Public Health Support for Basic Income: Advancing Health Equity through Comprehensive Approach

1. Public Health – A Key Ally in Making Basic Income a Sustainable Reality   North American Basic Income Congress McMaster University May 26, 2018 Co-hosted by Hamilton Public Health Services & McMaster Department of Family Medicine April 27, 2017 DBHSC Auditorium, 100 Main St W 8:30-9:30

2. Introductions 1. Public Health Support for Basic Income Pilot • Vanessa Parlette, Health Strategy Specialist, City of Hamilton Public Health Services • Dr. Lisa Simon, Associate Medical Officer of Health, Simcoe MuskokaDistrct Health Unit 2. Showcase Local  Provincial Action through “No Money for Food is Cent$less” Campaign • Jane Shrestha, Public Health Nutritionist/Registered Dietitian, Simcoe Muskoka District Health Unit 3. Considerations: Implementing UBI as a Measure for Reducing Food Insecurity • ZsofiaMendly-Zambo, York University 4. Discussion and Application: Public Health Roles Moving Forward

3. Objectives • Highlight public health’s rationale and role in advancing BIG as part of a comprehensive approach to health equity • Discuss ways public health sector can assist provincial and cross-sector partners through evidence, advocacy, and mobilization • Apply learnings to inform ongoing public health role and partnerships needed to guide post-pilot decisions

4. Public Health’s Role

5. Why Income and Health? Material Pathways and Psycho-Social Pathways = Cumulative Impact

6. Health inequities

7. Public Health Support for Basic Income • Income plays a major role in determining health and wellbeing • Evidence of positive health outcomes from BI pilots and BI-like programs in Canada and internationally • The Public Health Sector advocates for basic income as an effective policy component within a comprehensive approach to addresskey social determinants of health: Poverty: Basic income could be an effective, dignified, and efficient part of a comprehensive poverty reduction strategy Income inequality: Basic income could help close the gap in income and personal opportunity Precarious employment: Basic income could increase social security given substantial labour market changes and uncertainty

8. BI as part of a comprehensive social security framework

9. Strong Basic Income:BICN - The Basic Income We Want • Autonomous income and access to strong public services • Replaces income provided through social assistance, but need not replace income programs working fairly well • Provides security of an income floor that varies appropriately as situations change • Leaves no one on income supports worse off than before BI • Not a substitute for fair paid labour market or for addressing other societal contributors to inequality • Based on fair and progressive taxation (BICN, 2016)

10. Advancing Ontario’s Basic Income Pilot:Public Health’s Role

11. Background on alPHa-OPHA alPHa • 30 year old NGO provides leadership to Boards of Health and public health agencies: • Advocates for a strong public health system in Ontario and public health policies, programs and services on behalf of member health units in Ontario. OPHA • 67 year old member based charity: • Provides leadership on issues affecting the public’s health; and • Strengthens the impact of people who are active in public and community health throughout Ontario.

12. Ontario’s BI Pilot: Advocacy Context • Long history of expert support and debate • Public health interest - e.g. OPHA 1992 • Recent resurgence of support from politicians and public • Public health involvement in Ontario, 2015-16: • Provincial networks • Local education, advocacy, mobilization • Feb 2016: ON basic income pilot announced • April 2017: Ontario BI Pilot sites selected

13. Health Sector Support for BI • Alberta Public Health Association, 2014 • Association of Local Public Health Agencies (Ontario), 2015, and multiple local Boards of Health • Ontario Public Health Association, 2015 • Canadian Public Health Association, 2015 • Ontario Society of Nutrition Professionals in Public Health, 2015 • Canadian Medical Association, 2015 • ~200 Ontario physicians signed letter to ON Minister of Health & Long-Term Care, 2015 meetings with government • Registered Nurses Association of Ontario, 2016 • Also: Canadian Association of Social Workers; Food Secure Canada; Community Food Centres of Canada; and more

