Ottawa Legal The Big Picture: Ottawa Law Firms are Amongst the Best in the World

January 8, 2016 11:51 am
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It is the trade of lawyers to question everything, yield nothing, and talk by the hour.
— THOMAS JEFFERSON

From international media coverage of gripping court cases to the dramatic portrayals of lawyers on television and film screens, we love to watch the law. As a city that is home to some of Canada’s most respected law firms and talented lawyers, Ottawa undoubtedly plays a role in generating some of this interest. Hundreds of different types of law firms have set up shop in Ottawa, ranging from long established and internationally renowned firms, to local, new and vibrant boutique practices.


Starting at the top, Ottawa is home to the Supreme Court of Canada. It formally became the court of last resort for criminal appeals in 1933 and for all other appeals in 1949. The court was established first with six judges, and increased by one additional member in 1927. In 1949 the bench reached its current composition, of nine Justices.

The Supreme Court of Canada building was built between 1939 and 1946 from plans by noted Montreal engineer and Art Deco designer Ernest Cormier who included two candelabrum-style fluted metal lamp standards at the entrance, marble walls and floors in the grand interior lobby that contrasted with the châteaustyled roof. In 2000, it was named by the Royal Architectural Institute of Canada as one of the top 500 buildings produced in Canada during the last millennium.

The building also contains two court rooms used by both the Federal Court of Canada and the Federal Court of Appeal. The Canadian court system is pyramidal, with a broad base being formed by the provincial or territorial governments. At the next level are the provinces’ and territories’ superior courts, where judges are appointed by the federal government. Judgments from the superior courts may be appealed to a still higher level, the provincial or territorial courts of  appeal. Several federal courts exist in Ottawa (and across Canada) including: the Tax Court of Canada, the Federal Court, the Federal Court of Appeal, and the Court Martial Appeal Court of Canada. Unlike the provincial superior courts, which exercise inherent or general jurisdiction, the federal courts’ jurisdiction is limited by statute. In all, there are over 1,000 federally appointed judges at various levels across Canada, many from the national capital region.

Each year, the Supreme Court hires 27 recent graduates from across Canada to work as law clerks providing aspiring lawyers with a privileged opportunity to work with Canada’s top legal minds in the nation’s capital.

The Ontario provincial courts and Ottawa courthouse are located the heart of Ottawa at 161 Elgin St. It is not unusual to witness a flurry of media activity around these buildings, as reporters cover high-profile Canadian cases. When political figures find themselves in court, they often turn to Ottawa lawyers to defend them.

Many of Ottawa’s most reputable law firms – Osler’s, Gowlings, Nelligan O’Brien Payne, May & Konyer, and Soloway Wright, are located in close proximity to the courthouse on Elgin street, some of them in heritage buildings, others in modern towers. These firms specialize in a range of areas, from criminal law to business law to estate law. With over 100 law firms dispersed throughout the city, if you need a lawyer, you’re all set.

Ottawa is also a prime destination for law students as we have the largest law school in Canada. The University of Ottawa’s common and civil law programs accept close to 400 students every year. The Supreme Court hires 27 graduates from across Canada to work as law clerks providing aspiring lawyers with a privileged opportunity to work with Canada’s top legal minds.

Ottawa’s legal reputation today is a far cry from our roots as a rowdy, bawdy sawmill and lumber town.

Pre-Confederation, Bytown (as Ottawa was called then), was a scarcely populated lumber town that often erupted with violence and debauchery. Brawling was common. Lt. John By, responsible for the supervision of the construction of the Rideau Canal, was forced to reassign several canal workers to work as street patrollers. However, they had little influence or power. In 1842, fresh out of law school, 18-year-old, John Scott placed an advertisement in Ottawa’s then newspaper, the Bytown Gazette. Scott would later become Bytown’s first official mayor. That same year, Bytown’s first courthouse and jail were built by architect Thomas McKay. In 1841, citizens had voted in favour of the construction of the courthouse and jail, in an effort to reduce violence and crime. Though the original courthouse and jail burnt down, the structure was rebuilt in 1871 and still stands today at the corner of Nicholas St. and Daly St.

As the legal system developed in Bytown, so did the town itself. In 1855, its name changed to Ottawa, and it officially became known as a city. In1857, it was chosen by Queen Victoria to be the capital. By 1867, Canada had officially become a country, and the British North America Act of 1867 called for the creation of a federal Supreme Court. On April 8, 1875, the bill proposing the creation of this court was officially given royal assent, and law firms such as Henderson McVeity, established in Ottawa in 1887, began opening their doors for business in the nation’s capital.

In 1857, it (Ottawa) was chosen by Queen Victoria to be the capital of the provinces of Canada. By 1867, Canada had officially become a country, and the British North America Act of 1867 called for the creation of a federal Supreme Court.

Today, Henderson McVeity is known as Gowling Lafleur Henderson LLP (Gowlings) and is the second largest law firm in Canada with offices in Beijing, Moscow and London. Its Moscow office was one of the first Western law firms on the scene in post-Soviet Russia and the firm sent a young talented lawyer named Monique Couture to lead the charge in what was then the wild west of new Russia. Her work there is still paying dividends for the firm’s reputation today.

There are several Ottawa firms with an international presence. Cassidy Levy Kent’s main offices are located in Ottawa and Washington, Blake Cassels and Graydon has offices in Ottawa, Vancouver, New York, Chicago and London, and Osler has headquarters in both Ottawa and New York City, just to name a few. Osler has been in the business of law since 1862, when Bath Osler began to practice law in Dundas, Ontario (70 km west of Toronto). By the age of 23, Osler had opened two law offices (Dundas and Hamilton) and started his own venture in what would become one of North America’s  first commuter railways. In 1882, Osler moved his practice to Toronto, the provincial capital and at the time Canada’s second most important city for business, after Montreal. Within a decade, the enterprise grew to become one of the top three law firms in Canada and it would eventually set up shop in Ottawa. Almost from the start, the firm’s clients included many of the country’s largest companies and others that would grow to become leaders in key emerging industries including railways, banking and insurance, manufacturing and natural resources. As the firm prospered, it attracted international companies seeking opportunities in Canada. Osler’s has been ahead of the game in promoting women in a sector that was far too long known for having a glass ceiling for women. In 1968, Osler became the first large corporate law firm in Canada to admit a woman as a partner, Bertha Wilson, who went on to become the first female Justice appointed to the Supreme Court of Canada.

Other firms in Ottawa have had similar success while remaining true to their Ottawa roots. Nelligan O’Brien Payne LLP was founded in the capital in 1963 and the mid-sized general practice firm has kept Ottawa as a home base, with an additional presence in Alexandria, Kingston and Vankleek Hill. The firm and its lawyers have an exceptional and decades long record as active participants in the community, and support a wide variety of volunteer and locally based activities including the Terry Fox Run, the United Way campaign, the Ronald McDonald House Ski Day, and various other fundraising activities throughout the year. They also support numerous community events through sponsorships or donations and host the annual Lawyers Play where the musical and dramatic talents of their lawyers are put on display at the Great Canadian Theatre Company.

Nelligan has received an A+ rating from Ottawa’s Better Business Bureau. Real estate and business law firm Soloway Wright, established in Ottawa in 1945, prides itself on being a community-based firm, with locations in both Ottawa and Kingston. The firm is centered on community involvement, and has been recognized for its philanthropic efforts.

Though some of the city’s historical firms have been growing since Confederation-era Canada, others in Ottawa have only just recently opened but are prospering. LaBarge Weinstein LLP, opened in 1997, specializes in knowledge-based and technology companies, while the 20-year-old firm, Sicotte Guilbault LLP, is another growing vibrant general practice firm. From global to local, from old to new, Ottawa’s range of law firms suggests that the national capital region has become a hub for both experienced lawyers and aspiring ones.

Five Things You Might Not Know About Food Insecurity in Canada.

January 7, 2016 10:30 am
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For many Canadians, food plays a central role in the holiday festivities. But for those experiencing food insecurity, a bountiful feast will not be in the cards this year. Over 4 million Canadians, including 1.15 million children experience some level of food insecurity.

Food insecurity, also known as ‘food poverty,’ can cause significant anxiety over diminishing household food supplies and result in individuals modifying their eating patterns — adults skipping meals so children can eat or sacrificing quality food choices for cheaper, less healthy options, for example.  Food insecurity also often results in physical hunger pangs, fatigue and lack of concentration and productivity at school, work or play.  

Then there are the social impacts of food insecurity that most of us wouldn’t consider, such as not being able to invite friends and family to dinner or being unable to afford to meet people for coffee.  Food poverty can also create stress and conflict in family relationships and meals are often not a happy gathering opportunity.  

Here are five things Canadians need to know about food insecurity:

1) Food insecurity significantly affects health

Evidence shows that among children, food insecurity is associated with poorer physical and mental health outcomes, including the development of a variety of long-term chronic health conditions such as asthma and depression.

