Uber and the Accessibility Question

April 7, 2016 2:11 pm

A user organizing a ride through UberAssist. Photo by Eric Murphy.  

Ottawa’s plan to legalize Uber has locals who use accessible taxis concerned that the service they’ve fought for and relied on for years may be drawn-back, or even cease to exist.

“In Ottawa I can call West-Way taxi, or Capital Taxi or Blueline, say ‘I need a wheelchair accessible vehicle to pick me up at my house,’ and I get it,” says Peter McGrath, a lawyer for the federal government who uses a power wheelchair.

This service is essential for anyone like McGrath who needs to stay seated in their wheelchair while travelling. They cannot use Uber’s new Assist service because it does not require vehicles to have ramps, and Para Transpo is a poor alternative because riders have to schedule their trips well in advance.

If poor business forces the taxis to scale back, McGrath is afraid he’ll be left without a ride.


Peter McGrath is a lawyer for the federal government and a longtime advocate for people with disabilities.

“What will the city do to ensure that accessible vehicles are available 24 hours a day?” he asks.

Coun. Diane Deans, who led the planning committee that oversaw the proposed taxi regulation changes, says that Ottawa’s accessible taxis aren’t going anywhere.

“I can’t imagine the taxi business ever going out of business,” says Deans. “They have $9 million in accessibility service alone. They have all of the phone-call arranged taxi service in the city.”

Furthermore, Deans’ committee has recommended that if Uber is legalized, the ride-hailing company should have to either dedicate at least 15 per cent of its driving time in Ottawa to accessible vehicles, or pay 30 cents from every Uber ride into a fund for accessible services. Technically, the city currently isn’t able to force Uber to pay that 30 cent surcharge, but Deans says that they are pursuing the provincial authority that will let them do just that.

“That money would go into a pool and we would work with the Accessibility Advisory Committee to determine how best to use those funds,” Deans says.

Peter McGrath doesn’t share Deans’ confidence in Ottawa’s taxi service or the new fund.

“If Uber crowds out all the cab service, and why wouldn’t they, how are the cabs going to compete?” he asks.

McGrath doesn’t believe the cab companies can survive off of the $9 million accessibility service or the business that would come from phone calls and people who pay in cash. He is also concerned that the 30 cent surcharge on Uber rides would be largely directed to Para Transpo. McGrath argues that because you have to book it in advance, Para Transpo is woefully inadequate. He’s not alone in that thinking.

“I use Para Transpo…but it’s kind of my last resort,” says 21-year-old Sarah Mercer, who uses a manual wheelchair. “If something comes up, I can’t just call Para Transpo and have them pick me up.”

Mercer’s experience with accessible cabs hasn’t been perfect either. She’s called them and been left waiting for half an hour or a full hour, and sometimes they never arrive. One night, after waiting for roughly two hours for an accessible taxi, she used Uber instead.

“I’ve never really had a problem with [Uber] showing up on time,” Mercer says.


Some fear that the taxi companies may be edged out of the market, leaving a gap in accessible service. Photo by Eric Murphy.

Since Mercer uses a manual wheelchair, she can have an Uber driver help fold up her chair and store it in the car. However, people who must stay seated in an electric wheelchair, like McGrath, don’t have that option. Neither traditional Uber drivers nor those in the UberAssist service that launched in Ottawa on March 23 have the ramps or space that he needs.

Uber does have a power chair accessible service called UberWAV that’s available in a number of cities, including Toronto, but even if it were to come to Ottawa, McGrath is skeptical about the reliability of UBER’s model.

“The problem is that Uber is just an app…they don’t own their own fleet of vehicles,” he says. “I can request a wheelchair accessible van. What they can’t guarantee is that a wheelchair accessible van will be available.”

Users in other cities have faced that problem. In a 2015 article from Wired, a group of protesters weren’t able to summon an UberWAV vehicle while standing right in front of the company’s Manhattan headquarters.

“I’m not sitting here trying to cause a problem,” McGrath says. “If UberWAV can guarantee that they will provide more accessible trips than what’s currently available in the city of Ottawa now, sure, I’m happy to have it.”

