How will they affect us? What can we do about them?

Join the discussion – Refreshments served
Date: Thursday April 5, 2012
Time: 10:00 am—12:00
Rexdale Community Health Centre
8 Taber Road, Etobicoke, ON M9W 3A4

Bus 45 N towards Steels from Kipling Subway Station
(Near Kipling Ave and Redcliffe Blvd)

A group of Toronto health professionals is warning that proposed cuts to a variety of city programs are actually health-care cuts in disguise.

Axing or reducing funding to HIV and drug prevention programs, recreation centres, community health centres, shelter services and Wheel-Trans for some dialysis patients is going to create significant health consequences, said Russ Ford, the executive director of LAMP Community Health Centre in South Etobicoke.

“And we’re going to pay for it down the line, both physically and financially,” said Ford, whose centre is at risk of losing some funding from the city.

As of Friday, Ford (no relation to Mayor Rob Ford) had collected 280 signatures, half from local physicians, demanding the city back off from many of the proposed service cuts.

For Dr. Roy Male, who has worked with a community centre in Regent Park for eight years, this is an issue of health equity.

“I counsel my patients to exercise. You and I probably have a membership at a gym. End of story. My patients use community recreation centres, and these (proposed) fee increases mean, in a large number of cases, people are going to stop using them,” he said.

As of this week, the exhaustive 2012 budget process has finally entered the home stretch, with one more stop at the budget and executive committees this week and then off to council for the last time later this month.

When the discussions began more than a year ago, the Ford administration presented the “2012 budget” as Toronto’s moment of financial reckoning — judgment day for a spend-happy city.

One year later, after a massive public backlash that heard upwards of 1,000 deputations, the forecast is dreary, but nothing to head to the basement over. You are forgiven if you can’t quite remember what’s still on the chopping block. So below is your cheat sheet to all things budget in 2012.

PREVIOUSLY IN DANGER, BUT LIKELY SAFE:

Plans to trim 10 per cent from Toronto’s student nutrition program unofficially died at a December committee meeting when dozens of angry advocates trumpeted the educational benefits of learning on a full stomach. Thursday, mayor Ford announced he would not be pursuing cuts in this area.

It’s unlikely libraries will survive the 2012 budget completely unscathed, but proposed cuts to city branches sparked the first batch of public uproar. While some in Mayor Ford’s inner circle would like to see some underutilized branches closed, no one is willing to spend political capital fighting Margaret Atwood. There will probably be some reductions to hours and collections spending.

Daycare is another area politicians are not keen to take on. Giorgio Mammoliti is heading up the mayor’s task force on daycares and has demanded the province step up in this area. Especially given the unexpectedly large year-end surplus — as of last week, staff put the number at $154 million — and a reserve fund for this area, daycare cuts are highly unlikely.

Rob Ford ran on a campaign of back-to-basics government. He said smooth, clean roads and clean neighbourhoods are a priority for Torontonians. For this reason, proposals to reduce leaf collection and sidewalk snow plowing may not go far.

STILL ON THE TABLE:

The Toronto Environment Office is facing a 17 per cent cut, largely by removing six staff positions dedicated to helping Torontonians live more efficiently and develop a climate change strategy. The city’s tree canopy program, which helps air quality, could also be cut.

“Cuts to TTC services also have a huge impact on the environment. It’s extraordinarily upsetting. I’m scratching my head where this radical conservative agenda has come from. This is not what Torontonians have been asking for,” said Franz Hartmann, executive director of the Toronto Environmental Alliance.

Recreation is still in considerable danger heading into the 2012 budget debate. Despite an announcement last week that the mayor has directed staff to protect city-run programs at 12 community centres housed in schools, arena hours could still be slashed and some swimming and wading pools could be closed. For health professionals, the most troublesome proposal is planned hikes to user fees, especially in low-income neighbourhoods.

Shortly after Rob Ford came to office, his transition team began investigating the Community Partnership and Investment Program, which among other things, doles out millions in arts grants as well as AIDS and drug prevention funding.

If plans stay the course, Toronto transit riders are going to have a rocky 2012. At the same time the TTC has hiked fares 10 cents, raising $30 million in additional revenue, the commission is being forced to slash service on more than 60 bus and streetcar routes and cancel an order for 108 badly needed new buses.

