Budget Day 2016

March 24, 2016 3:48 pm
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Ever wish you were a journalist working on Parliament Hill? In the slideshow below, celebrated photographer Jean-Marc Carisse captures the excitement of Budget Day 2016.

Assisted Suicide for Those With Mental Illness is a Risky Proposition

March 15, 2016 12:48 pm
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Who but those who have experienced it can appreciate the soul crushing anguish of mental illness? Afflictions of the mind can be paralyzing and fundamentally change the way we perceive ourselves (I am worthless), anticipate the future (my prospects are hopeless), and experience the world (life is unfair and unforgiving). The combination of self-loathing, hopelessness and despair can tragically lead to suicide.

Parliament’s Special Joint Committee on Physician-Assisted Death, nevertheless, urged the federal government not to exclude individuals with psychiatric conditions from being considered eligible. Their reasoning comes down to this: mental suffering is no less profound than physical suffering, so denying individuals with mental illness access to physician hastened death would be discriminatory and a violation of their Charter rights.

People with mental illness are no strangers to discrimination. Two-thirds suffer in silence for fear of rejection and mistreatment. Only one in five children who need mental health services receive them, either because of concerns they will be stigmatized or supports are simply not available. Doors are constantly being closed on the mentally ill, denying them of stable employment, social opportunities, secure food and housing; and sometimes fundamental protections under our criminal justice system. They are marginalized, victimized and vilified.

Mental illness is one of the best predictors, more so than poverty, of inequitable access to healthcare in Canada. People with severe mental illness die about 25 years earlier than adults in the general population.

Making a fairness argument for the availability of physician-hastened death for a group of people treated so unfairly seems a cruel irony. In Oregon, having a psychiatric condition does not preclude eligibility for physician-assisted suicide. However, that condition must not impair the patient’s capacity to give consent and must, as in every other eligible case, occur alongside a medical condition with a prognosis of less than six months. Experts I met involved in Oregon’s Death With Dignity Act, in place 17 years now, could not fathom the idea of providing assisted suicide purely on the basis of non-terminal psychiatric disorders.

In the Netherlands, Belgium and Luxembourg, psychological suffering stemming from either a physical or mental condition is considered a valid legal basis for physician-hastened death. They account for a small but growing minority of death-hastening cases. Last month, a critically important study was published in the journal JAMA Psychiatry by American psychiatrist, Scott Kim.

Kim and his team reviewed 66 case summaries, published online by the Dutch regional euthanasia review committee between 2011-14, of people who had received either euthanasia or assisted suicide for psychiatric reasons. The majority were women, with issues including depression, psychosis, post-traumatic stress disorder, anxiety and substance abuse; some also had various forms of cognitive impairment (e.g. intellectual disability, early dementia) and autism. Most had personality disorders and were described as socially isolated and lonely. In one quarter of instances, despite differences of opinion between physicians, death hastening proceeded. In about one third of cases initially refused, most were carried out by new physicians willing to comply.

The parliamentary committee position seems premised on the recognition that physical suffering and mental suffering can be equally devastating. That does not mean, however, they can be approached the same. The nature of mental illness often leads people to see themselves as worthless, to believe that their situation is hopeless; and to perceive — often reflected through society’s judgemental gaze — that their lives have little value. But this context should help us see that a death hastening response is fraught with hazard; and runs counter to a recovery oriented practice advocated by the Mental Health Commission of Canada.

Like all Canadians, people with mental illness have rights that are protected under the constitution. And like all Canadians, these rights need to be balanced against the interests of a free and just society, wherein vulnerable persons must be protected. The most effective protections healthcare providers offer patients are built on the foundation of a caring and committed therapeutic relationship.

For patients whose illness tends towards self-destruction, and for patients whose suffering is rooted in social conditions like loneliness, a physician-assisted death option will crack that relational foundation. Current evidence shows that vulnerable persons will fall through that crack.

The committee, in its wisdom, expressed confidence that physicians would be able to figure this out. Hopefully, as lawmakers draft legislation in the days ahead, deeper wisdom will prevail.

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Dr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba and an expert advisor with EvidenceNetwork.ca. He holds the only Canada research chair in palliative care. He led an external panel, appointed by the federal government, looking at legislative options to Carter v. Canada.

When Labels Aren’t Just for Soup Cans & Rolodexes Just Aren’t Enough

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South Carolina is an American state whose reputation for political trench warfare precedes itself. Inside a crowded North Charleston auditorium as he stumped for his brother, Jeb, in South Carolina, former president George W. Bush reminded his audience that, while “There seems to be a lot of name calling going on but, I want to remind you what our good dad told me one time: labels are for soup cans.” However, when the polls closed, the results indicted that, contrary to former president George W. Bush’s words, labels weren’t just for soup cans.

As the 2016 Republican South Carolina primary ended, Jeb Bush had a less than stellar finish. In fact, he came in fourth place with approximately 7.8% of the vote. Donald Trump, the larger than life businessman and media personality, won the South Carolina primary by receiving a robust 32.5% of the vote. The two junior U.S. senators in the Republican race, Marco Rubio (from Florida) and Ted Cruz (from Texas) trailed Trump by 10% but had a photo finish between themselves for the race’s second and third place positions with Rubio ultimately winning 22.5% of the vote and Cruz winning 22.3%. In sum, even the former president’s eleventh hour return from the political abyss to campaign for his brother proved to be no more than an exercise in futility.

Republican Presidential Frontrunner Donald TrumpBy the end of that fateful evening, Jeb Bush threw in the proverbial presidential election campaign towel: he suspended his campaign. And thus the possibility of a third Bush moving into the White House in 2016 was no more. The ultimate establishment Republican presidential candidate lost to an opponent who — because of his inflammatory comments, boisterous behaviour and sparse policy details — is shaping up to be the ultimate Republican anti-establishment candidate.

As such, Trump wasted no time proving that labels weren’t just for soup cans in South Carolina. His long-standing labeling of Jeb as “low energy” proved itself to be a surprisingly effective tactical trope on the road to South Carolina. Effective indeed, especially since, as many cynical media critics aptly noted, Trump incorporated a triumphant escalator ride from the lobby of Trump Tower into the building’s atrium and food court, the site of his presidential announcement which occurred more than half a year in advance of South Carolina’s primary.

By the time that the Bush campaign realized that the Trump campaign wasn’t merely a political sideshow that could easily be dismissed as little more than the flavor of the week, it was too late. The Bush campaign created numerous electoral scenarios, but none predicted the visceral and systemic anti-establishment momentum that Trump’s campaign reflects. Even worse, Jeb Bush and his campaign failed to alter their strategies once it became clear that Donald Trump was morphing into a conservative populist juggernaut — albeit one whose rhetoric has largely been interpreted as initiating a state of civil war within the Republican party, stoking fears that his divisive campaigning could torpedo the prospects of the GOP winning the White House not just this November, but also for the foreseeable future.

Mary Matalin, a well-known senior Republican political insider, once said that “the maximum goal in professional politics is ‘No surprises.’” As was implied earlier, that mantra cannot be applied to the 2016 Republican primary race — both up to and then beyond South Carolina. But you would be hard-pressed to find tangible evidence that the Bush campaign playbook took note. In fact, the Bush campaign playbook appeared to be set in stone and, accordingly, was anything but agile. Therefore, when surprises on the campaign trail occurred, the Bush campaign was unable to counter its opponents’ messaging and lacked an action plan to get its own candidate’s message out to voters. Consequently, the Bush campaign broke what Matalin called “Cardinal rule 101 of politics: Never let the other side define you.”

MYRTLE BEACH, SC - FEBRUARY 11: Shadows are reflected on an American Flag as people line up to speak with Ohio Governor and Republican presidential candidate John Kasich at a restaurant in South Carolina following his second place showing in the New Hampshire primary on February 11, 2016 in Myrtle Beach South Carolina. Kasich, who is running as a moderate, is expected to face a difficult environment in South Carolina where conservative voters traditionally outnumber moderates. (Photo by Spencer Platt/Getty Images)

Photo by Spencer Platt/Getty Images.

To make matters worse for Jeb Bush, money didn’t talk. The Bush campaign ran the epitome of what many call an “insider” campaign fundraising strategy. Simply put, an insider campaign fundraising strategy can be classified as as a form of Rolodex fundraising in which fundraising is reliant upon connections and contacts and wherein the donations raised are raised in large increments. Front and center here are the so-called Super PACs which, in a nutshell, are recently developed fundraising committees that are legally entitled to raise and then spend unlimited sums of money accumulated from individuals, corporations, associations and unions to publicly promote (or dispute) political office seekers and incumbent officeholders. The catch is that these Super PACs can neither coordinate with the candidates they are advocating for or against, nor can they donate their funds to said candidates.

