Kazakhstan in Central Asia: Security, Safety and Peaceful Imperatives

September 16, 2016 1:54 am
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Global nuclear disarmament and nuclear non-proliferation, Kazakhstan’s commitments, International Atomic Energy Agency (IAEA) support and the next steps were very much front and centre at the August 28-29, 2016 Conference in Astana on Building a Nuclear-weapon-Free World,  co-hosted by the Senate and Ministry of Foreign Affairs of the Republic of Kazakhstan, and Parliamentarians for Nuclear Non-Proliferation and Disarmament (PNND).  An impossible task, but Their Excellencies President Nazarbayev, Chairman of the Senate of the Parliament of Kazakhstan and the Minister of Foreign Affairs Idrissov, together with PNND Global Coordinator Alyn Ware, managed to include more than 40 international speakers.

For me, the most poignant and illustrative presentations were the speakers for the “witness” countries where nuclear tests or attacks had effected their territories – i.e. Japan, Marshall Islands, Kazakhstan – describing the tragic loss of lives and long-term human health and environmental impacts.  Many articles and books speak of the declarative action by President Nazarbayev on August 21, 1991 to close the nuclear test site at Semipalatinsk (now Semey), after the region experienced 456 underground and atmospheric nuclear weapons tests, conducted by the Former Soviet Union. The timing of this step 25 years ago –supported by world leaders and the IAEA and its members– was indeed courageous as many have written. But, it was also politically bold. It occurred before the articulation of future policy directions and the new constitutions of the newly independent Commonwealth of Independent States.

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Kazakhstan is a signatory to the Treaty on the Non-Proliferation of Nuclear Weapons, and the Comprehensive Nuclear-Test Ban Treaty. Its leadership was critical to the establishment in 2006 of a nuclear weapons-free zone in Central Asia, and currently Kazakhstan has a seat as a non-permanent member on the United Nations’ Security Council.

Both legislative tools and a diplomacy approach to international security governance are to be discussed at the first Astana Peace Summit November 2016. The newly-established Nazarbayev International Prize for Contribution to Nuclear Disarmament and Security will be awarded during this Summit.

The concrete steps forward, on a consensus basis –in a world experiencing new threats– will be a serious challenge, particularly with the continuing presence of thousands of nuclear weapons.  Ideologies are not new; conflict is not new; nor is a marginalized youth seeking value parameters; and nuclear weapons (now almost a hundred years old) are also not new.  However, social media and new technologies are.   It is important to focus through parliamentary, regulatory and policy efforts not only on current areas of conflict, but rather on conflict prevention and confidence building.  Central Asia’s leadership will soon change (witness recent passing of Uzbekistan’s President Karimov); and there is a new generation growing up who will not have lived in the Former Soviet Union.

The most difficult post-conference discussions were the focusing of priorities, the direction of the Comprehensive Test Ban Treaty, cessation of producing materials under the perennially stalled Fissile Material Cut-Off Treaty, nuclear weapon stockpile reduction, and the Treaty on the Non-Proliferation of Nuclear Weapons. As one international parliamentary speaker said in trying to move the Conference agenda forward: “Where are we most likely to succeed, globally? “

There is still much room for Canada in international policy leadership, including the promotion of its own governance models, particularly the example of our national nuclear regulatory safety and security framework. Global accountability still remains the larger and more difficult question – and greater leadership from the IAEA on all of these issues would be a step in the right direction.  This week, world leaders at the 71st session of the United Nations General Assembly will address the critical issues of human rights, refugees and migration, the Climate Change Agreement, conflict prevention and peace.

They will be presented with another opportunity to address a world without nuclear weapons.

margaret_skok16x9_webMargaret Skok: Senior Fellow, Global Security
& Politics Centre for International Governance Innovation 
Ambassador (Retired)

A New Stage in Canada-Hungary Relations

September 14, 2016 12:29 pm
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There are more than 300,000 Canadians of Hungarian descent living in Canada today. Many of them are musicians, film producers and CEOs, one is even an 87-year-old Nobel Laureate. Hungarian Canadians live all over the country, from the East Coast to the West, and despite their diversity, many of them have one thing in common: the year 1956.

That year, roughly 37,500 Hungarian refugees arrived in Canada, fleeing the Soviet invasion of their country. This wave of migrants was the largest Canada had ever accepted in its short history, and few countries took in more refugees than we did. The success these refugees had in Canada set the precedent for Canada’s welcoming of 50,000 Vietnamese refugees two decades later and our current process of accepting Syrian migrants. It has also created a lasting bond between Canada and Hungary.

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Hungarian Ambassador Bálint Ódor

“Everybody has a connection to Hungarians, through family or friends or colleagues,” says Hungarian Ambassador Bálint Ódor, sitting at the conference table in his Metcalfe Street embassy. “1956 is not only a Hungarian history, and a Hungarian story, it’s also a Canadian one.”

To recognize the 60th anniversary of this exodus, and the partnership it inspired, Ódor and his staff are organizing cultural celebrations across the country. Beginning in September, they hosted a week of events in Montreal, including a Hungarian Film Festival. November 1st they are doing another major event in Halifax’s Pier 21, where many of the refugees originally landed.

The commemorations come to Ottawa on October 24th, where the Hungarian Foreign Minister will speak at the Canadian Museum of History.

“From the beginning of September to mid-November there will be events, from Halifax to Vancouver” Ódor says. He says that these commemorations will give Canadians a chance to celebrate and learn more about their common heritage with many Hungarians.

“It’s really just to look back and say thank you to Canada and to Hungarian Canadians who made their lives a success here in Canada, thus contributing to a positive image of Hungary,” Ódor adds.

These celebrations are a bit of a departure from Ódor’s normal role as ambassador. Since he took the position in 2014, he’s been focused on strengthening political and economic relations. After his arrival Hungary chaired the international organization named International Holocaust Remembrance Alliance (IHRA). One of the main events of the Embassy’s awareness raising activity in Ottawa was a memorable concert where an audience of five hundred could enjoy klezmer music and traditional Hungarian Jewish music.

Opening up trade and tourism in the two countries was also high on the agenda. That following year, he helped establish a direct flight route between Toronto and Budapest. Before that, there were no flights directly connecting Hungary and Canada, or Hungary and North America, for that matter.

“Between two countries geographically far from each other, this is a very important thing,” Ódor says. “The diaspora is able to come home and come back…it deepens relations.”

On the business side, he is focused on promoting innovation. Canada and Hungary have historically focused their trade on machinery, pharmaceutical trade and medical equipment. In 2012, trade between the two countries totaled $634.4 million, with Canada importing roughly twice what it exported.

Ambassador Ódor wants to improve upon this by creating new relationships centred on research and innovation.

“Hungary has always been a very innovative country,” he says. “I think the future between Canada and Hungary is very much in the field of research and development.”

The ambassador also plans to spend more time deepening relations in Quebec specifically, where many of the 1956 refugees landed in Canada.

“We want to bring Budapest and Montreal closer,” he says.

Budapest’s mayor will be opening the Montreal cultural week in September, an event that Ódor hopes will make many Montrealers, and other Canadians, consider visiting Budapest in turn.

Find out more about the cultural celebrations around the country by visiting 1956canada.developmentserver.ca/events or BudapestinMontreal.ca.

