How Proposed User Fees for Health Services in Quebec Threaten the Canadian Health System

October 20, 2015 12:54 pm
Health

While the federal campaign grabbed the majority of the headlines these past few months, a significant threat to Canada’s most treasured national program was going largely unnoticed.

For many years, certain physicians and clinics have quietly been charging extra fees for health services. In some provinces, the frequency of such charges has been increasing. These include hidden charges for medications that are many times their actual cost or access fees of hundreds of dollars for examinations such as colonoscopies. Because these fees are for services that are covered by the health system, this is in effect extra-billing, a practice that is against federal and provincial law.

In Quebec, Minister of Health Gaetan Barrette has identified these fees as a problem, as have many others for many years. You might expect Barrette – a physician himself – to clearly inform patients and practitioners that this practice is illegal and put an end to it. Instead, he is trying to regulate and “normalize” these fees, in direct contravention of the Canada Health Act.

When the Canada Health Act passed in the House of Commons in 1984 with unanimous support from all political parties, its primary purpose was to put an end to extra billing exactly like this. Charging patients at the point of care for medically necessary services strikes at the heart of the principle that access to health care should be based on need rather than ability to pay.  It undermines equity, increases system costs and reduces commitment to the public health care system. It’s also illegal.

Medicare is a defining program and a source of enduring commitment from coast to coast, and all political parties claim to support the Canada Health Act. Why are we not hearing resounding denouncement of Minister Barrette’s plan from our federal politicians? Who will commit to enforce the CHA in Quebec and elsewhere?

User fees are a deterrent to seeking care by the people who need health care the most. Research has consistently demonstrated that forcing people with less money to pay a fee to access care means they will not consistently choose to do so, and as a result, may not seek out medical attention until later in the course of their illness. This means patient outcomes are likely to be worse and treatment more complicated and costly. Given higher levels of illness among people in poverty, user fees also function as regressive taxation, shifting costs to those who use the system most but can least afford to pay.

Given these well understood problems with user fees, doctors in Quebec and across the country have expressed alarm at Minister Barrette’s proposed amendment to Bill 20, which regulates extra billing rather than prohibiting it. The Canadian Medical Association, Quebec Medical Association, Canadian Doctors for Medicare, Médecins Québécois pour le Régime Publique, and the Quebec College of Family Physicians have all come out against this decision, joining patient groups, all of Quebec’s opposition parties, and Raymonde Saint-Germain, the independent Quebec Ombudsman. The amendment was passed on October 7, with no public debate.

This is not the first attempt to introduce user fees in Quebec. Each time, such attempts have been beaten back on the basis of solid evidence and thoughtful public debate. A proposed implementation of system-wide user fees was cancelled in 2011 when further review showed that these changes would decrease access and not achieve significant system savings. In 2013, the Quebec National Assembly voted unanimously in favour of a motion against extra-billing.

Now, despite these previous decisions, public and expert opinion, and the law, Barrette is effectively bringing user fees in through the back door. Rather than introducing user fees charged by government, he proposes allowing clinics to do so. This further fragments care and makes access even more inequitable.

In the federal election campaign, the talk was centred around reducing barriers to access by improving coverage of prescription medicines, home care and mental health care. Yet at the same time that our federal parties are committing to such much-needed expansion, they are silent on protecting the core of medicare: publicly funded doctor and hospital services.

Any party that claims to be committed to the Canada Health Act should immediately state its position on the proposed amendments to Bill 20 in Quebec. To do less is to skirt the core federal responsibility for medicare in Canada.

Meili_Ryan_high resRyan Meili is a family physician in Saskatoon, founder of Upstream: Institute for A Healthy Society and an expert advisor with the Evidence Network.

 

 

 

 

 

Martin_Danielle_High resDanielle Martin is a family physician and Vice-President Medical Affairs and Health System Solutions at Women’s College Hospital in Toronto.

Both are members of the board of Canadian Doctors for Medicare.