But for Jeb Bush’s campaign and the Jeb Bush friendly Super PACs, there was another catch: the approximately $150 million dollars they raised was largely in vain. Much of that money was spent on crafting and then disseminating political advertisements which simply fizzled. The labeling of Jeb Bush as “low energy” coupled with the fact that Jeb Bush’s campaign largely failed to alter its campaign tactics to effectively address the insurgent Trump campaign and the fundamental anti-establishment sentiment in this presidential election cycle ensured that, even before the South Carolina Republican primary signaled the death knell of the Bush campaign, the writing was already on the wall. In essence, the lesson learned from the failed 2016 Jeb Bush presidential campaign is this: when running for president, labels aren’t just for soup cans and Rolodexes just aren’t enough.

Young Women Lead the Way for Change

March 14, 2016 10:48 am
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On February 5th, one of the most iconic figures of the feminist movement, Gloria Steinem, insinuated that the young women who supported U.S. presidential candidate Bernie Sanders did so because they were ‘following the boys.’ This statement sparked a backlash and outraged many, especially young feminists. For many of them, Steinem is an inspiration; but this statement undermined their agency and their ability to think critically – no matter which candidate they prefer.

What this comment highlights is that contemporary feminisms value the intersectional analysis of oppressions. Young feminists will not vote for a woman just for the sake of her being a woman. They care about much more than gender and it is time for us to listen to them. They see feminist issues as inseparable from, and deeply intertwined with, racism, colonialism, classism, LGBTQ issues, poverty, ableism and all forms of oppression.

In fact, young women are at the frontlines of some of the most significant social movements of our time. From Idle No More, to Black Lives Matter, to the movements for reproductive justice and refugee rights, they are speaking out against all forms of social injustice and are taking centre stage. One can only recall the iconic image of Amanda Polchies in Elsipogtog holding a feather in the face of a line of riot police, in defence of her land. Or Widia Larivière and Melissa Mollen-Dupuis spearheading Idle No More Quebec.

Here at Girls Action Foundation, we just celebrated our 20th anniversary. For the last two decades we have worked nationally towards girls’ and young women’s empowerment. As an organization that keeps its ‘ear to the ground’ and is responsive to the needs of a network of over 300 grassroots organizations across the country, we can say with confidence that girls and young women still care to identify as feminists.  More importantly, we have learned in our work that we cannot empower young women without speaking of the multiple and interconnected realities they face.

As we commemorate the 100th anniversary of the women’s right to vote this year, and celebrate the women advocates who have come before us, let’s also celebrate the future of feminism today, led by young women. Let’s not assume young people know less, have experienced less, struggled less – instead let’s listen to them and find a way to leverage the strengths of all experiences and perspectives.

Let’s also use this milestone, as well as the broadening of feminism as understood and led by young women, to encourage the creation of more intergenerational spaces, where women of all generations can all learn from one another and work together.

Finally, let’s remember that this year the Canadian International Women’s Day theme is about women and girls’ empowerment. What better way to mark this day than celebrating young women’s power as change-makers!

Saman Ahsan 2Saman Ahsan is Executive Director of the Girls Action Foundation, a national charity helping to create the next generation of strong Canadian women, based in Montreal. 

 

 

 

 

 

Myriam photoMyriam Zaidi is the Girls Action Foundation Communications and National Network Coordinator. She is responsible for liaising with a network of more than 300 organizations that work with girls and young women across the country.

It’s Time for the Federal Government to Take a Leadership Role on Rising Obesity Rates

March 9, 2016 2:53 pm
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Ban advertising of unhealthy foods to kids, tax sugary drinks, revamp food guide, prohibit use of trans fats, among Senate report recommendations. 

Almost two thirds of adults in Canada are overweight or obese, according to Statistics Canada – a dramatic increase that has taken place over the last thirty plus years.  Unfortunately the increase in obesity rates has also affected our children.  Around 13 per cent of Canadian children between the ages of five and 17 are obese while 20 per cent are considered overweight.  These are dangerously high numbers.

Put another way, the number of obese adults has doubled and the number of obese children in Canada has tripled since 1980.

It’s cold comfort to find that Canada is not alone. All industrialized countries have much the same pattern of increasing obesity rates.  However, Canada is among those countries leading the pack, with some of the highest obesity rates among OECD countries, ranking fifth among 40 countries.

What are the consequences?

During the same time frame, we’ve witnessed an increase in the rates of several chronic conditions: diabetes, high blood pressure, heart disease, stroke, osteoarthritis and certain cancers.  Even though Canadians live longer than in previous generations, these conditions are resulting in more unhealthy years at the end of life, and put an increased demand on our publicly funded health care system.  Evidence says these conditions are responsible for between 48,000 and 66,000 deaths in Canada each year.

In addition to lives lost and quality of life reduced, obesity also has economic consequences.  An increased burden of ill health on overweight and obese Canadians results in a lower rate of employment, higher absenteeism rates and decreased on-the-job productivity.

So what’s the way forward?

This week, the Senate Committee for Social Affairs, Science and Technology, released its report, Obesity in Canada: A Whole-of-Society Approach for a Healthier Canada and put forward 21 concrete recommendations, informed by expert testimony from a wide range of disciplines.

Bottom line: It’s time for the federal government to take aggressive measures to help Canadians achieve and maintain healthy weights.

In exploring ways for Canada to move forward, the report notes that we can learn lessons from Canada’s anti-smoking strategy.  For starters, the anti-smoking strategy relied upon several different policies and approaches implemented by all levels of government.  The anti-smoking strategy also had to convey the body of scientific evidence on negative health consequences to all Canadians.  And those working on the anti-smoking strategy understood they not only had to change minds, but behaviour too — and that this change in behaviour would take time.  It was also necessary for the federal government to provide the leadership for a pan-Canadian approach.

With this model in mind, the Senate report calls on the federal government to create a “health in all policies” approach and implement a National Campaign to Combat Obesity with concrete goals, timelines and progress reports, and in partnership with the provinces and territories.

Specifically, the report recommends a number of pragmatic measures that could be implemented right away, including strict controls on the advertising of unhealthy food and beverages to children.  It’s also time for a new tax on sugar-sweetened as well as artificially-sweetened beverages – and a prohibition on the use of partially hydrogenated oils to minimize trans fat content in food.

The report also emphasizes the need to find ways to increase the affordability of healthy foods, including removing or reducing taxes on them and considering food subsidies. To address escalating obesity rates in our northern and aboriginal populations in particular, the report calls on the government to implement the recommendations made by the Auditor General to the Nutrition North campaign.

Experts also told the Senate Committee that the Canada Food Guide is woefully out of date and out of step with the most recent research, and so we recommend that the Minister of Health immediately undertake a complete revision of Canada’s food guide in order that it better reflect the current state of scientific evidence.

The report calls for strict limits on the use of permitted health claims and nutrient content claims on food packaging – so Canadians can make informed, evidence-based decisions. For the same reason, the report calls on the Minister to require nutrition labelling on menus in restaurants.

Perhaps most surprising in the report is the OECD assessment which found the cost of implementing a comprehensive package of measures to counter obesity in Canada would cost us only $33 per capita.  A reasonable cost for helping Canadians stay healthy.

There are many policy levers all levels of government can implement to help Canadians make healthier lifestyle and nutrition choices – these are just a few.  Now it’s time the federal government helped coordinate the plan to make it all happen.
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Article By Senator Kelvin Ogilvie and Senator Art Eggleton

Kelvin K. Ogilvie and Art Eggleton are respectively the Chair and Deputy Chair of the Senate Standing Committee on Social Affairs, Science and Technology.

K&A: Our Perspective on Budget 2016

March 7, 2016 12:30 pm
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Kathleen Wynne (right) announced the new Ontario budget late February. Photo by Jason Hargrove under Creative Commons license.

As our client base continues to grow so too does their demand for objective insight into events like Budgets. This analysis of Ontario’s Budget 2016 and post discussion strives to provide an objective perspective on Budget 2016 complete with post Budget impact and chatter — with no partisan spin!

“We cannot simply trust that those fair economic winds will stay with us”  (Hon. Charles Sousa, Budget Address 2016, Queen’s Park)

Playing the Long Game

There was a time when government Budgets were big events. Lots of people in the gallery at the Legislature, lots of media attention before and after, the cool factor of being in a Budget lock-up to get “first-hand” analysis from government types who were “au fait” on the Budget and its process and, days and days of analysis and other contrived events to sell the document was usually the order of the day.

In the years since Kathleen Wynne was appointed Premier and subsequently elected as government, she and her solid majority government have, for all intents and purposes, subscribed to a low key Budget management program. That means, sticking to their mantra that they “have a mandate to spend and manage the public’s money” – the best they know how. It’s their modus operandi, in effect, to make events like their annual Budget Bills appear like low-key affairs. In fact, Budget non-events appear en vogue for all governments across Canada.

Budgets, too, are all about winners and losers.

