Environmental Scan April 29, 2021 - Unity Health Toronto
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Environmental Scan April 29, 2021 Prepared by Unity Health Toronto’s Strategy department For more information, contact StrategyDept@smh.ca
Background
The review is grounded in the PESTLE (political, economic, social, technological, legal and environmental) framework
used to analyze key factors – internal and external – that may influence or impact the sustainability and success of the
services Unity Health provides. Data for this analysis was gathered through an external scan of the health care
environment, review of publications, and input from the Senior Leadership Team.
Assessment
The health care landscape has undergone a number of changes, two of the most important being Ontario’s system-wide
transformation with the creation of a new agency, Ontario Health, and the shift in health care service provisions due to
the COVID-19 pandemic. With the creation of Ontario Health (OH), organizations including Unity Health, have adapted
to work more closely together and some provincial organizations have even transitioned into OH as a response. For
example, on April 1, 2021, the Trillium Gift of Life Network (TGLN) and non-patient care functions from the Local Health
Integration Networks (LHINs) were transferred to OHi.
Unity Health and its partners also continue to produce system improvements under the pandemic conditions such as
pivoting to legislative and political changes, mobilizing COVID-19 assessment, and setting up testing and vaccination
centres. With no current resolution in sight, the pandemic is also exacerbating disparities on the delivery of health care
in Ontario. Issues such as capacity and coordination of care in Long-Term Care (LTC) homes, supply chain management,
mental health and addictions support, use of virtual care, and increasing socioeconomic disparities continue to pose as
challenges for providers and patients.
Political Impact on Health care
Politics and policy play a critical role in health care and can change priorities quickly depending on the policy agenda.
The next provincial and federal elections, occurring in 2022 and 2023 respectively, fall within the timeline of Unity
Health’s current strategic plan.
With the provincial election next year, one area that there is expected significant movement is home care
transformation. COVID-19 has revealed some of the vulnerabilities in this area including gaps in care for the elderly and
adverse conditions in LTC homes. These vulnerabilities have pushed the government of Ontario to adapt their political
priorities. Long-standing concerns in practice such as agency staff working at multiple locations due to the lack of
available full-time positions were brought to light as this contributed to the rapid spread of the virus, and organizations
such as the Ontario Nursing Association have pressed the government to make more decisive actions to address such
gaps in careii. A report by the Canadian Institute of Health Information (CIHI) published in March of 2021 showed that
more than 34% of all Ontario LTC homes experienced an outbreak, compared with only 8% of LTC homes in B.C.iii The
severe impact of COVID-19 has prompted the Government of Ontario to conduct an inquiry into LTC homes and
recommend changes are anticipated to be shared before the end of 2021.
The province is also working to help stabilize the supply and delivery for PPE and increase support for domestic
production and supply through the advancement of Supply Ontario, a centralized procurement agency, established in
November 2020iv. The centralization of the government supply chain and streamlining of complex procurement
processes is anticipated to create many benefits including decreasing administrative burden and reducing red tape in
accessing critical supplies. Such changes are examples of how the current state of the health care system has forced
governments to re-think and adapt their approaches for care delivery ahead of upcoming elections.
2Economic Factors Involved
The COVID-19 pandemic has significantly impacted Ontario’s economy. The restrictions and closures implemented to
respond to the pandemic resulted in two consecutive quarterly declines in Ontario’s GDP in 2020, followed by an
increase of 9.4% in the third quarter reflecting household spending, business investment and exportsv. Overall, this is
5.3% below the level in 2019 Q3.
Over the past year, the federal government’s monetary involvement in health care increased. In April 2021, the federal
government presented a new budget of $101.4 billion, with plans to put forth billions towards COVID-19 relief efforts
such as improving long-term care facilities, mental health supports and maintenance of COVID-19 digital tools and
mobile appsvi.
The 2021 Ontario Budget was released March 2021 and builds upon previous investments to bring a total of $16.3 billion
to protect people’s health and $23.3 billion to protect the economyvii. Total provincial investments in COVID-19 as of
March 2021 comes to $51 billion. Protecting people’s health includes greater support for the provincewide vaccination
plan, increasing hospital capacities and providing additional PPE for frontline workers and vulnerable people.
Prior to the pandemic, the government had projected a deficit of $9 billion, however with the need to balance the
challenges, the projected deficit increased to $38.5 billion for 2020-21viii. The net debt-to-GDP ratio for the province is
also projected to be 47.1% for 2021, and this is projected to increase to 50.2% by 2023-24. Given this outlook, the long
term implication for the public sector is that finances will need to be managed in a sustainable manner. At the
organizational level, this may include phasing out ineffective programs and increasing digital service deliveries to create
efficiencies and reduce additional expendituresix. The long-term implications of such unprecedented spending by the
federal and provincial governments remains to be seen and the future capacities to manage the increased debt will need
to be addressed.