Citizenship Week Event Engages Youth

October 16, 2015 1:55 pm

Photo courtesy of Ryan Parent

How much do you know about Canada?

Historica Canada has celebrated Citizenship Week by engaging youth from across Canada. The event assembled 82 students and encouraged them to reflect on Canada’s history and identity.

Guest speaker Charlotte Gray. Image courtesy of Cara Des Granges.

Guest speaker Charlotte Gray. Image courtesy of Ryan Parent.

Taking place from October 12th to 18th, one event saw young Canadians gathering to hear Charlotte Gray, a British-born Canadian historian, share her insights on Canadian identity and great Canadians.

“I think we all love to engage with our history through the stories of extraordinary Canadians — hockey players, artists, entrepreneurs, activists. Each story gives us a glimpse into this country’s diversity, while underlining the collective will to make it work,” Gray said.

Held at the Fairmont Chateau Laurier, the youth participated in a bingo game that tested their knowledge about great Canadians such as Sir John A. Macdonald, Clara Hughes and Michaëlle Jean.

Four Encounters With Canada students won the bingo game, including Taylor Morrey (North Vancouver, BC), Eliza Moore (Calgary, AB), Brendon Hutchinson (Kamloops, BC) and Hayley Jones (Mission, BC). The team was awarded a prize pack which included a set of Heritage Minutes.

Engaging with students is Historica Canada’s top priority, says President and CEO Anthony Wilson-Smith.

“We believe that reflecting on some Great Canadians will teach and inspire them to become more active, engaged citizens.”

Encounters With Canada students with Charlotte Gray. Image courtesy of Cara Des Granges.

Students with Charlotte Gray. Image courtesy of Ryan Parent.

The Citizenship Challenge asks Canadians to study for and write a mock citizenship exam, in French or English, putting Canadian’s knowledge to the test. More than 200,000 people have taken the Challenge so far.

The Challenge believes that all Canadians should be ready to answer the same questions about their country as new Canadians. The program is made possible through funding from Citizenship and Immigration Canada.

Historica Canada is the country’s largest organization that is dedicated to enhancing awareness of Canada’s history and citizenship. You can learn more information about Historica Canada by visiting historicacanada.ca

Pharmacare is for Kids Too

11:57 am
Immunization of children in doctors office

Written by Avram Denburg and Steve Morgan

You are the parent of a sick child. You have a limited budget and you must decide to buy the medicine the doctor prescribed for your child or provide food and shelter for your family instead. What do you do?

Sadly this dilemma is one too many Canadians are facing. We have an incomplete health system where doctors and hospital care are paid for publicly but the drugs often necessary to treat health conditions are not. Prescription drugs can be costly – and not just for those living in poverty, but for middle income Canadians too.

Several studies have found that about one in 10 Canadians cannot afford medicines prescribed by their doctors. This affects approximately one in four Canadian households, including many young families.

Denburg_Avram_headshot

Avram Denburg

In most provinces, access to medicines for children is tethered to socioeconomic status, and therefore highly inequitable. The very poor sometimes have access to public assistance – a good thing. And the relatively wealthy have access to work-related private drug coverage. But too many of those in the vast middle ground fall through the cracks. This creates painful and unjust dilemmas for parents who have to choose between the costs of prescription drugs and other life necessities for themselves and their children.

Canada is the only universal health care system in the developed world that does not include universal coverage of prescription drugs. Canada is also an outlier for not having a universal program for prescription drugs for children in particular. Two of the four federal political parties in this election have committed to a universal pharmacare program – the NDP and the Green Party – while the Liberals have committed to cost-saving measures for prescription drugs. The Conservatives have been silent on the issue.

Most of the discussion has been centred on seniors’ access to prescription drugs. But pharmacare is for kids too. We need to press all the political parties to make prescription drugs accessible to Canadian children.