Budget 2016 is no exception. Here’s a snapshot:

  • Post Secondary students are big winners – viewers in the gallery could actually see the blood rush from Opposition Leader Patrick Brown’s face when the Minister of Finance announced that tuition would be free for low income families
  • Ontario citizens looking to save more for retirement – the government announced ORPP offering Ontarians an opportunity to save for their retirements with added kicker coming from the Ontario government,
  • Women and minority groups- with a pledge for monies to flow for aboriginal women’s issues and to create anti-racism strategies
  • Drivers – the government announced that it would axe the $30 Drive Clean tariff
  • Gamers and those who are looking to see OLG modernization and horse racing stabilize
  • Energy, environment and transit activists who have pushed and prodded for programs and plans to manage green house gas emissions (GHGs) and climate change
  • Hospitals – who get a boost in capital spending after getting nothing for years

From our vantage point some of the losers include:

  • Seniors with relatively good retirement nest eggs will pay more for their prescription medications
  • Commuters – about to get the proverbial “crap” beaten out of them on an increase in gasoline tax to almost 5 cents and the establishment of toll lanes on some of the 400 series highways
  • Home owners – will pay more – all in an effort to reduce GHGs and perhaps change behaviours toward less use of natural gas to heat their homes

The Budget Aftermath

We fully expected that the non-event would play out in the days after the Budget speech, but little did the Premier expect that her free tuition announcement and the subsequent accolades in public would get overshadowed by the fact that media seemed to demand more explanation as to Ontario’s massive debt. Ontario’s debt is larger than California’s, a state that has twice Ontario’s population. This fact seemingly turned a non-event Budget into a narrative that translates into a majority of Ontarians being unsupportive of it and by extension Ontario’s Liberal Government.

In fact, in the short week after the Budget and apparently as a result of further analysis by media and the public, polling suggests that almost two thirds of Ontarians do not support the Budget and, as a government, Premier Wynne’s Liberal Government are 17 points behind the almost invisible Conservative Patrick Brown, Leader of Her Majesty’s Loyal Opposition.

Budget Highlights

  • A plan for reducing Green House Gas emissions and climate control. The plan, governed by the Climate Change Mitigation and Low Carbon Economy Act, will be linked to the existing cap-and-trade systems in place in the province of Quebec and State of California under their recently ratified Western Climate Initiative. The Wynne government anticipates that its cap-and-trade scheme will cover a broad range of industries, which account for nearly 82 per cent of the province’s total GHG emissions. The scheme is expected to generate proceeds in excess of $1.8 billion through the sale of carbon allowances and is intended to do most of the heavy lifting necessary to enable the Ontario government to meet its greenhouse gas reduction obligations of 37% below 1990 levels by 2030.
  • Other infrastructure spending including transit funding and improvements for communities outside the GTA and an increase to other key infrastructure for the province will continue as a priority.
  • The Ontario Retirement Pension Plan – Ontarians will begin to participate in the scheme starting in 2017.
  • Another populist move – how about wine in grocery stores! Big win! Soured a bit by an announced increase in tax per bottle of beer and wine.
  • A $3.00 increase in tax on a carton of cigarettes.
  • A 4.2-cent increase in the price of gasoline.
  • Aboriginals, minorities, students wishing to attend university and hospitals were all mentioned in the context of spending promises in the Budget. To wit, $100 million would go to programs for indigenous women and to combat racism; post secondary education will be FREE for student from families whose average annual income is under $50,000 –grants will be available; hospitals will get a boost in capital spending to the tune of about $350 million in this fiscal year.
  • The province’s lottery and gaming corporation will continue to drive policy in the area of charity bingo adding more games and products – which is a boost to the industry. In turn, OLG will shore up its offering in Internet based gaming –boosting its presence to stave off grey market competition. At the same time, the OLG will integrate horse racing into its modernization strategy and funding will continue under the Premier’s promised transfer payment program, which will be extended for two more years. Beyond this land-based gaming contracts with private sector companies will continue.

What’s missing?

In our view, the government may come up short on its legacy. Let’s face it, the Budget is a non-event and the Opposition knows it – fighting it would only end in a tie. And in politics, like baseball a tie always goes to the runner! But the Premier and her Government appear so eager to establish a legacy for themselves through announcements in this Budget and it just appears elusive.

Case in point – the big announcement of Ontario’s Cap and Trade scheme is not something she can look to as a legacy for herself and her government. In fact, the Premier’s pronouncements about the province’s climate change solution are someone else’s legacy – namely California’s and Quebec’s – Ontario has merely signed on to it. Moreover, on this particular issue, what really appears to miss the mark is specifics about its Cap and Trade plan altogether. Some observers are tacit and muted in their concerns about the plan, quietly hoping they will get clarification as to where revenues from the “plan” would flow. Other observers cite mistrust of the program’s (moreover the Government’s) intent suggesting that the government may merely pass on the costs to the Ontario economy outright – meaning we all pay! If that’s the case, then, as some have questioned, why sign on to a Cap and Trade scheme? Or why support it at all? In fact, some have mused, the government would do better to engage all Ontarians in a climate change culture through the implementation of a carbon tax similar to British Columbia BC. The point is, that Ontarians themselves appear not to have a clear understanding of the Cap and Trade scheme and that knowledge delta might be a major contributor to the poor level of support enjoyed by the government for its Budget and ultimately the Government itself. But let’s save that discussion for the pundits and pollsters.

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In the new budget, attending post-secondary schools like Carleton University (pictured), would be free with those who have a household income below $50,000. Photo courtesy of Wikimedia Commons.

In the context of legacies, the Premier appears to be on a razor’s edge. She belongs to a Party that has held power in the province uninterrupted since 2003. She’s played a role in the legacy of the McGuinty Government from 2011 to 2013 – and it’s a good legacy too. One that has been earned by the closing of coal fired plants throughout the province; expansive investments in education; integration in healthcare leading to better outcomes for patients about which the province can rightfully brag and; sustained spending in roads and other infrastructure. But let’s face it too, this legacy may not be all good – there are many Ontarians who believe the gas plant, e-health, Ornge and other energy and gaming scandals still follow this current lot at Queen’s Park. While perhaps trying to distance herself from the McGuinty record by making the case that hers is a new government from 2012 onward, the distinction appears to be lost on Ontarians and that’s where support for the Wynne Liberal government appears to be on the wane.

Look, who’s kidding who? Astute political observers suggest that every government faces a mid-term drop in popular support. This time, though, we believe with the government now thirteen-years-old institutionalization may be taking hold and that’s a challenge. Couple this with the fact that Premier Wynne seems to be without the benefit of a tangible and appealing legacy, the government may be on a short leash going forward.

Couple this with the fact that the Opposition appears to be playing the long game – not blowing their gunpowder on the Budget when the public appears to be activist on it more. The best example we can highlight is the recent about face the Premier did on her Government’s Budget announcement that some seniors would pay more for prescriptions. Perhaps she listened to the public on the matter or perhaps was shown a media clip of a senior citizen in 1985 attacking then Prime Minister Brian Mulroney about his Budget item of de-indexing pensions. It turned quickly for him and so it appears the same for Premier Wynne in 2016.

The government’s energy strategy, too, seems to be its Achilles heel and we’ve commented on this time and again. It’s their toughest challenge and one that the public will not forgive them as electricity prices continue to rise.

Moreover, we believe the government just can’t mute the issue of the debt. The public has been condition for too long to think that deficits are bad – and this Government has done a great job reducing its deficit targets, in contrast though, it can’t seem to hide from the massive debt the province faces and that’s where the Opposition appear waiting to pounce – in the long term and well in advance of the 2018 election.

In the meantime, we continue to monitor the aftermath and the ensuing debate at Queen’s Park on the Budget and other issues in the days and weeks ahead and, as always, we’ll keep you apprised.

For more information on the Budget, please refer here.

For more information on K&A and how we can help you, please refer to our website. You can also find us on LinkedIn under Kealey & Associates and on Twitter using our tag @dmfk51

It’s Time to Test a Basic Income

March 1, 2016 9:50 am
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Recently I tabled a motion in the Senate calling on the government to create a pilot project that would test a basic income in Canada, also known as a guaranteed annual income. Canadians face immense challenges. Many families struggle to pay the rent, and some can’t afford their children’s school supplies or school trips. Many rely on donations at the food bank just to feed their families.

In numbers, one in seven Canadians lives in poverty. That equals to over five million people — including over one million children. And, there are an estimated 150,000 – 300,000 people homeless. Last year close to 900,000 Canadians used food banks every month, with over one third of those being children.

We also have increasing income and wealth inequality that is changing the core of our society. The Conference Board of Canada gave Canada a “C” grade for inequality, ranking us 12th out of 17 countries studied.

But why a basic income?

What we have done for far too long is simply not working. Even with all the social supports in place, the resulting income is often only enough to maintain a family in poverty. At their worst, existing policies and programs actually entrap people in poverty.

This is why we need a new way.

A basic income would work as a tax credit administered through the taxation system similar to the Guaranteed Income Supplement for seniors. If someone earns less or has less than the poverty line, they would simply be topped up to a point above the poverty line.

It would ensure that all Canadians would have an income that covers the basic necessities: clothing, food and decent shelter. It would provide a foundation that low-income people could then build upon for a better life.