Advanced Directives for Assisted-Dying a Dangerous Step

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The moment we are born, our lives take flight; and the longer we are airborne, the greater the chance of encountering turbulence along the way. While every flight is destined to land, some landings are harder to contemplate than others.

The parliamentary committee tasked with advising the federal government on how to roll out physician-hastened death must have struggled with the prospect of dying with dementia. Their advice to lawmakers was anyone with a condition likely to cause a loss of competence should be able to complete an advance directive any time after their diagnosis, directing that they should be euthanized.

This recommendation goes well beyond anything the Supreme Court of Canada intended.

The court stipulated physician-hastened death must only be considered for competent adults, in the circumstances of their current condition. The idea that Canada would make it lawful for people to consider a future version of themselves unacceptable and sign off on an order to have their lives ended was not something the court contemplated.

After all, in any assisted-dying regime, a competent patient is free to change their mind or express their ambivalence by withdrawing a request or postponing an assisted death. To permit an assisted death to proceed on the basis of an advance directive effectively denies this protection to persons who are no longer capable of making or expressing health-care decisions.

That is a risky proposition.

Research shows people are not very good at predicting what they would want and what they might need and feel in circumstances they have not yet confronted. The farther removed those circumstances are from today’s reality, the more difficult it is to imagine the response.

So why did the Canadian committee go as far as it did?

Fear is seldom a reliable guide to good social policy. But like most of us, parliamentary committee members must have found the prospect of turning into an altered version of their former selves terrifying. They likely did not appreciate that dementia is a progressive terminal illness; the seventh-leading cause of death in Canada. They probably did not appreciate the suffering they imagined was due to lack of adequate or appropriate end-of-life care these patients receive — despite ample evidence that the symptom burden can be comparable to cancer.

Patients with dementia are less likely to be referred for palliative care, have family caregiver involvement in decision-making or receive palliative medication, including pain medication.

Dutch legislators included a euthanasia advance-directive provision for patients anticipating a cognitive decline. While their rationale likely mirrored the Canadian parliamentary committee, the idea has turned out to be completely untenable. Despite requests occasionally being made, they are rarely adhered to.

Related: We Must Speak for Those who Can’t.

Related: Assisted Suicide for Those with a Mental Illness is a Risky Proposition.

In the vast majority of instances, physicians find it “inconceivable” to comply with the requests, given the patient with dementia has become a psychologically different person than the one who made the original request. Physicians are no longer able to determine the patient’s current wishes, feel the patient is not suffering or believe that they no longer want to die. While family members were supportive of not including life-prolonging treatment, they asked that the euthanasia advance directive not be followed because of uncertainty about the person’s current wishes, not being ready for the person to die or not sensing that the person is suffering.

As for planning a good death with dementia, end-of-life discussions need to start sooner rather than later. Patients must have the opportunity to express their wishes and preferences for care. Their pain and symptoms need to be well-managed. Advanced-care planning can ensure unwanted treatments, which may prolong the length of life without sustaining or improving the quality of life, are not imposed. Such planning can also reduce the likelihood of unnecessary hospitalizations and increase the chances of dying where people choose.

There is good data to demonstrate that compassion, a gentle touch, respect, and patience can benefit even those patients with moderate to severe dementia. Granted, this approach is not the quick and efficient landing the parliamentary committee members may have had in mind. But for now, it is the very best we can do.

Chochinov_Harvey_high resDr. 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. He is an adviser to the Vulnerable Persons Standard (vps-npv.ca).

Feds Kill Idea to Erect Cape Breton’s Never Forgotten National Memorial, Sloppily

April 1, 2016 9:15 am
NFNM Mother Canada

It was April 2009 and he was on a pilgrimage close to his birth place in Italy. Because he left for Canada when he was only four, he really didn’t remember very much about the area at all. Perhaps the cemetery off to the right was there back in 1950 when his parents left to settle in Canada, but he didn’t recognize it now, some 60 years later. Its layout was so immaculate that he decided to pay a short visit. Approaching the gate entrance, the sign announced it was a Commonwealth War Graves Cemetery. On entry, he respectfully approached the first headstone which read, “Pte Ted Truskoski, 17, Canada.”