The glaring gaps in drug coverage for Canadian children are made stranger by the economic dimensions of the issue. Children’s health care represents a drop in the ocean of health care budgets; extending universal drug coverage to children would constitute a small fraction of total pharmaceutical spending.

In fact, universal prescription drug coverage for children would save money both now and in the future. How so?

Morgan_2012

Steve Morgan

The long term benefits of universal drug coverage for children are compelling. Canada stands to benefit considerably from the developmental gains reaped by healthy children. Reliable access to medicines is crucial to the control of childhood diseases such as asthma, diabetes, cancer and immunologic disorders. Optimal disease management both improves survival and minimizes late effects. With time, this lays the foundations for a healthier and more productive society.

The UK, New Zealand, and the Netherlands have national approaches to optimizing pediatric prescribing practices. These countries have something else in common: they provide universal drug coverage for children. This provides an ongoing public rationale for prioritizing safety and efficacy in pediatric drug prescribing.

Most of the drugs for common pediatric conditions are available in relatively low-cost generic formulations which the government could prioritize over equivalent more expensive brand-name products. The price of such medicines would fall further if provinces and the federal government bought them in bulk under a universal pharmacare plan. Fluticasone, a commonly prescribed asthma inhaler, costs over $45 in Canada and under $15 in New Zealand, where government purchases medicines on behalf of the entire population. Ondansetron, a medicine used to treat nausea among pediatric cancer patients, costs Canadian governments over $3.00 per 4mg tablet and the US government less than $0.20 under its health program for all veterans. Amoxicillin and many other front-line antibiotics are likewise a fraction of the cost in countries committed to bulk purchasing for public provision of medicines.

Novel therapies also have an important role in pediatrics. Frequently costing thousands of dollars per year, specialized medicines for rare and often life-threatening pediatric diseases impose a financial burden that no family should be left to bear on its own. Such costs are far more easily managed and more fairly distributed at a population level – and in fact represent a very small proportion of overall drug use and expenditure.

It is rare in matters of policy that the economic, medical and moral dimensions of an issue all point to the same conclusion. Universal drug coverage for Canadian children is this rare exception.

With public discourse on universal pharmacare at a political tipping point, we are faced with a window of opportunity to do the right thing. As the federal election nears, Canadians should ask themselves whether our current patchwork of policies on pediatric drug funding – and the resultant gaps in drug access for children – is in line with our values and vision for Canadian society.

Dr. Avram Denburg is a paediatric oncologist at Sick Kids and a 2015 Trudeau Scholar. He sits on the Board of Canadian Doctors for Medicare.

Dr. Steve Morgan is an expert advisor with EvidenceNetwork.ca and professor of health policy at the University of British Columbia.

Donbass Refugees: Unwanted War

October 15, 2015 9:59 am
Olimp hostel in Bor, Russia provides each refugee a bed and a meal three times a day.

Photo courtesy of Valeriy Melnikov / RIA Novosti. 

One day residents of Donbass woke up to nothing. People had no jobs. Kids had no school to go to. Banks closed their doors. Food became scarce and expensive. This is how Olga describes life after the war in the eastern Ukraine began.

Another refugee, Lyudmila, remembers: “We had no money – nothing. Sometimes, we had nothing to eat.” Humanitarian aid from Russia and Ukraine came much later.

Olga’s five-year-old daughter Taisia adds that “In Ukraine, when we slept at night, there were always ‘boom-boom’ sounds. They were shooting.”

Refugees fleeing war-torn Donbass to Russia. UN High Commissioner for Refugees stated that in 2014 Ukraine surpassed the previous years’ leader, Syria, by number of people who wanted to flee their country.

Olimp hostel in Bor, Russia provides each refugee a bed and a meal three times a day. Photo by Damira Davletyarova.

Two months ago, when the women fled the region, Donbass was still hot with bombings and shootings. The women say the war in Donbass is an unwanted war. People there never wanted to fight.