A 2013 Environics poll found that this idea is supported by a majority of Canadians.

Interestingly, this support does not fall along party lines or political philosophy. People across the political spectrum support a basic income.

Conservative economist Milton Friedman was a proponent of basic income, as is former Conservative Senator Hugh Segal. On the other end, Green Party Leader Elizabeth May, Alberta NDP Finance Minister Joe Ceci and Quebec Liberal Minister of Employment and Social Solidarity, François Blais support the idea.

We also see communities across the country are on board. There are many other provincial, territorial and municipal leaders that have publically supported the adoption of a basic income or the adoption of pilot projects to that end. We also have organizations like the Canadian Medical Association that are calling for action on inequality.

Canadians have come to realize that there may be a lot of positives to this approach. A basic income is a simpler and more transparent approach to fighting poverty than our current patchwork of social programs. It would extend benefits to those who are currently not covered by social assistance programs, such as the working poor. And introducing a basic income could have a ‘stimulus’ effect by quickly injecting money into the economy.

In the 1970s, Canada piloted a basic income program known as ‘Mincome,’ in Manitoba, primarily in the town of Dauphin. Research done by Evelyn Forget from the University of Manitoba found that as a result “hospital visits dropped 8.5 per cent. Fewer people went to the hospital with work-related injuries and there were fewer emergency room visits from car accidents and domestic abuse. There were also far fewer mental health visits.”

What about employment? Research shows that only new mothers and teenagers worked less with a basic income. Mothers stayed home with their babies longer. Youth worked less but spent more time in school and graduated in higher numbers. Overall, labour force attachment remained strong.

Looking at these results, and other similar examples from around the world, Canada could see not only a great upsurge in the living conditions for our most vulnerable if a basic income were employed, but we could also realize a decrease in costs.

Poverty is costing us all (as much as $30 billion a year by one estimate) by slowing the economy, forcing up our tax bills, increasing health care costs and crime.

On the other hand, the now closed National Council of Welfare put the poverty gap in Canada at $12 billion in 2011.

If these numbers are correct, it’s obvious which one makes more economic sense.

But, let’s take this step-by-step. We need a pilot project that can provide new and robust Canadian data, that can determine how such a system would function in this day and age and that would make clear the benefits and costs.

A basic income is a different approach — a new path that has shown great potential. Let’s get the evidence. Let’s study this approach. If proven, we not only end poverty but we spend smarter, more efficiently and effectively.

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Art Eggleton is a Canadian Senator and former Mayor of Toronto and Member of Parliament.

Keeping Science Safe

February 25, 2016 11:46 am
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It’s time to close the gaps governing human participation in scientific research in Canada

The disturbing announcement recently that a man died and four others were seriously harmed in Rennes, France as a result of participation in a research study is a timely reminder of the importance of protecting those who volunteer to be subjects of research.  The drug being tested was thought to show promise in treating a variety of disorders including mood, anxiety and pain.  It was the first time this drug was given to people.

In 2014, we learned of the Facebook “Emotional Contagion” study in which, without their knowledge or consent, 690,000 subscribers’ newsfeeds, likely including the newsfeeds of youth and other vulnerable persons, were manipulated to see if their emotions, happy or sad, could be altered as a result.  They found out they indeed could manipulate subscribers’ emotions in this way.

The lesson we need to learn from these two seemingly disparate examples is that rules guiding the use of human subjects in science matter profoundly.  The Facebook study had no prior ethics review and the manipulation and lack of knowledge or consent by those enrolled violated ethical standards.  The Rennes study did have prior review by a French ethics committee, yet things still went very wrong.

The history of research, including research in Canada, shows that very serious harms may be suffered by persons taking part in research.  The rules are not perfect, and they continue to be refined when tragedies do occur, but prior review and oversight has proved a powerful corrective to make research safer for human subjects.

The problem is that these research protections don’t apply to everyone doing research on people in Canada — and they should.

In Canada, and most of the rest of the developed world, a consensus emerged during the 1970s through to the 90s, that a framework of binding rules was needed to protect research subjects.  This has led to the development of internationally recognized principles requiring that people in research trials be treated ethically – that is safely, and with protections for privacy, informed consent and vulnerable persons such as children.  These ethical standards also require prior review by an independent expert board – in Canada usually called a Research Ethics Board (REB) – to ensure that these vital protections are adhered to.

So what’s the concern?

In our country, key research regulations and guidelines have two sources.  First – the Tri-Council Policy Statement (TCPS) prescribes rules for research conducted at universities and large hospitals funded by the federal Granting Councils; and second – Health Canada and US FDA Regulations prescribe rules for new drug and medical device testing carried out primarily by pharmaceutical and biotechnology companies.

Remarkably, aside from these two categories of research, there is no legal requirement in Canada that any other human research undergo this or any other scrutiny.  Such a critical gap in Canada’s research rules for human subjects must be addressed.

For example, there is no requirement that research undertaken by federal or provincial governments undergo such review and oversight to protect human subjects.  A few individual federal government agencies have acted voluntarily to have their research reviewed according to the TCPS: Health Canada, the Department of National Defense, and the National Research Council (I am its REB Chair).  These agencies do this job cheaply and with generally good results.

But all other federal government departments and agencies, provincial governments and commercial and industrial companies (aside from those doing new drug and device research) have no rules requiring prior review to ensure they meet ethical standards.

This means that plenty of research with human subjects takes place every year in Canada without having to show that it is reasonably safe, that privacy is protected or that human subjects are treated fairly.

Doing high quality research on significant medical, scientific and social questions is of surpassing importance.  But research, particularly that involving human subjects, must be done ethically.

The Prime Minister and the Liberal Party made vigorous commitments to the twinned themes of science and integrity during the election campaign, and this priority has been echoed by many interests inside and outside the federal government.   As a start, the new government should act promptly to ensure that all federal government research takes place with mandatory ethics oversight to protect human subjects and urge others to follow.

Should we not provide ethical protections to everyone who gives of themselves to promote research for the good of us all – particularly when directed and funded by our own elected governments?  Let’s learn from past tragedies and help make sure they don’t keep happening.

Gordon DuVal is a Part-Time Professor at the Gordon DuvalUniversity of Ottawa Faculty of Law and a member of its Centre for Health Law, Policy and Ethics.

Albertans Must Get Inventive in Healthcare as Price of Oil Slides Further

February 9, 2016 10:45 am
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As world oil prices and the Canadian dollar slide perilously, Albertans must become more inventive and rigorous in managing our costs – and our expectations – especially in high-cost areas like infrastructure, education and health care.

Health care is the biggest challenge. We cannot turn off the population’s health care needs simply because provincial revenues are declining. Illness is oblivious to low commodity prices and market share.

Unless we become inventive, health service declines are inevitable. The temptation to reduce surgeries such as hip and knee replacements and cataract removal will be irresistible. The general public will notice these changes as increased wait times. In fact, we’ve already seen increases in wait times for hip and knee replacements in Alberta – one of the leading indicators of our health care system’s performance.

Yet hip and knee replacement is actually an area where we have inventive opportunities waiting to be tapped. “Gain sharing” is one such innovative approach.

Health care teams in hospitals around Alberta, supported by Alberta Bone and Joint Health Institute (ABJHI) and Alberta Health Services’ Bone and Joint Strategic Clinical Network, have for the past five years led efforts to improve the quality and efficiency of orthopaedic care. As a result, patients undergoing hip or knee replacement require fewer blood transfusions, are up and mobile sooner after surgery, have less pain and better physical outcomes, and are home from hospital sooner.

The savings in hospital beds freed up by patients returning home sooner and from blood transfusions have exceeded $40 million to date.

Allowing these health care teams to share in the gains they make by reallocating resources to more operating room time and more dedicated hospital beds to enable more surgeries would create a virtuous circle of improved performance and decreased wait times. It might also add an element of competitiveness as health care teams look to out-gain each other to the benefit of patients and the health system.

Alberta could further put some of the savings from this success into smart investments like an orthopaedic registry that would serve as a valuable storehouse of rich and current data on health care performance in critical areas of quality, such as recovery of joint function, pain reduction and implant safety.

Related: Can wait times for hip replacements in Canada be shortened? 

Alberta has made strides in collecting wait time data but there is no single registry in the province or anywhere else in Canada that collects the range of performance data needed to guide modern medical practice and service planning in orthopaedics. A storehouse of reliable information across a broad range of quality indicators would have positive effects on clinical decision-making and resource planning. The value to both patients and the health system would be enormous and the investment very modest.

One area of clinical decision-making that would have broad implications for patient satisfaction, economic savings and wait times is patient appropriateness for surgery. Patient feedback analyzed by ABJHI suggests that almost two in 10 knee replacement patients in Alberta derive little to no benefit from their surgery. A research team working in Alberta is now developing criteria to help surgeons and their patients assess the likelihood of benefit from knee replacement.

