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Hon. Premier Doug FordHon. Deputy Premier and Minister of Health Christine ElliottDr. David Williams, Chief Medical Officer of HealthMr. Matt Anderson, President and CEO, Ontario Health

We are deeply concerned about Ontario’s COVID-19 testing strategy. As the second wave progresses, COVID cases are once again on the rise. Communities across the province are reporting long testing wait times. In Toronto and Ottawa, people have had to wait in line for up to 6 hours for a test. In more serious cases, testing is completely inaccessible to highly marginalized and at-risk populations and communities. We need testing strategies that work for everyone; a one size fits all approach won’t work for all communities.

The province has previously communicated that testing strategies are being considered locally by Ontario Health in collaboration with local Public Health to make sure there are appropriate access points. This suggests that multi-pronged approaches are needed. We can’t rely on assessment centres in acute centres alone and expanding testing to pharmacies won't address all the barriers to access for all communities. Our testing strategy must leverage assessment centres, make mobile testing available and expand community driven testing in hotspots and in communities where no testing is available at all right now. We are seeing fee for service testing crop up so those who can afford to skip long testing queues can pay $400 for an at-home test, while precarious workers can’t take time off work to stand in long queues, stigmatized communities fear discrimination in mainstream testing environments, and diverse communities aren’t getting culturally appropriate messages about public health and testing measures. This is creating further inequities. Testing, care and treatment must be accessible to everyone who needs it, in a timely manner.

Community driven testing cannot be a one-and-done project. It is a critical ongoing strategy to reach the communities hardest hit by COVID-19. Here’s what the current COVID-19 testing strategy looks like:

• Sick people riding buses to the assessment centre because they can’t get the test close to home.
• Workers taking a whole day off to wait in line, or not getting the test because they can’t get time off.
• Parents not getting tested because they can’t leave their kids at home.
• Grandparents not getting tested because they can’t stand in line for hours.
• Neighbours not getting tested because they can’t self-isolate.
• People getting sick because those around them couldn’t get tested.

In some Toronto neighbourhoods, healthcare providers have worked together to develop solutions that work for hard hit communities. They have developed targeted testing and outreach in COVID hotspots. These models have been shown to address local needs and experiences, combat COVID stigma and misinformation, build trust amongst people who have experienced marginalization, exclusion or racism in mainstream settings, and bring testing to hard hit communities, eliminating the need for people to travel long distances to access testing. They have also trained and worked with outreach workers from those communities to mobilize populations. Despite their efficacy, the province has not made funding commitments to scale up community-led testing and COVID response in a sustainable way for all communities that need it. We urge the province to act now to scale up public, community-driven approaches that will be accessible to more people.

Ontario must act now to:

• Prioritize community-driven testing, fund existing pilot projects and mobile testing, and expand these models to other communities
• Leverage the skills of health system partners and community agencies to provide smaller scale testing centres to meet community needs.
• Resource and fund Indigenous-led health organizations to provide comprehensive testing services; ensure that PPE, contact tracing and case management are appropriately aligned. 
• Work with public health to integrate learnings from community-driven testing models into future health system planning.

Sincerely,

Adrianna TetleyCEO, Alliance for Healthier Communitieswww.allianceON.org

Caroline Lidstone- JonesCEO, Indigenous Primary Health Care Councilwww.iphcc.ca

Dear Prime Minister Trudeau, Minister Hadju, Minister Wilkinson and Minister Freeland;

There is much to be proud of in Canada’s response to the coronavirus pandemic. Our public, our healthcare system, our public health system, and our governments have worked together to make courageous and challenging decisions that prioritize health, save lives, and keep people safe.

As you prepare to invest in a stimulus package to spur economic recovery from the pandemic, you again have the opportunity to prioritize the health and safety of everyone in Canada. You can create jobs and save lives by investing in a healthy recovery.

In May, organizations representing 40 million healthcare workers worldwide -- two-thirds of the global workforce -- supported an open letter addressed to G20 leaders, calling on them to create a green and healthy recovery in order to support people through COVID-19 and its economic fallout, and to prevent further crises related to climate change and planetary decline. Hundreds of civil society organizations in Canada are calling for a just recovery that prioritizes people's health and well being without exception, and builds resilience to prevent future crises.

The Canadian Association of Physicians for the Environment have produced a report, which we endorse, that represents a Made-in-Canada set of recommendations based on this call to action.

This report includes 25 recommendations for upcoming federal fiscal stimulus spending, along with supporting regulatory measures, that protect human health through ridding Canada’s economy of greenhouse gas emissions, in line with Canada’s emissions reduction commitments. As you know, under the Paris Agreement, Canada committed to reducing its GHG emissions by 30% below 2005 levels by 2030. The Canadian government has also said we will achieve net-zero emissions by 2050.

This report provides a path to meet those targets, through investments in renewable energy, sustainable transportation, sustainable homes and buildings, sustainable healthcare, and protecting and connecting to nature.

Modelling in the report prepared by Navius Research shows that if Canada meets its climate targets, air quality improvements alone will save an estimated 112,081 lives between 2030 and 2050. Actions taken to meet these targets would also improve and protect health through reductions in heat related illness, improved physical activity levels, mental health benefits, and avoidance of the most extreme climate health impacts.