“It’s an undeclared war. It’s a political war. It’s all politicians – the government of Ukraine. People don’t want this war. The war now involves all countries. Civilians don’t understand why there is war in the eastern part of Ukraine,” Lyudmila says.

The war that started last spring was the consequence of the Ukrainian Revolution. The new government’s policies towards its Russian-speaking population sparked anti-government protests in the country’s southeast. As a result, Crimea joined Russia, Donetsk and Lugansk oblasts declared their intentions to separate from the country. This all brought on the war between Russia and Ukraine.

However, while the two countries are fighting, and the international community is trying to make peace protocols work, women and children are the ones who get caught in the conflict. They flee destroyed homes, seeking asylum in neighbouring countries.

It was last July, when the first refugees appeared in Bor, a small town on the Volga River in Nizhny Novgorod Oblast, Russia. Families came dragging their children who only had their summer clothes with them. Many people were sick and injured.

Local residents welcomed them, some people offered to let refugees to stay in their homes. The town’s Olimp hostel provided each refugee a bed and a meal three times a day. Volunteers poured into the hostel to help. Donations of clothes, toys and treats kept coming.

Over the year, Nizhny Novgorod Oblast accepted around one thousand refugees. While half of them stayed in the region, others left to seek their fortune in other parts of Russia. Bor’s Olimp now hosts 42 refugees, including 15 children.

No matter how Russia accepts the refugees from Donbass, it burdens the country. It costs the country 600 rubles ($12 CAD) per day to host one refugee in the hostel. The Federal Migration Service now counts over a million refugees living across Russia.

According to the federal government program, the refugees can stay in the hostel for one month to legalize their status as a temporary resident, which will provide them free medical insurance and work permission. The government also promised to short track their applications for the citizenship.

Many refugees, however, turned the hostel into a permanent place to live. One family has been living in the hostel for more than a year, during that time they gave birth to their sixth child. With the help of residents, the father found a job at a construction company. The family has no plans or means to move out from the Olimp in the near future.

Beds are made and ready for new wave of refugees.

Beds are made and ready for new wave of refugees. Photo by Damira Davletyarova.

There are also many challenges that come from working with refugees. One of the administrators of the hostel says the majority of young men get drunk and brawl every night. Instead of finding jobs, they get cash from helping around.

The administrator says: “There are no rules for them. They smoke in public places.” Moreover, she says, they damage furniture and fight all night.

The problem keeps going because the police can’t do anything. Refugees are not considered constituents under the Russian government. The police can come and try to talk things down, but can’t make arrests.

Newly-arrived Lyudmila and Olga, however, have no plans to waste time. Lyudmila’s eight-year-old daughter was left with her grandmother in Donbass. The woman had just enough money to buy a one-way train ticket. She is planning to find a job and bring her daughter to Russia.

The women, nonetheless, are happy that they can sleep and walk in peace. Lyudmila says, she was used to constant “bombings, banging and something exploding,” now she can’t get used to silence.

This is not home though. Both women say they don’t know what would happen next. They, like many people in Donbass, no longer believe in peace agreements. While the international community is trying to help, there are people suffering.

Taisia, Olga’s daughter, misses her home and school. Also, her kitten Loki was left with her grandparents. When asked why her grandparents didn’t want to come with them, the girl explains: “They didn’t want to come. Who is going to take care of the cat and dog?”

Olga and Lyudmila sit on one of the seven bunk beds in the hostel’s room. Taisia is busy making a bracelet out of colourful beads. Olga prays for war to end and for peace to come.

“We all want to return home. If they are destroyed, we are strong enough to rebuild them. Peace is what matters,” she says with a determined voice.

In the hall, the announcements on the walls that remind the guests to follow the rules are left unread. Tenants walk by them with eyes that reflect nothing but uncertainty.

The Olimp’s doors will stay open while the refugees keep coming. They will stop coming only when bombs cease destroying their homes and the world leaders stop playing with Ukraine, only concerned with their own interests. After all, they shouldn’t forget that they are playing with people’s lives.