Seventeen! He thought perhaps such a young age for a soldier was highly unusual – until he walked along row after row of Canadians killed in the Battle of Ortona, which was fought over the Christmas period in 1943. He realized that many soldiers, too many, including a 16-year-old from PEI, were high school age. It was only a year later that he was told that Ted had actually lied about his age and that he too was only 16 when killed.

Tony Trigiani realized that many of the Canadians who had travelled over 7,000 kilometres from their homes to purge a brutal enemy had been incredibly young. He made a silent pledge that he would find a way to honour their sacrifice and the sacrifice of all Canadians who crossed the oceans to help others recapture their freedom.

His research revealed that over 114,000 Canadians are buried in 2,500 Commonwealth Cemeteries around the world. This figure does not include the thousands lost or buried at sea. They will rest there forever, but perhaps, he thought, we could welcome their souls home and provide a quiet place in Canada where relatives and friends could remember, away from the hustle and bustle of urban areas where so many cenotaphs are located.

Later in 2009 he discussed the idea with a number of veterans he had supported financially during the fundraising campaign for the Juno Beach Centre in Normandy. Unbeknownst to him, one of the well known D-Day veterans, Bruce Melanson contacted Veteran’s Affairs in Charlottetown, alerting them to Tony’s idea for the monument. In April 2010 they contacted Tony and a senior official with Parks Canada joined the discussions, expressing interest and support for the concept.

A subsequent feasibility study, funded by Tony, concluded that there would be country-wide support for such a memorial. I was contacted for my opinion and was so impressed with the concept that I came on board as an ambassador for the project and was pleased that retired Colonel Alain Pellerin, a good friend for many years, agreed to join Tony’s team as a fellow ambassador.

The next step was to find a site. Considering the great majority of our fallen were buried in Europe it was decided that Canada’s East Coast would be the closest and best location, particularly Nova Scotia where the majority of troops dispatched to two World Wars embarked. Parks Canada suggested a number of sites in Cape Breton and Tony visited each one of them, including his eventual favourite, Lakie’s Head in Cape Breton Highlands National Park.

At a 2011 meeting with Parks Canada in Halifax, Tony expressed his desire to erect the memorial at Lakie’s Head. Parks Canada felt the site would be too small and recommended he return to Cape Breton and visit Green Cove, also in the National Park. Admiring its beauty from the tiny adjacent parking lot, in Tony’s words the site “spoke to me,” and he imagined a statue with open arms facing the sea, line of sight to the Vimy Memorial in France, welcoming lost Canadian soldiers home.

A month later Tony made a more detailed presentation at Veteran’s Affairs headquarters in Charlottetown, which was attended by an even more senior representative from Parks Canada who flew in from Ottawa strictly for the meeting. The presentation included a design for the monument based on Canada Bereft, the mourning figure on the magnificent Vimy Memorial in France. The family of Walter Seymour Allward, the original statue’s sculptor, gave their permission and plans were made to merely elevate the figure’s head and raise her arms, signifying a welcoming home gesture.

In February of 2012, Tony met with the Minister of Veteran’s Affairs in Ottawa. The Minister of the Environment joined the discussions as a keen supporter.

In July of 2013 we were advised by the Minister of the Environment that Parks Canada was authorized to negotiate with the Never Forgotten National Memorial Foundation regarding building the memorial in the Cape Breton Highlands National Park.

All costs for the construction and maintenance of the Memorial would be private funds.  Parks Canada granted the Foundation $100,000 to partially pay for a business plan including tourism forecasts and a website.

We naively assumed we were on a roll. A recent Vice Chairman of the Commonwealth War Graves Commission, Sir Alistair Irwin, graciously joined our Foundation as Co-Chair. He would subsequently hand a copy of our foundation booklet to Prince Charles.