Meeting our Paris Agreement targets is also the right thing to do for our economy. Navius Research modelling shows that by meeting our targets, Canadian clean jobs will increase from 210,000 full-time equivalent positions in 2020 to 1.5 million in 2050.

If we are going to protect health, we must take action on climate change. The World Health Organization tells us that climate change is the biggest health threat of the 21st century, and a recent UNICEF-Lancet-WHO Future Child Commission says that wealthy countries threaten every child’s future through their contributions to climate change. This includes children in Canada who will face wildfires, flooding, heatwaves, and illnesses not frequently seen in Canada, like Lyme disease, as the planet warms. The Future Child Commission currently ranks Canada 170th out of 180 in terms of sustainability. By acting now, we can build back better to create a safe and healthy future for our children.

It is crucial to note that Indigenous Peoples have been leaders on adaptation, mitigation, and living reciprocally with the Earth for thousands of years. In what is currently known as Canada, they have seen, and will continue to see disproportionate negative impacts of climate change, despite contributing the least to climate change. At the same time, historical and ongoing legacies of land dispossession, colonization, and systemic racism have led to inequitable health and socio-economic outcomes felt by Indigenous Peoples. When considering ‘recovery’, these experiences and lived reality must be considered as a priority in order to foster equitable, positive, and self-determined health and wellness outcomes for Indigenous Peoples. A truly Healthy Recovery must include investments that create healthy communities, stimulate Indigenous-led economies, and protect land, waters, and ice, while simultaneously addressing the chronic underfunding of Indigenous health systems. Recovery plans and by extension climate policy, including energy policy, must respect, protect, and safeguard Indigenous rights, including those affirmed in the minimum standards of the United Nations Declaration on the Rights of Indigenous Peoples.

The COVID-19 pandemic has exposed and exacerbated pre-existing challenges to Canadian health, healthcare systems, our economy, and our society. And yet, amidst the tragedy and disruption is the opportunity to create the world as we need it to be post-pandemic.

This is a critical moment to invest in the health of all people building a green and just future. We have the plan to decarbonize, save lives, and create jobs.

We need your political leadership to make this vision our reality.

Signed,Canadian Association of Physicians for the EnvironmentAlliance du personnel professionnel et technique de la santé et des services sociauxAlliance for Healthier CommunitiesCanadian Association of Nurses for the EnvironmentCanadian Federation of Medical StudentsCanadian Medical AssociationCanadian Physiotherapy AssociationCanadian Public Health AssociationCanadian Society of International HealthCollège québécois des médecins de famille (CQMF)Fédération interprofessionnelle de la santé du Québec (FIQ)Fédération médicale étudiante du Québec (FMEQ)Generation SqueezeHealthCareCANIFMSA-QuébecJeunes médecins pour la santé publique (JMPSP)Ontario Public Health AssociationLa planète s’invite en santéYoung Physicians for Public Health (YPPH)

Dear Hon. Minister Elliott, Hon. Minister Tibollo and Dr. Williams,

We write in response to the letter sent to you by the federal Minister of health, the Hon Patty Hajdu dated August 24, 2020, to encourage action at all levels to provide people who use drugs with a full spectrum of care from practitioners. We are supportive of this call to action and we urge you to address the concerns outlined in the Minister’s letter. We urge you to act now to provide essential supports to communities that face surmountable barriers in accessing health care.

The Alliance for Healthier Communities is a network of over 100 community-governed comprehensive primary health organizations in Ontario. In 2019, recognizing the severity of the overdose crisis, Alliance members signed a sector wide commitment in support of the decriminalization of drug use and possession, as well as expanded access to safer supply. Of Ontario’s 16 provincially funded consumption treatments services (CTS) sites, 11 are located in Alliance member organizations. Our sector has been monitoring the impact of the crisis closely. Additionally, four Alliance members currently house or are affiliated with safer supply programs operating in the province.

On August 31st Ontario commemorated International Overdose Awareness day. For many across the province, this was a somber and difficult day. As Minister Hajdu notes, Ontario experienced a 25 percent increase in overdose deaths from March to May 2020, compared with the same period last year. The Office of the Chief Coroner also notes that an estimated 55 people are dying per week of overdoses. The crisis is severe, people who use drugs need appropriate and effective care from trusted healthcare providers.

In April, the Alliance along with over 100 organizations called on the province to urgently act to provide safer supply. As community led health organizations responding to the ongoing crisis, we know that we cannot address the opioid crisis without adopting ambitious and forward looking strategies. The crisis is severe, our province urgently needs expanded access to clinical care models of safer supply. These low-barrier models reach people who are alienated from other models of health care due to structural barriers. Especially as Ontario responds to the ongoing threat of the COVID-19 pandemic, Ontario needs interventions that will reduce barriers to care.

As Minister Hajdu notes, the opioid crisis is a health and social issue. People who use drugs need to be treated with compassion and provided with the support they need. People in Ontario are dying preventable deaths. We urge you to respond to Minister Hajdu’s calls to action by:

• Immediately declaring the opioid crisis an emergency
• Immediately re-establishing the Ontario Opioid Emergency Task-Force to lead Ontario’s opioid response
• Prioritizing development of an Ontario strategy, in collaboration with practitioner colleges to advance access to safer supply as a response to Ontario’s severe opioid crisis.

We urgently need interventions now; the crisis is severe and we cannot wait.

Sincerely

Adrianna Tetley, CEOAlliance for Healthier Communities