Full names of the interviewees and their pictures are not printed due to the sensitive nature of the article.

Saskatoon’s Housing Crisis Is a Health Emergency

October 14, 2015 11:17 am
Sunset

Recently, a disturbing photo of five people sleeping in a Saskatoon bank lobby became headline news and filled social media feeds.

An earlier photo had contrasted the lush yards on the east side of the riverbank with tents in the bushes on the west side. A few days later, homelessness was back in the news, with the fire department discovering a makeshift living space under the closed Traffic Bridge. This spring, the Saskatoon Health Region closed numerous units in a downtown hotel due to conditions unfit for habitation.

These disturbing images and events each are part of a larger narrative: despite a strong economy, Saskatchewan has a deficit in access to safe and affordable housing.

Such stories put a human face on the state of housing and homelessness in the city. This summer, the Saskatoon Housing Initiatives Partnership performed a “point-in-time” count of people without a home on a given night and found 405 people. The number from these counts has steadily increased, with 260 people without a home identified in 2008 and 379 homeless in 2012.

What’s especially disturbing is that 45 of the homeless individuals in this year’s count were children. Across Canada, an estimated 235,000 people will experience homelessness in the course of a year, with 35,000 homeless on any given night.

Beyond those who are homeless, many Canadians struggle to maintain the housing they have. The Canadian Mortgage and Housing Corporation defines core housing need as paying more than 30 per cent of household income for housing. In 2014, one in four Canadians were in that situation, with the cost of their dwellings squeezing out the ability to pay for other essentials.

The health impacts of homelessness and inadequate housing are well known. A 2007 Wellesley Institute study showed that homeless people in Toronto were 29 times more likely than the general population to have hepatitis C, 20 times more likely to have epilepsy and twice as likely to have diabetes.

These conditions are related to an interplay between the social and personal factors leading to homelessness and the hardships of living in inadequate housing. Lack of shelter means exposure not only to the elements, with risk of heat stroke in summer and hypothermia in winter, but also to violence and other risks.

Accessing safe food and clean water becomes a challenge, and healthy social and family dynamics all but impossible. Managing mental health issues, addictions and other illnesses is improbable without a stable living situation.

As a result, hospitalization for unmanaged chronic medical conditions rises, as do ambulance pickups to address emergencies. The cumulative effect of these challenges has untold impact on individuals, and costs the Canadian economy more than $7 billion a year.

As one of the major upstream determinants of health, if housing is properly addressed we can avoid preventable illness and costs, and promote good health in our communities.

In Saskatoon, a “Housing First” pilot program spearheaded by the United Way provided housing to 10 local residents who have challenging health issues and social circumstances. In only six months, the program saved nearly $700,000 through decreased ambulance trips, hospital visits, police calls and detentions.

Along with these compelling immediate benefits, safe, stable housing allows people an opportunity to manage health issues, pursue education and employment, as well as develop supportive family environments. The Saskatchewan government’s advisory group on poverty reduction recently released recommendations for a provincial strategy.

Reflecting the role of housing in both preventing and alleviating poverty, its recommendations include establishing a province-wide Housing First model and strategies to increase affordable housing. All levels of government have a role to play in making safe and affordable housing available to all. As well as the direct development of affordable housing, cities have a variety of tools available to encourage and maintain such housing options in their neighbourhoods.

Federally, there is potential for leadership on this issue and practical initiatives such as earmarked funding for affordable housing. Canada remains the only G-8 country without a national housing strategy.

The people of Saskatoon have been rightly upset by recent pictures of homelessness. Now is the time for us to demand action from political leaders so that we can instead become the picture of health.

Meili_Ryan_high res

Ryan Meili.

Ryan Meili is an expert advisor with EvidenceNetwork.ca, a practicing family physician in Saskatoon and founder of Upstream: Institute for A Healthy Society and Chair of Canadian Doctors for Medicare.