Tiffany McDowell was thrilled to land a customer service position at an Oshawa technology firm last January, several months after her daughter’s first birthday.

The job, which required no night work and was located on a bus route near her daughter’s babysitter, seemed like a perfect fit for the financially strapped single mom who had worked in a book store and a call centre before Alexandra was born.

But her hopes of climbing out of poverty were dashed last July when IQT Solutions went bankrupt and McDowell discovered she didn’t have enough insurable hours to qualify for employment insurance.

“It was a real blow to lose that job,” she says. “And without EI, I had no alternative but welfare.”

McDowell, 25, is among a growing number of area workers who either aren’t covered by EI or don’t qualify and could benefit from a proposed “Jobseeker’s Loan” designed to bridge the gap between employment insurance and welfare, says social policy researcher Michael Mendelson.

Last year, more than 700,000 unemployed Canadians were either not covered by EI or ineligible, he says. Across the GTA, only about one-quarter of unemployed workers received EI.

Under Mendelson’s proposal, income-tested forgivable loans would be available in bi-weekly payments of almost $700 for six months. The loans would be repaid based on total earnings for the year the money was received — they would be completely forgivable for those with incomes below about $10,000 and fully repayable for those earning about $71,000. At about $51,000, recipients would have to repay half of the Jobseeker’s Loan. All adults looking for work would be eligible for the full loan of almost $9,000 every five years and it would could cost the federal government about $1 billion annually.

“I hope people will explore it and think about it as an alternative to welfare, which is a very oppressive, paternalistic and stigmatizing program,” says Mendelson, who came up with the scheme with colleague Ken Battle as part of a larger review of EI released in November by the University of Toronto’s Mowat Centre.

“It would fill a large hole in Canada’s income security system, at a reasonable cost,” he adds.

The labour movement and others have urged Ottawa to expand EI coverage, beef up payments and extend benefits for up to two years. But Mendelson argues it would be difficult and prohibitively costly to design a more generous program that would include self-employed and contract workers. Liberalizing welfare would be equally onerous, he adds.

However, Mendelson thinks both programs would likely be easier to reform if there was a loan program to provide a time-limited, income-tested bridge between the two without the asset stripping, myriad rules and stigma of welfare.

He compares his Jobseeker’s Loan to the income-tested Guaranteed Income Supplement for low-income seniors receiving Old Age Security (OAS) payments.

It would be non-stigmatizing and give all adults actively seeking employment the opportunity to get back on their feet “without losing everything and having to restart financial life from zero” by being forced onto welfare.

“I see it as a sort of ‘Working Income Supplement’ paid in advance,” adds Mendelson, a senior scholar with the Caledon Institute for Social Policy.

But the Ontario Federation of Labour, which has been highly critical of the idea, has called it “little more than a payday-loan scheme for unemployed workers in precarious and non-standard work.”

The plan downloads the cost of unemployment supports to workers who can least afford it, says Pam Frache, the union’s research and education director.

“It undermines any incentive for government to expand access to EI,” she says.

More worrisome, Frache sees Mendelson’s proposal as another form of Australia’s Income Contingent Loan Repayments (ICLR) for post-secondary education.

When first implemented about 20 years ago, student incomes were relatively high before they had to repay their college loans. But government cost-cutting over the years has pushed the threshold lower and increased student fees, adding significantly to students’ debt burden in that country, she says.

“Even if the authors truly believe the majority of jobseekers’ debt would ultimately be forgiven and funded out of general revenue, the lived experience with ICLR schemes for more than 20 years is one of decreasing generosity,” she says.

But Mendelson says governments can cut any program, as witnessed by cuts to EI in the 1980s and 1990s. Moreover, the proposed Jobseeker’s Loan would be a new program in addition to EI and welfare, not a replacement.

For McDowell’s part, she thinks the Jobseeker’s Fund would be a welcome boost.

Most of her $922 monthly welfare cheque goes toward rent and utilities, while she struggles to pay for groceries, transit, clothing and other costs on her monthly child benefits and tax credits of less than $500 a month.

“Diapers alone cost $50 to $60 a month,” she says.

