1. How Health Units Can Advocate for BI Dr. Lisa Simon, Associate Medical Officer of Health OSNPPH Nutrition Exchange May 12, 2016

2. Outline Why health units are advocating for BI Public health advocacy for BI to date How health units can advocate for BI

3. WHY HEALTH UNITS ARE ADVOCATING FOR BI

4. NCCDH 4 Roles for Public Health

5. Moving Upstream Source: National Collaborating Centre for Determinants of Health. (2014). Let’s talk: Moving upstream.

6. Health inequities

7. Key Public Health Rationale For BI 1. Poverty: Basic income could be an effective, dignified, and efficient part of a comprehensive poverty reduction strategy. 2. Income inequality: Basic income could help close the gap – in income, personal opportunity, and power. 3. Precarious employment: Basic income can increase social security in a time of substantial labour market change and uncertainty.

8. Key BI Evidence & Experience Manitoba GAI field experiment: Mincome, 1974-79 8.5% decrease in hospitalization rates for participants vs. controls, and decline in physician contact Child benefits (CCTB) and seniors benefits (OAS/GIS) in Canada: Have led to demonstrated health improvements Well accepted programs, recent expansion of CCB

9. BI should be seen as part of a comprehensive social security framework Includes: Affordable housing High quality, affordable child care Labour law reform Education and training Etc.

10. PUBLIC HEALTH ADVOCACY FOR BASIC INCOME TO DATE

11. Health sector support for BI NOW THEREFORE BE IT RESOLVED THAT … endorse the concept of a basic income guarantee; AND FURTHER THAT …request that the Ministers of … prioritize joint federal- provincial consideration and investigation into a basic income guarantee, as a policy option for reducing poverty and income insecurity and for providing opportunities for those in low income. “ ”

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

13. Growing public & political support for basic income in Canada Local & regional basic income support groups Prominent Canadians Mayors of large and small communities Municipal and regional council motions Provincial politicians in several provinces Quebec government now examining Federal political party resolutions Federal Minister of Families, Children & Social Dev …Ontario pilot!

14. Learnings from provincial and local BI advocacy to date Public Health has respected voice in the SDOH – problems and interventions Collaborate within and across sectors, and capitalize on that weight Link with policy influencers when possible Timing matters but is hard to predict, so be ready

15. Key debates BI will replace other needed social programs  Should be seen as a replacement for social assistance, not everything BI vs. investing more in other poverty-reducing policies/SDOH (e.g. child care, affordable housing)  Not mutually exclusive: need set of poverty-reducing policies BI costs too much  A modest BI through Negative Income Tax approach is expensive but affordable, if we make it a priority

16. HOW HEALTH UNITS CAN ADVOCATE FOR BI

17. Advocacy goals for PH sector in era of BI pilot Continue building awareness and support for BI, throughout pilot Collaboratively refine our vision for BI Contribute to pilot design, implementation & evaluation, as appropriate

18. If you’d like to engage your health unit in BI… Begin with HU engagement in SDOH in general! Consider engaging community partners, including Community & Social Services Consider seeking Board of Health endorsement Making the case: Link to your health unit’s current priorities and past advocacy Cite support of other health organizations, use their resources For Board - rationale beyond health alone

19. Facilitators and Barriers to Health Unit Involvement Facilitators: Leadership and Board of Health able & willing to support Public health sector interested in SDOH Concrete policy idea, achieves several goals Barriers: Not strictly a ‘health’ issue – requires collaboration Complex policy issue – range of priorities & values

20. Potential HU Roles in BI Advocacy Lead or participate in local collaborations on BI, ideally within existing partnerships Role of HUs in this advocacy: credible voice, local data, research evidence, skill set, relationships, etc. Coordinate with other health units and communities – common messages and approaches

21. Local advocacy opportunities Community engagement Advocate to MPs and MPPs Seek support of local politicians/ councils Public awareness

22. Advocacy for municipal support

23. Know your stage in the policy process & advocate accordingly

24. Policy engagement Form/engage community partnerships & coalitions Bring issue to individual politicians or municipal council Make your case beyond health rationale alone (e.g. social, economic, crime, etc.) Know details: effectiveness, unintended effects, equity, cost, feasibility, acceptability (NCCHPP, 2012) The ‘ask’: endorsement of BI concept and/or support for the Ontario pilot

25. Strategies for Gaining Support Policy Readiness Tool: Understanding Readiness for Policy Change and Strategies for Taking Action (2014) – Strategies for ‘Majority’ Communities: Provide evidence and outline public opinion Frame issue from majority perspective Engage and mobilize community to take action Build relationships and maintain momentum Provide tools (and incentives) for policy adoption

26. Success Stories City of Kingston Peterborough County Niagara Region And several others

27. In Summary Key role for HUs in advocacy for BI and other policy interventions to address food insecurity, health inequities Collaborative, strategic advocacy can yield success

28. Thank you Miigwetch Gracias 谢谢 Dankie Takk Spacibo Dziękuję Mahalo Merci