In this series, AMS Healthcare addresses the challenges facing healthcare today – particularly in light of the COVID-19 pandemic. The AMS Community promotes compassionate care, development of the leadership needed to realize the promise of technology and the understanding of how our medical history influences the future of our healthcare. A new piece will be posted every Friday on Healthy Debate.
Many of us struggle to live with the consequences of bad decisions. A toxic romantic relationship we don’t leave. A career we find depressing or unfulfilling. Sometimes those decisions blow up in our faces – through divorce, firing, the worst kinds of mid-life crises.
Sadly, Canada is in one of those moments now. COVID is laying bare the consequences of four decades of neoliberal social policy choices. Our moment of reckoning has arrived.
I spent the first two months of the COVID-19 pandemic as lead physician in the creation and operation of a temporary recovery site, in a Toronto hotel, for people experiencing homelessness to shelter and recover from the virus.
This project required the rapid mobilization and cooperation of every level of government, health oversight agencies, hospitals, community health providers and homeless service organizations.
We were largely successful. We developed a unique operation that runs smoothly, is well liked by clients, and has addressed health and social services agencies’ fears they would be left alone to support people with COVID who had nowhere else to go.
The process took its toll, though. Many of us reached near-burnout levels of stress and anxiety, working 12-plus-hour days without a break for weeks. Navigating clashing organizational priorities, nervous administrators and lawyers, desperate community demands. And facing an unpredictable pandemic that we feared could explode at any moment among people experiencing homelessness.
While proud of our work, we faced an existential quandary throughout: if our clients had homes, they would never have required our service and could have recovered at home, like most people with COVID-19.
We spent thousands of hours and millions of dollars to build a large bandage. We were scrambling to cover a wound that had been festering for years.
Our recovery site was only necessary because there are tens of thousands of people in Toronto who do not have a safe space to live or to isolate.
Which brings us back to those choices we made, starting decades ago, that created the social crisis behind the pandemic.
We embraced a path of neoliberal austerity. We elected leaders who promised to slim down government, minimize social programs, cut taxes. We hoped they were going to leave more money in our pockets and allow a free market-driven society to function with minimal government interference. We were swept up in a utopian political vision of freedom and growth and self-actualization.
But cracks opened in the system almost as soon as it was developed. As we cut back or failed to develop our social programs – social assistance, employment insurance, childcare, education, affordable housing – social inequality, and its horrific effects on marginalized individuals, began to rise.
More and more people faced barriers to an adequate income, appropriate housing, a decent job, a healthy life that were becoming insurmountable.
Like no moment I have lived through before, this pandemic has made evident the holes in our social support system. The poverty, homelessness and precarious work we tolerate and try to bury under inadequate social supports. The entrenched historical structural inequities like racism and sexism we sweep under the carpet but are the driving determinants of who is most negatively impacted by COVID and most other illnesses.
Quick-fix solutions will not be enough. Recovery hotels will not cure homelessness. Temporary income support programs like the CERB will not cure poverty.
But we can use this moment as a launchpad for deeper change. Our recovery plan must look to correct the inequities that have driven the social crises revealed through this pandemic.
It is time to develop real, lasting programs to cure our social wounds, to end poverty, homelessness, racism and other manifestations and drivers of deep inequality. And it is time to challenge the structures of institutions that reinforce social injustice.
We all make mistakes. Some of them are too big to live with. Canada can emerge from this crisis strong and resilient. But we will have to acknowledge where we went wrong and commit to a path to recovery that builds a social support system that doesn’t just cover social wounds but that corrects the injustice that caused them.
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Thank you for your efforts to address the needs of vulnerable people during this pandemic. I agree with your observation that COVID has illuminated many inequities and offered us an opportunity to create more lasting change. Perhaps, to begin with, we could revive the cancelled guaranteed annual income program. I accept Dr. Oliver’s challenge and will try to find some way to contribute personally.
Thanks Gary for a superbly written piece that clearly makes the right diagnosis and prescribes the appropriate treatment.
The pandemic has laid bare the gaps and weaknesses in our heath care and social support systems. The most vulnerable as always have borne the blunt of the impact. The human costs have been enormous, and now Canadian society has (as you say) to reckon with the far greater costs of this pandemic on providing adequate accommodation during the crisis (“the thousands of hours and millions of dollars to build a large bandage”). Will we? Will the memory of this experience soon pass and will we revert to our usual habits, especially as we reckon with the massive national debt and deficit? There may be a silver lining here in the new cooperation and collaboration you witnessed between government, health oversight agencies, hospitals, community health providers and homeless service organizations. We cannot let up on this advocacy. Now more than ever.
Bravo, well said. And to anyone reading this who agrees with what Gary has to say, I urge you to join with others who are working on these issues so we can leverage some real change. There are many organizations working on these issues that could use more volunteers in many different capacities. And if you don’t have the time or inclination to volunteer, these organizations also need monetary donations. I am not naming any specific organizations, because there are many good ones out there and I don’t want to leave any out. I’m talking about organizations that use a social justice lens to tackling poverty, racism, and all the other ills of our neoliberal society.