Michael Schwandt is a Public health physician and Assistant Professor, Department of Community Health and Epidemiology, University of Saskatchewan.

 

What I Didn’t Learn in Medical School

October 13, 2015 10:59 am
Medical School

Sometimes doctors can’t fix what makes their patients sick in the first place.

I began medical school optimistic about what becoming a physician meant I could do for my future patients. Naively, I presumed my career would involve treating patients’ illnesses so they could return to lead full and fulfilling lives. Yet for the one in seven Canadians living in poverty, it is often difficult for doctors to achieve this goal.

Take Christina, a 64-year old woman with diabetes, who came to me with new-onset numbness in her fingers and toes (a serious and progressive consequence of poorly controlled diabetes). As she struggled to leave on her walker, her prescription fell out of her purse. When I retrieved it for her, she mentioned that it hardly mattered because she would not have enough money to purchase the medication anyway.

Then there was Andrew, a 36-year old man who had been physically assaulted while panhandling. He had a prosthetic hip from a work accident that had left him with a pronounced limp, a chronic disability and no job. While I could screen Andrew for fractures and neurologic deficits, I could do nothing for his unemployment or his inability to find safe shelter at night.

These are but two of many encounters I have had that starkly contrast the values of social medicine I have learned in medical school. What good is it to treat illness if we can only send our patients back to the conditions that helped make them sick to begin with?

Healthcare is just a small part of what determines our well-being. In fact, our health is strongly influenced by factors such as income, our working environment and affordable housing, over which neither patients nor medical doctors have much control. This is why Canada needs better public policy that safeguards the global health of all Canadians.

As the ninth richest country in the world, we have managed to ignore the erosion of social assistance and the rise in income inequality that has taken place over the last decades. While we are one of the countries consistently spending the most on healthcare, we don’t do a very good job of providing a social safety net for the growing numbers of Canadians who are living paycheck to paycheck or are under or unemployed.  We are also one of the few OECD countries without a national housing and homelessness strategy, which the United Nations Committee on Economic, Social and Cultural Rights considers a “national emergency.”

For a nation that once prided itself on being ranked “the best country in which to live,” we have a lot to do before warranting the title once again.

It does not have to be this way. Public policy decisions, including those that determine the allocation of tax revenue, strongly influence health outcomes. These decisions need to be critically re-examined, particularly when most Canadians have demonstrated their support for policies that improve conditions for the most vulnerable.

In 2009, a Nanos research poll reported that most Canadians strongly supported the public health system and strengthening publicly funded healthcare. In 2014, a poll by the Broadbent Institute found that 77 per cent of Canadians recognize the widening income gap as a serious issue for the country, while 71 per cent believe this gap undermines Canadian values. The same poll found that most Canadians are in favor of increasing taxes to fund public programs that will reduce the impacts of income inequality.

This means that Canadians are far ahead of their governments in supporting solutions to close the gap between the rich and poor, and, often at the same time, the healthy and unhealthy.

Canada’s current public policies could better meet both the health needs and social values of its citizens. As a soon-to-be physician I hope to practice medicine in a nation where income is not an obstacle to good health, and where polices and legislation are accountable to Canadians’ priority of health for all.

vivian tamVivian Tam is a second year medical student at the Michael G. Degroote School of Medicine at McMaster University.

 

 

 

 

 

Ford Jones_Lee (1)Elizabeth Lee-Ford Jones is an expert advisor with EvidenceNetwork.ca, and Professor of Paediatrics at The Hospital for Sick Children and the University of Toronto.

Are we finally in a health election campaign?

October 9, 2015 9:57 am
Medicine

Why more affordable medications for Canadians should be an all-party priority in this federal election.

It’s become almost a matter of faith: health and health care are perennially among the top priorities for Canadians, but are nearly invisible in election platforms and debates. This observation has led health care providershealth care advocates and labour leaders to call for greater attention to this key issue, and others to try to explain why it is an issue of which politicians may be well-advised to steer clear.

