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‘We Have Always Been Disposable’: The Structural Violence of Neoliberal Healthcare

Canadian PoliticsHuman Rights

COVID-19 is particularly dangerous for elders, particularly those with chronic illnesses. Photo from Flickr.

The marriage of neoliberalism and the medical industrial complex has had disastrous results in Canada, even without the presence of a pandemic. This toxic relationship has led to decades of healthcare cuts, privatization of services, and warehousing of disabled and elder populations. Now, COVID-19 is exacerbating an already broken system.

Italy and Spain have instituted policies that prevent COVID-19 patients with chronic illness from accessing medical services, causing the loss of entire generations, and leaving disabled communities to suffer and in some cases perish as a result of an ableist and ageist policy response.

Given that Canadian provinces are likely to run out of ventilators before the crisis peaks, upcoming policy and medical decision making threatens to expose what disabled peoples have known for a long time—this pandemic will kill us, and governments will be left with blood on their hands.

All levels of government have repeatedly warned the public to “stay inside to protect our most vulnerable: the elderly and people with chronic health conditions.” This response, however, is blatantly aloof to the impacts of privatization which have systematically disadvantaged disabled populations for years.

Bára Hladík, a chronically ill writer and arts facilitator spoke to Canadian Dimension about the hypocrisy at the heart of the government’s responses: “So borders are shutting down, apparently for my safety, yet no doctor is checking if I’m OK [or] giving me lifesaving information, and my regular access to care is cut off.”

The unnecessary deaths at Lynn Valley Care Centre in Vancouver are a national tragedy. We need to recognize the failure of these institutions, and to expose the systemic violence of neoliberal healthcare regimes. Lynn Valley is a privately-owned, provincially regulated, 153-bed long-term care facility. The first several COVID-19 deaths in Canada occrred at Lynn Valley and, as of March 31, the facility has been the site of 11 deaths.

Privatization of Long-Term Care

Canada’s mainstream media has so far failed to trace the policies that led to the outbreak at Lynn Valley, and the facility’s subsequent inability to contain its spread.

Throughout the 1990s, provincial governments ended direct capital funding for long-term care institutions, resulting in the mass privatization of services and workers. In the proceeding decade, this pattern increased in lockstep with the demand for spaces, resulting in the powder keg we see today. Complicating matters is the rapidly expanding senior population in Canada. The 2016 census reported a 20 percent increase in the 65-year age category from 2011, compared to an average population growth rate of six percent over the same period. This means long-term care institutions like Lynn Valley are fundamentally unprepared—and underfunded—to face any sort of crisis whatever, let alone a public health emergency of the scale and severity of COVID-19.

Ontario previously mandated municipalities to operate a public long-term care institution, but this policy has recently changed, forcing municipalities to partner with private corporations to maintain their operation. In Ontario, more than 58 percent of long-term care institutions are operated by private, for-profit companies, and this number is set to increase as the provincial government under premier Doug Ford loosens regulations. Similarly, nearly 65 percent long-term care institutions in British Columbia are operated privately.

Transinstitutionalization masked as Deinstitutionalization

The deinstitutionalization movement seeks to end institutionalization of disabled populations. However, deinstitutionalization under neoliberalism has produced mixed results. Governments have viewed deinstitutionalization as an avenue for privatization, transforming the movement’s demands for community care into the privatization of personal support workers (PSWs), private group homes, and increasingly privatized long-term care facilities.

Transinstitutionalization is the process of reconfinement, or the transferring of persons from residential institutions for those with disabilities, to other forms of custodial institutions such as prisons, long-term care facilities, and group homes. Transinstitutionalization is imposed on people as young as 15 years of age, and this policy wrongly places many people in long-term care facilities. At the time of writing, there are 5,000 people under the age of 55 in long-term care in Ontario alone.

Disabled and elder populations who are already susceptible to severe illness as a result of COVID-19 are put at a higher risk as a result of their placement in large, privately-owned institutions. The placement of people in custodial institutions is itself a response to shortages in homecare funding and community support that for-profit institutions are meant to replace.

Accountability for Harm

PSWs are becoming increasingly involved in healthcare provision. As a result of their low wages and lack of unionization, the number of PSWs are projected to overtake nurses in Canada’s healthcare systems. PSWs are perhaps the strongest demonstration in the country of the effects of neoliberal policy on a single industry.

As a job category, PSWs lack regulation and are typically filled by workers on short-term contracts. Saving lives and bringing about a quicker end to the COVID-19 pandemic (and indeed future outbreaks) will require greater protections for PSWs, higher wages and an increased overall level of direct public funding to respond to reported labour shortages.

Doug Ford’s recent healthcare reforms amalgamated 14 health networks and agencies, which worked together but specialized in all aspects of health services from cancer care to staffing, into one “super” health organization. Dorothy Palmer, an Ontario disabled seniors activist, shared her recent experience with her PSW, who is an elder contract worker and often works in several long-term care facilities, along with taking house calls. She sometimes engages with more than 500 people each day. Because Palmer is at a higher risk of complications, she has been without a PSW for three weeks. Recently, when she called her agency they informed her that “PSWs were only available for end-of-life care.”

PSWs are largely precarious workers with wages between $14 and $17 an hour, responsible for their own transportation between homes. These workers lack organizing power, akin to workers in the so-called gig economy. These working conditions force most PSWs to pick up as many shifts as possible, even if they become ill, in order to scrape by. Importantly, 96 percent of PSWs identify as women, and are disproportionately racialized.

Increasingly, PSWs have been scapegoated for spreading COVID-19, thus absolving neoliberal governments of their fundamental role in exacerbating gaps in our public health infrastructure, and creating working conditions that endanger high-risk populations.

Parker, however, does not blame PSWs. She acknowledges that the spread of COVID-19 is “attributable back to the cuts and to making things more efficient, but [the pandemic] shows it never was efficient.”

COVID-19 has publicly exposed the structural violence caused by austerity in Canada, the very same forces that the disabled and elder communities have been fighting for decades. While any rhetoric around sacrificing the ‘old’ for the sake of the economy should be roundly condemned, we must also hold governments accountable for the decades of cuts that have made this pandemic worse than it should have been. Canada’s creeping neoliberal regime is causing harm to the same people the government is telling the public to protect by staying home.

Megan Linton is a disabled, occasional writer and graduate student based in Winnipeg and Ottawa. Her research interests focus on sexual citizenship, institutions and disability, with a commitment to disability justice. Find her tweeting about sex and disability @PinkCaneRedLip.

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