For adults, research shows that food insecurity is independently associated with increased nutritional vulnerability, poor self-rated health, poor mental, physical and oral health and multiple chronic health conditions including diabetes, hypertension, heart disease, depression, epilepsy and fibromyalgia. Studies also show that food insecurity impacts a person’s ability to provide self-care and manage chronic health conditions.

Evidence also shows the health impact of food insecurity exists on a gradient – meaning adults in more severely food-insecure households are more likely to report chronic health conditions as well as receive diagnoses of multiple health conditions.

2) Household food insecurity is a strong predictor of healthcare utilization and costs

A study in Ontario found that among adults, total healthcare costs — including inpatient hospital care, emergency department visits, physician services, same-day surgeries and home care services – increase significantly with the level of household food insecurity.

In other words, food insecurity costs us all through increased healthcare use.  Compared with adults in food-secure households, annual healthcare costs were, on average 16 percent (or $235) higher for adults in households with marginal food insecurity, 32 percent (or $455) higher among those with moderate food insecurity and 76 percent (or $1092) higher among those with severe food insecurity.

3) Food bank use is a poor indicator of food insecurity  

Food Banks Canada recently estimated food bank use for a twelve month period at 1.7 million people, yet the number of food insecure individuals living in Canada is more than double this estimate. The main reason for this discrepancy is that most people struggling to afford the food they need do not turn to charities for help. The evidence suggests that using food banks is a last resort. Because food banks rely on donated food, both the amount and type of food available for distribution is limited, and agencies are unable to provide for everyone in need.

4) An adequate and secure level of household income is strongly linked to food security

It is perhaps surprising, but households reliant on wages and salaries make up the majority of food insecure households in Canada at 62 percent. Households whose main source of income was either pensions or dividends and interest had the lowest rate of food insecurity in 2012 at seven percent — compared to 11 percent for people in the workforce and 70 percent for people on social assistance (i.e., welfare and disability support programs). Researchers suggest the low rate of food insecurity among Canadian seniors reflects the protective effects of our public pension system.

5) Relatively modest increases in income have been found to lessen food insecurity among low-income families

Studies have shown that improved incomes and changes in employment can reduce food insecurity. An example of this can be found in Newfoundland and Labrador where evidence shows that from 2007 to 2012 the rate of food insecurity among households living on social assistance in this province fell from a staggering 60 percent to 34 percent. During this time period, the Newfoundland government made several changes to improve the circumstances of people living on social assistance, including increasing benefit levels and indexing them to inflation (until 2012). 

Let’s not let another year go by without addressing food insecurity in Canada.  In a country as rich as ours, there’s no reason anyone should go hungry. 

 Shimmin_Carolyn_HIGH RESCarolyn Shimmin is a Knowledge Translation Coordinator with EvidenceNetwork.ca and the George and Fay Yee Centre for Healthcare Innovation.

 

 

 

 

 

tarasuk aug 11 2015Valerie Tarasuk is a Professor in the Department of Nutritional Sciences and Dalla Lana School of Public Health at the University of Toronto and Principal Investigator of PROOF, a research program funded by the Canadian Institutes of Health Research to identify policy interventions to reduce food insecurity in Canada.

Why Canada Needs a National Plan to Address Dementia and Alzheimer’s

December 22, 2015 10:47 am
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One of the biggest threats to quality of life and health in ageing is the loss of cognitive abilities and functional autonomy that are associated with dementia, including Alzheimer’s disease. The projections of the number of Canadians living with dementia are staggering, with over 750,000 individuals affected today, an attendant doubling by 2030 – and with health care costs of $293B by 2040.

In September 2015, the Canadian Academy of Health Sciences (CAHS) held a Forum on dementia in Canada. This brought together social scientists, biomedical and health services researchers, healthcare practitioners and technology experts to review current knowledge about prevention and care of dementia with the goal of advancing solutions.

The overarching message of the Forum was that while we have seen many successful pilot projects across the country, there is no mechanism to ensure that these best practices and evidence are scaled up so that all communities in Canada benefit.

So what should be done?  Canada needs a national action plan to address dementia and Alzheimer’s.  And we need one soon.  Here’s why.

Drugs are not presently the answer, and imminent pharmaceutical solutions seem unlikely with more than 200 drug development failures in the last 30 years.

Prevention is promising but challenging.  The recently reported FINGER study shows that dietary counselling, exercise training, blood pressure control and cognitive training achieved significant benefits in cognition and well-being.  Unfortunately there is no clear way to scale-up these important findings for the population as a whole.

Then there’s quality of life, mobilization and sustaining a safe environment which are also critical for people already living with dementia in their homes and community settings.  There are promising solutions, ranging from age friendly community design to technology – much that Canada could learn from.

Dementia-friendly communities and optimizing built environments are being explored internationally enhance accessibility, way-finding and engagement in community life. Those affected with dementia may also stay in their homes longer, through “smart” technologies that prompt tasks and collect data that can be relayed to family and healthcare providers. Robotics, too, may support an individual’s cognitive strength while futuristic self-driving cars come ever closer to implementation.

In other words, there’s no magic bullet.  What we need is a multi-faceted approach that requires real leadership and adequate resourcing for implementation.

There are some key challenges across the country that need addressing for starters.  Accessibility to assessment, diagnosis, treatment and comprehensive continuity of care is a major challenge in all jurisdictions across the country. Quebec offers a promising model with the family doctor at the center of an interdisciplinary team, coordinating care and supporting affected individuals and their families through their disease course.

Homecare needs national attention too.  The type of home support available across Canada varies widely, with limited provision being the common feature. The truth is family and friends of persons with dementia provide most of the care and the healthcare system tends to be reactive rather than guiding or integrating care.

We can address this with a national focus.  There are noteworthy programs that have been developed within provincial boundaries but which have not yet spread to other jurisdictions.

In Saskatchewan, for example, researchers and clinicians have created a “one stop shop” dementia intervention clinic using telehealth, allowing more care to be provided in the home community, making it easier for those living in rural areas – a major challenge in Canada.

A national plan also needs to address the later stages of living with dementia. Right now we are highly dependent on residential care settings where there are significant challenges across the country in providing consistent quality of care, quality of life and quality end-of-life care.

We can no longer hope for simple solutions or a miracle drug to cure our dementia problem in this country (if we ever could).  And the status quo simply won’t hold.  What we need is a strategic action plan for the country that facilitates prevention strategies, advances systems of care delivery, re-shapes our living and built environments and mobilizes technology so that all Canadians with dementia – regardless of who they are or where they live – are supported in their communities as long as possible, and when that is no longer possible, receive exemplary quality care.

We’ve known about the rising rates of dementia – and the catastrophic costs to the healthcare system ­– for years.  What we need now is a multi-faceted action plan with government, the private sector, and the community at large coming together.

Feldman-Howard-MEDI 06Howard Feldman is an advisor with EvidenceNetwork.ca and Professor of Neurology, Faculty of Medicine, University of British Columbia. 

 

 

 

 

 

ESTABROOKS_Carole-resized (1335x2000)Carole Estabrooks is Professor & Canada Research Chair, Faculty of Nursing, and University of Alberta.

Canadians Should Modernize not Privatize Medicare

December 21, 2015 11:27 am
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National Medicare Week has just passed, buoyed with optimism as a fresh-faced government takes the reins in Ottawa – elected partly on a promise of renewed federal leadership on health care.  Yet these “sunny ways” are overcast by recent developments at the provincial level that entrench and legitimize two-tier care.

Saskatchewan has just enacted a licensing regime for private MRI clinics, allowing those who can afford the fees – which may range into the thousands of dollars – to speed along their diagnosis and return to the public system for treatment.  Quebec has just passed legislation that will allow private clinics to extra-bill for “accessory fees” accompanying medically necessary care – for things like bandages and anesthetics.

Once upon a time, these moves would have been roundly condemned as violating the Canada Health Act’s principles of universality and accessibility.  These days, two-tier care and extra-billing are sold to the public as strategies for saving medicare.

Under Saskatchewan’s new legislation, private MRI clinics are required to provide a kind of two-for-one deal: for every MRI sold privately, a second MRI must be provided to a patient on the public wait list, at no charge to the patient or the public insurer.  Quebec’s legislation is touted as reining in a practice of extra-billing that had already grown widespread.

Underlying both reforms is a quiet resignation to the idea that two-tier health care is inevitable.

This sense of resignation is understandable, coming as it does on the heels of a decade-long void in federal leadership on health care.  Throughout the Harper government’s time in office, the Canada Health Act went substantially unenforced as private clinics popped up across the country.  Even in its reduced role as a cheque-writer, the federal government took steps that undermined national unity around health care, switching the Canada Health Transfer to a strict per capita formula, which takes no account of a province’s income level or health care needs.

If Canadians hope to reverse this trend, we cannot simply wage a rearguard battle for the enforcement of the Canada Health Act, as it was enacted in 1984.  Even if properly enforced, the Act protects universal access only for medically necessary hospital and physician services.  This is not the blueprint of a 21st century public health care system.

