility requirements for disability support makes it likely that people will slip through the cracks. They will put the responsibility on the municipality to provide services, meaning that care is likely to differ between providers.
“The onus is going to be on individual service providers on all these people to really decide who really fits this idea of being disabled enough to be on the service versus it being like sort of supervised by the province,” stated Jama.
Additionally, in February 2019 the provincial government announced plans to streamline and centralize the health care process. Under the proposed model, Ontario Health teams led by a central provincial agency will replace the existing 14 local health integration networks across the province.
Brooks noted that this has not been the first time that the province sought out to reform healthcare. Having worked in community health for years, Brooks remarks that the changes that are made to healthcare frequently exclude people on the margins.
“It's always the people who are the most marginalized, the most vulnerable, the socially isolated and historically excluded that remain on those margins all the time regardless of the change that go through,” said Brooks.
Currently, patient and family advisory committees work to inform the work of LHINs. The government has not announced whether PFACs will be retained under the new model, but Ing worries that a centralized model would leave patients and families out of the decision making process.
However, Ing recognizes that the current system is far from perfect, noting that disabled communities were not adequately represented on PFACs. According to Ing, this speaks to the much larger problem of political erasure of people with disabilities.
“Disability justice means that we must organize across movements, and we must be led by the people who are most impacted,” writes Ing.
The DJNO was created in order to mobilize disabled communities and demand a holistic approach to healthcare reform. According to Jama, this includes seeing race, income, and disability as fundamentally interconnected.
However as social assistance measures are cut at the provincial level, the future for disability justice is murky. The results of the updated Code Red project paint a sobering picture of the state of health inequality in Hamilton. Given the direction that healthcare reform is taking on the provincial level, health and poverty advocates worry about the future of healthcare equality in Hamilton.
Disclaimer: This piece was written prior to the changes made on Jan. 17 by the Ford provincial government regarding tuition for postsecondary education. Changes to the Ontario Student Assistance Program include increasing the length of time students must have graduated high school to qualify as an independent student from four to six years, removal of the grace period for repayment of loans upon graduation, and removal of many grants for lower-income students. Read the provincial government's statement here: https://news.ontario.ca/maesd/en/2019/01/affordability-of-postsecondary-education-in-ontario.html
The Ontario Student Assistance Program, a financial aid program offered through the provincial government, has helped many Ontario students get through university. OSAP offers funding through grants and student loans, and can be used to help offset the cost of tuition and school-related expenses.
Almost all Ontario residents may apply for OSAP but the amount of aid offered to each individual is dependent on the individual’s education expenses, course load, and personal financial situation. This last factor essentially boils down to your family’s income. If your family makes enough money deemed by the government to sufficiently cover educational expenses, then this renders you ineligible to collect OSAP.
While this appears to favour students from low-income households, as it should, it neglects the possibility of students from high-income households where parents do not or cannot pay for tuition. There are many reasons why this occurs ranging from the parents’ genuine inability to allocate funds for their children’s education to refusing on the grounds of principle. Though these students truly demonstrate financial need, their concerns often go unrecognized.
As these students are not able to collect OSAP, they typically have to work several part-time jobs to pay for tuition, or try their luck at applying for private loans that do not carry the benefits of student loans like interest relief during schooling and grace periods after graduation.
As of now, the only way to receive OSAP if you are from a high-income family is to be considered an independent student with an income below what the government deems as excessive or to declare a family breakdown. To be considered an independent student, one must meet several criteria. For example, both your parents must be deceased, you’ve worked full-time for at least 24 months in a row, or you’ve been out of high school for four or more years.
These provisions show the assumption of the provincial government that parents will support their children for four years of postsecondary education. This often false assumption also has no rational grounds; why the decision for a seemingly arbitrary four years? What occurs only after four years from high school that makes someone financially independent?
The alternative, to declare a family breakdown, is also insufficient. To declare a family breakdown renders you an independent student but you must show proof of estrangement from your parents “due to documented mental, physical, sexual, and/or emotional abuse or drug or alcohol addiction in your family”. This provision is too narrowed and does not reflect the many other reasons that parents may be unwilling or unable to support their children’s postsecondary education expenses. Your parents could very well be supporting you, just not financially.
Rather than requiring students to jump through hoops to receive aid, there should be an honour system for students applying for OSAP. If students claim that they are financially independent from their parents, they should be believed at face-value. Perhaps the stipulation can be a restriction for these applicants to receive student loans only, so that grants can be reserved for students from lower-income families.
There will undoubtedly be individuals that misuse such an honour system. But is the potential for misuse strong enough cause to warrant not supporting individuals who could legitimately benefit from such an option? That’s subject to debate.