Quoting Robert C Bowman <[log in to unmask]>:

> Cities have all of the economic, social, political, and other resources
> that they need.   They must make different decisions.

Not true of Ontario cities. In 1997, the Mike Harris Conservative Government
passed legislation that downloaded responsibility for various social services
to municipal governments but failed to give them the funding to deliver those
services. Recently, with Mayor David Miller's efforts, the City of Toronto has
gained new powers that allow it to access more of the resources it needs for
service delivery. But it will take more than this to repair the damage.

You are right that the resources exist in Canadian and US cities to end poverty
and improve health. Different decisions regarding resource allocation must be
made. But there are political, legal and other barriers to making it happen.

For more info on Harris' so-called "Common Sense Revolution" and Bill 103, you
can start with Wikipedia:  http://en.wikipedia.org/wiki/Common_Sense_Revolution

> Major medical centers self determine the physicians and providers of their
> areas. They choose not to deliver care where it is most needed. They choose
> not to hire the physicians that could improve access and outcomes.

I agree with this point. For instance, the University of Toronto Faculty of
Medicine has long wanted to concentrate its teaching hospitals in a few little
blocks in downtown Toronto. This is nice and convenient for medical students,
but terrible for patients (particularly those who can't afford to travel or who
are in urgent need of care) and terrible in the event of an emergency (imagine
something like Katrina wiped out the downtown core).

Of course, the Harris Government obliged with this plan when it set out to
"restructure" the Ontario health care system. Not only were more services not
provided to the growing "former suburbs" (i.e., Scarborough) that needed them,
but downtown hospitals that demonstrably improved access for historically
marginalized groups (i.e., Wellesley Hospital, Women's College Hospital) were
deliberately targeted for closure. So, poor decisions are often made by those
who have too much power, and the rest of us are left to protest and/or try to
make things better under difficult constraints.

You can read about Ontario healthcare restructuring and the Wellesley Hospital
case in my co-authored book, Survival Strategies: The Life, Death, and
Renaissance of a Canadian Teaching Hospital (Canadian Scholars' Press, 2006).

Jeff

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