We desperately need universal coverage for a full array of health care goods and services – pharmaceuticals, mental health services, home care and out-of-hospital diagnostics.

Canada is unique among OECD countries in the paucity of what it covers on a universal basis despite falling in the top quartile of countries in levels of per capita health spending.  Far from being our savior, the Canada Health Act in its current incarnation is partly to blame – not because of its restrictions on queue-jumping and private payment but because it doesn’t protect important modern needs, like access to prescription drugs.

There are limits on what a public health system can provide, of course – particularly as many provinces now spend nearly half of their budgets on health care.  But fairness requires that these limits be drawn on reasoned basis, targeting public coverage at the most effective treatments.

Under our current system, surgical removal of a bunion falls under universal coverage, while self-administered but lifesaving insulin shots for diabetics do not. A modernized Canada Health Act would hold the provinces accountable for reasonable rationing decisions across the full spectrum of medically necessary care.

Instead of modernizing medicare, Saskatchewan and Quebec are looking to further privatize it.  Experience to date suggests that allowing two-tier care will not alleviate wait times in the public system.  Alberta has reversed course on its experiment with private-pay MRIs after the province’s wait times surged to some of the highest levels in the country.

The current wisdom is that long wait times are better addressed by reducing unnecessary tests.  A 2013 study of two hospitals (one in Alberta, one in Ontario) found that more than half of lower-back MRIs ordered were unnecessary.

Skirmishes over privatization have to be fought, but they should not distract us from the bigger challenge of creating a modern and publicly accountable health system — one that provides people the care they need, while avoiding unnecessary care.  Achieving that will make National Medicare Week a true cause for celebration.

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Colleen M. Flood.

Bryan Thomas is a Research Associate and Colleen M. Flood is a Professor, Centre for Health Law, Policy and Ethics, University of Ottawa.  Colleen is also an expert advisor with EvidenceNetwork.ca.

Shaw Creating Turbulence in Canadian Telecom by Acquiring Wind Mobile Corp.

December 17, 2015 4:23 pm
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What Happened?

Shaw Communications Inc. announces a $1.6 billion (Enterprise Value) acquisition of Wind Mobile Corp., a privately held wireless carrier with subscribers and infrastructure in Ontario, Alberta & British Columbia. Wind has earned expected revenue of $485 million in 2015, implying Shaw is paying a multiple of 3.3x estimated revenue. With this purchase, Shaw acquires 924,000 wireless subscribers making it the fourth largest Canadian telecom carrier.

Brace for Impact

This acquisition allows Shaw to diversify its product portfolio adding wireless into its bundle (Already including WiFi internet, fibre broadband, and cable). Shaw previously owned wireless spectrum acquired from the Canadian government in the 2008 wireless spectrum auction for $189.5 million. Rather than building out a Wireless business at that time, Shaw decided to dispose the asset, selling the spectrum to Rogers for an estimated $350 million ($250 million to secure the option and $100 million to execute) yielding a holding period return of 85%.

Shaw is paying 3.3x revenue and 24.6x EBITDA for WIND which appears to be a steep price. Comparable EBITDA multiples for Canadian wireless companies range from 6.0x – 8.1x. However, revenue multiples are in line with Canadian wireless peers trading at 2.8x – 3.1x revenue. The exit multiple of 3.3x implies a premium of between 4% – 17% to secure controlling interest from the private equity consortium of West Face Capital, Tannenbaum Partners, and Globallive Capital, former Wind Founder Tony Lacavera’s investment fund. This deal is likely synergy rich since Shaw has access to Wind’s subscribers, infrastructure, and distribution network of storefronts. It likely also factors in Wind’s current trajectory to grow its subscriber base and ARPU, as subscribers have grown from 800k to 924k and ARPU from an estimated $31 to $43.74. Shaw will likely increase Wind’s monthly average revenue per user up to a figure in line with peers of $61 as the LTE network comes online by 2017.

The incremental EBITDA of $65 million will likely increase, assuming Shaw plans to decrease operating costs with their additional scale, normalizing margins upwards from 13% to 30%. One way this can occur is with better purchasing terms with handset suppliers. For the past year, Shaw’s share price has been a laggard relative to its peers. Year-to-date its share price has fallen 13.97%, compared to the broader S&PTSX composite down 10%. The risk of cord cutting (consumers cancelling their cable subscription to use more internet and mobile services to satisfy their specified utility) applies a greater degree to a firm like Shaw, whose revenue is predominantly cable generated and threatened by the increasing adoption of IPTV. This deal could be the stimulus investors are looking for to regain excitement about Shaw. Shaw insists that it will maintain its investment grade status with the ratings agencies (currently BBB- which is the lower limit for investment grade), and has $398 million of cash on its balance sheet (as of August 31st their last reported quarterly statement) an insufficient standalone amount. The company has secured bridge financing from a consortium of Canadian banks and is not ruling out issuing preferred stock or additional equity either to finance this purchase. This does present some dilution risk to current equity holders. However, this cannot be confirmed until further details are disclosed upon the transaction close.

Calm After the Storm?

This will likely apply some pricing pressure on the incumbent carriers BCE, Rogers, and TELUS, but likely not a material downward shift. TELUS may experience a higher Churn as a result in Western Canada as Shaw will offer a stronger product in this region, in which TELUS has a threatening presence. It is reasonable to speculate that Wind’s ARPUs will rise as Shaw continues to fulfill Wind’s current transition from 3G to an LTE network to offer a competitive suite of voice and data services to Canadians. Shaw CEO, Brad Shaw indicated this in an interview with the Globe and Mail.

As the quality of the wireless service offering improves, Shaw will likely charge a price in line with what their competitors offer (noting a possible discount), but employ a similar price differentiation strategy such as bundling with their current cable and WiFi customers. Shaw possesses scale, is a proven network operator, and has access to financial capital that WIND does not which is necessary to compete in this capital-intensive industry. (Wind did recently raise financing at below high yield rates, this is not the norm, and was likely done to recapitalize and make the firm more attractive for acquisition)

Shaw has all the ingredients of being a fourth incumbent and a welcome addition to the Canadian Telco Oligopoly. Shareholders rejoice while consumers prepare for the same old song and dance.

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David A. Pickett is a former equity research associate from a large Canadian Broker Dealer and has over four years of telecommunications experience in both sales and analytical capacities. He studied his MBA at McMaster University with a focus in Finance and Business Valuation and his interests include history, business, baseball, and board games.

The Planet is Dying of Consumption and Only Citizens can Halt the Process

December 15, 2015 10:03 am
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At the 2015 Paris Climate Conference, COP21, the focus has been on promises countries make to reduce their greenhouse gas (GHG) emissions. These macro level commitments are always made with varying degrees of sincerity because few political leaders will be willing to cause real or even perceived damage to their economies.

In other words, it may be unrealistic to expect the bold and courageous political leadership necessary to address the magnitude of the climate problem.

Although Canada’s reputation as an environmental laggard evolved while the Harper government was in power, it should not be forgotten that the Chretien government’s support of the Kyoto Accord was mainly symbolic. Even the most cursory research would reveal that Canada worked to weaken parts of the final Kyoto Protocol through market-based, flexibility mechanisms that reduced Canada’s responsibilities to combat climate change.

For instance, Canada favoured Joint Implementation and Clean Development Mechanisms which allow one country to fund and receive credit for emission-reduction in another country. These devices, embraced by other countries including Japan, the U.S. and Australia contributed to a watering down of national targets to make them palatable to economic interests.  

Regardless how determined the current Liberal government may be to tackle climate change, there are powerful political and economic forces it has to contend with.

That is why if the warming of this planet is to be slowed — if not halted — it will not come about by government fiat, nor should it. Governments are reluctant to impose unpopular measures and the corporate sector will resist attempts to curtail our freedom to consume. This is the elephant in the room: the planet is dying of consumption, a fact that was recognized four decades ago.  

So what’s the solution? The impetus must come from citizens. Their overwhelming support will stiffen the spines of political leaders.

It will require nothing less than a popular uprising, especially in the industrialized world, to convey the message that tackling climate change is urgent. And Canadians must express their willingness to swallow the bitter medicine necessary to solve the problem. For a start, we need to be less wasteful — we throw out more garbage per capita than people in any other developed country.  We also throw away half our food, but on this matter, we are not alone.

People in industrialized countries enjoy an unsustainable lifestyle that swallows up the bulk of the world’s resources. With about five percent of the world’s population, Canada and the U.S. consume 32 percent of its resources. If the rest of the world caught up with us, it would be catastrophic.

It’s easy to ignore the impact of individual actions on the environment.  Whether it is using energy for our mobile devices – the smart phones that never leave our sides – or the proliferation of two-storey inflatable Santa Clauses (or their seasonal equivalent) that adorn more and more lawns, few of us even think of the consequences of our spending habits. Consumption must be addressed.

COP21 was an opportunity for citizens to inform governments that they are ready to make painful choices. But we, at the grassroots level, must drive the process otherwise governments will continue to meet and sign accords with lots of wiggle room and it will all be for show.