Health care continues to face long-standing challenges related to workforce shortages, including decreased enrollment
in nursing school, faculty shortages, an aging nursing workforce and retirement of leaders. To address these challenges,
the Ontario government launched a recruitment and training drive directed at long-term care. Some of the key areas of
action include creating new positions for personal support workers, registered nurses and registered practical nurses;
expanding education and training, as well as improving working conditionsx.
There have also been shifts for many organizations to work from home. Health care organizations, and other
organizations, have rapidly transitioned back-office services to work from home roles in response to COVID-19. This
transition has reduced the need for a large office footprint, lengthy commutes, and some argue it has increased
productivityxi. Many organizations are faced with the decision to permanently leave their office spaces and continue to
work from home, or when able, slowly transition workers back into the office.
Social Factors and Implications
There has been an uprise in advocacy for equity and anti-racism over the past year as COVID-19 has highlighted some of
the challenges Ontario’s system faces with regards to the social determinants of health (SDOH). Advocacy groups
congregated on the streets and on social media demanding social justice and equity around vulnerable, racialized and
marginalized populations in Ontario including the frail elderly, homeless, those struggling with addictions and mental
health and people of color. Understanding the influence of social factors on health and well-being allows proper
planning of services to meet our community’s needs.
The population of the Toronto census metropolitan area (CMA) was 5,928,040 in 2016 with 2.8 million people
concentrated in the City of Toronto. There are striking population differences in the Toronto CMA compared to the rest
3of Ontario, including the proportion of visible minorities. In Toronto, visible minorities account for 51.4% of the
population (3,011,900), significantly higher than the rest of Ontario at 11.8% (873,685)xii. With increased social justice
advocacy, media coverage and social media commentary, open discussions of these matters is needed in the realm of
health care.
Homelessness in Ontario has been increasingly visible as homeless shelters place limits on the number of beds they offer
to facilitate physical distancing, resulting in a large number of encampments in parks. Additionally, many people have
lost their jobs and are unable to meet high rent payments. The ability to match income to available, affordable housing
has been an economic concern for many years, but self-protective practices are pushing people to opt for the streets as
this provides them with as much distance as they can to keep themselves safexiii. There have been a number of
government initiatives and funding to support isolation facilities and testing for the homeless, but housing for low-
income earners and homeless residents will continue to be a pressing issue.
Role of Technology on Improving Health care
Technological advancements in health care produce long-term, positive impacts on patients, providers and operations.
Within these advancements, an emerging type is Artificial Intelligence (AI). Under the subsets of AI, machine learning is
one domain that can result in improved methods to utilize research or patient-based data to inform decision-makingxiv.
The Vector Institute, a not-for-profit research organization focused on machine learning and based in Toronto, has
worked with local hospitals such as Unity Health Toronto and government agencies to implement AI solutions. In 2019,
the Vector Institute partnered with Public Health Ontario to use computer vision in automatically identifying blacklegged
ticks that may carry bacteria causing Lyme Diseasexv. This initiative is intended to spinoff longer-term applications such
as a smartphone app so that anyone can obtain a rapid medical assessment of high risk tick bites through a photo. Such
examples demonstrate the power of technologies like AI in improving health care and continue to be implemented by
health care institutions.
The pandemic with its lockdowns, closure of community programs and social distancing measures continue to accelerate
the use of technology in health care. For example, the MOH introduced temporary billing codes to support the delivery
of telemedicine and virtual carexvi. Zoom, Ontario Telehealth Network (OTN), Microsoft Teams and other virtual
technologies have allowed health care organizations to continue to deliver care while reducing the risk of disease spread
by keeping people at home and out of health care clinics. The health system has been able to improve access and save
time as nearly 7 in 10 Canadians who sought medical assistance during the pandemic had a virtual visit and reported
that it saved them time in addition to decreasing risk. Additionally, more than three-quarters of Canadians reported they
are willing to use virtual care after the pandemic endsxvii.
However, a large gap exists in certain population groups who do not having access to virtual services due to limitations
of income, homelessness, technological literacy, lack of Wi-Fi access, or cognitive impairmentsxviii. It is critically
important that organizations consider equity and confidentiality concerns and challenges before implementing digital
health solutions.
As a result of the pandemic, there have been interruptions to education but technology has enabled teachers and
learners at all levels to continue to engage despite the closure of in-person classes and institutions. Although this has
increased the role of technology, it has impacted the experience of both educators and students. For example, the
inability for spontaneous conversation, collaboration and relationship building, lack of space in their homes, and inability
to celebrate milestones with their peers including graduation has negatively impacted teachers and students of all
agesxix.