Applying such criteria could reduce wait times for those who need – and are likely to benefit from – the surgery with some of the savings produced used to enhance non-surgical treatments known to produce excellent outcomes.

There are silver linings in those dark economic clouds over Alberta. If we are resourceful and make evidence-based, intelligent decisions now, there is no doubt the province will be much better off when the sun shines again.

Ferguson-pell_MartinMartin Ferguson-Pell, Ph.D., is Executive Director of Alberta Bone and Joint Health Institute and a contributor to EvidenceNetwork.ca.

From Grievance to Growth

February 8, 2016 2:19 pm
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James Wilson argues that the Maori in New Zealand have created a system we should aspire to emulate.

How Indigenous-led business partnerships can lead the way.

Moving Manitoba’s Indigenous peoples from the liability to asset column was a topic that consumed some of Manitoba’s most innovative First Nations and mainstream business minds during recent a two-day ‘design-thinking boot camp.’

It was facilitated by Karl Wixon and Trevor Moeke, two Maori business leaders from New Zealand who, as part of a broad Indigenous-led partnership, have helped create and stoke a movement in their homeland that has transformed the role their people play in the island’s economy.

As directors of a treaty settlement trust, they have been part of a wealth creation plan that saw their initial settlement of $176 million in 1996 grow to an asset value of $1.3 Billion today.

More broadly speaking, the Maori are now responsible for 40 percent of the fishing industry; 36 percent of forestry; 30 percent of lamb production; 12 percent of sheep and beef, and 10 percent in each of the dairy and kiwi fruit sectors.  By any measure, it’s an astounding story of growth and success from an Indigenous group that represents just 10 percent of the New Zealand population.

It is the wide open, collaborative “design thinking” process that has guided them through to the creation of industry-led strategies, not strategy-led industries in New Zealand.   At its heart, is the cumulative work that has been done to transform the country’s story, from one of conflict and discrimination, to one that celebrates and relies on its Indigenous character to help it build business opportunities abroad.

Fundamental to the shift towards wealth creation to support culture, language and environment was a shift from grievance to growth thinking.  From dispute and protest that pitted Maori vs. Government to mindset that allowed Maori to work with government.  In this move from grievance to growth, tradition and a strong connection to the land were not lost, they were enhanced.

In fact, Maori leaders are now creating 75 and 100 year business plans for sustainable fishing and forestry sectors. Managing valuable commodities like rock lobster (called crayfish in NZ) which are harvested by open water deep divers then shipped straight to Shanghai that night for consumption, requires a deft hand to protect the resource for future generations.

As Wixon says, “We still have our dust-ups with government, but that’s no longer what we are solely about.”

“Initially, we sent our youth out to become lawyers. A generation of hundreds of lawyers and they got in dust-ups. Some still do that,” he said.  “Now we send our youth out to get commerce degrees, and environmental management degrees. We have moved beyond the dust-ups by having our communities invest in their own futures.”

Some of this shift was predated by settlements attached to Waitangi Tribunal.  “Once assets change hands, the ‘biff biff’ approach changes to become about how we transmit wealth inter-generationally, said Moeke.

In the midst of this transition, the Maori have discovered that they have a value added effect on New Zealand business. They could help the country create a differentiating factor that would allow them to increase the value of products.

Related: Before the National Inquiry.

Honey is a perfect example.  The Miere honey coalition takes ‘a genuine path to market that is supported by provenance and storytelling, that is traceable and safe, and is able to command a premium.’ Premium meaning $40 per kg vs. regular honey selling for $4 per kg (and expected to grow upwards to $100 per kg).  Again, the power of allowing indigenous-led development increased value.

We have a lot to learn from the Maori in how to sell our Indigeniety as something that can attract investment (both monetary and social) from the rest of the world.  Luckily, we can add to this learning as we already have a model that helped shape Manitoba’s business future internationally, many, many decades ago.

It was the Hudson’s Bay Company that first made formal business partnerships with First Nations in Manitoba. They used ‘chiefs’ to act as their agents, taking advantage of millennial old Indigenous trade routes to bring goods to York Factory.  First Nations were not pawns of the fur trade, but active agents who largely controlled its markets for a 200 year period.  The trade protocols they used (both HBC and First Nations) were based on Treaty protocols, which, in many senses, were our earliest economic agreements.

Whether we look to our past or our present, one thing seems certain.  While conflict may still be necessary, now may be the perfect time for Manitobans to stop investing in dust-ups and, instead, invest in relationships that bear the fruit originally intended in our earliest Treaties together.

Wilson_Jamie_Learning to walkJames Wilson is an advisor with EvidenceNetwork.ca and commissioner of the Treaty Relations Commission of Manitoba, a neutral body mandated to encourage discussion, facilitate public understanding, and enhance mutual respect between all peoples in Manitoba. @jamesbwilson_

OLM Editorial: The LeBreton Flats Fiasco and Why Melanie Joly Must Reform the NCC

February 3, 2016 1:55 pm
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A concept image for Rendevous LeBreton. 

For years the National Capital Commission (NCC) has been the most inept, closed, secretive, elitist and incompetent organization in the federal government. Their tagline should be “The NCC- We Never Miss an Opportunity to Miss an Opportunity.”

The NCC board of directors has 15 members, including the chairperson and the chief executive officer (CEO). Thirteen members represent the regions across Canada. Five are from the Capital Region. They are appointed by the minister responsible for the National Capital Commission (now the Hon. Melanie Joly), with the approval of the Governor-in-Council. Their role is to oversee the corporation, ensure that the corporation’s resources are used effectively and efficiently; to monitor, evaluate and report on performance; and to foster relationships between the NCC and other levels of government and the public. In all cases they get an F.

The NCC’s continuous incompetence over decades is mind boggling. Where to start? They botched the memorial to Victims of Communism project, interfered and tried to delay Ottawa’s $1 billion light rail, against the wishes of the democratically elected Ottawa City Council. In 2011, they spent 5.2 million taxpayers’ dollars to install seven new ice chalets at a cost of $750,00 each (shacks) along the Rideau Canal which is double the value of most families homes in Canada. They messed up the so called Metcalfe Grand Boulevard plan, the King Edward Avenue redevelopment plan in the 1980s, spent decades fighting with Public Works Canada and the City of Ottawa over the development of Sparks Street, embarrassed the entire country by making a complete mess of the Millennium Celebrations in 2000, tried to unilaterally expand the Champlain Bridge against the wishes of every local city council in the region, destroyed the town of Hull in the late 1960s with the horrible development of federal buildings on the Quebec side of the Ottawa River. In 1998, Rhys Phillips, in his book Great Gaffes of the National Capital Commission said of the NCC and Hull: “what emerged from the rubble was a textbook example of the twin horrors of postwar urban renewal and late-modernist architecture. Brutalist concrete buildings encase a soulless mall that spans a bleak, six-lane street; they cruelly mock the former humanely scaled cityscape. Four thousand people were displaced. The new ‘city centre’ turns a cold shoulder to the river and the parliamentary precinct across the water.”

IllumiNATION LeBreton

IllumiNATION LeBreton

The NCC board members are largely unknown. One is a forest industry person, another in general management and marketing, a philosopher and the rest are all either government administrative or education management bureaucrat types. There is not one serious entrepreneur or businesses corporate executive like a Terry Matthews or Jim Balsillie. This explains the insanity of the current LeBreton Flats redevelopment proposal. NCC conditions for applying were so ridiculously secretive and onerous that only two bidders stepped up. Of these, only the Rendezvous LeBreton, 100 per cent private money proposal led by Ottawa Senators owner Eugene Melnyk is credible. The other, the LeBreton Re-Imagined by Devcore, Canderel and DLS Group (DCDLS) is not a serious bid. Their plan is built around an NHL arena and reliance on existing government incentives (whatever that means!). DCDLS does not own an NHL team and will not own one. This should disqualify them immediately from consideration. If the NCC board is dimwitted enough to proceed with the DCDLS LeBreton Re-Imagined proposal (and we know from their track record that they are foolish enough to do this) it will create the biggest white elephant in the region’s history. DCDLS is jesting in the media that they can build and then sell their rink to the competition. This is unprofessional and disrespectful to what should be a serious process. Their glib remarks about Mr. Melnyk are in poor taste to the Ottawa Senators organization who has put hundreds of millions of dollars into our economy over the past quarter century, including millions to local charities. The Rendezvous LeBreton proposal should be approved and given the fast track to proceed as soon as possible. Heritage Minister, Melanie Joly should introduce a bill to disband the NCC and set up a new agency that can better serve Canada’s capital region, of which the Mayors of Ottawa and of Gatineau should be permanent ex-officio members. The incompetence of the NCC does not serve the public interest and continues to destroy the soul of our great city.

What We Need to Learn from the Death of Sammy Yatim

February 1, 2016 1:57 pm
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As long as there is something we can learn from the shooting death of Sammy Yatim by a Toronto Police Officer, than the 18-year-old’s passing will not have been in vain.  If you follow the innumerable examples of wrongdoing by police, not just in this province but across Canada, one thing is clear, and that is that there is something seriously wrong with the way law enforcement are policing our communities.  While Yatim’s murder has set off a maelstrom of public outrage for many of us who work in the justice system, or have concerns about how we are being policed, the topic is not a new one.