During the following months a large number of well-known and respected Canadians joined the project as patrons. Margaret McCain, Brian Burke, Rex Murphy, Jean Charest, Frank McKenna, Paul Manson, Mila Mulroney, Roy McMurtry, Hugh Segal, Ian Tyson, Peter Stoffer and numerous other Canadians offered their support.

Dr. Donald Julien, the Executive Director of the Confederacy of Mainland Mi’kmaq, joined us as a patron ensuring the interests of the Confederacy would be an important part of the planning process.

During this process, a highly respected former Minister of the Environment told me to prepare for glacial project progress as Parks Canada was the most byzantine organization he had ever encountered. We discovered the hard way that he grossly understated his warning.

In order to proceed with the project, Parks Canada required a Basic Impact Analysis be conducted at the site to address any environmental issues. Consultation with the local community was also a prerequisite and something the foundation continued to push Parks Canada to arrange.  The foundation’s requests for public meetings started early in 2013, yet these were delayed by Parks Canada until October 7, 2014.  These requirements were completed with encouraging results. Although there were outspoken critics at the Town Hall deliberations, they were a distinct minority and were sometimes even drowned out by the “yea” side’s standing-ovations.

In July of 2014 we were shocked when Parks Canada advised us to pay for and undertake a Detailed Impact Analysis, a much more comprehensive undertaking with a price tag well over $200,000.

During the entire time between 2013 and 2016 we weren’t able to start fundraising without a completed DIA. It would have been inappropriate to solicit and accept private funds when we didn’t have a Licence of Occupation (“Building Permit”) which could only be issued on completion of the DIA process. Meanwhile our critics, in a well coordinated campaign to halt the project, started gaining momentum. To our dismay, even editorials from influential news organizations joined the band wagon, repeating false-truths and giving them inappropriate and unearned credibility.

We were accused of planning construction within the Park’s Restricted Zone when we were clearly outside that zone. We were allegedly covering a unique (definition: “being the only one of its kind”) rock formation when in fact the monument only partially covered 0.4 of a hectare, a miniscule portion of a 26,000 hectare suite. The creation of a parking lot for 300 cars was routinely quoted when the plans called for a mere 60. A “towering monstrosity” was a favourite criticism when the actual height, at 20 meters in the current plan, pales in comparison to the Statue of Liberty at 45 meters and Christ the Redeemer in Brazil at 38 meters and is only a bit higher than the fiddle replica greeting the tour boats as they dock at Sydney harbour. Not satisfied with just “towering,” an “ugly” monstrosity entered the debate. This in spite of the fact that the monument’s image was based on the design of Canada Bereft that won a competition with 160 entries in 1920, and is now an essential part of the Vimy Memorial in France. For heaven’s sake, even the government financially supported Vimy Foundation, which I have outspokenly supported along with six other charities assisting soldiers over the years, turned their back on us even though our objectives coincided to honour our fallen. Out of nowhere, because they were aware of our intentions years earlier, trademarking “Mother Canada” got their knickers in a knot and they joined the cue of critics. What a shame, missing an opportunity for some synergy in honouring our fallen.

In the area affectionally referred to as North of Smokey, and where the monument would stand, local resident Lisa MacLeod started a Facebook page in support of the memorial that grew to thousands of followers. This led to petitions totalling over 1,100 signatures which local MP Mark Eyking presented to the House of Commons on January 28, 2016 in a less than inspiring manner.

Perhaps the lowest blow of all was the accusation that Tony, the ‘devious Toronto businessman,’ would be flogging cheap trinkets in a gift shop and placing sponsor’s signage on the monument site itself. Some even claimed he had trademarked Mother Canada’s image in his own self-interest. These vindictive comments never mentioned that the approval to build required that millions of dollars be provided for the monument’s long-term maintenance, and that trademarking would avoid “cheap trinkets” on the market. The plans also clearly directed that there would be absolutely no sponsor’s or anyone else’s signage on the monument site itself.

Four years and thousands of dollars after commencing the process to complete the final DIA to the satisfaction of Parks Canada, it was finally submitted on February 4, 2016.

