COVID-19 highlights an urgent need to expand access to healthcare for all

As we tackle the COVID-19 pandemic, people across Canada have expressed tremendous pride and gratitude towards our public health care system. Frontline health and social service workers are lauded for their tireless efforts, and public health officers have newfound celebrity status.But as the conversation has increasingly shifted to recognizing that the health of our communities is dependent on every individual living in it, the pandemic has also shone a light on cracks in a health care system we've long touted as 'universal'. It has amplified the deafening silence around some of the chronic inequities in access to healthcare in our communities. As we celebrate proactive public health measures, we are reminded that we've left some of the most marginalized segments of our communities behind.While it is widely believed that our healthcare system is universal, many groups regularly find themselves uninsured - including newly-landed permanent residents or migrant workers, international students, undocumented people and returning Canadians.This means that while we are all trying to do our part to stop the spread of COVID-19 by physically distancing and handwashing, thousands of people in Canada are not eligible to receive the care they need, and are at risk of being slapped with mammoth bills when they try to.With this in mind, a national coalition of health care providers, legal experts, and those working with impacted communities have come together to call for immediate action.  We have sent an open letter endorsed and signed by over 220 medical, migrant, trade union, legal and allied community organizations across the country to the federal government on the matter.  We call on Canada's federal government to work with provincial and territorial governments, health institutions, and public health leaders to ensure and support access to healthcare for all people living in Canada, including those currently living in detention, regardless of immigration and citizenship status.Health care is a human right. This should not be happening here in Canada under any circumstances – and especially not in the midst of a global pandemic.Early in the pandemic, the health community in Ontario raised the alarm, leading to unprecedented measures to provide care to uninsured people in the province.  This is a measure which must be expanded across the country. While other provinces have made changes, the approach has been variable: in some provinces, limited to COVID-19 care only, and in others, no policy change at all.Unfortunately, all provinces that have taken steps to expand access, including Ontario have also indicated that these changes are temporary.  This begs the question: why does someone only have the right to access health care during a pandemic?Many uninsured individuals are also worried about being reported to the Canadian Border Services Agency (CBSA) and facing detention or deportation. Some will avoid treatment for essential health care services as a result.  We need to be able to assure these individuals that patient privacy policies are in place and their information will not be shared with the CBSA.  Everyone in Canada should feel safe coming to a hospital or clinic, during and after this pandemic.The United Nations Human Rights Committee has condemned Canada in the recent past for denying immigrants access to healthcare.  Doing so is not only a human rights violation - it is a clear threat to public health and flies in the face of an equity-driven public healthcare system.  We need to ensure universal access to health care that does not discriminate based on our immigration status or ability to pay.  Ensuring access to health care for everyone improves the health and safety of our communities as a whole.An important part of the long-term solution to this issue is to provide resident status to all people, regardless of immigration status.  According to the Canadian Public Health Association, beyond access to health care, social determinants of health include income and income distribution, unemployment and job security, social security, race and gender, among others.  Unfortunately, even with access to health services, inequities in these social determinants will persist and will continue to place the health, well-being and safety of migrants at risk. A national digital and social media rally of migrants and allies advocating for full immigration status for all was organized for June 14.It is time for federal leadership to ensure a consistent approach from coast to coast that ensures uninsured individuals are able to access the healthcare they need without fear of denial, medical bankruptcy, detainment or deportation.Dr. Ritika Goel is a family physician in Toronto, a board member of Canadian Doctors for Medicare and a core member of OHIP For All. Dr. Arnav Agarwal is an internal medicine resident physician at the University of Toronto and a core member of OHIP For All. Mac Scott is a regulated Canadian immigration consultant and a member of the No One Is Illegal movement. All three are members of the Healthcare for All National Coalition.

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