If our new federal government truly believes in hope and change, it will come up with more robust means to reduce greenhouse gas emissions.  Prime Minister Trudeau has announced to the world that Canada is back and if that means we’re back to a wishy-washy approach to environmental solutions, the hopes that are riding on his shoulders will soon evaporate.

Barrie,Doreen_PoliSci_Sep2015Doreen Barrie is an Adjunct Assistant Professor of Political Science at the University of Calgary.

It’s Time to End Canada’s Opioid Epidemic – An Open Letter to Canada’s New Minister of Health

November 30, 2015 11:18 am
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Dear Minister Philpott,

Congratulations on your appointment as Minister of Health. As an experienced physician, you bring valuable perspective to the post. While there are many contentious matters before you, including a new health accord, physician-assisted dying and marijuana legalization, few could be more pressing than the prescription opioid epidemic, an issue all but ignored by your predecessors. This is the greatest drug safety crisis Canada has ever faced.

When you returned to Canada in 1998 after nearly a decade of practice in Africa, you witnessed the seeds of this epidemic being sown, with strong painkillers like OxyContin prescribed liberally for chronic back pain, arthritis and fibromyalgia. You heard experts say these drugs worked well for chronic pain, that the risk of addiction was low, and that doctors who resisted prescribing them were “opiophobic.” Perhaps you even began prescribing opioids for chronic pain, as did I and thousands of our colleagues, unaware that what we had been told was untrue.

It’s clear now that we were objects in an elaborate marketing effort. Cloaked as it was in the virtues of compassion and beneficence, it was a remarkable success – until, that is, we consider our patients. Today, doctors’ offices are inundated with people who have been harmed more than helped by these drugs. Thousands more are dead. No demographic has been spared. And yet the marketing continues, with pain specialists and advocacy groups opposing moves to curtail opioid prescribing, their efforts financed by the very companies that make these drugs. These forces, coupled with the societal expectation that pain be medicated, threaten every community in this country.

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Canada’s new Health Minister Jane Philpott.

An estimated 10,000 to 20,000 Canadians have died from opioids since 1995, and an untold number now suffer from addiction. The federal government must take the lead in dealing with this crisis, rather than offloading responsibility to the provinces. I propose several concrete measures to that end. Some are squarely within your purview; others will require provincial cooperation.

We must quantify the toll of the epidemic. In the United States, more than 16,000 people die of opioids each year; remarkably, there are no corresponding data for Canada. We can’t fix what we don’t even measure. The Public Health Agency of Canada should work with provinces to develop mechanisms to quantify opioid-related deaths. These data should be public.

Prescription monitoring programs should connect pharmacies in real time, in part to identify the small but important subset of patients seeking prescriptions for misuse or resale. These systems can also identify physicians whose prescribing falls afoul of good practice or, in some instances, the law. In an era when teens on different continents play video games in real time, it’s absurd that pharmacies in the same town operate in isolation.

Some measures involve specific drugs. Eliminate nonprescription codeine products from Canadian pharmacies. These are poor analgesics prone to abuse at high doses, resulting in deaths from acetaminophen and ASA toxicity. Revoke approval for “generic OxyContin” tablets, which are easily crushed and disproportionately benefit the dealers who sell them. The popular painkiller tramadol is increasingly abused and should be reclassified as a controlled substance, as its pharmacology demands and as Health Canada contemplated in 2007 before being lobbied by Purdue Pharma. Finally, treatment with fentanyl – an especially dangerous drug – should be restricted to patients willing to return used patches for new ones.

People with opioid addiction need more support and less marginalization. They require greater access to addiction specialists and medications like buprenorphine, along with supervised injection sites for those who choose this path. These save lives, as does the antidote naloxone, which should be freely available to anyone who wants it. Health Canada’s review of naloxone, inexcusably glacial, must be accelerated.

Finally, the government should introduce legislation akin to America’s “Sunshine Act”, illuminating the financial relationships between pharmaceutical companies and doctors, specialty organizations and advocacy groups. The money here flows in one direction only, its sole purpose to increase drug sales. This initiative, sure to be opposed, will necessitate provincial cooperation.

Some of these suggestions are more easily implemented than others, but all warrant your consideration. With more than a hundred Canadians dying every month, there is no time to waste.

Juurlink_David_HIGH RESDavid Juurlink MD, PhD is a Professor and Head at the Division of Clinical Pharmacology, University of Toronto. You can find him on Twitter at @davidjuurlink.

Dear Health Minister Philpott — We Need Leadership In Medicare Restored

November 19, 2015 11:00 am
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Dear Minister Philpott,

It is fantastic news that as a family doctor you are our next federal health minister.  You will know very well that our healthcare system shows its age.  Born in the middle of the 20th century, its primary focus on doctors and hospitals is outmoded as technology shifts and our health needs change.  But forging change in Canadian heath care has proved an extraordinary challenge.   

In the past, the stickiness of the status quo means that even if new federal dollars for healthcare are transferred to the provinces, they will be spent mostly on increased fees for physicians and hospitals. You will also know too well from history that real change won’t happen by providing more federal money with unconditional transfers.  

Real change will require helping provinces to shift the focus of our health system away from those who are relatively well resourced to new areas of care, such as essential pharmaceuticals and homecare.

So what should you do?  

First, and most importantly, you should accept and endorse a shared responsibility for healthcare in the federation.  

The Harper decade was a dark one for healthcare leadership.  His mantra was that all healthcare decision-making was a matter for the provinces.  It has since become a common refrain for media pundits to claim healthcare is a matter of exclusive provincial jurisdiction although our Constitution clearly provides it is a matter of shared jurisdiction.

Federal leadership in healthcare does not mean dictating to the provinces what to do or how to do it, but it does mean bringing provincial leaders together in the spirit of cooperation and under shared initiatives with specific targets, goals and money attached.  

There are two areas that could most benefit from critically needed federal-provincial shared leadership: pharmaceutical drugs and long-term care/homecare.    

We are the only developed country with a universal health system not to insure its citizens for prescription drugs.  This means too many Canadians are going broke to afford their essential medicines or forgoing them altogether, and costing Canadians far more in acute health services in the long run.  

But apart from the access problem, we also have a cost problem – we spend a lot on medicines.  Indeed, the OECD has just issued a report showing Canadians are (still) paying some of the highest prices for pharmaceutical drugs in the world.  

We are in this situation because we rely on multiple (and largely unregulated) private insurers with most government plans covering the poor and very old.  Neither have been strong bargainers on our behalf with pharmaceutical companies.

So how do we shake up the status quo? We need universal drug insurance covering all Canadians.  We can’t go on with a medicare that doesn’t cover essential drugs like insulin or cancer medications, for example.  

It is a false economy to think the expansion of public money is a luxury we can’t afford when, overall, if we had universal drug insurance we would have better control of total (public and private) spending than we presently do — and the ability to negotiate better prices for drugs.   

To get there we could follow in the footsteps of Australia.  In the 1940s, Australians changed their constitution so the federal government assumed jurisdiction over pharmaceuticals. An appropriate first reaction might be that a constitutional change in Canada has a snowball’s chance in hell, but it may be easier than you think.  Canadian provinces once agreed voluntarily to just this kind of arrangement for pharmaceuticals during the last Liberal administration.  Don’t say no this time.  

Another option might be to amend the Canada Health Act to tie fiscal health transfers to provinces on the condition they provide some form of insurance for important prescription drugs.  How they do this would be their decision, but leadership from the federal government would go a long way in making critical medicines accessible to all Canadians.  

Finally, Canada needs real change in homecare and long-term care.  Prime Minister Trudeau already promised $3 billion dedicated to homecare, but please make sure the provinces are required to use this money to get people more needed homecare and long-term care rather than being used to maintain the status quo.

New money must drive real systematic reform.  

You need to lead and explore with the provinces new ideas like possible universal long-term care insurance (similar to CPP) or other innovative financing strategies that maximize individual autonomy and choice.  One idea could be personal support budgets which are popular in Europe and allow those in need a source of funds to buy homecare and other supports in the community rather than being forced into (costly) public institutions.

Minister Philpott, we need new models of thinking about how we provide essential medicines and health services to Canadians. The same-old-same-old thinking will no longer do.

Flood_ColleenColleen M. Flood is a Professor, Director of the Centre for Health Law, Policy & Ethics, and a University of Ottawa Research Chair in Health Law & Policy.

Why Police Fear Evidence-Based Research

November 12, 2015 11:21 am
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While almost every sector of society in the 21st century recognizes the importance of evidence-based decision making, police organizations are caught up in outdated policing approaches that are devoid of empirical evidence.  The major reason police are so resistant to the new regulations on carding announced by the provincial government is the fear that they will be subject to increased scrutiny.  

In short, it’s not carding that they fear but evaluation and evidence-based policies that will be able to measure their effectiveness.  Jeff McGuire, president of the Ontario Association of Chiefs of Police, argues that the new carding regulations will strain ties with the community and lead to an increase in complaints against the police. This is as devoid of empirical evidence as the misguided argument that carding helps police solve crime.