Something changed recently when Tom Mulcair announced that an NDP government would implement a national pharmacare program. With this he joined Elizabeth May and the Green Party in advocating for a program that, if implemented, would be the biggest step forward for Canadian health care since the introduction of medicare. The Liberal party has advanced plans for controlling drug pricing through bulk purchasing of medications but have shied away from universal coverage.

Meili_Ryan_high res

Ryan Meili is a practicing family physician in Saskatoon and founder of Upstream: Institute for A Healthy Society and Chair of Canadian Doctors for Medicare.

Are we finally in a health election campaign? Will the Conservative party also come forward to act on an issue of critical importance to the health of Canadians?  Public opinion polls in favour of introducing pharmacare suggest they’d be wise to do so.

National drug coverage has long been a priority for the over one in five Canadian households that can’t afford to buy needed prescription medicines. But in spite of decades of calls for a new program by expert panels and commissions, the idea seemed not ready for prime time. The cost of national pharmacare was seen to be too great in a time of low political appetite for new universal benefits.

But it turns out that pharmacare isn’t a money sucker – it’s a money saver. A new look at the numbers has people realizing that the cost of not having national drug coverage is far greater than that of implementing it. A groundbreaking economic analysis in the spring of 2015 by Steve Morgan and Danielle Martin demonstrated that universal drug coverage would save over $7 billion dollars in private and public spending, with little or no increase to government budgets.

Where do these savings come from? Canada is the only OECD country with universal health care that doesn’t include drug coverage, and as a result we miss out on opportunities to get value for money when we buy drugs. The popular anti-cholesterol drug Lipitor, for example, costs $800 per year for a Canadian patient. In New Zealand, where bulk-buying and aggressive price negotiations are part of a national drug plan, the same medication costs only $15 year. That’s not a typo.

This means that Canadians are either paying far more out of pocket for medications, or they’re simply not taking them at all. A recent Angus Reid poll showed that 23 percent of households surveyed had not been able to properly take prescribed medications due to cost. This is obviously bad for the health of those individuals; and it also contributes to greater costs in other parts of the health system when patients suffer preventable consequences.

In my practice, as in medical practices across the country, I see patients with chronic illnesses like diabetes, high blood pressure, HIV and lung disease who are too often forced to choose between the medications that are essential to keep them well and necessities of life, such as rent and nutritious food. This is not just an issue for very low income Canadians – it spans across income lines as drugs become more expensive and employer benefits less common. Doctors are so concerned about the issue that the Canadian Medical Association’s General Council voted 92 percent in favour of a resolution in support of pharmacare last month. The general public agrees: recent polls show 91 percent of Canadians are also in support of universal drug coverage.

Federal elections should be a time to concentrate on what matters most to Canadians. This includes health care when we’re sick, as well as action on the upstream factors that determine whether we get ill or well, such as housing, income, child care and the environment.

What else are our elections about, if not the quality of our lives, our health and well-being?

Health and health care may be dangerous territory for politicians, fraught with ideology and emotion, but the argument for pharmacare is so compelling that all parties should be moved to take action.

It’s extremely encouraging to see the Greens and the NDP join the Canadian public in their support of this important step forward. The Liberal Party approach is a start, and would reduce costs, but falls short of what is really needed to remove barriers to access. Hopefully we will hear soon from the Conservatives as we move to a national consensus on this sensible and timely approach to controlling costs and improving health outcomes.

Ryan Meili is a practicing family physician in Saskatoon and founder of Upstream: Institute for A Healthy Society and Chair of Canadian Doctors for Medicare. 

City Announces New Plan for Safer Streets

October 8, 2015 3:12 pm
Safe City

Over are the days of cars ruling the roads, as the City of Ottawa has just put a red light on their 50 year-old practice of automotive domination. On October 7, the Transportation committee unanimously backed The Complete Streets Implementation Framework, keeping the interests of pedestrians, cyclists, and transit users in mind on our roadways, and creating safer, healthier, and more sustainable transportation for all.