British Columbia’s Failed Healthcare Experiment

August 23, 2016 2:14 pm
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Paying Doctors More Did Not Improve Primary Care – and Cost the Province Hundreds of Millions of Dollars

Our first point of contact with the health system – often referred to as ‘primary care’ – should result in prompt and efficient care for our general health concerns, and coordinate our journey through the system when we need more specialized care.

That’s if things are working properly.  Unfortunately, this isn’t always the case.

In the early 2000s, there was widespread concern across Canada that primary care was in decline.  Walk-in clinics and emergency departments became the de facto point of care for patients who lacked timely access to a family doctor.  Patients struggled to find doctors to take them on as regular patients.

Though British Columbia was not alone among Canadian provinces in recognizing the need for primary care reform, it was unique in its approach to solving the problem. BC’s chosen fix for primary care was based on the simple and appealing idea that we have to pay for what we want.

BC attempted to coax individual doctors to provide important primary care services (chronic disease management, mental health care and preventative care, for example) and discourage walk-in style practice by providing additional incentive payments within the public fee-for-service system.

In contrast, other provinces changed the structure and organization of primary care, moving toward team-based models of care and away from fee-for-service compensation for doctors. Other countries also implemented incentive payments for doctors, but unlike BC, these models were tied to reporting on performance.

The costliest incentive implemented under the BC program was a $315 annual payment made to doctors – on top of regular patient visit fees – for providing ongoing care for complex patients (someone with two or more qualifying chronic diseases). BC now spends more than $50 million each year on this single incentive and another $100 million on similar ‘extra’ payments for obstetrics, mental health care, preventive risk assessment and management of individual chronic diseases.

In a recently-published study in the Canadian Medical Association Journal, we investigated the effects of these complex care payments. We observed that two out of three eligible patients have these incentives billed for their care.  However, we saw no change in the number of primary care visits patients received or in the continuity of their relationships with a regular doctor.  Hospitalization rates did not go down.

From what we can see looking back, care remained the same, while costs went up.

More broadly, BC patients today still struggle to access quality primary care where and when they need it.  Even patients with a doctor often resort to emergency departments and walk-in clinics because less than a third of BC doctors report having any other arrangements for after-hours care.

The incentive payments for doctors failed to achieve the stated goal of improving primary care for patients.

The incentive program improves compensation for physicians doing the important work of caring for patients with complex disease, but this was not the primary objective of the incentive program and incentives are not the only – or even best – way to pay doctors doing this work more fairly.

While the program was no doubt implemented with the best intensions, it reduces physician motivation to dollars billed, while doing nothing to address other practical and structural barriers to doctors providing quality, accessible primary care.

There is a new push for primary care reform in BC, this time embracing team-based models, which include nurses, pharmacists and other service providers to help improve accessibility, quality and efficiency of care. This is exciting, but there are lessons to be learned from the failed experiment with incentive payments.

The incentive-based programs were planned by the Ministry of Health and representatives from Doctors of BC (then the BC Medical Association), which helps explain their focus on the activities of individual physicians.

This time around, before spending billions, we need to agree on what success looks like, and monitor progress from the start. Some approaches may not work, and that’s okay – even expected – as long as a lack of effect is recognized and acted on quickly.

We need to measure performance in real-time against clear goals and accept ongoing change as a necessary part of doing better, rather than thinking a one-time course correction is enough.

Most importantly, we need to broaden the team that is involved in choosing reforms to include Health Authorities, nurses and other service providers – and patients. All are necessary to delivering primary care and so all should have a hand in shaping it.

Mcgrail_KimKimberlyn McGrail is an expert advisor with EvidenceNetwork.ca and an Associate Professor in the School of Population and Public Health at UBC.

Lavergne_Ruth_2Ruth Lavergne is an Assistant Professor in the Faculty of Health Sciences at Simon Fraser University.

Ottawa Vanier MP Mauril Bélanger – May A Son Of Ottawa Rest In Peace

August 19, 2016 11:16 am
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Prime Minister Justin Trudeau issued the following statement after learning of the death of Member of Parliament Mauril Bélanger.

“I was incredibly saddened to learn today of the death of my friend and colleague Mauril Bélanger. On behalf of all Canadians, Sophie and I offer our deepest condolences to his family, friends, constituents, and many, many admirers.

“Mauril served the people of Ottawa-Vanier for over 20 years, and was a tireless advocate of francophone rights, national unity, and a fair and just society for all.

“For his efforts, Mauril was given the Commandeur de l’Ordre de la Pléïade (an order of La Francophonie), named Officer of the Order of Merit of the Republic of Hungary, and received the l’Ordre national Grand-Croix ‘Honneur et Mérite’ from Haiti.

“Mauril held many positions in Cabinet over the years, including Deputy House Leader and Government Whip. Despite being very sick towards the end of his life, Mauril continued to serve Canadians with great dignity, courage, and strength.

“A politician universally respected by parliamentarians of all parties, he was named Honorary Speaker of the House of Commons by unanimous consent in December 2015.

“Mauril’s immense contributions to our country will be honoured and remembered. We are all the poorer for his passing.

“Goodbye my friend.”

Ottawa Life Magazine had many dealings with Mauril over the past 20 years. Mauril was a wonderfully authentic, intelligent, thoughtful and kind person. He loved public service. In March 2010 Mauril was featured on the  cover  of Ottawa Life Magazine in honour of his tireless work for the community. He appeared  as part of the series Our City Our Children which highlighted efforts being made to assist young  people and children at risk in the community. Mauril was a champion of the people and a one of the best MPs ever to represent an Ottawa riding since Confederation. He will be missed.

Criminology and Police Policy Expert Darryl Davies Calls on City Councillor Keith Egli and City Council to “Do Something” About Rogue Police Association President’s Actions

August 16, 2016 4:26 pm
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Dear Mr. Egli,

The latest instalment of policing chaos in this city comes at the hands of Matt Skof, the President of the Ottawa Police Association.

It’s beyond belief that Matt Skof would post a video to YouTube and publicly call Charles Bordeleau, the Ottawa Chief of Police, a liar without facing any consequences. It’s an act of extreme insubordination and city council and the Police Services Board must do something to reaffirm public confidence in Ottawa’s police. The public needs to be assured that the police force in the city has a functioning chain of command.

The issues raised by Matt Skof should be dealt with at city council or by the Ottawa Police Services Board, but they certainly shouldn’t be posted on YouTube without consequence.  Instead we see turmoil rocking the OPS because Skof appears to have absolutely no regard for the untold damage such a video could do to this City and, more importantly, the credibility of the Ottawa Police Service. This video has been posted for the world to see and it is a disgrace that no one at City Hall (specifically the Mayor) is calling him out for it.  Skof’s action follows his previously ignorant and egregious comments after the violent beating death of Abdirahman Abdi at the hands of Ottawa Police Constables Dave Weir and Daniel Monstion. He said “To suggest that race was an issue in this, it’s inappropriate.” Skof made these remarks before any investigation determined whether or not that was the case, which infuriated many in Ottawa’s Black community.

This is part of the continuing saga that shows the Ottawa Police Association, the Ottawa Police Services and the Ottawa Police Services Board are in a crisis.  We have police (SKOF) filing complaints against the Chief with the OIPRD. We have the President of the Ottawa Police Association running around talking about ‘his’ men as though he is the de facto Chief of Police. We have a Chairperson of the Ottawa Police Services Board who appears not to have a clue about how to address the issues and a Mayor that has steadfastly failed to speak out on the policing crisis in our city. The track record of police misconduct in this city borders on inexplicable.