14. Advocacy Context: Ontario’s BI Pilot Ontario BI Pilot: alPHa and OPHA Advocacy

15. Examples of Local Involvement of PHUs • Resolutions and/or letters of support from Boards of Health include: • Brant County • Durham • Grey Bruce • Haliburton Kawartha Pine Ridge • Hamilton • Lambton • Leeds Grenville Lanark • Middlesex-London • North Bay Parry Sound • Northwestern • Peterborough County City • Simcoe Muskoka • Sudbury and Districts • Toronto • Timiskaming • Waterloo Region • Wellington Dufferin Guelph • Windsor Essex • And Others

16. Examples of Local Public Health Activities • Engaging boards of health, municipal politicians, MPs, and MPPs

17. Examples of Local Public Health Activities • Building community awareness and support for local consultation

18. Examples of Local Public Health Activities • Facilitating Anti-Poverty & BI Networks

19. Examples of Local Public Health Activities • Raising Awareness of Food Insecurity Tie to Income

20. Household Food Insecurity in OntarioPublic health advocacy for income solutions Jane Shrestha Registered Dietitian / Public Health Nutritionist North American Basic Income Congress McMaster University May 26, 2018 Co-hosted by Hamilton Public Health Services & McMaster Department of Family Medicine April 27, 2017 DBHSC Auditorium, 100 Main St W 8:30-9:30

21. What is Household Food Insecurity? • Household Food Insecurity (HFI) = inadequate or insecure access to food due to financial constraints • “No money for food” • A better indicator of material deprivation than income alone

22. HFI – How big a problem? • Over 4 million Canadians live in food insecure households • 1 in 8 households • For Ontario alone almost 1.6 million people are food insecure • 1 in 8 households • 1 in 6 Ontario children experience food insecurity • almost half a million children

23. HFI – an urgent public health problem • Takes a toll on physical, mental, social health • Affects people at all ages and stages of life • Has an impact on health care use and costs • Health care costs 121% higher for people with severe food insecurity compared to people with no food insecurity

24. Community responses to HFI • Community responses focus on food • Food donations • Access to community food programs • Widely-held belief that food can fix HFI • But HFI prevalence = basically unchanged over past decade • Food insecurity cannot be solved with food • Need to shift thinking from food “solutions” to income solutions

25. HFI is an income problem • Urgent need for provincial and federalpolicies to address inadequate incomes • Ontario social assistance rates are inadequate • 64% households receiving social assistance = food insecure • Having a job (or two) is no guarantee • Almost 60% food insecure Ontario households = the working poor

26. Food insecure households – main income source

27. Public Health – tracking local HFI • Nutritious Food Basket (NFB) survey • Carried out by all Ontario public health agencies1999 – 2017 • Local measure of basic cost of healthy eating • Local NFB + rent compared with income from • Social assistance OW, ODSP • Full time, minimum wage work • Indicator of income adequacy - dismal results year after year after year

28. Rent + food compared to income (2017)

29. Single person: OW compared to BI (2017)

30. Family of four: OW compared to BI (2017)

31. Ontario Dietitians in Public Health (ODPH) • Voice of Registered Dietitians in Public Health in Ontario • includes Food Insecurity Workgroup • Position Statement on Responses to Food Insecurity

32. Basic income – a tool to address food insecurity

33. Basic income – a tool to address food insecurity • Would it work? • Canadian seniors have guaranteed annual income (OAS, GIS) • Turning 65 cuts rate of food insecurity in half • Newfoundland/Labrador poverty reduction strategy • Put in place range of policy changes that led to increased incomes • Food insecurity in social assistance recipients dropped by almost half (2006 – 2012) • Important component in toolbox of public policies that together support income adequacy

34. No money for food is … Cent$less A local communication campaign to build community support and advocacy for policies that mean more money for food. • Policies that …. • Keep basic income pilot a priority • Ensure social assistance rates cover real living costs • Encourage good jobs with regular hours, benefits • Developed by the Simcoe Muskoka District Health Unit

35. No Money for Food is … Cent$less • Awareness raising – ongoing • Campaign webpage • Social media – Facebook, Twitter, YouTube • Press kit • Engage others, build local capacity for action • Presentations, discussions • Explore possible actions together • Make supports for action available • Encourage and support community advocacy • Videos • Postcard to Premier • Posters