Under Mendelson’s plan, McDowell would be eligible for bi-weekly payments of $692 — a 62 per cent increase over what she receives on welfare.

After six months, if she was able to find a job similar to the one she lost (which paid $11 an hour), her loan repayment would be less than $5.

“A loan program would certainly help people like me,” she says. “It would be great to give it a try.”

United Way of Greater Toronto report
Losing Ground: The persistent growth of family poverty in canada’s largest city, November, 2007

Key findings:

• Toronto families are losing ground and falling far behind the Toronto CMA*, the province, and the country
• The median income of Toronto lone-parent families is in a continuous downward spiral.
• A large gap has opened up between the median income of Toronto two-parent families and their counterparts in other areas. While the median income of two-parent families across the country has risen, the median income of Toronto two-parent families remains below 1990 levels.
• Toronto family poverty continues to grow and the gap continues to widen between the City of Toronto, and the rest of the Toronto CMA, the province and the country.
• In 2005, slightly more than half of all lone-parent families in the City of Toronto were low-income compared to 1 in 3 in 1990.
• In 2005, nearly 1 in 5 of Toronto’s two-parent families were low-income, compared to approximately 1 in 10 at the national, provincial and rest of Toronto CMA levels.

*Toronto Census Metropolitan Area

Lilia Martinez is happy to clean offices, cook in a restaurant, look after children — you name it.

But the 52-year-old Mexican immigrant, who has done all of these jobs, has had trouble finding a Toronto employer willing to pay her the minimum wage.

“I like to work. I won’t take welfare,” Martinez says through a Spanish interpreter. “But in the past, I have found they only want to pay cash.”

“I can’t survive on what they pay,” adds the social worker and former factory owner, who came to Canada in 2008 to escape a violent 30-year marriage.

The truth is, however, Martinez and most other Ontario workers struggle even when employers pay the provincial minimum wage of $10.25 per hour, say workers’ rights advocates.

They are hoping Queen’s Park makes good on its election promise to appoint a minimum wage advisory committee as part of its annual progress report on poverty reduction, which is being released Monday.

They also want the government to make permanent a two-year, $6-million labour ministry initiative launched in 2010 to clear the backlog of workplace violation complaints.

Now that the backlog is cleared, advocates want the money pumped into proactive enforcement of Ontario’s Employment Standards Act, the province’s minimum workplace regulations protecting low-wage, vulnerable workers from abuse. Currently, there are only 20 ministry investigators working in this area.

“The government says the best route out of poverty is a job,” says Deena Ladd of the Workers’ Action Centre, a non-profit, worker-based organization. “But people working full time earning minimum wage are still having trouble paying the bills.”

Between 2003 and 2010, the McGuinty government raised the minimum wage from $6.68 to $10.25. There was no increase this year.

Meantime, TTC fares are going up by 10 cents, rents are rising by 3 per cent, and services are being cut.

“Increases to the minimum wage are the only pay raises people like Lilia Martinez ever get,” Ladd says. “That’s why it is important minimum wages reflect the cost of living.”

And enforcement is key to ensuring workers get what they are owed.

“Any initiative the government takes to alleviate poverty for low wage workers has to be backed up by enforcement,” Ladd adds.

A survey of 520 low-wage Ontario workers released earlier this year found about one-third were victims of wage theft, either because they weren’t paid the minimum wage or weren’t paid for the hours they worked.

The report urged Ontario’s labour ministry to proactively target employers in high-violation industries such as hospitality, cleaning, retail and construction, which attract newcomers, young workers, visible minorities and other vulnerable workers.

In June, Martinez found an office cleaning job that pays minimum wage. She is delighted to be bringing home an official paycheque and proud to be paying taxes in her adopted country. But because she works just five hours a day — from 5 p.m. to 10 p.m. — she only earns about $1,100 a month. It’s not enough to make ends meet.

Martinez realizes she would have more options if her English was better, but she can’t afford to go to school on such low wages.

“I am desperately looking for full-time work,” she says. “My story is the story of a lot of Latin American women living here. We are trying to make a contribution, but it’s hard to find employers willing to treat us fairly.”

A group of Rexdale youth have challenged Toronto City councillors to “walk in their shoes” by riding the TTC from January 10 – January 17, 2012. The group of youths and volunteers from North Western Toronto posted a video on YouTube issuing the challenge.