The following day, Tony was advised on an early morning phone call that Parks Canada was withdrawing its support for the project and the monument would not be permitted to be built in the Park. The follow up e-mail from Parks Canada on behalf of the Minister of the Environment follows:


Parks Canada has reviewed the entire Never Forgotten National Memorial initiative as well as the key elements and timelines within the Memorandum of Understanding (MOU) that guides this complex proposal.

Based on that review, Parks Canada has concluded that there are too many key elements that remain outstanding for the project to be achieved by the planned date of July 1, 2017, including the availability of funds to the Foundation, agreement on the structuring of the funding for construction and maintenance, and a definitive final design plan.

After careful consideration, Parks Canada has decided to withdraw from the MOU and the project. Parks Canada will no longer be working towards the realization of the memorial in Cape Breton Highlands National Park. As a result, the project will not be moving forward on Parks Canada land.

Parks Canada appreciates the Never Forgotten National Memorial Foundation’s vision in honouring Canadians who made the ultimate sacrifice for their country and wishes the Foundation success in its on-going pursuits.

Daniel Watson
Chief Executive Officer
Parks Canada Agency

I never imagined how many misleading and inaccurate comments could be crammed into one media release. A number of the issues raised in that release had been well addressed numerous times including a detailed letter sent the previous month including the funding issues and the modified timeline for the completion of the memorial. To elaborate, the following provides some illuminating facts.

1. Parks Canada media release– the Foundation did not have availability of funds.

Fact – Parks Canada had been told numerous times that there were large donors waiting to contribute funds but were waiting on Parks Canada to approve the DIA and issue a license of occupation.  What major donor was going to contribute funds to a project that was still not approved?  Major donors included a large national retailer and well known philanthropists in Canada.  Parks Canada were told on a number of occasions about these “donors in waiting” but continued to play delay games.

2. Parks Canada media release– No agreement on structuring of funding.

Fact – Parks Canada dramatically increased the maintenance endowment funding amounts for the Foundation to raise, without any reasoning, explanation or any details of what they would do for the millions in funding that they were asking the Foundation to hand over to them.  Parks was insisting that they would only keep the Memorial open during the park season and never told the Foundation if they would do anything more than empty out the garbage cans.

3. Parks Canada media release – No Definitive Design Plan

Fact– A definitive design plan can only be produced once Parks Canada makes a determination on the final DIA.  Parks Canada had not made a decision. The Foundation spent thousands of dollars on making numerous changes to the plans every time Parks demanded, including a submission of requested changes to the DIA that were sent the day before the announcement.

All of us, including a large number of Cape Bretoners, are gutted with the termination of the government’s support for the project. We are, however, embarrassed and angry regarding the disrespectful way a unique, yes unique, Canadian patriot was treated in the final days of the Never Forgotten National Memorial. Mr. Tony Trigiani, with the purest of reasons and an unmatched dedication to this country’s soldiers, having sacrificed his health and expended over a million dollars of his own money to underwrite a process made more expensive and time consuming each and every time Parks Canada inflicted another bureaucratic requirement, deserved so very much more than an early morning phone call from a bureaucrat displaying a shocking lack of insight regarding the project and a follow up e-mail perpetuating the myths appearing above.

Once the previous government approved the project in 2013, with the exception of Peter MacKay, we received little or any support from ministers. In truth, they were speed bumps throughout the process. But to their credit they had the decency to grant us an audience or respond to our letters.

At the very least, the current Minister of the Environment should have invited Tony to her office to communicate her decision face to face, thank him for his patriotism and express regrets regarding the glacial decision-making process within her Parks Canada. It is hoped that good manners alone will dictate such an invitation. After all, it is 2016.

Lewis MacKenzie resizedArticle by Major General (Ret’d) Lewis MacKenzie.

Budget Day 2016

March 24, 2016 3:48 pm

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

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.


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

12:00 pm
Jeb Bush

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

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

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.
KKO Offical Photo 2012 High Res.official photo 2012

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

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.


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

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.

official photo 2012


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

Keeping Science Safe

February 25, 2016 11:46 am

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

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

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
Rendevous LeBreton

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

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
Trudeau Jean Marc

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

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.

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