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Canada’s healthcare system is at a crossroads. Despite its reputation for universality, inequities in access, outcomes, and experience persist and in many cases are worsening. Dr. Andrew Boozary has emerged as a leading voice diagnosing this gap — not simply as a delivery failure, but as a failure of design, governance, and imagination. His work reframes homelessness, poverty, and “social admissions” as structural conditions requiring upstream solutions, not clinical blame.
This white paper presents a synthesis of Boozary’s scholarship and institutional leadership. It explores the hidden cognitive tax of poverty, the illusion of universality in a system that excludes essential services, and the emergence of hospitals as last-resort safety nets for structurally marginalized patients. It introduces the social medicine model developed at the Gattuso Centre for Social Medicine at UHN, where permanent supportive housing, stabilization centers, mobile outreach teams, and peer navigators are redefining what healthcare can and should be.
Policy recommendations include expanding public coverage to include mental health and medications, integrating social and health governance, embedding lived experience into care teams, and shifting system metrics toward equity and prevention. This white paper concludes that Canada must reclaim its commitment to equity — not just in language, but in funding, design, and law.
The choice is clear: continue paying the cost of system incoherence, or invest in a future where care begins with dignity, trust, and structural alignment.