THE VIDEO: Rexdale Youth Challenge Toronto City Councillors12-06-20-20-29.mp4

Do you think that Toronto City Councillors should accept the challenge before deciding on proposed cuts to texisting TTC routes?

 * Source: Noor Javed Staff Reporter from the Toronto Star

In the decade she has worked at the volunteer health clinic for the uninsured, the one story that Toronto public health nurse Jennifer D’Andrade can’t seem to forget is that of a man named Jose.

Maybe it’s because of how hard she tried to get the failed refugee claimant from Guatemala into a local hospital for chemotherapy to stop his esophageal cancer from spreading.

Maybe it’s because D’Andrade knew that if he had OHIP, Jose might have been “salvageable.”

Maybe it’s because she knew that clinic director Dr. Paul Caulford was holding the 42-year-old in his arms when he died last year in the east-end apartment he shared with his brother. They use Caulford’s office in the evenings

“There was a reasonable chance he would have survived,” says D’Andrade, sitting in a patient assessment room at the Scarborough Academic Family Health Centre at Markham and Ellesmere Rds., out of which the volunteer clinic operates. “But he had no insurance, no money, and no one would take him in. So there was nothing we could do.”

This is just one story. D’Andrade has hundreds like it. Stories she has accumulated from a constant stream of patients who have been coming to the free, walk-in Community Volunteer Clinic for Medically Uninsured Immigrants and Refugees — the only one like it in the GTA — over the past 11 years.

For almost all the patients she sees, the Scarborough clinic is their only option short of the emergency room. In most cases, they have found out about it from the signs posted at the local OHIP office. When they arrive, they are almost always immensely grateful.

“As long as we can keep them in the clinic, we’re happy,” says D’Andrade. “It’s when we have to go to a hospital or get a referral for a specialist that it gets tricky and it becomes all about money. Then you don’t know how things will turn out.”

Care for the uninsured in the GTA occurs largely under the radar — administered through an uncoordinated mix of community health centres, emergency rooms and free clinics. But an increasing number of front-line health-care workers and advocates are pushing for better access to care for the uninsured, amid concerns the patchwork system in place is not only unethical and costly to the system but is putting the lives of the most marginalized and vulnerable at risk.

“In Canada, we live with this notion that everyone has health insurance,” says Michaela Hynie, associate director of the York Institute for Health Research and a psychology professor at York University. “So our biggest problem is that most of us don’t even know that the problem exists.”

In Ontario, the uninsured fall into four major groups: new immigrants and those returning to the province, who have to wait three months for their health insurance to kick in; refugees and those who have been denied asylum; people who have lost their documentation, such as the homeless and mentally ill; and those who are in the country illegally.

Accurate numbers of how many people are living without insurance in the city are hard to find. The Scarborough clinic sees around 1,200 patients a year. Hynie conducted a study of emergency rooms from 2007 to 2008 and found that more than 5,000 people who had registered had no insurance. But these numbers don’t account for the estimated 30,000 to 100,000 undocumented workers who are believed to live in Ontario, or the more than 50,000 permanent residents who will immigrate to the province this year and spend three months without health care.

But Caulford says quantifying the problem makes little difference at the policy level. He believes lack of action comes down to a lack of political will.

“Over the past 10 years, things have gotten worse,” he says. “Our volumes are up and there has been no policy change. The truth is that most politicians see the issue of giving health care to the uninsured as political suicide. I have had politicians say to me, ‘I want to do something, but I don’t know how to spin it.’ ”

In Ontario , the emergency room is the great equalizer. It is the one place in the health system from which no patient can be turned away, which makes it an entry point for most of the uninsured.

But it’s not cheap for them. At some hospitals, registration can cost upwards of $350. If a hospital stay is required, charges of between $1,000 and $2,300 per day — or even more — can apply, depending on the treatment. Many people can’t afford to pay, forcing hospitals to absorb the cost. But there are exceptions. D’Andrade says she can recall one man who paid back his bill to a Toronto hospital in instalments of $5 every two weeks, because that was all he could afford.