Two years ago Dan Donovan, the founder and Publisher of Ottawa Life Magazine, and I launched a Kickstarter Campaign hoping to raise funds to establish a police centre that would collect and post all cases of police incidents in Canada online. The purpose for creating the site was to track the investigation of these cases by oversight bodies and the courts and to post consequences to the offending officer(s) on the site.  We felt the establishment of such a site was needed because we were very familiar with the widespread frequency with which police officers were committing offences and then receiving penalties that amounted to nothing more than a temporary demotion or suspension of pay for a few months.  In short, we were appalled at the conduct being exhibited by police officers and the fact that no one, including our elected politicians, were saying or doing anything to correct the problem.  To our dismay the site garnered less than $2,000 in contributions from the public, far short of our goal of $75,000.

However, once criminal charges were filed against Toronto Police Constable James Forcillo for the shooting death of Sammy Yatim, the public suddenly woke up to the fact that policing in this province and across the country is in a state of crisis.  Forcillo’s conviction suddenly galvanized the public mind in a way that it never has before about problem policing.  People now recognize that there are serious issues with policing and they are looking for answers to the problem.  As a criminologist who has worked in the criminal justice system for over 25 years, I would like to put forward some remedies that would vastly improve the current state of policing.

First, we have to address the inadequacies of the current training system, which in my view is 50 years out of date.  Training should reflect what police officers actually do on the job as opposed to what the general public thinks they do.  Research shows that less than 20 per cent of a police officer’s work relates to law enforcement.  Police spend over 80 per cent of their time on order maintenance functions such as directing traffic, responding to noisy parties, writing reports and responding to neighborhood disputes.  Contrast this with the fact that the training is just the opposite.  Eighty per cent of the training for recruits focuses on firearms competency, use of force scenarios, tactical training and crowd control and less than 20 per cent involves mediation, communications, race relations, and mental health issues.  It should come as no surprise to learn therefore that 80 per cent of complaints filed against police from members of the public relate to order maintenance functions of which they are poorly trained and unequipped to deal with

Second, the current training program for police (outside of the RCMP) lasts for no more than eight to 10 weeks.  It’s unrealistic to think that in such a short space of time a recruit could be even remotely prepared for the challenges that they are going to face on the street once they graduate.  Police training should last a minimum of one year and the program should teach them the skill set they will need when they graduate. These officers need to understand the Canadian Charter of Rights and Freedoms, verbal judo, important rulings from the Supreme Court of Canada and de-escalation techniques.

Third, once recruits leave police college they should be subject to a two year probationary period under the supervision of a certified training supervisor.  They should not be allowed to take the oath of office to become a police officer until such time as their training has been validated in the field.  Certified training supervisors should be required to have a minimum of at least five years experience in street policing.

Fourth, although recruits receive a battery of psychological tests to gain admission to a career in policing, they are never evaluated on the job.  There should be mandatory psychological tests administered to every street cop who has policed for at least five years.  Such tests would help weed out officers who are suffering from psychological issues or who have a propensity to be aggressive or violent towards members of the public.

Related: Why Police Fear Evidence-Based Research

Fifth, we know from research that the police subculture plays a major role in changing the behaviour and attitude of young recruits more so than training.  To address this issue, police recruits should be reminded that their loyalty must be to the rule of law and the public they serve. Police officers should be required to renew their oath of office every year to ensure that this point is driven home.

Sixth, there should be a quarterly performance and evaluation review of every officer in order to identify problem issues relating to behaviour and their performance on the job.  At the present time this is not the case and what this means is that problem behaviour can go undetected for years before it explodes with violence in the public domain.  It has been widely reported in the media that Constable James Forcillo had a tendency to frequently draw his weapon on the job even when it was neither necessary nor justified under the circumstances.

The measures set out above will go a long way to correct deficiencies in our police system.  If we couple them with dramatic changes to our oversight process for policing in Ontario than perhaps we will stand a chance at turning around the tidal wave of bad policing that is infecting our society and blighting our justice system.  Whether it would have prevented Sammy Yatim’s death no one can say for certain.  However, what it will mean is that Sammy’s death will not have been in vain, and in my opinion that is no small matter.

The views expressed are those of the author in his personal capacity.

Darryl T Davies is an Instructor in criminology and criminal justice with the Department of Sociology and Anthropology at Carleton University.

The New Health Accord could be Trudeau’s Most Significant Achievement

January 27, 2016 10:00 am
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Photo by Jean-Marc Carisse.

Health Ministers Must Spend Smarter and Negotiate Wiser.

This week the country’s 14 health ministers have been gathering in Vancouver for a pan-Canadian summit to begin negotiating a new Health Accord. The previous accord saw $41 billion transferred to the provinces over the last decade. This next one may be even bigger.

The challenge facing our health ministers is to set clear priorities for how federal health dollars should be used. If we learned anything from the previous Health Accord, it is that wide-ranging agreements get diluted and that diluted agreements do not achieve their intended results – even when they boost provincial coffers.

The rationale for a Health Accord lies in the lackluster performance of our health systems when compared to other industrialized countries and the catalytic role that federal government leadership can play. Canadians currently pay more, receive less, wait longer and live shorter than citizens of most other industrialized countries. We only look good in international rankings when compared to the United States.

We can do better, and this Health Accord is our best opportunity for doing so. But health ministers will only succeed if they commit to spending smarter and negotiating wiser.

To start, spending smarter means channeling any new health dollars strategically towards those services that will achieve the greatest health impact. We do not need to invest in more of the same. This means ending what amounts to unlimited budgets for costly curative health care at the expense of other health-promoting initiatives like home care, public health, rehabilitation and social services.

In particular, the vast majority of government health dollars currently go towards hospitals and physicians, both always shamelessly crying poverty no matter how comparatively well-funded they may be. This leaves fewer dollars for new ways of delivering care and for population health strategies that keep us well in the first place.

The best principle for channeling new health dollars is value-for-money. This means gathering all available evidence on the benefits and costs of each service and prioritizing accordingly. Measuring cost-effectiveness can be difficult.  We do not always have complete information and it takes expertise to pool results from different studies. This can be overcome by centralizing these assessments nationally and linking federal funding recommendations to which provinces can respond.

More difficult are the politics of implementing value-for-money policies. No politician will win votes by funding even the most cost-effective services like public health if the people who benefit don’t know it. They are also not helped by the Canada Health Act which petrified priority for hospital and physician services instead of creating an automatic process for updating priorities as needs change, values evolve, evidence develops and cost-effectiveness becomes clear. As a result, the hospital and physician winners of today’s underperforming system have also understandably created the most powerful lobbies.

All health ministers and Canadians would benefit from institutionalizing in the Health Accord a binding commitment to spending smarter. Status-quo champions would find their influence diminished when health ministers can argue that unpopular value-for-money decisions are about spending tax dollars wisely.

Related: Toward a True Health Accord.

To get there, health ministers also need to negotiate wiser. Next week’s meeting need only have three results. First, a commitment to spending new federal health dollars on the most cost-effective initiatives. Second, a mandate for officials to begin work on a mechanism for identifying, constantly updating and adapting those initiatives for the unique context faced by each government. And third, a detailed plan for delivering a final Health Accord including a target date for a First Ministers conference.

In this way, the new Health Accord will not only commit governments to principles and processes worthy of celebration, but also to a plan for kick-starting a more sophisticated partnership that reflects our federation in which all fourteen governments share constitutional jurisdiction over health.

The political conditions are right for getting such an ambitious agreement and setting this new collaborative tone. Canadians overwhelmingly support health reform, provinces have an appetite for change, federal politicians are willing leaders and the risk of silly partisan disagreements is low. There is also growing understanding that the status quo is unacceptable and that we can do better.

Negotiating this new Health Accord could end up being the most significant achievement of the recently elected federal government. It could be Trudeau’s Obamacare. But all governments will collectively be judged for the Accord’s success or failure.

Steven HoffmanSteven J. Hoffman (@shoffmania) is a member of the University of Ottawa’s Centre for Health Law, Policy and Ethics and an Associate Professor of Law and Director of the Global Strategy Lab at the University of Ottawa and an Adjunct Associate Professor of Global Health & Population at Harvard University.

 

 

 

Patrick FafardPatrick Fafard (@pcfafard) is a member of the University of Ottawa’s Centre for Health Law, Policy and Ethics and a former senior government executive and Associate Professor of Public & International Affairs at the University of Ottawa.

Toward a True Health Accord

January 25, 2016 10:46 am
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This week Canada’s Minister of Health, Dr. Jane Philpott, will meet with her provincial and territorial counterparts in Vancouver. This is no ordinary get-together. In his letter to the Minister, Prime Minister Trudeau tasked Philpott with “engaging provinces and territories in the development of a new, multi-year Health Accord with long-term funding agreement.” This is a distinct change in tone; the previous federal government had refused to meet with provinces to negotiate a new agreement after the accord ran out in 2014.

