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

2. 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

3. 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

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

5. 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

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

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

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

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

10. Posters for Staff and Residents 10

11. Web Content for Staff and Residents 11

12. Identification Requirements 12

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

14. 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

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

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

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

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

19. 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