“The problem is that by the time people get to emergency, they are in need of more serious and acute care,” says Hynie. “These are conditions or illnesses that could have prevented. But because of high costs, or other fears, many of the uninsured leave before even getting treatment.”

Provincially funded community health centres are the only arm of the health system that receives financing to see the undocumented. While they are serving a need in the community, many workers in the centres say they are underfunded, restricted to caring for people in the neighbourhood, and in most cases are so full they have had to close waiting lists to new patients.

A Toronto Central Local Health Integration Network (LHIN) task force is trying to assess just how much it costs hospitals when an uninsured patient comes to emergency.

Downtown hospitals are seeking solutions to questions such as: how do they convince the province to fund those who are underground, undocumented and here illegally?

“There is that notion that people will cheat the system if we were to make health care truly universal,” says Hynie. “But there is no proof of that. If we believe that health is human right, then to argue that some people deserve human rights and others don’t on the basis of citizenship or poverty is problematic.”

The easier fix, advocates agree, is the elimination of the three-month wait for landed immigrants. Last week, the Right to Health Care Coalition, made up of more than 80 groups, and Toronto’s Medical Officer of Health, Dr. David McKeown, took their case to eliminate the three-month wait period to Queen’s Park.

“These people have been approved, and they have gone through all the proper channels,” says Bob Gardner, the director of policy at the Wellesley Institute, a think-tank focused on advancing urban health and health equity. “You could say it’s even fraudulent to invite people to Ontario and then say to them when they get here, by the way, don’t get sick for a few months.”

Ontario, B.C and Quebec are the only provinces that make new immigrants wait three months for health care. But Quebec alone does offer coverage when it comes to domestic violence, maternal care and infectious diseases. The Ontario Ministry of Health introduced a three-month wait period for all new immigrants and returning residents in 1994, on the grounds it allows officials time to confirm a patient’s resident status.

The policy, which saves Ontario $90 million a year, is a way to protect the health-care system from abuse, says Health Minister Deb Matthews.

“We are not looking at changing the three-month wait period at this time,” she says. “It’s important that when people come to Canada, they know that they won’t have health insurance for three months, so they should get insurance before they come.”

Try explaining the government policy to the “almost-citizens” such as Raj Gupta and his wife, Pallavi.

On this blustery Tuesday evening, the recently landed immigrants are happy they have found the Scarborough clinic, where they have brought 2-year-old Arnav, who has had a high fever for three days.

“For elders, it is okay, we can resist,” says Pallavi. “But with a child, you can’t take a risk.

“I feel like I won’t be able to breathe until the three months are over.”

The Guptas arrived in Toronto in October, aware that they would be without health care for three months. They bought insurance, but that covers them only for emergencies. So Raj went to Scarborough General to find out how much it would cost him if he needed to bring in his son.

“They told me its $300 for registration,” says Gupta, a family physician in India, who found out about the free clinic at the local OHIP office. “If you call the ambulance, it is $250 more. Once the doctor comes, he will charge $100, and other examinations are extra. And if you need to stay a night, it’s another $1000.

“It would cost me less to send both of them back to India where they could get care right away. If it wasn’t for this clinic, we might have done just that.”

The clinic started in May 2000, with D’Andrade and Caulford seeing patients in basements and community centres twice a week. They would bring in tackle boxes filled with gauze, needles and syringes.

Over time, they applied for funding from the Ministry of Health and Long-Term Care and received $100,000. It’s just enough to cover the cost of diagnostic and lab tests for patients and a small stipend for the eight physicians who rotate through to cover the two-days-a-week clinic. Many of the drugs and supplies are donated, as is the time of nurses, volunteers and the pediatric doctors who come to the clinic to treat children one Saturday a month.

Some advocates say the walk-in concept of the Scarborough clinic offers a “brilliant model” that could be adapted in different communities. But D’Andrade notes that in its current form — built on the generosity of volunteers — it isn’t sustainable.

With proper funding from the province, however, it would be a cost-effective alternative to sending patients to the emergency department, she contends. Yet there has been little willingness on the part of Queen’s Park to even consider it.

“It’s frustrating,” she says. “Maybe they haven’t looked into the eyes of the people we see and see how legitimate their issues are, and how much they have struggled to make it here. Now that they have made it here, the least we can do is help them.”