So why do police fear evidence-based approaches to policing?  First, police organizations in the past have functioned with relatively little outside scrutiny as to how they conduct their operations.  This independence has helped them avoid being evaluated and criticized for the way they police the community. For example, it’s a well known fact among academics that police organizations are very wary of letting researchers carry out empirical research on how they police.  This resistance is one of the major reasons there have been so few studies that look at police use of force, racial profiling, carding, police community relations and race relations, to name just a few.

Second, police organizations are generally very conservative and are more interested in preserving the status quo than making major changes to how they police.  This abhorrence to change comes from the fact that many police chiefs came up through the rank and file where compliance and conformity is rewarded and innovation and creativity is discouraged.  Staying the course is easier than adopting new methods of policing and it’s so ingrained in the police culture that any change is actively discouraged.

Third, police leaders are afraid that evidence-based research that reveals flaws in the way they police may lead to them being fired or removed from their jobs.  As a result police agencies see empirical research as a potential threat to their occupation.  This is particularly true for police leaders who have no formal education or understanding of the role that research can play in improving their organization’s overall effectiveness in policing.  Many police chiefs still have stereotypical ideas about crime, punishment and criminality that bear no actual resemblance to research evidence in the 21st century.  Some police officers still see themselves and society gridlocked in an ‘us versus them’ dichotomy when dealing with the public.

Fourth, many police organizations are ignorant of the value that evidence-based research can play when it comes to improving their relations with the public and in reducing crime.  Carding is a good example.  While some police chiefs claim that the new carding regulations will negatively affect their relationship with the community they completely overlook the enormous harm that carding has caused in the discriminatory manner in which it has been used by police to bully, intimidate and label minorities.  Police have repeatedly ignored the fact that carding is a violation of the Canadian Charter of Rights and Freedoms and that it is a non-transparent form of surveillance that records and retains data on non-convicted people.  It has absolutely no place in a civil and democratic country that is governed by the rule of law.

Before stepping down as the Chairperson of the Toronto Police Services Board, Alok Mukherjee outlined a new model of policing for the City of Toronto.  His policing model was not based on antiquated concepts and ideas that are 40 years out of date but rather on solid empirical evidence about policing in the 21st Century.  Most people are not aware that less than 20 per cent of a police officers time actually deals with law enforcement related activities.  In fact, studies show that police officers spend 80 per cent of their time filling out reports, facilitating traffic at construction sites, responding to noisy parties and helping mediate neighborhood disputes.  Does it make sense that we should be paying a police officer $80,000 a year for these duties when they could for a fraction of the cost be transferred to bylaw officers or other people to perform these tasks?  In the nation’s capital the Ottawa Police Service is responsible for enforcing the rules governing bicycles.  Is this a productive and cost-effective utilization of their time?  The fact is that if more people were aware of what police do with their time some people might actually start questioning the costs of policing in their neighborhoods.

Under the Canadian constitution it’s not the role of the police to make laws in society and police chiefs and police associations should not be accorded any special status, privileges, treatment or influence in directing government policy in Ontario that is not equally afforded to the average citizen.  The fact is that police organizations must change the way they police citizens in this province by adopting innovative policing measures in the 21st Century that are evidence-based, progressive and cost-effective.  Citizens should expect and demand nothing less.

The views expressed are those of the author in his personal capacity and they do not necessarily represent the position of Carleton University.

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

Many Patients with Chronic Health Conditions Also Have Mental Health Issues that Go Undiagnosed and Untreated

November 9, 2015 11:02 am
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We need to better integrate physical and mental health services

Our health system often divides mental health from physical health into distinct silos of care and treatment, yet no such mind-body duality exists in actual patients.  Many individuals with chronic health conditions simultaneously experience mental health issues — and the reverse — and such “concurrent” health challenges are far from uncommon.   

According to the World Health Organization, four of the six leading causes of disability are due to mental illness.  Awareness campaigns have lately flagged the importance of mental health services as a critical part of the healthcare system.

What’s less well understood is that individuals suffering from psychiatric illnesses also have high rates of physical health conditions, such as diabetes and cardiovascular disease, and as a result, live up to 20 fewer years than those without mental illness. And individuals with chronic medical conditions are at increased risk of mental illness, such as depression, in comparison to the general population.

Yet it is far too difficult for individuals with both psychiatric and medical illnesses to get the care they need when and where they need it because of the way health services are currently delivered.  In Canada, individuals with diagnosed medical illnesses often have their psychiatric illnesses go undetected and untreated. And individuals with diagnosed psychiatric illnesses are known to have poor access to medical care.  

The impact of ignoring the reality of concurrent physical and mental health conditions is increased hospitalizations, poor adherence to medical treatment, social isolation and poor self-care.  It costs the system and hurts patients.  

It doesn’t have to be this way.  

There are several well-studied models of integrated care where patients receive both physical and mental health treatment in family physician settings, such as IMPACT (Improving Mood – Promoting Access to Collaborative Treatment) and COMPASS (Care of Mental, Physical and Substance Use Syndromes) from the United States.  Evidence from these studies shows that when nurses and consulting psychiatrists are available to patients when they visit their family physicians, they experience improved medical and mental health outcomes. Studies also show such integration of mental health care directly into primary care is cost-effective.

Unfortunately, these evidence-based, integrated models of care have not been widely adopted across Canada.

The good news is that we are taking steps in the right direction.  In 2014, the Medical Psychiatry Alliance (MPA) formed in a unique partnership between the Centre for Addiction and Mental Health, The Hospital for Sick Children, Trillium Health Partners and the University of Toronto with a $60 million dollar investment from the Ontario government, an anonymous generous donor and the four partners. The first of its kind in Canada, the partnership aims to address gaps in concurrent physical and mental health care in Ontario through clinical, research and education initiatives.

The goal of the MPA is long overdue, yet attainable: to create future integrated care practitioners in the province who are able to advocate and care for patients with complex physical and mental health issues. The goal is for patients to get seamless, integrated care for mental and medical illnesses when and where they need it.

To that end, a cadre of experts gathered at the 2nd annual Medical Psychiatry Alliance Conference last week in Toronto to focus on transforming medical education across healthcare professions to train future healthcare teams in medical psychiatry integrated care.

It’s a good start but much more needs to be done.  Our health system needs to reflect the needs of patients and address fragmented care. Integrated care needs to become the norm rather than the exception.  So how can we get there?  

For starters, it is the responsibility of all health profession educators to reform training to better reflect the common reality of co-occurring physical and mental illness and to align with emerging integrated physical and mental health care models. Imagine the medical student whose early clinical experiences allow him to better help a patient suffering from schizophrenia to engage in care for their untreated diabetes. Or the healthcare professional who is now able to identify and treat depression in patients with heart disease before it impacts their medical care.

But we also need leadership from the government to reshape the health system, to break down silos and help practitioners establish team-based models of care.  We need to do a much better job of integrating medical and psychiatric care so that it is patient-centred and timely – and gives Canadians a better return on our publicly funded healthcare dollars.  

It’s time to stop dividing the mind from the body and treat the whole patient.   

 Kurdyak_PaulDr. Paul Kurdyak is an expert advisor with EvidenceNetwork.ca, the MPA Director of Health Outcomes and the Director of Health Systems Research at CAMH.

 

 

 

 

Sockalingam_SanjeevDr. Sanjeev Sockalingam is an expert advisor with EvidenceNetwork.ca, the MPA Director of Curriculum Renewal and the Director of Continuing Practice and Professional Development at the University of Toronto.

Canada has too many kids in care – and the situation is not improving

November 6, 2015 10:00 am
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It’s time for national leadership.

What happens to kids who authorities determine can’t live safely with their own parents or caregivers? Thousands of Canadian children are in this situation right now.

Many children are sent to foster homes, while others are sent into other types of out-of-home care on behalf of child welfare agencies. But we don’t know how many, nor do we know how well they are doing.

Why? Canada does not keep reliable national statistics on kids in care, instead relying on provincial reporting. But each province has its own child welfare policy and its own definition of children in care, which may not include other types of out-of-home care, such as care from family relatives (kinship care) or group homes.

This matters, because it is difficult to know what to do — how to improve outcomes for Canadian kids — if we are not keeping track of what is going on. Some analysts say child welfare systems suffer from underfunding, staffing cuts and not enough foster families or resources to support them.  But policy makers have a hard time deciding what to fund without statistics to measure possible outcomes.  Also, reliable numbers can help provinces compare best practices for child welfare.

Instead, Canada’s foster children story is a patchwork of data and news headlines reporting foster care crises where some children have died while receiving child services.

Here’s what we do know:

Back in 2011, the National Household Survey counted approximately 30,000 foster kids in Canada. This figure is based on a single-day count that does not include children in other types of out-of-home care, such as group care.  Also, statisticians caution that this survey is voluntary, which often results in less accurate data from low-responding groups such as Indigenous peoples, new immigrants and low-income families.