As you are aware, Dan Donovan, Publisher and Managing Editor of Ottawa Life Magazine, myself and many others involved in criminal justice matters have been writing and speaking out about problem policing in Ottawa for many years.  Despite this fact, city councillors remain unconcerned and asleep at the switch.  Pretending the problem will simply go away is not an option.

I think that it’s time the provincial government stepped in and brought an end to this chaos because it’s clear that Ottawa City Council has completely lost control over policing in this city. The death of Mr. Abdi is just another gross blight on policing in Ottawa.

I am requesting that you send a letter to the Honourable David Orazietti, the Minister of Community Safety and Correctional Services who is responsible to the taxpayers for policing in this province.  I would like you to formally request that a management board be established by the province to restore some sanity to the policing mess that we have in the City of Ottawa.  It’s clear that our municipal officials are doing and saying nothing and for the Mayor to be telling the media (which he did recently) that we have a superb police force clearly shows that he is completely out of touch with reality.

Since it’s clear that the Mayor and Ottawa City Council are doing nothing in a serious and substantive way to address the problem, I am formally calling upon you to take action. The taxpayers of this city deserve nothing less. You can view the original YouTube video below.

Thank you,

Yours truly

Darryl T Davies

Here’s What Happens When I Write About Parenting a Child with Autism for the Mainstream Media

August 10, 2016 1:33 pm
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I’m not entirely sure why I write about my personal experiences parenting a child with autism for the mainstream media.  Mostly I hope my own experiences may help someone else on their autism journey – and they won’t stumble through as I have done in the early days.  Parenting a child with autism is challenging, joyful, frustrating, heart-wrenching and rewarding all jumbled together.   Making those experiences heard is also an important step toward wider acceptance of autism in the community at large.

But what I’m never quite prepared for are the letters I get whenever I publish something about autism in the mainstream press.  Here are a few responses that never fail to happen.

1. Someone writes to tell me vaccines cause autism. 

Can we just stop this already?  Vaccines don’t cause autism.  They never did.  The study that kicked off this speculation was proven to rely on falsified data and the author had financial motives for making up his findings.  The journal retracted the study years ago and the author has been widely discredited.

If that’s not enough to placate, there have been dozens of significant studies trying to establish such a link just in case, and all of them came to the same conclusion: there’s no relationship between autism and childhood vaccinations.  End of.

2. Someone writes to tell me they have the cure for autism.

The people who send me these kinds of letters are either snake oil salesmen preying on parental hope purely for monetary gain but also people who really think they’ve single handedly stumbled on the cure and want to spread the good news.  In either case, save your breath.

There’s no known cure for autism.  Yes, many studies have shown there are some excellent therapies (behaviour, speech, occupational, sensory, drug, diet) that may help enhance certain abilities or lessen certain behaviours in some individuals with autism, but these are not cures.

We’ll all be better off if we stop seeing the individual with autism as ‘sick’ or ‘broken’ and in need of a cure and provide them with the supports they need to live and thrive in the community instead.

3. Someone writes to tell me I’ve caused my son’s autism. 

Yes, really.  I like to call them jackasses, but I believe other journalists call them ‘trolls.’ Turns out trolls don’t just save their bullshit for political commentators but share their misery with parenting columnists too.

I’ve been told my son has autism because: I fed him formula as a baby (no), I was on anti-depressants while pregnant (nope), I fed him genetically engineered foods (sigh) and, of course, because I had him vaccinated (of course I did – read #1).  One special jackass told me it was ‘karma.’

4. Someone offers me money.

See — it’s not all bad.  Strangers also offer to send me money to help me parent my son with autism.  It’s just the sweetest gesture and my faith in humanity is always restored by these letters.

I thank them, but always kindly decline and recommend they give to a local autism charity instead.  There are many autism families that are in far greater need than myself (raising a child is expensive – raising a child with autism is astronomical) and the front line autism charities are the best at putting resources where they are needed most.

5. Someone offers my son gifts.

Many readers want to send my son gifts.  It happens every time I write.

It is such a beautiful gesture and I am touched by every offer.  But again – for reasons of protecting privacy and because my son is already spoiled rotten, I always say no.  Again, I recommend they donate to an autism charity and I think many of them actually do this.

People, it turns out, can be very kind.

I did accept one time: when the city transportation office offered a tour of the local bus facilities after a story about how much my son loves city buses (he memorizes the bus routes and ‘articulated bus’ was one of his first toddler phrases).  They gave us a half day tour and a goodie basket full of bus-related items.  My son still talks about it today.

None of these responses ever stop me from writing.  In fact, the first few make it clear how badly I need to keep writing to combat the misinformation that’s still floating around out there.  But the best news?  The kind gestures always outnumber the jackasses.

1276991_588866957837667_1084464500_oKathleen O’Grady is a Research Associate at the Simone de Beauvoir Institute, Concordia University, Montreal, and the mother of two sons, one with autism.  Her writings on autism and disability have appeared in the Chicago Tribune, the Huffington Post, the Montreal Gazette, The Ottawa Citizen, among other publications.  You can follow her on twitter @kathleenogrady. 

When is Police Use of Force Justified?

July 19, 2016 11:16 am
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I am a seventh generation Black Canadian. I was also a police officer for 36 years. I have worked in a city, rural, and federal environment.

The growth of the Black Lives Matter movement has come out of the lack of information, accountability, and racist behavior by some individual police officers. This is nothing new. Canada fails to teach the long conflict between black communities and the police. I have lectured, presented, and facilitated, on the subject of Police/Race Relations since 1970.

The use of force by police officers is mandated in part by a Use of Force curriculum. In fact, if you Google “Use of Force Model Ontario” it will be described. The use of force model is a guide not a firm policy. And so it should be. However, it is used to explain the police officers’ use of force to the courts and their police organization. The citizen rarely hears of the model. Why not? All police use-of-force disputes among, politicians, police, citizens, police boards, including Black Lives Matter members, should know how the model applies.

The Head of the Police Union in Toronto (and all police union heads) should be asked the following questions: Please define Racism/Racist behavior. Does racist behavior take place in his organization by some individual members? Should it take place? What proactive steps have you taken as head of the police union to eliminate racist behavior? If not, why not?

I can tell you that racist behavior takes place inside and outside of police organizations. (Google Calvin Lawrence Racism RCMP) (Space between words). There are some police officers that will put their personal belief system before their oath. In this case, racist behavior. This includes all police organizations. All individual police officers do not practice racist behavior.

If you want to minimize the conflict, the police, SIU, and Police Services Board, must do a timely, accurate, open as possible, investigation and then tell the truth no matter who it helps or who it hurts. Once that is done, exonerate or hold the police officer accountable by the courts and/or the police organization. Then implement policies and/or changes to existing policies if need be.

Parliamentary Wrap-Up Session With Rona Ambrose

July 14, 2016 3:03 pm
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Attention: Rona Ambrose is not running for the Conservative leadership. However, after a stellar performance in the last Parliamentary session many wish she would. We sat down with the interim Leader of the Official Opposition to discuss the last Parliamentary session.

OTTAWA LIFE MAGAZINE: What are your observations of the new Liberal government over the last Parliamentary session?

HON. RONA AMBROSE: They have done a lot of consulting, and they still seem to be trying to find their way. Things seem a bit unorganized. I understand that it takes time to settle in. Prime Minister Trudeau didn’t come into office with much training. He was vaulted from leader of the third party to prime minister. Usually you spend time as leader of the opposition and then win an election and go into government. It’s the same for his ministers.

