In health care, for a prescription to be effective it is crucial to ensure that the diagnosis is correct. In other words, our solutions must address the actual problem and its root causes. To come out of the pandemic and build back better, we must do the same: fix the root causes that led to this crisis. If the last two years have shown us anything, it is how precarious work is a key driver of the pandemic. Improving working conditions is therefore an essential public health measure needed now more than ever.
The pandemic has been the great magnifier of our society’s inequities. Consider, for instance, that the province’s most diverse neighbourhoods when compared to the least diverse neighbourhoods had twice the mortality rate from COVID-19, three times the rate of infections and four times the rate of hospitalizations and ICU admission.
The spread of COVID-19 has been exacerbated by unfair wages, lack of paid sick days and limited protections for workers. This and more is highlighted in a new groundbreaking report by the Decent Work and Health Network (DWHN), which the Ontario Medical Students Association (OMSA) and dozens of other organizations have proudly endorsed. The report draws on available public health evidence and interviews with frontline healthcare workers and provides a detailed policy prescription.
As a physician in training, I am taught to identify structural inequalities that impact the health of my patients – factors that are beyond the scope of medical treatment. To address systemic determinants of health, we must demand healthy wages and decent hours for all workers. As the DWHN report outlines, precarious work has been on the rise in Ontario, with a more than fivefold increase in the number of workers making minimum wage since 1997. Under Premier Doug Ford, the Ontario government cancelled a minimum wage hike in 2018, which cost minimum wage earners $3,000 to $6,000 in lost income. Last October, when Ford increased the minimum wage to $15 per hour, it was too little and too late. With record high inflation, workers need at least a $20 per hour to lead a healthy life.
Many patients working in low-wage jobs face further precarity due to being part-time, casual or temporary employees. In Ontario, temporary agency workers make 40 per cent less than directly hired workers, and part-time workers earn a median of $17 per hour compared to $26 per hour earned by full-time workers.
Low wages are associated with a higher incidence of chronic health conditions and reduced access to medications. These are risk factors for worse COVID-19 outcomes. Low wages are also associated with unsafe and crowded living and working conditions, both risk factors for becoming infected with the virus. Increasing the minimum wage, legislating equal pay for equal work and supporting full-time quality jobs helps alleviate these risks.
In addition, mandating 10 paid sick days for all workers plus an additional 14 during pandemics is crucial to building a healthy society. Whoever forms government this June must take an active role in enforcing such a policy. As the DWHN report outlines, paid sick days must be universally available to all workers, immediately accessible without the need for sick notes, fully paid by employers, adequate and permanent.
The report contains stories of people working at jobs – some for more than 10 years – who were forced to work while sick because they lacked paid sick days. This is far too common in Canada, particularly among low-wage workers.
Despite overwhelming evidence supporting the benefits of this policy, the Ford government has voted against effective paid sick days over 25 times. Paid sick days save lives, particularly in a pandemic where people require time off to get vaccinated or tested, or to isolate when necessary without losing wages.
Furthermore, to be able to access paid sick days and fair wages, workers need better protections to advocate for healthy workplaces. This can be done by providing full immigration status for all, ensuring just-cause protection to prevent wrongful dismissals, ending misclassifications and supporting access to unions.
Unionization in particular has been shown to lead to better health outcomes. Consider for example that Ontario construction workers who are unionized have 25 per cent fewer occupational injuries than non-unionized workers, or that unionized nursing homes had a 30 per cent relative decrease in COVID-19 mortality over non-unionized homes. The collective power for workers to better advocate for their rights significantly improves their ability to advocate for their health.
With the Ontario elections coming up, health workers like myself are demanding that we learn the lessons from the pandemic and build back better. Decent work must be a central policy focus if we want to ensure a just recovery rooted in equity. As the report concludes: “The way beyond the pandemic is to support the frontline workers who sustained us during the pandemic: long-term care workers advocating for higher wages and full-time hours, warehouse workers advocating for permanent jobs, migrant farm workers advocating for permanent immigration status, and gig workers advocating for full employment rights. Their lives must be regarded as being as essential as their labour.”
Hisham Shokr is a medical student at Western University and a member of the Decent Work and Health Network.