In 2007, the Canadian Child Welfare Research Portal reviewed provincial annual reports and counted over 65,000 Canadian children in care on a single day.

More recent provincial data tell us that Canada has one of the highest rates of kids in care in the world.

Let’s take Manitoba, which has reliable statistics on the issue. In 2014, Manitoba Family Services reported more than 10,000 children in care.  And here’s a fact that should alarm every Canadian: by the age of seven years, 7.5 percent of all Manitoba children have been placed in care at some point in their lives.

When compared to other countries, Manitoba’s data is even more startling: Manitoba’s rate of out-of-home care for children under 11 years of age was 10 times higher than that of Western Australia. Our rates of care for children during the first year of their lives are higher than Sweden, Western Australia, England, New Zealand, and the U.S.

Manitoba is not alone. Although we cannot do province to province direct comparisons because the data measure different things, the total numbers of children are still alarming.  In 2013, Association des Centres Jeunesse de Quebec reported 11,250 children in kinship care, foster care and group careIn 2012, the Saskatchewan government reported 6,738 children in out-of-home care.

We also know that not all Canadian children are equally likely to be placed in care.  The First Nations Child and Family Caring Society of Canada estimates that Indigenous children comprise 30-40 percent of kids in care even though aboriginal population is less than five percent of the total population of Canada.

So, why does Canada have so many kids in care?

The answer largely lies in the approach. Canada (as well as the U.S.) favours a “child safety” approach to children’s welfare. This means that if a welfare agency identifies a child at risk, he or she is removed from the home. Child welfare agencies rely on foster homes and other types of placements to provide temporary, day-to-day care for children until the risks of abuse or neglect are resolved.  But with so many kids in care, securing quality out-of-home care is a challenge across Canada.

Australia and several European countries take more of a “family welfare” approach.  This means that when a child is at risk, the whole family is given intensive home support to try and remove risks while the child stays with the family.  Sweden’s child and family well-being policy has made remarkable progress in reducing child poverty and family violence, which are two major risk factors for child welfare.

It’s time we took a dramatic new approach to kids in care and overhauled our system to focus on preventing rather than reacting to child maltreatment.

It’s time we had some federal leadership on a national strategy to make sure some of our most vulnerable citizens are not left by the wayside, but instead treated as valued and respected members of our communities.

There’s no greater folly as a nation than wasting the potential of our children. Or worse, putting them at risk.

Marni Brownell is an expert advisor with EvidenceNetwork.ca, a Senior Research Scientist with the Manitoba Centre for Health Policy (MCHP) and Associate Professor in the Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba.

Neeta das McMurtry is a freelance writer.  She specializes in making academic and scientific writing accessible to broader audiences.

 

Catastrophic pharmacare is a catastrophe

November 5, 2015 10:07 am
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Why the provinces don’t need $3 billion in federal tax dollars for flawed prescription drug policies

Last week, the CD Howe Institute called on Ottawa to give provinces nearly $3-billion to establish national standards for catastrophic drug coverage and to mandate a system of transparent price negotiations with pharmaceutical drug manufacturers. Acting on those recommendations would represent a major step backward for Canada, one that would cost Canadians billions of dollars per year.

The CD Howe Institute claims it is not feasible for Canada to implement what their own evidence suggests is the best pharmacare model – national standards for universal, comprehensive coverage of medicines of proven value-for-money. They instead argue the feasible policy option is to have all provinces pay for drug costs that exceed three per cent of household incomes. This is surely “feasible” because as good or better drug coverage already exists for most people in most provinces without billions of new tax dollars provided by the federal government.

The “feasible” model of catastrophic drug benefits is also already a proven failure for patients, businesses and taxpayers. How so?

Catastrophic drug coverage fails to ensure universal access to necessary medicines. Numerous studies that have shown that deductibles under catastrophic drug plans act as barriers to filling necessary prescriptions.

Residents of British Columbia – the only province with exactly the kind of pharmacare program recommended by the CD Howe Institute – are more likely to skip prescriptions because of cost than residents of provinces with more comprehensive drug coverage. If Ontario adopted the same type of coverage, as many as 68,000 elderly Ontarians would find their prescriptions too costly to fill.

Financial barriers to filling necessary prescriptions result in worse health for patients. They also result in increased use of taxpayer-finance hospital and medical care. In other words, they don’t save anybody money in the long run.

The catastrophic model of pharmacare also imposes considerable direct costs on families and on the businesses who sponsor extended health benefits for workers and retirees. In 2003, when British Columbia adopted the model recommended by the CD Howe Institute, the private sector had to pick up an additional $134-million per year in drug costs. Today, in Ontario alone, a similar policy shift would likely increase employers’ and families’ drug costs by over $500-million.

This brings up another key failing of catastrophic drug coverage: it does the opposite of controlling costs because it unnecessarily increases administrative costs and dramatically reduces purchasing power. Both of these outcomes result from involving private insurers in the financing of medically necessary prescription drugs.

Private sector analysts estimate that up to $5 billion spent by Canadian employers on private drug benefits is wasted because private drug plans are not well positioned to manage drug pricing or the prescribing and dispensing decisions of health professionals.

To remedy that problem, the CD Howe Institute recommends that provincial governments work to lower prices paid by private insurance companies through a transparent system of drug pricing in Canada. Sounds great in theory, but it won’t work in practice. Why?

The era of transparent pharmaceutical pricing is over.

So many nations – including Canada – have historically regulated drug prices based on what manufacturers charge in other countries that firms now artificially inflate their list prices for medicines worldwide. Then, instead of giving every country price reductions offered to those with effective negotiating power, pharmaceutical manufactures now simply do price deals in secret.

In effect, pharmaceuticals are now priced like new cars: there’s a manufacturers “list” price, and then there is the confidential price that each customer actually negotiates. Recommending that Canada have a transparent system for drug pricing is equivalent to saying that our governments cannot negotiate deals. This would not lower prices for the private insurers incapable of negotiating on their own. And it would eliminate the opportunity for governments to save hundreds of millions of dollars per year on behalf of taxpayers.

To act on the recommendations of the CD Howe Institute is a “feasible” way to squander billions of dollars of federal transfers on a model of pharmacare that will cost Canadian patients, businesses and taxpayers billions every year. Better, more equitable and sustainable options are viable for Canada, especially if $3-billion in new federal money is on the table.

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Steve Morgan is a professor of health policy in UBC’s School of Population and Public Health. Follow him on twitter at @SteveUBC.

Five Quick-Wins for Trudeau’s First Day in Office

November 3, 2015 10:00 am
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Photo by Jean-Marc Carisse.

While it takes time for a new prime minister to translate campaign rhetoric into effective policies, there are at least five quick-wins that Justin Trudeau can achieve on his very first day in office. All five can be implemented in a few minutes through simple orders-in-council at the cabinet table or by instructing new ministers in their mandate letters.

1. Trudeau can restore the mandatory long-form census.

The mandatory census collected more detailed information about Canadians, facilitated better municipal planning and helped tailor community services to local needs. The replacement voluntary census brought in by the Harper government was a boondoggle – millions more expensive, considerably less reliable and disastrous for long-term policy evaluation and planning. The 2016 census is about to be launched; instructions on the additional long-form survey just need to say it is “mandatory” not “voluntary.”

2. Our new prime minister can immediately restore access to health care for refugees waiting in Canada as their claims or appeals are adjudicated.

The 2012 cut meant that too many refugees seeking safe harbour in Canada were denied health care services, including children, pregnant mothers and persons with disabilities. The Federal Court of Canada has already ruled that the cut violates the Canadian Charter of Rights & Freedoms and represents “cruel and unusual treatment.” Restoring these services will take seconds of cabinet’s time, improve the lives of our most vulnerable visitors and cost very little money – if any at all.

3. Government scientists can be freed from muzzling after almost a decade of silence.

Of course these scientists remain public servants who must defer and remain loyal to their new government, but their scientific findings and expert opinions on today’s most pressing matters are vital to Canadians and should be made available. This is how science works. It would be simple to ask all new ministers in their mandate letters to remove any obstacles preventing government scientists from publishing their research and speaking freely about it.

5. Trudeau can end Canada’s visa restrictions against Ebola-affected countries, Guinea and Sierra Leone.

The visa restrictions are patently illegal – contrary to the International Health Regulations that are legally binding on 196 states. But they also run afoul of what the World Health Organization recommends is best for global public health. They dangerously discourage countries from reporting the presence of future pandemics.

It was the previous Liberal government that had championed irrational bans on trade and travel like these Ebola visa restrictions after Toronto had unfairly been slapped with a travel advisory during SARS. Trudeau, on his first day in power, can bring Canada back into compliance with its international legal obligations and boost an important global health treaty that its predecessors prominently ignored. Besides, as Ebola case numbers in West Africa have remained for weeks at single digits and dwindle towards zero, even the original misguided rationale for this policy has all but disappeared.