You have experience as a minister in government. Is there anyone who has impressed you so far or who stands out?

Minister of Health, Jane Philpott. During Question Period, she gives real answers and straightforward information. When I worked as the minister of health, opposition MPs would often come up to me and thank me for giving straight answers in Question Period or committee, and I always thought that was odd. But now being in the opposition, I see what they meant and how valuable that is. Philpott is constructive, forthright and respectful of the process.

What are your thoughts on Bill C-14? The assisted dying bill is a contentious issue, especially now that the Senate has weighed in on widening the parameters of who should be eligible.

The bill reflects a good balance. When it was brought to the House, there was, at times, emotional and passionate debate. I thought the bill was good and agreed with most of it, but I didn’t vote for it because it was an open vote and I still have some concerns. I think we need to add safeguards and provisions that address concerns raised by many in the disabled community and also for the mentally ill. It’s a very complex matter and there are so many ethical issues at stake. As for the Senate, it certainly has the authority to propose amendments but it becomes problematic when they entirely reject a bill sent to them by elected members of the House.

 The government is indicating it does not wish to be part of the F-35 consortium. Prime Minister Trudeau says the F-35 fighter jets don’t work. Comment?

The Prime Minister’s remarks about the F-35 are simply not true: they do work. Decisions on fighter jets should not be made by politicians, but by the air force. The F-35s are better for interoperability; not having them would put us out of step with our allies. The previous Conservative government supported their purchase for Canada. However, the procurement was delayed over audit, budget and oversight issues. The Hornet that the Liberals are now talking about is a good fighter jet but sole-sourcing is not the answer. The Liberals should have an open competition to see which planes to buy, but they won’t because they know if they did, the F-35 would win.

What about the debate on pipelines?

It’s interesting that Alberta’s NDP premier Rachel Notley campaigned against pipelines, and now she’s recognized they’re required and they’re safe. Now we have a Conservative premier from Saskatchewan, NDP premier from Alberta and Liberal premiers from Ontario and New Brunswick all supporting the Energy East pipeline.

There is similar debate around liquid natural gas (LNG) plants, most specifically the one proposed in B.C.’s Skeena Watershed. One hundred and thirty scientists wrote to the Prime Minister contesting the National Energy Board’s (NEB) approval of the project.

We have to trust the NEB’s process. They have made recommendations, and it will be problematic for the Liberals if they’re not going to listen to the science and evidence given to them by the appointed governmental body just because they don’t like the answer. They said decisions will be based on evidence. How can they not agree with the NEB on these issues? They are the body that decides what can happen based on all the input and the evidence.

The Conservative Party recently amended its opposition to same-sex marriage. What does that mean for the Party?

It was an important step. A large part of the Party is libertarian and they believe government should stay out of people’s lives. Then other Conservatives believe strongly in freedom and economic prosperity, and not to have their government interfere in their lives. There are also representatives from the LGBT community in the Party, so I’m very pleased and proud that the change was made.

Can you comment on the previous Conservative government’s handling of Aboriginal Affairs in Canada?

I think we did much more than we are credited for. Stephen Harper officially apologized for residential schools and initiated the Truth and Reconciliation Commission. The Conservative government settled many comprehensive land claims and was also very focused on Aboriginal economic development programs that were starting to show signs of success. A significant push was made for improving the conditions and funding in education for Aboriginal children via new federal legislation. Unfortunately, that legislation, which would have injected $2-billion new dollars into education for Aboriginal children across Canada, was halted because of an internal rift within the Assembly of First Nations. This caused AFN Chief Shawn Atleo to leave. The legislation had widespread support across the country so it is sad that it did not proceed. I think it is fair to say that we (the former Conservative government) did not communicate very well in regards to the many things we did on the Aboriginal file.

You were affected personally by the Fort McMurray Fires. Are you confident the government is doing everything properly to assist the residents as they go back and rebuild?

There was a lot of support from the Alberta government and the private sector and NGOs. The federal government has also been assisting – as they should – but I will take a “wait and see” attitude as people come home from the fires and work at getting back on their feet.

Finally, many in the Conservative Party and many media pundits have suggested that you are making the Tory Leadership race tough because of your impressive performance to date as Interim Leader. Many are saying you should be allowed to run so you can stay on.

I took the job as interim leader and I am not running. I’m going to start wearing a t-shirt that says, “I’m not running.” The Conservative Party has so many great potential leaders from within politics and even some outside of politics. I’m sure we will pick a good one and then I’ll lend them as much support as I can.

Solving Canada’s Opioid Epidemic Must Include Tackling What Got Us into the Predicament in the First Place

July 7, 2016 10:51 am
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By all accounts we are in the midst of a deadly drug epidemic so severe and widespread few people in North America will remain untouched by it.  In case you think I’m exaggerating, right now we have probably the highest rates of narcotic abuse and deaths in modern history.

Critics have begun pointing the finger at the medical system and its prescribers – well-meaning doctors and specialists who’ve been giving too many patients excessively powerful opioid medications to deal with modest pain.  But we can dig deeper and look at the relationship between medical education and pharmaceutical company influence as a significant contributing factor.

Typically the suggestion of an epidemic is hyperbolic, but it doesn’t seem so in this case.  Last week, Dr. Perry Kendall, the provincial Health Officer in British Columbia said that BC has a bona fide “public health emergency” on its hands, mostly due to the alarming number of overdose deaths linked to prescription opioids.

Opioids include prescription narcotics like Oxycontin, hydromorph Contin and fentanyl (which some say is 100 times stronger than morphine).  Dr. Kendall said that there were more than 200 opioid-related overdoses so far this year in BC, and if those numbers continue, there’ll be 800 by the end of the year.

What’s happening in BC is just a small microcosm of what is happening across Canada, where we have some of the highest rates of prescription opioid consumption in the world.  From 2006 to 2011, use of opioids in Canada rose by 32 percent and that rise has continued unabated, despite efforts to slow it down.

The United States is also in full-on damage control mode, trying to stem the incredible numbers of deaths due to opioids.  In 2012, there were 259 million prescriptions written for opioids — enough to give every American adult their own bottle of pills.  Since 2000, the overdose death rate in the U.S. has risen by 200 percent and there were nearly 19,000 opioid-related overdose deaths in 2014.  Two weeks ago, I sat in a room while Dr. Vivek Murthy, the new Surgeon General of the United States, told the assembled crowd that he was driven to make the opioid epidemic a top priority in his administration due to the devastation he’s seen in communities all across the country.

He told us the U.S. experiences an overdose death every 24 minutes and the life expectancy of white, male, middle class Americans is dropping.

The problems, as well as potential solutions, are incredibly complicated but I agree with Dr. Murthy when he says that curbing society’s exposure to opioids — particularly those that come from a prescription pad in a doctor’s office — is absolutely vital.  As he said:  “Physicians need to be retrained to think twice — or three or four times — before writing that first opioid prescription.”

It’s important to recognize that liberal prescribing of opioids is a very recent problem and, since the mid-1990s, can be linked to the message-crafting activities of the pharmaceutical industry which helped shape both patient perceptions of pain and influence how doctors thought about the safety of these drugs.  Doctors were increasingly encouraged — sometimes through industry-funded educational activities or by using textbooks on pain management paid for by the makers of opioids — to prescribe the drugs for a much wider population of patients experiencing pain.