4Ontario Legislation
Legislation guides the direction and behaviours of the public and our health care system to respond to changing
conditions. For example, the Connected Care Act, 2019, promotes a modernized approach of patient centered care and
is behind the creation of Ontario Health. Additionally, the Connecting People to Home and Community Care Act has been
proposed in response to an outdated provincial model of carexx. It is designed to remove existing barriers to innovation
and integration. Modernizing home and community care will lay the foundation to improve care for patients, including
allowing referrals at any point of care under an OHT and offering a team-based approach to home care that spans
sectors.
Legislation is being proposed to help address racism in health care. The federal government recently announced that
they are developing new legislation to combat anti-Indigenous racism in health care and give Indigenous communities’
greater say over how their health care is deliveredxxi. This legislation will be co-developed alongside Indigenous leaders
and will have impact on the delivery of health care.
Many legislation and directives issued in the last year have affected how we are working. For example, legislation on
education, workplace and labour had an impact on daily work life, relationships with unions, and how we interact with
the workforce. Two notable pieces of legislation were passed this past year including, Bill 195 – Reopening Ontario (A
Flexible Response to COVID-19 Act), 2020 and Bill 197 – COVID-19 Economic Recovery Act, 2020xxii which have substantial
impact on employment law in Ontario. For example, for nurses and health care providers, these bills enable employers
to deny or cancel vacation time, redeploy them to another unit or health care facility at any time, impact benefits and
some argue they hold too much authority without appropriate oversightxxiii. Health care organizations will need to plan
for adequate staff and financial resources to address changes to these recommendations and other possible legislation.
Environmental Impact
Over the past year, we have seen public and private sector collaboration and innovation as well as the inspiring and
dedicated actions of young Ontarians bringing about positive environmental changes. Looking ahead, significant
opportunities and challenges have emerged, as well as new innovations and technologies, including clean technology
and hydrogen. The Environmental Plan, released by the Ministry of the Environment, Conservation and Parks in late
2018, has evolved significantly in response to the pandemic. This includes a plan to reduce the amount of waste going to
landfills, keeping our water safe and clean, protecting our air, protecting natural spaces and species, addressing climate
change, holding polluters accountable and supporting infrastructure development while ensuring environmental
protectionxxiv.
The pandemic has caused a 30% reduction in global oil consumption as non-essential commuters worked from home
and travel restrictions dramatically scaled back airline travelxxv. As oil prices plummeted and the need for PPE increased,
the manufacturing of virgin plastics from fossil fuels became less expensive than recyclingxxvi. The cost incentives along
with changes in human behaviour have resulted in an increase in plastic pollution as well as overall waste caused by
single-use, disposable PPE. This is causing an increase in exposure to toxic chemicals leading to increases in health
outcomes such as mortality, morbidity and disability-adjusted life yearsxxvii.
Climate change leads to environmental changes including increased emissions, increased water and air pollution which
can lead to respiratory issues, allergies, stress, and disease. The Federal government enacted a plan for 2021 to combat
the effects of climate change and improve environmental conditions and accountability. This plan includes increasing the
price of carbon from $50 per tonne in 2022 to $170 per tonne in 2030xxviii, holding car companies accountable for not
selling electric vehicles, and introducing new legislation to protect Canadians from toxic chemicals like BPA, phthalates,
formaldehyde, and the dry-cleaning chemical PERCxxix. This will help to ensure that vulnerable communities located near
factories are better protected. Future architecture and environmental planning should reflect the values of renewable
5energy, focus on building spaces that are welcoming, encourage engagement, be spacious, be accessible, and remove
barriers for those who are differently abled. These upfront investments will lead to long-term environmental gains and
improve overall health.
6References
i
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ii
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iii
Ireton, J. (2021, March 30). Canada’s nursing homes have worst record for COVID-19 deaths among wealthy nations:
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xiii
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xiv
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xv
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DoctorCare. (2020, March 16). Temporary OHIP Billing Codes for Telemedicine and Virtual Care.
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xvii
Canada Health Infoway. (2021). A Healthy Dialogue: Findings. https://access2022.ca/section/a-healthy-dialogue
xviii
Cukier, A. (2020, November 17). ‘Left out of this equation’: Why virtual health care is leaving some Ontarians behind.
TVO. https://www.tvo.org/article/left-out-of-this-equation-why-virtual-health-care-is-leaving-some-ontarians-behind
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Burke, L. (2020, October 27). Moving into the long term. Inside Higher Ed.https://www.insidehighered.com/digital-
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xxi
Slaughter, G., Agecoutay, C. (2021, February 4). Legislation to fight anti-Indigenous racism in health care is coming,
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xxii
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xxiv
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xxv
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xxvi
Adyel, T. M. (2020). Accumulation of plastic waste during COVID-19. Science, 369(6509), 1314-1315.
xxvii
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xxviii
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