We were reminded in the provincial fall economic statement that we had a bigger than expected deficit and everyone would have to sacrifice — without exception.

The sacrifices will be tough.

The social assistance review detailed the sacrifices that are going to be made by people on disability. Their benefits are only going to rise by 1.5 per cent instead of the 3 per cent they were promised. Sure, the amount they can earn from work will be increased from $200 a month to $300, but exceed that, and they will be hit with a 75 per cent tax levy — a tax rate higher than billionaires pay.

Things will also be harder for those who need help. Rule changes will make it more difficult to get and keep social assistance. I understand the aim is to get people into work, but structural unemployment makes this difficult. There are more people looking for jobs than there are vacancies. Add automation, artificial intelligence and jobs going offshore and unemployment will rise.

I hope those on assistance will not be asked to make any more sacrifices.

Low paid workers will have to sacrifice. They will not get the extra $2,000 a year in pay that a $15 minimum wage would have given them. Instead, they will get less than half that as a tax credit called LIFT. Clearly the minimum wage would be more of a lift than LIFT. Workers will have poorer workplace protections with the repeal of Bill 148, because it was considered too onerous for industry.

We are now a high-income country where paid sick days are considered a luxury rather than a right.

Minority groups are also making sacrifices. The province has decreased its responsibility for the welfare of refugees. Francophone populations have lost their proposed university as well as the government office that looked after Franco-Ontarians.

Poor neighbourhoods have lost access to jobs and educational opportunities as plans for new universities have been shelved. Children have lost their advocate. Even the climate has made sacrifices — experts predict that the provincial climate change policy will slow down our fight against greenhouse gases.

A lot of sacrifices will be made by vulnerable people, but so far, I have not seen any significant sacrifices by business or richer people.

That worries me as a doctor because the gap between rich and poor impacts health. Researchers from both the U.K. and the U.S. have reported that high income inequality is bad for health and life expectancy. We are already the most unequal province in Canada. If people at the bottom are getting poorer while richer people stay the same, the gap increases, and our population’s health suffers.

Some will argue that Ontario needs to be open for business — I do not argue with that. However, I do think there is a difference between being open for business and being open for exploitation.

Recent history shows that business does not pass down the wealth to employees. Businesses are keeping a higher percentage of profits and passing less and less back to employees. They are employing fewer people, giving them fewer benefits, and pensions, while precarious employment increases. They are playing countries against each other: they will go to the U.S. if it has poorer standards than Canada. As countries compete for jobs we enter a race to the bottom when it comes to wages and benefits.

For business to have a positive impact, it needs to treat employees well, positively impact the social and physical environment and pay its fair share. It needs to be socially responsible. When people sacrifice, business should too — and we need to hold them to that standard. The most important reason for rising income inequality in Canada is government inaction.

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So far I have not seen business sacrifice. I have seen them given tax breaks, offered less red tape, offered payment not to pollute, and given lucrative opportunities to sell cannabis — and I expect private companies will be given more access to health care.

In the fall economic statement the most vulnerable have been asked to sacrifice. I hope that when we see the full budget next year we see businesses and richer people being asked to sacrifice as well. If we do not, we will see inequality rise and that will impact public health.