In 2014 a Statistics Canada report found that income inequality was associated with 40,000 preventable deaths per year. As health professors writing in the Star explained, “Income inequality is not only bad for our quality of life and economic productivity; it is directly related to the deaths of Canadians on an almost unimaginable scale.”

Ontario’s Fair Workplaces, Better Jobs Act, 2017 is an important part of the response to inequality: raising the minimum wage to $14 an hour in 2018 and $15 an hour in 2019, improving labour standards around equal pay for equal work and scheduling, and providing 10 days of emergency leave (two of them paid).

We are health workers who advocate for policy changes that support decent work and health. We support the Fair Workplaces, Better Jobs Act based on our understanding of the social causes of health and illness. For example, a higher minimum wage and equal pay for equal work can reduce income inequality and its deadly health effects, and paid sick days allow workers to recover faster and protect public health by not going to work sick.

Despite the outcry from those who benefit financially from the status quo, this new employment law does not go too far and is not happening too quickly. If anything, the new legislation does not go far enough. For example, there are still exemptions that deny the higher wage to agricultural workers. And while we called for seven paid sick days, only two of the personal emergency leave days are paid. Still, the new law is an important step towards a broader prescription for decent work and health.

That’s why we were dismayed to hear that within days of the new legislation coming into effect, several Tim Hortons franchises tried to tear up this prescription. Owners of the Cobourg franchise, for example, eliminated paid breaks and cut dental and health benefits. These regressive changes at Tim Hortons — implemented under the watch of parent company Restaurant Brands International — roll back the health benefits of the new law and put the health of workers at risk.

Protesters rallied Jan. 10 at several Tim Hortons locations against cuts some outlets made to employee breaks and benefits after Ontario’s minimum wage hike. Toronto demonstrators explain why they don’t support a boycott. (The Canadian Press)

Cuts to health and dental benefits, in particular, could offset the health benefits of the higher minimum wage. According to a 2012 study in the Canadian Medical Association Journal, 10 per cent of Canadians are unable to take their prescriptions because of cost — and this rises to more than 35 per cent among people with no insurance and low household incomes. Meanwhile, one in five Canadians is unable to access dental care because of cost. Forcing employees to cover 50-75 per cent of their benefit costs, as is happening at the Cobourg location, means that many Tim Hortons workers may no longer be able to afford dental coverage.

Punitive changes that strip workers of benefits add to an unhealthy work environment. As a World Health Organization 2010 report explained, “high job demand, low-control, and effort-reward imbalance are risk factors for mental and physical health problems.” A punitive work environment may also increase the risk of health and safety issues in the workplace. Those with precarious employment are least likely to report health and safety concerns to employers for fear of retributions. It is hard to imagine that Tim Hortons’ harsh response to the increase in minimum wage will foster a culture of safety and respect for employees.

As frontline health providers, we see the health impacts of precarious work: workers whose poverty wages prevent them from filling their prescriptions, whose working conditions impose physical and mental stress, and who have no paid sick days to recover and protect public health. As we brace for the peak of the flu season, now is the time to enforce the Fair Workplaces, Better Jobs Act to promote decent work and health, not undermine it through unhealthy policies.

Rainbow Foods in Ottawa tried to eliminate paid coffee breaks but reversed this decision under public pressure. We hope Restaurant Brands International and the Tim Hortons franchises it oversees that have cut away employee benefits, similarly reverse course — and that a health lens informs the broader discussion of income inequality. Let’s make 2018 a year to “roll up” wages and conditions.

Jesse McLaren and Kate Hayman are emergency physicians in Toronto. They are members of the Decent Work and Health Network.

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