Implementing a Sanctuary City Policy From a Public Health Perspective Anna Pancham Toronto Public Health March 5, 2016.

Undocumented Workers in Toronto 2013 Toronto is a “Sanctuary City” “City Council re-affirm its commitment to ensuring access to services without fear to immigrants without full status or without full status documents.” 2

Finding Our Mandate Undocumented Workers in Toronto (2013)  Toronto is a “Sanctuary City” Medically Uninsured Residents (2013)  Access barriers & health impacts Solidarity Network- City service audit (2014)  25% turned away 3

City Policy Don’t Ask Don’t Tell (policy) Access without Fear (policy) AccessTO (brand) Sanctuary City (media) 4

Challenges in Accessing City Services 1.Lack of awareness of P&S 2.Eligibility & registration? 3.Discrimination 4.Language barriers 5.Perception that they do not have required ID 5

Outline I.Implementation across the City of Toronto II.Implementation at Toronto Public Health 6

I.IMPLEMENTATION ACROSS THE CITY OF TORONTO Target Population: Undocumented Residents 7

Implementing Sanctuary City The TASK:  Informing 38,000 City staff  Informing thousands of undocumented residents 8

HOW? Regular reporting to Committee & Council Review of ID requirements across all City programs Communications campaign Complaints process 9

Posters for Staff and Residents 10

Web Content for Staff and Residents 11

Identification Requirements 12

II. IMPLEMENTATION AT TORONTO PUBLIC HEALTH Target Population: Medically Uninsured Residents 13

Before Sanctuary City Immigration status was not a barrier Provide staffing support at a community clinic for uninsured residents Member of the Women’s College Hospital/Wellesley Network for Uninsured Clients Core work includes prioritising marginalised residents 14

Finding our Mandate Inequitable access to healthcare Inequitable health outcomes Access to healthcare is a determinant of health 15

Implementing Sanctuary City at Toronto Public Health The TASK:  Informing 1,900 Public Health staff  Informing thousands of residents without health insurance 16

How?  New content on TPH website  Updated list of healthcare options  Internal training  External knowledge exchange  Public awareness campaign 17

Key Messages TPH services: Are free Do not require an OHIP card Provide free interpretation We do not report to immigration authorities 18

Progress? Essential to have this mandate Implementation – good start, long way to go Implementation will vary by division Need regular audits & research Need residents to complain Is access to City programs & services important? 19