While the HRC claims that its proposals are based on "balanced, rational and evidence-based arguments," analysis reveals the council failed to meet all three standards. The authors cite the following examples of the committee's research flaws: errors in data collection and population estimation; anecdotal, second-hand evidence that is selective and unsubstantiated; internal contradiction; inconsistent use of evidence; unexplained reliance on focus groups with no reference to weighting; disregard for significant amounts of its own data; under representation of certain groups; and inadequate definition of "care."

"These errors throw into question the validity of the report and its recommendations for change. We urge the Commission not to base restructuring on such flawed research," says Feldberg.

The authors also challenge the HRC's claim that its changes would save money. For example, the HRC naively assumes that medical technology will lead necessarily to savings, although the American experience suggests otherwise. And while the HRC recommends "that resources be reallocated to informal caregivers (family and friends) to ease the burden of care," there is no reference to any estimated cost for such support. This suggests an intention to privatize the burden of care at the expense of women who will bear a disproportionate burden. Women will lose out in the workforce, in the home, and in their own personal health, while the local and national economies will miss their expenditures and governments their tax contributions.

The HRC's claims about the shift in population distribution in Metro Toronto from the centre to the periphery are misleading, the authors say. Both Metro and the GTA continue to grow due to migration, particularly international migration, and natural increase. The HRC's report fails to factor in the impact that this increase would necessarily have on hospital needs.

The authors argue that the HRC grossly underestimated the number of young women, aged 15-44, in the downtown core. This is strikingly depicted in an exhibit which suggests that the catchment areas containing the University of Toronto, its hospitals and Ryerson University have the lowest populations of women aged 15-44. Given that almost half of the University of Toronto student body is female, that 4,200 students live in residence on the St. George Campus and another 4,200 within a two-mile radius, the HRC's claims seem implausible, says Feldberg.

The HRC also failed to consider how socio-economic shifts and changing patterns of infectious disease would affect the populations's need for hospital services. It did not, for example, gauge the impact that increased unemployment and reduced welfare support will have on the health of Torontonians and their need for hospital services. In particular, it did not assess the impact of increasing rates of drug-resistant tuberculosis and other infections on either health status or hospitalization needs.

"Rather than serving as a research report, the Final Report and the background documents that inform it are tools calculated to legitimate, facilitate and justify changes and decisions which have already been made," the authors conclude. "The language of the report, its assumptions, its choice of evidence, and its conclusions are pre-directed, in that they justify an outcome that was envisioned before research began. They do not address the range of hypotheses or interpretations that one would expect from a research document."

The York Centre for Health Studies (YCHS) is an organized research unit of York University. Established in 1990, the Centre encourages examination of health issues within a context of social, political, economic and cultural concerns. The Centre conducts research in six thematic areas, one of which is health policy, professions and institutions. YCHS also houses the National Network on Environments and Women's Health, a Centre of Excellence funded by Health Canada.

For more information, please contact:

Sine MacKinnon
Senior Advisor for Media Relations
(416) 736-2100, x 22087

Georgina Feldberg, A.M., PhD, Director
York University Centre for Health Studies
(416) 736-5941
YU/062/96