If revising the messaging around opioids was a business-oriented strategy of the opioid makers, we cannot place the blame solely upon them. Some of that blame has to do with the co-dependent relationship between physician education and the drug industry, which funds a substantial portion of physician education in Canada.

Is this epidemic not dire enough to finally build the absolute firewall we need between physicians education and the pharmaceutical industry?

We need unbiased, safety-oriented messages around the appropriate use of opioids and knowledge of their wicked addiction potential.  We also need to remind ourselves, both patients and prescribers, that any incredibly powerful and effective drug can also be incredibly dangerous and destructive.

The focus to tackle the addiction problem has to be serious, multifaceted source control.  We need greater access to addiction treatment facilities, and methods to rescue people from the depths of addiction, certainly.  But we also need to curb society’s underlying dependence upon drug company money for doctor training.

Cassells_Alan_new high res-apr2012 5x7Alan Cassels is an expert advisor with EvidenceNetwork.ca and the author of the just-published, The Cochrane Collaboration: Medicine’s Best Kept Secret.

The Good, the Bad and the Unintended Consequences of an Expanded CPP

July 4, 2016 11:17 am
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By Robert L. Brown

Amazingly, eight of ten provincial finance ministers and the federal government have agreed to a modest increase in the Canada Pension Plan (CPP).  The two provinces who have not signed on are Manitoba, where the government is only four weeks old, and Quebec, which has chosen to allow itself the option of adopting a differing strategy.  Since there is already a separate Quebec Pension Plan (QPP), this should have a minimal impact — although it will complicate administrative records for employers with multi-provincial employee groups.

While the new, second tier CPP is modest, it will have some important impacts.  Some will be good, some will be bad, and many may be unexpected consequences.

The new CPP will be fully funded which means everyone pays for their own benefits in full with no debt passed to the next generation.  That’s good since it minimizes intergenerational transfers of wealth.  It also implies enhanced security to plan participants because future generations of participants are not relied upon.  Finally, full funding is consistent with the existing CPP legislation (from 1996).

But, it is also bad.  It means that full new benefits will not be available until at least 39 years after 2025 when the initial implementation of the CPP expansion is completed.  The larger fund (versus the base CPP) also means more volatility than if the plan were financed on a pay-as-you-go basis since investment returns, upon which fully funded plans are dependent, are more volatile year to year than demographic variables like fertility, mortality and migration upon which pay-as-you-go plans depend.

The new CPP will be pan Canadian except for Quebec.  This is good as it will be a large enough plan to invest in alternative assets such as infrastructure and private equity.  It should result in low management expenses.  And the plan can collectively carry the longevity risk and pay out lifetime benefits which is a huge advantage.

But it is also bad.  A plan this large will accrue around $1 trillion in assets.  Where can one invest $1 trillion today in a prudent fashion that will still earn high returns?

But it is also bad.  A plan this large will accrue around $1 trillion in assets.  Where can one invest $1 trillion today in a prudent fashion that will still earn high returns?

But it could be bad.  Will participants understand that the new tier does not bring guaranteed benefits?  What will happen when you have to freeze or even reduce benefits or increase contributions?  Is this politically feasible?

The new CPP may also bring some surprising consequences.  Some will be good.  Obviously for a worker with no pension or a very weak pension, that person now gets a new tier of (modest) benefits.  Smaller plans may be well advised to close and effectively move their workers into the more effective and efficient new CPP.

But there are remaining concerns.  How many small plans will respond by just closing?  Many of these plans are well administered and we should not create incentives for them to terminate.  Many workers will now be forced to pay a second tier of contributions, but when benefits are paid, will lose a significant portion of their Guaranteed Income Supplement and other welfare benefits.

Even with a new Working Income Tax Benefit, is that fair?  Have we targeted the correct audience with this reform?  The new plan could discourage private savings — not the hoped-for result.  And it could stifle private sector innovation.  Again, an unintended consequence with negative impacts.

Is this “one size fits all” solution the best we can do?  Unfortunately, we may not really know the answer for decades to come.  Obviously, there is room for more discussion and debate. This story is not over as yet.

Robert L. Brown is an expert advisor with EvidenceNetwork.ca and a Fellow with the Canadian Institute of Actuaries. He was Professor of Actuarial Science at the University of Waterloo for 39 years and a past president of the Canadian Institute of Actuaries. 

Ontario Offers Free Legal Advice for Survivors of Sexual Assault

June 30, 2016 3:44 pm
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One in three women and one in six men experience some form of sexual assault in their lives. Knowing that this is a struggle many Canadians endure, the Ontario government has come up with a way to help survivors take their first steps forward in the aftermath of assault. Ontario is piloting a new program that will give survivors access to free legal advice, regardless of how much time has passed since the incident.

Starting June 28, sexual assault survivors living in Ottawa, Toronto and Thunder Bay will be able to receive up to four hours of free confidential advice from a lawyer, which can be provided over the phone or in person.

Tracy MacCharles, the Minister responsible for Women’s Issues, says that the government understands that navigating the justice system can sometimes be difficult for those who have been involved in a sexual assault, especially at the beginning.

“Providing free legal advice helps them know their rights and provides critical support in their pursuit of justice,” said MacCharles.

All survivors can access the program by filling out and submitting a voucher request form. Women living in Toronto also have the option to access the program directly through the Barbra Schlifer Commemorative Clinic.

Helping ensure survivors of sexual assault are informed and supported is part of It’s Never Okay – Ontario’s Action Plan to Stop Sexual Violence and Harassment. The plan is meant to help change attitudes, improve supports for survivors and make workplaces and campuses safer and more responsive to complaints about sexual violence and harassment.

“Sexual assault survivors need to know they have choices and they have power,” said Yasir Naqvi, Ontario’s Attorney General. “Providing them with information on support services that are available is only one piece. Offering them free legal advice is key to helping them make decisions about what is best for them as they move forward,”

The pilot is expected to run until March 2018. During that time, the province will assess the effectiveness of the program and determine its next steps.

These legal services are available to both women and men 16 and up whose assault occurred in Ontario. These survivors will have a choice within a roster of lawyers who can provide them with legal council, but not further represent them in court, although they can refer them to another lawyer who can represent them in court.


Any survivors of sexual assault in any of the pilot sites can get information about the program in multiple languages through the toll-free, 24/7 phone line: 1-855-226-3904.

 

Ombudsman Calls For Less Force in Police Training

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Paul Dubé, Ontario’s ombudsman, opened his press conference yesterday by stating that the way police are trained to handle the mentally ill and people in crisis should no longer be a matter of academic debate; rather it is quite literally a matter of life and death.

A Matter of Life and Death is the title of the Ombudsman’s latest report, which was sparked three years ago by the fatal police shooting of Sammy Yatim.

Yatim, 18, was on a streetcar late at night in Toronto holding a knife, brandishing it erratically, apparently mentally unstable. While confronting the lone Yatim on the streetcar with several other officers, Toronto Police Const. James Forcillo shot Yatim nine times after telling him to drop his weapon. Forcillo was eventually charged with second-degree murder and attempted murder, and convicted of the latter.

Public outcry was loud and fierce, especially since the incident was caught on videotape. This event, and similar fatal police shootings of mentally ill people have lead to an overall investigation of Ontario’s police training policies. According to the report, these policies need an outright overhaul. 

