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1. HEALTH
AND SOCIAL SERVICES
ADVISORY COMMITTEE - TORONTO CHARTER COMITE CONSULTATIF SUR LA SANTE ET LES SERVICES SOCIAUX
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That
City Council:
1. Endorse
the Toronto Charter for a Healthy Canada, as per Annex 1 of this report.
2.
Request
that the Federation of Canadian Municipalities endorse the Toronto Charter for
a Healthy Canada.
Que le Conseil municipal :
1. Entérine
la Charte de Toronto pour un
Canada en santé.
2.
Demande
à la Fédération canadienne des municipalités d’entériner la Charte de Toronto
pour un Canada en santé.
Documentation
1. Co-Chairs, Health and Social Services Advisory Committee report dated 1 October 2003 (ACS2003-CCV-HSS-0002).
2. Extract of Draft Minute, 16 October 2003.
Report to/Rapport au:
Health, Recreation and Social Services
Committee
Comité de la santé, des loisirs et des services
sociaux
and Council/et au Conseil
1 October 2003/le 1 octobre2003
Submitted
by/Soumis par: Co-Chairs/Coprésidentes,
Health and Social
Services Advisory Committee
Comité consultatif sur la santé et les services
sociaux
Contact/Personne-ressource: Brenda Emond, Coordinator/Coordonnatrice
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Ref N°: ACS2003-CCV-HSS-0002 |
SUBJECT: HEALTH AND SOCIAL SERVICES
ADVISORY COMMITTEE - TORONTO CHARTER FOR A HEALTHY CANADA
OBJET: COMITE CONSULTATIF SUR LA SANTE ET
LES SERVICES SOCIAUX – CHARTE DE TORONTO POUR UN CANADA EN SANTÉ
REPORT
RECOMMENDATIONS
That
the Health Recreation Social Services Committee recommend City Council:
1. Endorse the Toronto Charter for
a Healthy Canada, as per Annex 1 of this report.
2. Request
that the Federation of Canadian Municipalities endorse the Toronto Charter for
a Healthy Canada.
Que le Comité de la santé, des
loisirs et des services sociaux recommande au Conseil municipal
1. D’entériner
la Charte de Toronto pour un
Canada en santé.
2. De demander à la Fédération
canadienne des municipalités d’entériner la
Charte de Toronto pour un Canada en santé.
The Health and Social
Services Advisory Committee (HSSAC) met with the staff at the Carlington
Community Health Centre on Feb. 25, 2003 and with representatives from the
Ottawa Coalition of Community Health and Resource Centres (CHC's and RC's) at
Centretown CHC on May 26, 2003.
Discussions took place on the Toronto Charter for a Healthy Canada and
it was agreed the Advisory Committee would take the lead role in requesting
City Council’s endorsement of the Charter.
Subsequently, the Health and
Social Services Advisory Committee at its meeting of 29 September 2003
unanimously approved the following motion:
Whereas the Toronto Charter for a Healthy Canada was developed by health
and social services experts participating the Social Determinants of Health
Across the Life-Span Conference in December, 2002;
Whereas the Toronto Charter has been endorsed by the City of Toronto;
Whereas the Boards of a 11 of Ottawa's Community Health and Resource
Centres have endorsed the Toronto Charter (the other two will consider it in
early October);
Be it resolved that the HSSAC:
1)
endorse the
Toronto Charter;
2)
request
through the Health, Recreation and Social Services Committee, that Ottawa City
Council endorse the Toronto Charter;
3) request the City of Ottawa to ask the
Federation of Canadian Municipalities to endorse the Toronto Charter."
DEPARTMENTAL COMMENTS
The People Services Department supports the
recommendations of the Health and Social Services Advisory Committee.
FINANCIAL
IMPLICATIONS
There are no financial implications to approving this report.
SUPPORTING
DOCUMENTATION
Document 1 – Toronto Charter for a Healthy Canada
DISPOSITION
The Committee Coordinator will inform the Health and Social Services Advisory Committee of Committee and Council’s decision.
Document 1
Strengthening the Social Determinants of Health:
The Toronto Charter
for a Healthy Canada
From November 29 to December 1, 2002 a conference
of over 400 Canadian social and health policy experts, community
representatives, and health researchers met at York
University in Toronto, Canada to: a) consider the state of ten key social or
societal
determinants of health across Canada; b) explore the
implications of these conditions for the health of Canadians; and c) outline
policy
directions to improve the health of Canadians by
Influencing the quality of these determinants of health. The conference took
place at a
time when Canadian social and health policies were
undergoing profound changes related to shifting political, economic, and social
conditions.
Ten social
determinants of health -- early life,
education. employment and working conditions, food security, health services,
housing,
income and income distribution, social exclusion, social
safety net, and unemployment and job insecurity were chosen on the basis of
their prorninence in Health Canada and World Health Organization policy statements and documents.
The conference was a response to
accumulating evidence that growing social and economic inequalities among
Canadians are
contributing to higher health care costs and other social burdens.