The top-down approach by the Harper government was greeted with two distinct reactions. There were those that saw the cancellation of the Health Accord as a step backward that would further reduce the federal portion of funding for health care, offloading costs to the provinces.  Others criticized the past accord, billed as “a fix for a generation,” because it didn’t buy the intended change. While progress was made on wait times for certain services, other innovations in home care, primary care, prevention and health promotion, and the development of a national pharmaceutical strategy were not achieved in any meaningful way, with most of the increased funding getting absorbed into regular health budgets.

Both of these perspectives hold merit.

There is a strong case to be made for a return to the original 50/50 funding arrangement, which is one of the key reasons the provinces signed on to Medicare in the first place and has steadily been eroded in the decades since. There is also a fair criticism that increased funding should have been used more deliberately to attempt to achieve the intended change. An increase in private and public health spending in Canada from $124 billion in 2003 to $207 billion in 2012 bought little in the way of meaningful change in system performance or health outcomes for Canadians.

So as the health ministers meet in Vancouver, how can they bend the curve toward a less costly and more effective health care system? How can they ensure the funds invested this time around will buy real improvements in health?

Some of the directions for this can be found in the Prime Minister’s mandate letter to the Minister of Health, which included an exhortation to “support the delivery of more and better home care services.” Investment in quality home care has been shown to improve patient experience while easing pressure on acute and long-term facilities.

The letter also encouraged Minister Philpott to “encourage the adoption of new digital health technology.”  If done right, electronic medical and health records can greatly expand our ability to effectively treat individuals and the population.

A third major element described in the mandate letter was a call to “improve access to necessary prescription medications” by “joining with provincial and territorial governments to buy drugs in bulk,” and “exploring the need for a national formulary.” This falls short of a national pharmacare program, but does not close the door to the possibility.

Related: A New Health Accord Needs to Include Better Planning

Canada is the only nation with a universal health care system that doesn’t include drug coverage; one in five Canadians reports being unable to afford to take necessary medications as prescribed. A national pharmacare program would eliminate that problem while saving Canadians approximately $6 billion per year in excess costs. Half measures in this area will not achieve the desired savings or accessibility.

The directives from Trudeau to Philpott are helpful, but there are two key ingredients missing. The first is that the flow of health care funds needs to be connected to clearly articulated goals. Indiscriminately increasing fund transfers with no accountability for how they will be used is a recipe for continually increasing costs without improving the quality and accessibility of care.

The second is that all levels of government need to move toward a Health in All Policies approach that understands all areas of government – policies affecting income, education, housing, food security, for example – impact health outcomes. Health care is the greatest cost driver in provincial governments, but it isn’t the area in which spending has the greatest impact on health – and it’s not where those costs can best be controlled.

The decisions emerging from this upcoming summit could change the landscape of health care policy in Canada. We can only hope that Dr. Philpott will be practicing “medicine on a larger scale,” looking first and foremost to improve the health and well-being of Canadians.

Meili_Ryan_high resRyan Meili is a family physician in Saskatoon, vice-chair of Canadian Doctors for Medicare, an expert with EvidenceNetwork.ca and founder of Upstream: Institute for A Healthy Society.

Ottawa Expertise on Display In Kazakhstan/Central Asia

January 21, 2016 2:59 pm
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Downtown Astana, photo by Ken and Nyetta.

Kazakhstan is a country on the move.

Kazaks are the ancestors of the great Genghis Khan. Today, their diverse multicultural society, with its historical tribes, numerous languages and religions and their international outlook in global affairs has made it one of the most compelling countries to watch in Central Asia.

Economic growth in Kazakhstan is led almost exclusively by the coal, iron, gold and copper sectors. It is the world’s largest supplier of uranium. It has the second largest uranium,  chromium, lead, and zinc reserves, the third largest manganese deposits and one of the world’s largest copper reserves. It is a significant diamonds exporter and has one of the world’s largest reserves of petroleum and natural gas. The giant Kashagan field in the Caspian Sea has made Kazakhstan one of the world’s top oil exporters. The past decade has also seen exponential growth in its banking and financial services sector. The country is on a roll but none of this came easy. After the dissolution of the USSR in 1991, Kazakhstan experienced a difficult transition from a planned to a market economy. One of the key problems was dealing with the consequences of the fallout of 456 Soviet nuclear weapons tests held in northern Kazakhstan between the 1950’s and late 1980’s covering a geographic area larger than France. Over 1.5 million Kazakhs still suffer radiation-related illness from those tests today. Under the leadership of its first (and only) President, Nursultan Nazarbayev, Kazakhstan voluntarily rid itself of all nuclear weapons and signed the Nuclear Non-Proliferation and the Comprehensive Test Ban treaties. Nazarbayev then launched Project ATOM (Abolish Testing is our Mission) to promote nuclear disarmament and end nuclear testing resulting in the passing of the Declaration on a Nuclear-Weapon-Free World at the UN General Assembly. These efforts were supported by Canada.

Nazarbayev also devised an economic plan for the newly emerged country. A slow but gradual recovery began in the early 2000s, followed by a rise in Kazakhstan’s total trade in the second half of that decade, when it became one of the world’s top grain exporters and its mining economy started moving into overdrive. As a result, the Kazak people have seen their standard of living, incomes and quality of life improve dramatically. Nazarbayev’s free market economic reforms have made Kazakhstan Central Asia’s strongest and wealthiest economy and its capital, Astana, has become one of the most important financial centres in Central Asia.

In his sunset years, Nazarbayev is now working to secure the future for Kazakhstan and protect his legacy with Constitutional changes that embrace democratic governance models and the rule of law, all overseen by the country’s freely elected bicameral Parliament.

Some of the wealth and profits generated from Kazakhstan’s diverse economy have gone to underwrite the wonderfully extravagant capital of Astana. This city is like Dubai on steroids. To see it is to believe it. Astana has an energetic vibe and boasts an impressive skyline of buildings, ministries, museums, malls and boulevards that scream 21st century. Kazak citizens are young, educated, professional, multi- ethnic and busy. Very busy. They are true internationalists and whether it’s in the private or public sector they look to other countries to gain knowledge about how to best develop their own governance and business models. Canadian diplomats and NGO institutions from the Ottawa area are playing an important and active role in this effort.

On December 9th the Canadian Centre for International Governance Innovation (CIGI) organized the inaugural Central Asia Security Innovation in Astana in cooperation with the Kazakhstan Ministry of Foreign Affairs and the five Central Asian states (Kazakhstan, Kyrgyzstan Republic, Uzbekistan, Turkmenistan and Tajikistan) to discuss security governance challenges in five major key areas: anti-terrorism, border management, human and drug trafficking, energy and nuclear security, and transboundary water management. CIGI policy experts were on hand to provide a Canadian perspective these matters.

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Participants from CIGI, Canadian Embassy and Central Asian States at the Central Asia Security Innovation Conference in Astana Dec. 9.

The tone was set at the outset of the conference by Shawn Steil, Canada’s Ambassador to Kazakhstan, the Kyrgyz Republic and Tajikistan and Ottawa based Margaret Skok, Senior Fellow, CIGI and a former Canadian Ambassador who both observed that there was an absence of region-wide cooperation between Kazakhstan and its smaller neighbouring countries. Skok suggested these five countries work on setting aside their various enmities and try to work on a multilateral relationship that could provide them with a collective influence as a Central Asian bloc. Steil said it was his experience that “lots of dialogue, conversation and programs are the key things that build trust between states.” He also said this was easier said than done, noting that “Kazakhstan must balance the competing interests between its geographical neighbours, Russia and China, against its determination to maintain its own hard won independent foreign policy and economic relationships with the European Union, the United States and Canada.” Steil and Skok suggested Kazakhstan and the other Central Asian republics – Turkmenistan, Tajikistan, Uzbekistan and Kyrgyzstan – have a vested interest in closer regional co-operation.

Stockwell Day, Canada’s former Minister of International Trade and former Minister of Public Safety, said that the Central Asian states should work together and share information wherever possible on mutual security matters, on technical matters and on health issues. Day noted that the United States-Canada relationship was “a friendship based on respect and the ability to link arms and work together on issues and share information in areas of mutual concern in security, trade technical matters, health issues and even military.” He said that cooperation and preparation are the things that can get countries “through moments that could otherwise be disastrous” and noted that “Canada had learned from disasters within its borders and among its neighbours.”

A common theme raised by the five central Asian countries was the issue of how to prevent Central Asian citizens from joining international terrorist groups like ISIL and then returning home to cause havoc. Former Canadian Deputy Minister of Foreign Affairs and former CSIS Director Reid Morden responded to these security issues with a recommendation that Central Asian governments consider coordinating their intelligence efforts. Reid said that “intelligence today comes from across all areas whether its transportation, health, immigration, export, trade or other areas, but intelligence gathering must be based in law through an act of Parliament.” When asked about the guidelines and rules related to the collection of intelligence, Reid said that “while intrusiveness is allowed, it must be governed by the proper oversight and that there must always be a balance between security needs and the inherent rights of citizens.”