“When facing a person armed with a knife, they are taught to pull their guns and loudly command the person to drop it. Although that tactic might prove effective with rational people, a person waving a weapon at armed police is irrational by definition. Too often, the command only escalates the situation. It can exacerbate the mental state of a person who is already irrational and in a state of crisis. And once police have drawn their guns, using them is often the only tactic they have left.”

That’s an excerpt from the Dubé’s report. It goes on to discuss that Ontario police training is heavily weighted towards use of force, which in turn means gun use, instead of relying on de-escalation techniques. The Ombudsman suggests that in the right circumstances, de-escalation could save the lives of the people the police are trying to detain.

According to the report, there have been more than 40 fatal police shootings involving people with mental illness since 2000. They blame this on poor and imbalanced training, saying that Ontario police get just 12 weeks of basic training, which is less than any other province in the country. Within this training, the officers only go through five 90-minute sessions of de-escalation training.

They then have a pass/fail test that is mostly about using force rather than their de-escalation techniques. Police must also undergo annual requalification in firearm and baton training, but that there is no such refresher on de-escalation. That means that throughout a police officer’s career, which could last decades, the Ministry of Community Safety and Correctional Services only delivers seven and a half hours of training in de-escalation.

The report also mentions police culture as a major fault in this issue, stating that in some circles, the idea of fatally shooting those with a mental illness is inevitable. The ombudsman stressed that it was not police they were critiquing, but the government’s training of police.

The report lays out 22 recommendations for how to improve police training; here are a few examples:

  • The Ministry of Community Safety and Correctional Services should institute a new use of force model that is easy to understand and clearly identifies de-escalation options, rather than just use of force options.
  • The Ministry of Community Safety and Correctional Services should offer more guidance for recruits and in-service officers on the use of the police challenge, including when the police challenge has not been successful in de-escalating a situation and when, so long as safety and tactical considerations permit, to use de-escalation techniques. This guidance should be incorporated into a de-escalation regulation.
  • The Ministry of Community Safety and Correctional Services should use the expanded Ontario Police College curriculum to offer more training on mental illness, and strategies to de-escalate situations involving persons in crisis.

Not only does the report offer recommendations, it emphasizes the human toll of the type of police training that values force over de-escalation and management of the situation. The report has in depth accounts of the deaths of each of the following: Lester Donaldson – Toronto, 1988; Edmond Yu – Toronto, 1997; Otto Vass – Toronto, 2000; O’Brien Christopher-Reid – Toronto, 2004; Byron Richard Debassige – Toronto, 2008; Douglas Minty and Levi Schaeffer – OPP, 2009; Aron Firman – OPP, 2010; Evan Jones – Brantford, 2010; Steven Mesic – Hamilton, 2013; Michael Eligon, Jr. – Toronto, 2012.

Each one of these victims was either noticeably mentally ill or at a time in crisis. None were wielding a gun, and they all died due to police shooting.

The new minister of community and safety David Orazietti told the press that he was absolutely committed to having de-escalation written into the reevaluation of the Police Services Act, the legislation that manages police in Ontario.

“I recognize that things need to change,” Orazietti said.

But as the ombudsman report states, there has been a lot of talk, a lot of study, and not enough action, maybe this will be the year that that begins to change.

People Need Less Money to Live As They Get Older? If Only.

June 29, 2016 10:15 am
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Pension plans for teachers, hospital workers and public servants target of study hype

By Michael Wolfson

Last week the C.D. Howe Institute released a short study just in time for the finance ministers’ meeting – rolling out the tired, old argument that as people age, they do not need as much money to live as when they were younger.  If only retirement were so easy.

The study focuses on public servants’ pension plans in particular – including those of teachers and hospital workers — arguing that indexing them to inflation is too generous.  But at the same time the study acknowledges that the broad public system – including the Guaranteed Income Supplement, the Old Age Security pension, and the Canada (and Quebec) Pension Plans —   appropriately provide benefits which are fully indexed for inflation because they offer incomes to fund basic necessities.

So why the double standard on indexing for public system pensions but not public servants’ pensions — and all workplace pensions for that matter?

First let’s look at the old chestnut that as we age, we don’t need as much money. The study gives an image of Canadians’ inexorable decline into frailty, especially after we reach age 75.  They stress that we need to do our vacation travel while we still have our health, because after age 75, we’ll be too disabled to travel or even to go to the movies or dine out.  As a result, the study concludes, public sector workers can safely cut their pension contributions significantly by scaling back their plans’ inflation protection.

This image is wrong from both a health and social perspective, and in terms of its economic analysis.

Of course, as we age, we’re more likely to have a disabling condition.  But the simple fact is that  more than half  of Canadians age 65, 75, and even 85, are not so disabled that they do not need a decent income.  As we hear increasingly, “60 is the new 50,” and so on up the age scale.

Also, expectations for individuals to pay for health and social care are increasing.  Hospitals, doctors and drugs in most of Canada are covered by public health programs.  But a substantial portion of health and social care costs are not covered, and depending on how much provincial governments cover the growing needs for home care and assisted living, these costs may increase significantly over coming decades.

There is broad agreement that most Canadians, given the choice, would rather live at home and not in an institution as they age – that costs money.  Many would be able to age in place if they could have assistance with housekeeping and shopping, for example.  But such assistance can be a substantial draw on post-retirement incomes.

Disappointingly, the study makes little or no reference to these realities.  And the only Canadian data it shows are copied from a highly criticized McKinsey study (which fails the basic scientific canons of openness and replicability), in turn drawing on old (and sadly discontinued) Statistics Canada data up to only 2008.

So what did the C.D. Howe study conclude from these Canadian data?

They show the average levels of inflation-adjusted consumption from age 54 to 77 for those with “middle” incomes declining by almost 50 percent. Seems pretty clear, right?

Except the figures fail to take account of household size.  That’s quite an oversight.

Consumption at age 54 is typically for households with two or three or more members, while at age 77, these are households with only one or two members – a major difference.  If the study had shown consumption per capita (as noted in a footnote), there would be no such dramatic decline.

If we look at these same C.D. Howe/McKinsey results, but this time comparing inflation-adjusted consumption levels of 65 (not 54) year olds to 77 year olds, the decline is only about 10 percent – not the kind of dramatic drop that would support a frontal attack on inflation indexing of public servants’ pension plans.

Furthermore, the decline in real consumption from age 54 to age 65 is driven not only by declines in household size, but also by people withdrawing from paid work, and the general inadequacy of Canada’s retirement income system to replace their incomes from work with decent pensions.

What we really need – instead of such worn out arguments against  inflation protection based on poor evidence – is a reasoned and evidence-based public discussion of the consumption needs of Canadian seniors, both now and projected for coming decades.

Before we can sensibly discuss a wide range of pension policy questions, we’d better have facts based on sound analysis.  Unfortunately, the C.D. Howe study misses the mark.

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Michael Wolfson is an expert advisor with EvidenceNetwork.ca and Professor, Ottawa Centre for Health Law, Policy and Ethics.  He holds a Canada Research Chair in population health modeling/populomics at the University of Ottawa. He is a former assistant chief statistician at Statistics Canada, and has a PhD in economics from Cambridge.

BREXIT – The Economics

June 27, 2016 2:48 pm
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“Britain’s exit from the European Union is of less significance than the economists have contemplated” at least to the UK.

