U of T Nursing professor advises Toronto city council as it strengthens health care for medically uninsured

Toronto city council addressed the needs of the medically uninsured and voted 21 to 7 in favour of increasing help for those without Ontario Health Insurance Plan (OHIP) coverage on May 9.

In the recommendations presented to council, Bloomberg Nursing associate professor, Denise Gastaldo, strengthened the case for affordable, accessible health care through inclusion of her research findings on Latin American Undocumented Workers in the Greater Toronto Area. 

As one of the few academics invited by the Board of Health to participate as a key informant in the report, Gastaldo’s research contributed to the need for improvements at the program and policy level. 

She speaks with U of T News about what this decision means for health care in Toronto.

Why is access to health care an issue we need to discuss in Toronto today?
There is an assumption that everybody who resides in Ontario has OHIP. If you are a recently arrived landed immigrant or an undocumented worker in the GTA, you have no right to health care. Even in case of severe illness, my research participants have delayed seeking help, were turned down or were charged expensive amounts for health care; much more than what is charged to OHIP. When you don’t have OHIP, it is very hard to access preventive services and hospitals can charge any amount for emergency care. For instance, I know of someone in his 20s who was still in his three-month uninsured period as landed immigrant and he fainted in class. After three days in a downtown Toronto hospital he had to self-discharge because his bill was already over $14,000. Very few can afford a cost like that and if you’re in a precarious employment situation with poor wages and no safety net, expenses like that are impossible to pay back.

What do you think about the Toronto Board of Health report that city council voted on?
I am encouraged by city council’s decision to find meaningful solutions to the health needs of Torontonians who can’t access OHIP. Toronto Public Health and the Board of Health should be congratulated for their courage and vision. Toronto prides itself on being a global city and as such, can no longer look for one-dimensional solutions for the complex global issues that impact its citizens regardless of status. We need to engage with new alternatives, thinking about occupational citizenship and health for all.

What was your contribution to the Board of Health recommendations that were presented to city council?
I was a key informant during the report development and my research report on undocumented workers residing in the GTA and the health issues they face. This evidence was used to create recommendations as to why we need to provide health care to this segment of the population and were put forward by the board.

Some people argue that the cost is too much for the Toronto taxpayer, is this true?
This is a misconception that looked at from a short-term perspective, the answer would appear to be “yes” but in the long term, the answer is a resounding “no.” There are three things we have to have in mind: first, prevention is much cheaper than treatment of severe conditions. Providing pre-natal care and a safe birth is far cheaper than treating a sick mother and baby; ensuring safe working conditions is cheaper than treating injured workers.  Second, presently people delay seeking care because it’s too expensive or they are afraid of deportation. Third, to regularize the status of people who are living and working here for years is a pathway to increase tax revenues from both employers and employees. The report proposes to address issues at the federal and provincial level, to discuss a formula of affordable (OHIP-like fee) care for those who can pay, and a better system to support clinics and community health centres that presently offer services for refugees, migrants and non-status residents.  If we do nothing, it will cost us much more and a lot of unnecessary suffering and discrimination will occur. Toronto now has the opportunity to lead global cities by being an example of a health promoting, fair-minded city.

Kendra Hunter writes for the Lawrence S. Bloomberg Faculty of Nursing.