Ambassador Steil said that better communication between Central Asian states was the first step in moving forward to form a “Central Asian bloc” and that region-wide cooperation in a variety of areas including trade, border controls and the harmonization of customs regulations were good starting points. CIGI invitee and Former Ambassador of the United States to Kazakhstan (2009–2011) and Tajikistan (2003–2006) Richard Hoagland said that the kind of cooperation that could drive Central Asian prosperity would be stunted unless there was an end to “endemic and sometimes government-sanctioned” corruption. He said that the Central Asian states themselves need to understand that it is in their interest to fight corruption for their own international reputation and credibility.

Colin Robertson, a trade expert, former Canadian diplomat, CIGI fellow and Vice President of the Canadian Global Affairs Institute stressed the importance of these Central Asian nations to develop a professional civil service. He said that those involved in the military, policing and border security should be “well educated, well trained and have a high esprit de corps because these are traits that help protect countries from corruption practices.” He added that “border enforcement is important but so is trade, and it is important to expedite goods at the border and keep them moving.” Robertson said that the Central Asian countries should not see cooperating and the sharing of information as something that weakens their country, but as a strength. He noted “that sharing info builds trust and that the Central Asian countries should share info on infrastructure, roads, and pipelines.” Robertson provided numerous examples of cooperation between the American and Canadian governments in trade, commerce and border issues. He said that Canada and the United States understand the importance of dialogue and communication on many issues but they also understand that on other issues “good fences make good neighbours.” Attendees to the conference  included representatives from key ministries in Kazakhstan and the four other Central Asian governments and a large group of Central Asian university students. Two graduate students told Ottawa Life Magazine that they were impressed with the views of the Canadian participants. One said he was very impressed by the way Reid Morton explained the requirement in democracies to balance security needs with citizens’ rights and a female student said she thought Ottawa’s Margaret Skok was an outstanding moderator who “got Kazakhstan” and really seemed to understand Central Asian issues.

Moving Forward on Health Care Reform

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Why more money for health care is not the answer

In the Speech from the Throne and since, the new Liberal government has clearly said it is ready to re-engage with the provinces and territories on health care. This is a welcome development. For most of the past decade, the Harper government was distinctly unwilling to provide any leadership or even play a secondary role in health care reform.

The fact that the new Trudeau Liberal government is ready to work with the provinces and do so quickly is a big step forward.  But the prospect has likely raised many expectations of what new arrangements might emerge.

First, many players will be looking for more money to flow from Ottawa to the provinces. But the Harper government, even as it withdrew from active participation, committed to adequate transfers to the provinces until 2024. There may be legitimate debates about the distribution of those transfers across the provinces, and there may be some new funding called for to support new initiatives in areas such as pharmacare or mental health, but the federal money now on the table in support of the range of health care services is more or less adequate.

The health care problems we face are not the result of insufficient spending. In fact, more money may be counterproductive.

The primary focus of any new accord needs to be on the structure of the federal-provincial arrangements. The most commonly visualized instrument seems to be a return to something like the Health Accords of 2003 and 2004. Indeed, the Minister of Health referred to a promised re-engagement in these terms. What these Accords did was to identify a number of problem areas — most notably, wait times — where provinces pledged remedial actions to remedy them and Ottawa committed to increasing cash transfers to be used at the discretion of provincial governments.  

The expression at the time was that the cash transfers would “buy change” necessary in the health care system. But the link between the provincial actions and the federal money was tenuous at best in 2003 — and all but absent in 2004.

So while the Accords did initiate significant flows of new money to the provinces and territories, they were not successful in spurring necessary health system reforms. They were not sufficiently specific to generate sustained efforts or sustainable change.

In fact, the extra money Ottawa provided probably did more to hinder health reform across the country than promote it. Rather than “buying change,” the extra money bought peace and serenity (at least temporarily).  Throwing additional money at problems was a lot easier than tackling structural change.

The Accords were weak because to some extent the provinces and territories have different needs and priorities.  To reach consensus on a single agreement it was necessary to be vague and general in terms of what each province and territory would do by way of reform.

A better alternative going forward might be to more directly address particular regional concerns with a distinct contract between Ottawa and each province rather than a single accord.

For a model for this we could look to the Paul Martin Liberal government’s arrangement for funding in two other areas. The first was the transfer of gas tax revenue to municipalities via the provinces for infrastructure investments. Ottawa signed one-to-one agreements with every province and territory. While the broad goals and structures were the same across all provinces, the individual contracts included variations that permitted some provinces to pursue regional goals within the national framework. A significant amount of much needed municipal infrastructure investment resulted from these agreements, and continues today.

The same general model was used by the Martin government to conclude childcare agreements with the provinces, but before they could be implemented the Harper government was elected and chose not to proceed.

This model of federal-provincial fiscal arrangements can more effectively promote health care renewal and should be considered by Minister Philpott going forward.

A set of pharmacare agreements might be concluded that would create nationally universal and portable coverage while recognizing that provinces are starting from different positions and may have different specific needs and administrative arrangements in mind. Other issues such as home care and long-term care facilities might be addressed at the same time or in a separate set of contracts.

The federal government would retain the capacity to represent national goals and interests, and the provincial governments would have flexibility to pursue their respective regional objectives within the national framework.

A stronger link between national objectives and each province’s priorities offers a better chance of sustainable health care reform.  

Maslove_alanAllan M. Maslove is an expert advisor with EvidenceNetwork.ca and a Distinguished Research Professor, School of Public Policy & Administration, Carleton University.

Why it’s time for a National Autism Strategy

January 20, 2016 11:55 am
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Over a year ago, I was invited to celebrate World Autism Awareness Day on Parliament Hill.  It was attended by a dozen or more Senators from both major parties, political staffers and invited guests mostly from autism non-profit organizations.  I expected a predictable ‘feel good’ event about how far we’ve come and how far we have still to go.

But an hour later there weren’t many dry eyes in the chamber.  

It turns out, many of the politicians who decided to join the event that day had personal experiences with autism.  One Senator spoke at length of his daughter who struggles to get adequate services for his grandchild with autism, and how challenging it has been – economically, physically and emotionally — for the whole family.  He cried openly.

Another Senator spoke of a family she knows that is struggling with long wait times for essential services, such as speech or behavioural therapy.  More than one participant spoke of the difficult choice families have made to uproot and move across the country to Alberta or British Columbia where autism services are often more readily available and flexible, particularly if a family happens to have more than one child on the autism spectrum.  

Others spoke of the economic burden of pursuing private therapies – funded out of pocket (my own experience), often in the tens of thousands of dollars per year.  Many have to refinance homes or sell them altogether just to get their child with autism the basic supports they need to learn and thrive.

What became clear that day is something I’ve heard autism champion, Senator Jim Munson say before: autism doesn’t affect Liberals or Conservatives or NDPers. It’s an equal opportunity neurodevelopmental disorder that affects Canadians across the political spectrum and clear across the country.  

What was also clear that day – and from a number of reports since — is that autism families in Canada are struggling, diagnosed cases of autism are on the rise, and most provinces are not able to keep up with necessary services.

According to a recent survey from the Canadian Autism Spectrum Disorders Alliance (CASDA), almost three quarters of parents of preschoolers in Canada with autism wanted, but did not receive, early intensive behavioural intervention (IBI) for their child — one of few interventions for autism with solid peer reviewed evidence.  

A similarly troubling report, released last month from the Ontario Auditor General, reveals that in some jurisdictions in the province, there are more children waiting for autism services than receiving them, with more than 16,000 children on wait lists that continue to balloon.  

It’s not an exaggeration to say we have an autism services crisis in Canada.  So what can be done?  Plenty.  

Evidence shows proper health and educational supports for those affected by autism pay off.  Early intervention heads off more expensive and extensive supports that are needed later in life if it is not provided.  It makes economic sense, in other words, to provide autism services early.

Kids with autism are not lost causes, they are full of potential.  We are failing them.

The last federal government made a good start establishing an Autism Spectrum Disorder Working Group to bring together those working on the issues across the country to discuss key concerns and share best practices.  But much more federal support is required to make things better – now — for Canadian families.

For starters, the new Liberal government could dust off the excellent cross-party Senate report – aptly titled – Pay Now or Pay Later: Autism Families in Crisis from 2007 and get to work.  It’s number one recommendation? A comprehensive national autism strategy.  

We’ve waited almost a decade.  Now is the time for the federal government to bring together the brightest minds in the country on the issue and enact a federal strategy to give our kids with autism the services they need to survive and thrive in communities across the country.
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Kathleen O’Grady is a Research Associate at the Simone de Beauvoir Institute, Concordia University, Managing Editor of EvidenceNetwork.ca and mother of two sons, one with autism.

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