Indeed, the Kirby Report on the Federal Role in Health Care points
out that 75% of our health is determined by physical,
social and economic environments. Evidence was also accumulating that a high
level of poverty - an outcome of the growing gap between rich and poor-- has profound
societal effects as poor children are at higher
risk for health and learning problems in childhood,
adolescence, and later life, and are less likely to achieve their full
potential as
contributors
to Canadian society.
The Social Deterrninanls of Health Across the Life-Span Conference coincided with the release of the Romanow Report on the
Future
of Health Care in Canada that called for
strengthening the Canadian health care system by resisting privatization,
expanding its
coverage, and increasing financial investment. The report
also discusses the importance of economic and social determinants of health.
The evidence heard at the Conference reinforced the view
that immediate and long-term improvements in the health of Canadians
depend upon investments that address the sources of
health and disease.
The participants
at the
Social Determinants of Health Across the Life-Span
Conference therefore resolve:
Whereas the
evidence is overwhelming that the health of Canadians is profoundly affected by
the social and economic
determinants of health, Including -- but not restricted to -- early life, education, employment and working
conditions, food security,
health
care services, housing, income and its distribution, social exclusion, the
social safety net, and unemployment and
employment security; and
Whereas the evidence presented at the conference clearly
indicates that the state and quality of these key determinants of health
are
linked to Canada's political, economic and social environments and that many
governments across Canada have not
responded adequately to the growing threats to the health
of Canadians in general, and the most vulnerable in particular; and
Whereas these social determinants of health are
also human rights as defined in the Universal Declaration of Human Rights and
the International Covenant on Economic, Social and Cultural Rights, which Canada is obliged to
protect and promote: and
Whereas the evidence presented indicates that
investments in the basic social determinants of health will profoundly improve
the
health of Canadians most exposed to health threatening
conditions -- the poor, the
marginalized, and those Canadians excluded
from
participation in aspects of Canadian society by virtue of their living
conditions - therefore providing health
benefits for all
Canadians; and
Whereas the evidence presented to us has indicated the following
to be the case:
1. Early childhood development
is threatened by the lack of affordable licensed childcare and continuing high
levels of family
poverty. It has been demonstrated that licensed quality
childcare improves developmental and health outcomes of Canadian
children in general, and children-at-risk in particular.
Yet, while a national childcare program has been promised, 90% of
Canadian families with children lack access to such
care.
2. Education as delivered through
public education systems has helped to make Canada a world leader in
educational
outcomes. Our education systems are now at risk due to
funding instability and poorly developed curriculum in many
provinces. These conditions may weaken the trend toward
greater number of students graduating despite evidence that those
who do so show significantly better health and family
functioning than non-graduates.
3. Employment and working
conditions are deteriorating for some groups - especially young families -- with
potential
attendant health risks. One in three adult jobs are now
either peripheral or precarious as a result of increasing contracting out
of core jobs and privatization of public employment.
These jobs are often temporary, with low pay and high stress. The
weakening
of labour legislation in many jurisdictions is directly related to precarious
working situations. These changes
threaten the gains made by workers in the past,
jeopardizing their health and well-being.
4. Food security among Canadians and their families is
declining as a result of policies that reduce income and other resources
available
to low income Canadians. In Canada, food insecurity exists among 10.2% of
Canadian households representing 3
million
people, Monthly food bank use is 747,665 or 2.4% of the total Canadian
population which is double the 1939 figure;
41 % of the food bank users or 305,000 are children under
the age of 18.
5. Health
care services can become a social determinant of health by being reorganized to support health. Many examples of
effective - but all-too-rarely
implemented - means of preventing deterioration among the ill through chronic
disease
management and rehabilitation are available. Screening that
has been carefully assessed for its effectiveness can support
health.
Preventing disease in the first place by promoting the social and living conditions that support healthy lifestyles has
also
been neglected. While the Romanow Report reaffirmed the principles of the
Canada Health Act, missing were strong
statements about the important roles public health,
health promotion, and long-term care play in
supporting health.
6. Housing shortages are
creating a crisis of homelessness and housing insecurity in Canada. Lack of affordable
housing is
weakening other social determinants of health as many
Canadians are spending more of their
income on shelter. More than
18% of Canadians live in unacceptable housing situations
and one in every five renter households spent 50% or more of their
income on housing in 1906, an increase of 4310 since
1991.
7. Income and its equitable distribution have deteriorated the past decade. Despite a 7-year stretch of
unprecedented
economic growth, almost half of Canadian families have
seen little benefit as their wages have
stagnated. Governments at all
levels
have let the after-tax and transfer income gap between rich and poor grow from 4.8:1 in 1989 to 5.3.1 in 2000. The
growing vulnerability of lower-income Canadians
threatens early childhood, education, food
security, housing, social exclusion,
and ultimately, health. Low income Canadians are twice as
likely to report poor health as compared to
high income Canadians.
8. Social exclusion is becoming increasingly common among many Canadians. Social exclusion is the process
by which
Canadians are denied opportunities to participate in many aspects of cultural, economic, social, and
political life. It is
especially prevalent among those who are poor, New
Canadians, and members of racialized - or non-white -groups. As our
racialized
composition grows, it is unacceptable that these groups earn 30% less than whites and are twice as likely to be
poor. These trends contribute to social and political
instability in our society.