The economic pundits, always in sync with the status quo have hopped on a new bandwagon!  They shout “The evil English have separated from the EU and they will be punished.”  Punished for what and by whom?  Though the driving force propelling Brexit sadly seems to have been racial migration, perhaps the underlying economic need for exit makes Brexit an essential, if not communal action.  Putting it simply, the EU, its banking, its sovereign capabilities, and its sustainability is in serious trouble.  Yes, most of the world’s banking and reasonable governance is at risk, but none so great as the EU, and none are so dangerous to the rest of the world.  England cannot continue to afford being one of the pegs in the crutch of the Eurozone kicking the can down the road until the fall into oblivion.  (See “China? Oil Prices? Saudi Arabia? Iran? Why Volatility? The Grand Surprise Part Two” January 12, 2016 European section).  It is clear that the longer the can gets kicked down the road the greater the disaster for the Eurozone and its influence on the world’s economy.  It mostly cleaned up its act to be a supportive party to EU foolishness.  Should, in the hope that the EU remain intact, as unlikely as that appears, will the UK suffer in its economic future?  Yes — but that damage will be a small dollop compared to its suffering had it voted “REMAIN.”

A few details (speculative) of the future UK – EU relationship

Lets start with Banking.  As almost every banking institution in mainland Europe is technically insolvent, it is unlikely there will be a massive pull out of banking from the largest infrastructured banking community in the world, London.  It would also accelerate the EU banking death spiral to exclude the British based banks from doing business in Europe.  Would a major banking organization move from London to Paris?  Unimaginable to me.

Switzerland?  After the drubbing the Swiss banks received and continue to receive from governments around the world the hospitality towards American and British institutions would be limited at most, and more likely non-existent.

Frankfurt, Germany.  It is not a great likelihood the US and UK banking establishment will put its future in the hands of the Germans – not to mention English speakers lack enthusiasm in both their lives and businesses to speak other languages.  There are no other even remote possibilities for banking to move.  Banking will stay.  Whether it will flourish is another matter but not one to do with Brexit.

Trading with the EU

It is unlikely the EU will inhibit its trading with the UK as the UK buys €77 billion more goods from the EU than it sells; the EU has trade surplus.  From Germany alone the UK buys €89 billion of goods while selling only €38 billion.  The importance of UK/EU trade to the EU cannot be over emphasized and will not be inhibited.

Borders and employment rules will not be severely impaired.  The UK employs more than 2.0 million non-UK EU nationals.  The likelihood that the EU would spitefully cut off free movement of labor between the two zones is analogous to “cutting of its nose to spite its face.”

The list goes on and on but, simply put, the UK will continuously benefit from being out of the yoke of a failing EU while losing little ground in the relationships should it so choose.  My fear is only the acceleration and exacerbation of the EU’s demise, certainly an issue arising out of Brexit.

SOS Children’s Villages’ Response to the Refugee Crisis

June 21, 2016 11:56 am
Photo Curtesy of Mr. Joris Lugtigheid. A Child refugee trying to keep up with his parents at the border line between Macedonia and Serbia.

Submitted by Boyd McBride, President and CEO, SOS Children’s Villages Canada.

Today, we mark World Refugee Day. United, we stand to support refugees – those who must flee their home because of violence, war and natural disasters. There are over 60 million refugees in the world, over half of them are children, and this number unfortunately continues to rise. Child and youth refugees, especially those that have been separated from their families, need special protection, and have been a priority for SOS Children’s Villages in our key response efforts.

Below are just a few of the efforts SOS Children’s Villages undertakes to support refugees and their children:

Transitory Care and Emergency Response

SOS Children’s Villages has provided on-the-ground aid to refugees, internally displaced families and unaccompanied children in at least 14 countries since 2015. Four SOS mobile emergency response teams have helped thousands of refugees on the move, and SOS Children’s Villages has cared for over 1,100 unaccompanied or separated children in SOS Children’s Villages Interim Care Centres and SOS Children’s Villages. It is no easy feat, but our relationship with local partners enables us to act quickly and in coordination with others to help displaced families on their journey.

SOS Child Friendly Spaces (CFS)

SOS Children’s Villages has offered a safe and protected environment to thousands of displaced children at 13 SOS Child Friendly Spaces. These spaces provide children with structured activities that are carried out in a safe, child friendly, inclusive and stimulating environment, designed to provide a sense of security for the children, and help them cope with what they have experienced during the crisis. Children are provided with informal education, psychological care as well as recreational activities such as storytelling and art workshops. This care is immensely valuable and allows children a safe haven from an often very turbulent reality.

Helping Refugees Reconnect

At six SOS ICT Corners, SOS Children’s Villages has helped hundreds of thousands of refugees and aid workers connect through internet services, phone charging opportunities, and other information and communication services.  Often, the ability to connect with family either at home or their final destination can be a needed and empowering motivator for refugees on their journey.

Partnerships for Social Innovation

Through corporate partnership, SOS Children’s Villages has contributed to innovative solutions to improve humanitarian emergency response.

SOS Children’s Villages International and the University of Salzburg are collaborating on a project that uses satellite imagery and geo-technology to enhance aid organisations’ abilities to respond to emergencies, by providing key information such as the locations of roads and water sources.

SOS Children’s Villages has also contributed to the development of a crowd-sourced emergency response application, called ‘Eden’, from Erste Group, that will enable refugees, NGOs and volunteers to share up-to-date and local information to respond to human needs.

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Photo curtesy of Ms. Katerina Ilievska. Two children trying to keep warm at the refugee transit centre Tabanovce, Macedonia

Tackling Longer-Term Needs of Refugees

Despite the overwhelming number of people currently displaced, SOS Children’s Villages has seen a decline in the number of refugees arriving at transit facilities. The growing need is to provide longer-term services at camps along the Balkan route from Greece to Central Europe, where many refugees currently remain. In response, SOS Children’s Villages Macedonia is expanding its Child Friendly Space (CFS) to help refugees living at the Tabanovce transit centre, where hundreds of people have taken shelter since national borders were closed to new migrants earlier this year.

Throughout the world, SOS Children’s Villages has pledged to protect the rights of children; to provide practical support for vulnerable families displaced from their homes; to form partnerships lending our expertise in child care to government agencies and other non-governmental organisations; and, when required, to deliver alternative care for unaccompanied and separated children.

SOS Children’s Villages is there to speak up on behalf of children, provide a platform for young people to express their opinions, and call on authorities to redouble efforts to find long-term solutions to ensure that families can stay together and that refugee and migrant children are not deprived of their childhood.

Call to Action

To learn more about what SOS Children’s Villages is doing to respond to the refugee crisis, and to contribute to our efforts, click here.

About SOS Children’s Villages Canada

SOS Children’s Villages works in more than 130 countries to support families and help children at risk grow up in a loving home. In a world filled with poverty, violence, and injustice, the greatest victims are often children. For more than 65 years, we have worked with partners in each community to either help families care for their children or to provide an alternative, for instance an SOS family, in which the love of a carer is essential. Everything we do is based on the best interests of the child, and each has an individual development plan. We focus on the care, health, education and general development of each individual.

Personalized Medicine for Child Health is a Distraction

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Genetics will save the day – at least that’s the message you see pretty much everywhere in the media, and sometimes even in the academic literature.  Newspaper articles herald “breakthroughs” in finding genetic biomarkers for autism. Magazine headlines trumpet finding a biomarker for Attention Deficit/Hyperactivity Disorder (ADHD). We read in the grocery line that a gene linked to depression has also been found!