5. The incoming government can formally de-link international development assistance from Canada’s economic interests.

In theory, Canada was once committed to a foreign aid strategy that emphasizes initiatives that have the greatest social impact. However, in 2012, Canada adopted a new policy of giving aid based on how much of it gets kicked-back to Canadian companies. This is trade, not aid. As a result, Canada has been ridiculed internationally, taken flack for snubbing its international commitments and lost influence in global fora. Ending this colonial anachronism would help Trudeau and his government bring Canada back to the multilateral table as an influential middle power.

Implementing the full range of changes promised in this last election campaign will take a long time, probably many years. Quick-wins will be important for Trudeau to show Canadians that his Liberal government can bring about the breadth and depth of change for which he was given a majority. Fortunately for him, he has many options. These five quick-wins are primed and ready to go. Implementing them in the few minutes of cabinet table time that they require could make for one very productive – even historic – first day in office. It would certainly signal real change coming.

Steven HoffmanSteven J. Hoffman is a member of University of Ottawa’s Centre for Health Law, Policy and Ethics, 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 Fafard

Patrick Fafard is a member of University of Ottawa’s Centre for Health Law, Policy and Ethics and an Associate Professor of Public & International Affairs at the University of Ottawa.

Why the Federal Government Needs to Keep its Promise to End Income-Splitting

November 2, 2015 12:05 pm
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Children’s Health More About Good Social Policy than Medicine Alone.

More of Canada’s children are living in poverty than ever before. A new report reveals that child poverty rates in Canada remain unconscionably high. Almost one-third of children in Toronto live in low-income households. Population measures of child health in Canada are also troubling, including above average rates of infant and under-five mortality and below average marks on indices of child well-being as compared to high-income country peers.

We are awash in riches, yet plagued by poverty. Why do we tolerate such disparity? Ironically, our national preoccupation with health care is partly to blame.

Our public discourse on health, including child health, has tended to focus on acute medical problems and technological solutions to them. This has blinded us to the disproportionate role of social circumstance – facets of daily life as fundamental as food and housing security – in determining child health and well-being.

Greater attention to the social determinants of child health need not crowd out efforts to optimize access to quality health care, which every child surely deserves. But it should direct our gaze upstream, towards the often-remediable sources of childhood illness and suffering.

Disparities in child health and well-being in Canada find their source in the values that drive social policy choices for children. The values that shape our political culture, that ground the legislative and policy priorities of government, often matter more to child health than the results of any clinical trial ever will.

In this federal election, we bore collective witness to a clash of values with real bearing on the life chances of Canadian children.

We witnessed opposing stances on income tax policy – notably, with respect to income-splitting for couples with children. Since its announcement last fall, this policy has been consistently framed by the Conservatives as a defense of Canadians’ economic freedom – a way for “people to put more money back in their own pockets.”

But as numbers from the Parliamentary Budget Office make clear, income-splitting primarily benefits middle- and upper-income families, provides relatively little tax relief for low-income families, and skirts single parents altogether. Just as importantly, it acts to deter both parents from equal engagement in the workforce and devalues family policies that promote dual engagement.

From the point of view of child health, evidence suggests we should be doing just the opposite. Family policies that favour dual-earner households – universal childcare, enhanced parental leave and robust early childhood education – are associated with gains in child survival.

The more generous a country’s policies toward dual-earner families, the lower its infant mortality rate: remarkably, among OECD countries, every increase of one percentage point in dual-earner support correlates with 0.04 less infant deaths per 1000 births. Knowing this, one might reasonably ask what inspired the Conservatives’ resolute defense of income-splitting. Its logic is rooted in values that increasingly suffuse large parts of our political system and society: ones that define social citizenship by degrees of economic liberty and spurn equality and universalism as foundations for social policy.

Our ever-deepening ideological commitment to market freedom has obscured the lessons of good science. We’ve become a society that defends a narrow form of liberty at the expense of equality or solidarity. A free and just society depends on liberty; but liberty unchecked abets polarization and social dislocation.

If we want to improve the health of Canada’s children, we must begin to re-imagine the values that found our social policies.

Prime Minister-designate Trudeau campaigned on a promise to scupper income-splitting, recognizing its inherent inequity. Canadians seem to have recognized this too. Our new government should follow through on this promise. While laudable, promises to roll back this policy represent a very small step toward confronting disparities in child health and well-being in Canada. Income-splitting is one manifestation of a broader set of social values that has come to pervade our political institutions and discourse.

Going forward, Canadians should continue to press for values and policies that buoy all our country’s children, rather than leave those most vulnerable among us to be buffeted by rough market seas.

Denburg_Avram_headshotDr. Avram Denburg is an expert advisor with EvidenceNetwork.ca, a paediatric oncologist at Sick Kids and a 2015 Trudeau Scholar. He sits on the Board of Canadian Doctors for Medicare.

Liberals Have Plenty of Talent to Make Up Gender-Balanced Cabinet

October 27, 2015 10:08 am
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Photo by Jean-Marc Carisse.

Justin Trudeau promises to have gender parity in his cabinet. He announced that in his Democracy package back in June and, when asked about this on the weekend, he reaffirmed his position.

So who are the women who could make up his cabinet?

In a 30-member cabinet, Trudeau has to pick 15 strong female candidates and he certainly has enough to pick from given the women elected on October 19.

Judy Foote

Judy Foote. Photo courtesy of Wikimedia commons.

On the east coast is Judy Foote who was first elected as an MLA in the Newfoundland and Labrador legislature and served as minister in industry, trade and technology.

In Quebec, one of the new candidates is lawyer and social activist, Melanie Joly, who almost won the mayor’s job last fall.

Also in Montreal is Marwah Rizqy, an international tax law expert and professor. There’s also Linda Lapointe, a business woman and former Member of the Quebec National Assembly, from just north of the city.

Ontario has some seasoned MPs, Carolyn Bennett, the junior health minister in Paul Martin’s government, Judy Sgro and Kirsty Duncan from the Toronto area. A newer member, Chrystia Freeland, elected in a by-election last year, is a journalist and author in economic affairs.

Jane Philpott from just north of Toronto is a possible health minister – she has been Chief of Family Medicine at Markham-Stouffville Hospital.

In Brampton, Ruby Sahota is a lawyer specializing in criminal law, litigation, and dispute resolution, and in Cobourg, Kim Rudd is a past president of Willis College and the Cobourg Chamber of Commerce.

In the Ottawa area there are several stars, Anita Vandenbeld and Catherine McKenna both have international development experience – Vandenbeld in building democracy and McKenna in law and human rights; and Karen McCrimmon is a former lieutenant-colonel in the Canadian Forces, a trailblazer in the air force.

In Manitoba, MaryAnn Mihychuk , former provincial MLA and minister of industry and mines (albeit as a provincial New Democrat) has ministerial experience. Vancouver has two experienced MPs. Hedy Fry who was multiculturalism minister in the Chretien days and Joyce Murray a former provincial minister of environment and of government services.

Jody_Wilson-Raybould

Jody Wilson Raybould. Photo courtesy of Wikimedia commons.

Jody Wilson-Raybould is former crown prosecutor, treaty commissioner and Regional Chief of the Assembly of First Nations and a Liberal star candidate.

And while we are on the subject, there are several male potential cabinet members. Ralph Goodale occupied the finance portfolio for two years under Paul Martin. Current finance critic Scott Brison, Bill Morneau – a Bay Street business leader and social activist – and Jim Carr from Winnipega could all be influential in the Liberal’s new cabinet. Another contender is Francois-Phillippe Champagne, an international business person from Quebec.

In defence, there could be retired general Andrew Leslie from the Ottawa area and Mauril Belanger, who was associate minister of defence under Martin, also an expert on cultural and national identity issues.

In justice and national security roles there are Marco Mendicino, a crown prosecutor who beat Conservative finance minister Joe Oliver and former police chief Bill Blair, both from Toronto; and former solicitor general Wayne Easter from Prince Edward Island.

Also on the east coast is Dominic LeBlanc, a lawyer and experienced parliamentarian who is a confidante of Trudeau, as is former fisheries minister from Nova Scotia, Geoff Regan.

Marc_Garneau

Marc Garneau. Photo courtesy of Wikimedia commons.

In Ontario, Peter Fonseca from Mississauga is a former Ontario minister of Labour and of Tourism and Recreation. Navdeep Bains, also from Mississauga, is a former MP and a visiting professor at the Ted Rogers School of Management at Ryerson University. Bob Bratina has been mayor of Hamilton since 2010. In Toronto, former city councilor Adam Vaughan has had a lot of input into the party’s urban agenda, and MP Michael Levitt is an experienced businessman and community activist in the north of the city.

In Quebec, there is former Liberal Leader and environment minister Stephane Dion, former astronaut Marc Garneau, who has been an effective foreign affairs ciritc, and Emanuel Dubourg, elected in a recent bi-election who was a member of the National Assembly. Jean-Claude Poissant is a major figure in the agriculture and milk producing industry in Quebec, where he has been a leader with the Fédération des producteurs de lait du Québec, think TPP trade deal. Jean-Yves Duclos is Director of the Department of Economics at Université Laval and co-founder of the Poverty and Economic Policy Research Network. Denis Paradis is a former MP and Minister of State for Financial Institutions under Paul Martin. Anthony Housefather is the Liberal candidate in the hotly contested Mount Royal and the popular mayor of Côte-Saint-Luc within the riding.