9. Social safety nets are changing in character as a result of
shifting federal and provincial
priorities. The 1990s has seen a
weakening of these nets that constitute both threats to
the health and well-being of the vulnerable. The
social economy may
provide opportunities for community organizations to provide services in more democratic, transparent and
community
sensitive ways. It may be, however, unable to meet
emerging needs without further burdening caregivers in the community or
inadequately compensating them, many of whom are women.
10. Unemployment continues at
high levels and employment security is
weakening due to the growth of precarious, unstable
and
non-advancing jobs. Higher stress,
increasing hours of work, and increasing numbers of low income jobs are the
mechanisms that link employment insecurity and
unemployment to poor health incomes.
Unionized jobs are the most likely to
help avoid these health-threatening conditions.
11.
Canadian women, Aboriginal people, Canadians of colour, and New Canadians are especially vulnerable to the
health
threatening effects of these deteriorating conditions. This is most clear regarding income and its distribution,
employment and
working conditions, housing affordability, and the state
of the social safety net.
It is therefore resolved that:
Governments
at all levels
review their current economic, social, and service policies to consider
the impacts of their policies upon
these social determinants of health. Areas of special importance
are the provision of adequate income and social assistance levels,
provision of affordable housing, development of quality
childcare arrangements, and enforcement of anti-discrimination laws and human
rights codes. It is also important to increase support
for the social infrastructure including
public education, social and health services,
and improvement of job security and working conditions;
Public
health and
health
care associations and agencies educate their members and staff about the
impacts of governmental
decisions upon the social determinants of health and advocate
for the creation of positive health promoting conditions. Particularly
important is their joining current debates about
Canadian health and social policy directions
and their impacts upon population health;
The
media begin to seriously cover the rapidly expanding findings concerning the importance of the
social determinants of health and
their impacts upon the health of Canadians. This would strike a balance between the predominant coverage of health from a
bio-medical and lifestyle perspective. It would also help educate the Canadian public about the potential
health impacts of various
govermrnental decisions and improve the potential for
public involvement in public policymaking; and
that
Immediate Action
As a means of moving this
agenda forward, the conference recommends that Canada's Federal and
Provincial/Territorial governments
immediately address the sources of health and the root
causes of illness by rnatching the $1.5 billion
targeted for diagnostic services in
the Rorrranow-Repe4
on the Future of Health Care in Canada by allocating an equal amount towards two essential
determinants of
health for children and families: 1) affordable, safe
housing; and 2) a universal system of high
quality educational childcare; and
Long-Term Action
Similar to governmental
actions in response to the Acheson inquiry into Health inequalities in the
United Kingdom, the federal
government should
establish a Social Determinants of Health Task Force to consider the
findings and work to implement the
implications of the material presented at this
Conference. The Task Force would
operate to identify and advocate for policies to support
population heath by all levels of governmental. The
federal and provincial governments would respond to these recommendations in a
formal manner tnrough annual reports on the status of
these social determinants of health.
So resolved, this
December 1, 2002, in Toronto, Canada.
HEALTH
AND SOCIAL SERVICES – ENDORSEMENT OF THE TORONTO CHARTER FOR A HEALTHY CANADA
SANTE
ET SERVICES SOCIAUX – CHARTE DE TORONTO POUR UN CANADA EN SANTÉ
The Committee heard from Mr. Brian Jonah, from the City of Ottawa’s Health and Social Services Advisory Committee. Mr. Jonah indicated he was present at the 2002 conference, held from November 29th to December 1st, where over 400 delegates discussed ten key social or societal determinants of health across Canada. He stressed the importance of the City of Ottawa endorsing the Toronto Charter, and of the Federation of Canadian Municipalities (FCM) following the City’s lead, to convince the senior levels of government to support it as well.
Ms. Marguerite Kealey, from the Coalition of Community Health and Resource Centres, spoke in support of the report recommendations, noting these fit well with the City’s Official Plan to guide smart growth, as well as with the five precepts of the recently-approved Human Services Plan.
Ms. Cathy Jordan, Acting Director, Western Ottawa Community Resource Centre, echoed the comments of the earlier speakers, adding that the Resource Centres see how vulnerable clients are, and want to further advocate for, and help, those clients.
In reply to comments from Councillor Dwight Eastman, Ms. Kealey indicated there are numerous academic papers and studies that illustrate the financial benefits provided to the taxpayer by programs such as homecare, special education and other social programs. She made reference to the University of Ottawa’s Institute of Population Health, saying some of the material could be obtained from this source, and agreed with the Councillor that it would be helpful for policy makers to have this information as well.
After further discussion, the Committee approved the report recommendations.
That
the Health Recreation Social Services Committee recommend City Council:
1. Endorse
the Toronto Charter for a Healthy Canada, as per Annex 1 of this report.
2. Request
that the Federation of Canadian Municipalities endorse the Toronto Charter for
a healthy Canada.
CARRIED