These are serious conditions, so of course parents and public health officials alike are enthusiastic about the potential of finding genetic causes. The same articles that hype the discoveries also calmly assure us that once genetic biomarkers are identified, gene therapies will solve all our problems.  Genetic discovery will lead to personalized medicine and we will all be winners.

Unfortunately, the reality is much more complex. While understanding how genes influence behaviour and development is important, evidence now suggests that genetic influence in many developmental disorders is not as significant as first imagined.

We are a long way off from identifying definitive biomarkers and personalized gene therapies are likely generations away. The hype is big, but our hope is misplaced.

Autism is an excellent example. It’s true that when one identical twin has autism, the chances of the second twin also having autism are increased (though not a certainty), showing a genetic connection. However, geneticists have not been able to identify a “smoking gun” single gene for autism, but rather have found many genes, each exerting its own small effect in a complex polygenetic interplay.

The truth is, even when specific genes are implicated, personalized gene-therapies addressing multiple genes are not very likely.  So why is this focus on genetics problematic?

The focus on biomarkers and the potential of gene therapies may have distracted us from using and expanding services and supports that show promise or already work for many children.

Numerous studies show that children with autism improve with intensive social-focused treatments such as speech, behavioural and occupational therapies. For decades evidence has been accumulating about how supporting parents and providing interventions to enrich children’s educational environments can dramatically help improve developmental outcomes.

Similarly there is solid and growing evidence for psychological and social interventions, along with family supports for addressing ADHD, with solid outcomes.

We do not mean to imply that there is no genetic component to the developmental hurdles children with autism or ADHD face.  But waiting until we understand the genetic underpinnings – or funneling essential funds into genetic discovery — distracts us from investing in ordinary community strategies that can help these children and their families be successful today.

Let’s take depression as another example.  We know that people who carry certain genes related to depression (short alleles of the serotonin transporter gene) are more likely to be depressed as teenagers and adults when they were also raised in difficult conditions, such as experiencing neglect or abuse as children.

On the other hand, others with those same genotypes thrive as teenagers and adults when they had optimal early environments. This speaks to the important role of positive social conditions for these specific gene variants. On the surface, genotype seems to matter, but only under poor early environmental conditions.

So, rather than assessing children for their genotype in order to identify children at risk for this specific cause of depression, we could benefit all children, including those at risk by ensuring that all young families and communities are adequately supported to provide their children with the best start in life.

In this example, the evidence is clear.  Many family and community supports such as early intervention, income support, group prenatal and parenting programs, perinatal home visiting and high quality educational child care could protect children and youth from potential serious behavioral and emotional problems, regardless of their genotype.

Related: Putting Children’s Health and Resiliency on the National Agenda.

So in a range of issues such as autism, ADHD and depression – all with long track records of distinct evidence-based social and community interventions – genetic discoveries are interesting, certainly, and worth pursuing, of course, but do not provide the help that is needed today.

Let’s save the hype for what helps families now.  Let’s invest in evidence-based therapies and social and community supports so that families get the help they need now.

Children facing developmental challenges and hurdles can’t wait for a sensationalized personalized genetic future.  They need early childhood education and classroom supports, one-on-one therapy, parenting supports and income supports to keep the family out of poverty.  In other words, tried and true social and community-based treatments that don’t need to be discovered because the research is already there – and they work.

Nicole Letourneau is an expert advisor with EvidenceNetwork.ca, and the author of Scientific Parenting.

Suzanne Tough is an Alberta Innovates Health Scholar.  Both are professors at the University of Calgary’s Owerko Centre focused on children’s neurodevelopment.

Reforming Healthcare Funding to Address the Needs of Our Aging Population

June 20, 2016 10:39 am
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Why we need a publicly funded insurance program for home care and long-term care

By Réjean Hébert

Funding home care and long-term care is fast becoming the main challenge of our outdated medicare system – a system developed in the mid-twentieth century for a young population that mostly required acute care from hospitals and physicians.  But that need is changing rapidly with our aging population.

The Canada Health Act states that all “medically necessary” services should be covered by public funding.  The chronic diseases of today’s aging population render the existing definition of medicare coverage obsolete.  Our health system routinely fails to address the complex needs of seniors.

Let’s face it: Canadian baby boomers are getting older and many will soon require home care and long-term care.  We need important reforms now to fund the health care system that they will need in the all too near future.

The perverse effects of our current system of health funding result in the use of costly resources from hospitals and other institutions to respond to disabilities and chronic conditions instead of using more cost-effective home care services.  In the current funding paradigm, which prioritizes hospital and acute care, it is unrealistic to expect that home care will be prioritized.

It is equally unrealistic to believe the elderly will have the fundamental freedom to choose their living environment or care providers without basic reforms in how the health system is financed.

As it stands now, many older Canadians in most provinces have to endure the tyranny of public institutions which decide the level of home care services provided, the limits of any home care provided and even the time a senior should leave their home for long-term care and where they should move to. This is unacceptable.

After a long career of research in health services for older people, I became Minister of Health and Social Services in 2012 in the minority government of Pauline Marois. In a recently published article in HealthCarePapers, I outline how one of my top priorities was to implement an Autonomy Insurance (AI) plan. It was an attempt to introduce publically-funded long-term care insurance, which includes home care coverage, in the healthcare system.

Similar funding systems have been introduced with success in many European and Asian countries, such as Germany, France, Japan and South Korea.  The design of the AI plan was based on the assessed needs of the elderly and those with disabilities, using a disability scale. Under the proposed plan, the benefit would fund public institutions or purchase services from private providers. Case managers, already in place in Québec as part of the integrated service delivery system, would be responsible for performing assessments and helping users and their families plan services and decide how to best use the AI benefit.

The funding of the AI plan was based on general tax revenues without any capitalized funding (“pay-as-you-go”), under a separate protected budget program. Cost projections were made; although requiring additional budget increase, the AI would be affordable and less expensive than the status quo.  All the legal, administrative, funding, training and contractual issues were dealt with, in anticipation of the plan’s implementation in April 2015.

Bill 67, creating the AI plan, was introduced in the National Assembly of Québec in December 2013. Unfortunately, the minority government of the day was defeated in April 2014 and the Bill died on the legislative agenda.

Bill 67 demonstrated that a long-term care insurance plan is feasible within our universal tax-funded healthcare system. While Bill 67 was stillborn due to political circumstances, its underlying concept still has merit today.

Clearly, our hospital and physician centered healthcare funding model is not appropriate for our aging population. A different approach must be taken to ensure that home care and long-term care is funded appropriately.

An insurance plan like the one conceived by Québec should be implemented by the provinces.

Should it be a federal program?

It is technically feasible for the Government of Canada to put forward a long-term care program and partially fund it, as was done in the 1960s for the health insurance system at that time. This would be a major step to improving healthcare in this country and a judicious use of federal health transfer payments in the coming years.

Politically, however, is the federal government ready to negotiate with the provinces on an issue that has historically been a political minefield?  To improve an antiquated healthcare system, ensure its long-term sustainability and responsiveness to the needs of older Canadians, it is worth trying to get a consensus around this issue.

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Réjean Hébert is a geriatrician and gerontologist and advisor with EvidenceNetwork.ca.  He is also Professor at the School of Public Health, Université de Montréal; former Scientific Director of the Institute of Aging and former Minister of Health and Social Services in Quebec 2012-14.

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