Inappropriate Handling of Special Diet Allowance Forms in Ontario

Feb 4, 2010

Health Providers Against Poverty is quite concerned about a directive issue by the Minister of Community and Social Services that allows front line social service workers to invalidate the medical opinions of physicians as provided on Special Diet Allowance forms. This not only undermines the medical profession, but also threatens the dignity and privacy of people living on social assistance. It is demeaning to be required to discuss one’s personal health conditions with staff who are not trained health professionals.

Letter to Toronto City Councillor Janet Davis
Letter to the Ontario Medical Association

Letter To Attorney General of Ontario On Unequal Justice

Honourable Chris Bentley
Attorney General of Ontario
McMurty-Scott Building
720 Bay Street, 11th Floor
Toronto, On M5G 2K1

Sept 1, 2009

Re: Unequal Justice: Roots of Social Exclusion

Dear Attorney General Bentley:

I am writing on behalf of Health Providers Against Poverty (HPAP), a coalition of front line health providers dedicated to reducing the health impacts of poverty. We are extremely concerned about the impact of the current inequitable system of Legal Aid on the health and wellbeing of our patients. We, in support of the positions put forward by the Criminal Lawyer’s Association of Ontario, strongly believe Legal Aid Ontario needs to be re-examined to ensure equal justice is available to Ontarians who live in poverty.

Low income is the leading risk factor for the health of people living in poverty. There are a number of possible reasons for this, including the stress of living in relative and absolute poverty, inequitable access to health care, and the inability to maintain a healthy lifestyle.

We hear often, from our patients, of another important element to their struggle to maintain their health: the unjust and onerous demands placed on them by a social assistance system that treats them with suspicion and tries to remove access to benefits at every turn. One important element of this social assistance system is Legal Aid. For those of our patients who have had contact with the criminal justice system, time spent in defending themselves against criminal charges, and serving penal sentences for those charges, is fraught with stress, inattention to the rest of their wellbeing, and the extended diversions from their struggle to extricate themselves from poverty.

The current system of Legal Aid leaves many of the most vulnerable Ontarians on a second tier of justice: often having to make do with inexperienced counsel, inadequate resources to employ high quality expert witnesses, and the extra burden of having to wade through an onerous and suspicious Legal Aid bureaucracy that impedes their ability to resolve their legal issues in a fair and timely manner. Access to top quality defence lawyers and to a streamlined, efficient criminal justice system, is a major element in reducing these individuals’ stress and time spent involved with the justice system. Such access should be considered an important determinant of our patients’ health.

At this time, with the Government of Ontario filling in the details of a comprehensive strategy to reduce poverty, it is opportune to examine Legal Aid through a lens of its impact on the poor, and on increasing access to justice and equity for the most vulnerable Ontarians. As front line health providers acutely aware of the multifaceted reasons for the poor health of our patients who live in poverty, the creation of a just and equitable system of Legal Aid, and the revision of Legal Aid with justice and equity for the poor in mind, is an important factor in improving the health of our patients and neighbours who live in poverty, and in reducing the health impacts of poverty in Ontario.


Gary Bloch MD CCFP
for Health Providers Against Poverty

Cc: Honourable Dalton McGuinty
Premier, Province of Ontario

Download a PDF copy of the Letter

Letter To Toronto City Council on Inconsistencies with the Special Diet Allowance

Community Development and Recreation Committee
City of Toronto

Feb 15, 2007

To The Community Development and Recreation Committee:

I am a nurse practitioner working in downtown Toronto. I work primarily with low income individuals and families on social assistance, people living in poverty. I write to you today as a member of Health Providers Against Poverty (HPAP), a group of health providers who recognize that poverty is the most powerful determinant of health. Poverty represents the biggest health challenge facing Ontarians today.

Along with my colleagues at HPAP I wish to specifically address the inconsistent approach social assistance workers have in their task with regards to the allocation of the Special Diet. Social assistance recipients are entitled to different benefits depending upon their eligibility. With regards to the Special Diet forms, it is the responsibility of the welfare worker to provide the social assistance recipient with the form when requested. It is then the responsibility of a designated health provider be it a physician, a nurse practitioner, a dietitian, or a midwife to fill the form as per their client’s health conditions. The decision as to what constitutes a health condition for a particular individual lies solely with the designated health provider, in consultation with the client. What happens inconsistently, but all too frequently, is that individuals and/or families are denied the special diet form by their worker when requested or denied certain funds allocated by their health provider on their Special Diet form. These seemingly arbitrary and inconsistent practices cannot continue.

In November 2005, City Council passed a resolution calling for all entitlements under the Special Diet to be provided and for welfare staff to be trained to ensure this happens. Sadly, we witness and hear of far too many gaps and inconsistencies by welfare offices throughout the city.

As members of Health Providers Against Poverty we are asking that this matter be addressed by this council and that the 2005 resolution be reviewed and re-implemented as needed.

Thank you for your attention to this important matter.


Anne Egger RNEC, on behalf of Health Providers Against Poverty

Download a PDF version of the Letter