36. Current Campaign Phase • Focus on lead-up to provincial election • Now making deputations with advocacy “asks” to local municipalities • Encourage Simcoe Muskoka residents, organizations to • Share concerns about food insecurity • Ask candidates where they stand • Speak out for policy change • Support the ODPH provincial campaign

37. ODPH – No money for food is…Cent$less • www.odph.ca/centsless

38. ODPH – No money for food is…Cent$less campaign • Province-wide campaign adapted from SMDHU campaign • Goal: All Ontarians have adequate income to cover the cost of food without compromising their ability to pay for other basic necessities • Phase 1 – make HFI a provincial election issue • e-letters for organizations, groups, and individuals to send to provincial party leaders • Phase 2 – advocacy targeted to new Ontario government re: action on HFI

39. For more information …. Contact: Jane Shrestha, RD, Public Health Nutritionist Chronic Disease Prevention - Healthy Lifestyle Program Simcoe Muskoka District Health Unit jane.shrestha@smdhu.org

40. Considerations regarding the implementation of UBI as a measure for reducing food insecurity in Canada ZsofiaMendly-Zambo

41. Overview • A solution to food insecurity that relies on BIG to turn people into more effective consumers of food without addressing the underlying structural reasons people have become food insecure in the first place is unlikely to solve the problem over the long-term • Public health can advocate for a more just food system, one that is not built on environmental degradation & worker exploitation, and is in line with basic tenets of food sovereignty

42. What is the economic context in which we can understand food? • Food as a commodity or private good • Characteristics of a private good (rival, exclusive) • What is the economic context in which we can understand food security? • What mechanisms deliver food security to us? • Food security is a public good. • Characteristics of a public good (non-rival, non-exclusive) • Why free markets are often inadequate for providing public goods (Rocha, 2007)

43. Food Insecurity is a Market Failure “…a circumstance in which the pursuit of private interest does not lead to an efficient use of society’s resources or a fair distribution of society’s goods” (Weimer & Vining, 1999 cited in Rocha, 2007 p. 7). • Governments respond to market failure with interventions & policy • Regulation, public ownership • Basic income

44. Shortcomings of BIG in addressing Market Failure • Does not change the underlying market structures that lead to food insecurity • Does not address externalities of the food system • Environmental degradation • Worker exploitation

45. De-commodifying food • To allow individuals to have access to food (and other goods such as education, childcare, healthcare) independent of their ability to participate in the labour market • Government failure in de-commodifying food is a fundamental barrier to asserting the individual’s right to food (Smolski, 2017)

46. Food Sovereignty “…Food sovereignty is the right of each nation to maintain and develop its own capacity to produce its basic foods respecting cultural and productive diversity. We have the right to produce our own food in our own territory. Food sovereignty is a precondition to genuine food security” (Via Campesina 1996; emphasis added, cited in Patel, 2009).

47. Food Sovereignty “In many ways, food sovereignty is a social justice ‘counter-frame to food security’: it emphasizes solidarity over individualism, insists food is more than a commodity, rejects ‘free’ markets, and demands state intervention and market regulation” (Desmarais 2016, p. 365-366).

48. Policy Options • Retail and farmer co-ops with government investments and subsidies • Nutrinor (Quebec), Organic Meadow (Ontario) • Subsidized retail store (‘LCBO’ type store) • Subsidized eateries “People’s Restaurant” - Brazil • Bulk purchasing/selling boards e.g., Canadian Wheat Board

49. Greenland Food Subsidy Policy • Strict regulatory framework for food pricing, and state-run and regulated stores • State-run Pilersuisoq stores • Food at regulated prices • Banking and postal services (Galloway, 2017)

50. The Nutrition North Canada Program • Market-based system, delivery model in partnership with Northern retailers • Major restructuring in 2011 under the Harper Government replacing Food Mail Program • Lacks accountability • Not comprehensive in location and items • Only available to individuals with credit cards, require knowledge of English or French (Galloway, 2017)