From Alberta, Kent Hehr, a lawyer and former Alberta MLA, was elected in Calgary and high profile management consultant Randy Boissonnault was elected in Edmonton.

From the north, Nunavut’s Hunter Tootoo is a former MLA, minister and speaker of the territorial legislature

There are also many more who have considerable economic and business experience, with expertise in other fields as well.

Andrew Cardozo is president of the Pearson Centre for Progressive Policy and is an adjunct professor at Carleton University.

New Government Should Start by Making the RCMP More Accountable

October 26, 2015 2:27 pm
RCMP photo

Photo by Flickr user Jamie McCaffrey. CC.

Now that there’s a new Liberal government in power in Ottawa, one can only hope that a new public safety minister will make it a priority to address the myriad problems created by the Harper government in the criminal justice system over the past 10 years. In addition to reinstating conditional sentences and abolishing mandatory minimum sentences and victim fine surcharges, the new Public Safety Minister should focus on making major changes to the management structure and accountability of the RCMP. Ever since the Conservative government came to power many experts believe they’ve made ludicrous appointments that have had a disastrous impact on the reputation and credibility of the RCMP. According to many pundits, a new public safety minister should immediately replace Bob Paulson, the current Commissioner of the RCMP. Although there are many reasons for replacing him, several are particularly noteworthy.

First, the Mounted Police Professional Association of Canada (MPPAC) called for Bob Paulson’s resignation earlier this year. In May 2015 the RCMP were charged with four counts under the Canada Labour Code in relation to the tragic shooting deaths of three officers and the wounding of two other officers in Moncton New Brunswick back in June 2014. The charges under Section 148(1) of the Labour Code, are related to equipment, training and supervision of officers who responded when the gunman opened fire at officers in Moncton.

The MPPAC applauded the laying of these charges and stated that the RCMP’s failure to equip front-line officers with adequate equipment such as patrol carbines and body armour may have contributed to the Moncton tragedy. As MPPAC spokesperson Rob Creasser stated: “For us, we see the force trying to protect its reputation rather than its members, which in a policing organization is the worst kind of leadership failure. Our members deserve better,” said Creasser.

Another area that has been a complete failure has been the RCMP’s inability and ineffectiveness at dealing with sexual harassment in the RCMP. When Bob Paulson was sworn in as Commissioner of the RCMP his marching orders from the Minister of Public Safety Vic Toews was to tackle this issue as his number one priority. In June 2013, Bob Paulson appeared before a Senate Committee and gave a rather bizarre account detailing his take on sexual harassment in the force.

Paulson did not appear to be concerned about the class action lawsuit filed by more than 300 former and current RCMP female constables in the RCMP. In his response to a question from Senator Grant Mitchell he stated: “I don’t know of the hundreds of complainants you refer to.” Mitchell responded, “There are 300 cases.” Paulson replied, “its’ a game of cat and mouse, in my estimate.” “It’s not a game,” said Mitchell.

“I can’t be continually defending against outlandish claims,” Paulson replied. Dan Donovan, Ottawa Life Magazine’s Editor and Publisher, stated on CBC radio that it was the most disgraceful performance he has ever witnessed by a Commissioner of the RCMP before a government Committee.

Third, a class action lawsuit filed in Vancouver against the RCMP in October 2015, claims that the RCMP breached the privacy of a number of Mounties by wrongfully disclosing their mental health records. The MPPAC pointed out that Dr. Mike Webster who had built a career on treating members with mental health issues had become the target of a vendetta by the RCMP because he had been publically outspoken about the callous manner in which they treated members who became psychologically ill on thejob. The RCMP went so far as to file a complaint against Dr. Webster with the College of Psychologists which was immediately dismissed. The MPPAC points out in their press release ‘that documents show that the decision was made at the very top, with Commissioner Paulson reviewing and approving the submission to the College.

In addition, there have been a number of incidents where Bob Paulson has publically made derogatory comments about members such as Cpl. Ronald Francis who was suffering from mental illness. Cpl. Francis suffered from Post-Traumatic Stress disorder and was filmed smoking marijuana in an RCMP uniform. Instead of showing compassion and understanding towards the officer and getting him help, the RCMP subjected him to public humiliation when they arrived at his residence and confiscated his uniform in full view of the media. He later committed suicide.

In addition to replacing Bob Paulson, the new public safety minister has to completely overhaul the Civilian Review and Complaints Commission for the Royal Canadian Mounted Police. You will recall that every time the RCMP were in hot water the Conservatives trotted out the refrain that they were amending the RCMP Act and that they would be introducing newer and tougher measures to deal with wrongdoing by members of the RCMP. Presumably these changes would ensure accountability with the RCMP and would also provide the public with confidence that their complaints against members would be investigated fairly and impartially.

The problem is that when you look at this so called Civilian Review and Complaints Commission for the RCMP there is really nothing ‘civilian’ about it. Of the 11 employees who are the top decision makers for this organization, only two employees – the Chair, Ian McPhail (handpicked by the Conservatives for the job) and a lawyer – are civilian. Five employees who occupy senior positions in the Commission are held by retired RCMP officers and four were seconded directly from the RCMP. How can anyone call this Commission an independent and impartial organization for investigating and adjudicating complaints against the RCMP?

The public deserves better, but this is a clear example of how the Conservative government operated by giving the appearance of doing something when in fact all they were doing is preserving the status quo. The staffing process for the Civilian Review and Complaints Commission for the RCMP needs to be overhauled so that ‘civilians’ and not retired or current members of the RCMP hold management positions. Without such changes, what confidence can the public have that their complaints will be investigated in a non-biased and non-prejudicial manner? The very purpose for having an oversight body is to ensure that it will function at arm’s length from the RCMP. Without this independence such an organization lacks credibility. The new public safety minister should make it a priority to clean house so that the Civilian Review and Complaints Commission can be trusted by the public to investigate complaints against the RCMP in a fair and impartial manner. The current situation where the majority of senior management positions are held by former and retired RCMP officers makes a complete mockery of accountability. The new Liberal government has to change this now.

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.

Change

October 23, 2015 11:56 am
Trudeau Justin  photo C Jean-Marc Carisse 2015 0921_0235 (1)

Photo courtesy of Jean-Marc Carisse.

Voters Decided It Was Sunny Ways Rather Than Rainbows and Unicorns

Ten years is a long time for any government to be in power. Stephen Harper led Canada through some tumultuous times. He deserves a great deal of credit for guiding Canada through the 2008 global recession that threatened the very underpinnings of the Canadian and world economy. However, the record is less stellar internationally. The Harper government made no bones about where we stood on most issues. However, our bravado on the Ukraine or the Syrian crisis was not matched with meaningful contributions on the ground that made a significant difference. The Harper government was in denial about climate change and its shameful and mean-spirited response to do more to provide for certain Syrian migrants sealed Mr. Harper’s fate.

The Conservatives’ perceived callousness on that one issue upset millions of Canadians who viewed the response as both vulgar and contrary to core Canadian values. The Harper response, that Canada was doing more on Syria than it was being credited for, was blown to pieces by Canada’s former Chief of the Defence Staff, retired General Rick Hillier. Hillier said that not only was the response wrong, but that Canada could bring in 100,000 refugees by Christmas. Hillier’s heft contrasted against the lightweight and at times nasty Minister of Immigration, the now defeated Chris Alexander, only highlighted the need for change.

Enter Justin Trudeau. His discipline in the campaign is a good harbinger for things to come. His positive message contrasted sharply against the angry and negative approach of the Conservatives. His call for a government with a greater spirit of generosity and one focused on hope rather fear resonated big time with Canadians. Thomas Mulcair came across as creepy at times or smug and short-tempered. Trudeau seemed to have his pulse on the mood of the country. The biggest loss to Ottawa in this campaign was the defeat of Ottawa Centre NDP MP Paul Dewar. They don’t make MPs much better than Dewar. However, Mulcair’s misreading of the niqab issue and lax campaign combined with the tough battle with the talented Liberal candidate Catherine McKenna proved too much.

In the dying days of the election, Harper referred to Trudeau and the Liberals as “all unicorns and rainbows” while Trudeau talked about “Sunny Ways.” Obviously, Canadians prefer sunny ways.

We hope you enjoy our 15th Annual TOP 25 People in the Capital issue. Kevin Vickers leads the list for his actions during the terrorist attack on Parliament Hill last year. The CBC’s Catherine Cullen has proven her mettle as one of Canada’s top national reporters and Ottawa Sens GM Bryan Murray is revered by Sens players and fans alike and beloved by all in our great city. Pierre Poilievre was the lone Conservative in Ottawa to win his seat. We applaud his achievements and hard work but note that sunny ways for him and his party may have to wait. His days may soon be filled with unicorns and rainbows. Enjoy.

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