The transportation committee’s motivation lies in the creation of streets that are for moving people of all means, not just cars. These changes will make it easier and more accessible to cross the street, walk to shops, bike to work, and reduce carbon footprint and traffic congestion.

“Complete streets are about moving people, not just cars,” says Graham Saul, Ecology Ottawa’s Executive Director, adding that “it’s about time we had a framework that reflects the interests of all users.”

Although The City agreed to take on a complete streets policy in 2013, they’ve only now agreed on a plan detailing how to make this happen. Information on how moving across Ottawa will actually be changing is still vague, but a recent press release promises that “if you walk, cycle or take public transit you will no longer be left out of the traffic engineer’s design formula.”

Some of the Most Complex Needs of My Patients Stem from Poverty and not Disease Alone

9:59 am
hospital-840135_1280

Why Canadian children need a champion.

A young girl is referred to a pediatrician’s office for inability to pay attention in the classroom. The child’s teacher is concerned she has attention deficit hyperactivity disorder (ADHD), and possibly, a learning disability.

I am a second year medical student working in the clinic at the time of her visit. I am beginning to establish my approach to patient problems and complex medical illness.

As I make my way through the medical history, the child’s parents tell me they are struggling to make ends meet. Despite their best efforts combined with collections from a nearby food bank, the little girl often goes to school hungry.

The problem seems clear: how could any child concentrate in the face of hunger? When your groceries consist of the non-perishable offerings of others, how do you nourish a developing brain?

How does a physician properly evaluate a learning problem when a child’s basic needs are unmet? 

I am now a pediatric resident, pursuing specialist training in the diagnosis and treatment of childhood illness. Years later, I still can’t help but feel that some of the most complex needs of many of my patients stem from the constraints of poverty and not disease alone.

Unfortunately, as physicians, my colleagues and I do not have the therapeutic tools necessary to “cure” the social conditions that so often impact the health of our patients.

Beyond anecdotal confirmation, there is strong evidence linking poverty to poor health outcomes for children: higher levels of mental illness, accidental injury, obesity, asthma, poor brain development and more. These problems have a cost that we all bear. When children are exposed to the toxic effects of poverty, the detrimental impacts can be felt for generations – and they impact entire communities.  

In 1989, the year I was born, Canada’s House of Commons vowed to eliminate child poverty by the year 2000. Twenty-six years later, Canada’s children are still suffering. Current data suggest that over half a million Canadian children live in low in-come households.

Provincially and territorially, efforts to curb levels of child poverty have had variable success. Provinces like Quebec and Newfoundland and Labrador have significantly reduced levels of child poverty after introducing poverty reduction strategies that include enhanced early childhood education and child care. Conversely, in Manitoba where a poverty reduction strategy has been in place since 2009, levels of child poverty continue to be some of the highest in the country. The same rate holds true for British Columbia, the only province without a committed poverty reduction strategy.  

Without a coordinated effort and strong national leadership, we risk leaving too many children behind.

The time has come for Canada to adopt a child poverty reduction strategy and to appoint a Commissioner for Children and Young Persons who will guarantee its success.  If we succeed in making a federal commitment to our children, we stand to make real change.

Let’s hear what our political parties have to say about a cohesive, national child poverty reduction strategy in this election season. A number of evidence-based policy and program solutions, including, but not limited to, guaranteed minimum income and universal childcare, are at our disposal and could inform this effort.

But here’s a plea: A strategy without true accountability will put us no further ahead. Canada’s children need a non-partisan, independent, “advocate” or “champion” to represent their best interests.

A Commissioner for Children and Young Persons could report on the status of children. They would ensure all sectors consider children in decision-making. A Commissioner for Children and Young Persons could also provide a framework of accountability for a federal commitment to eliminate child poverty.

This is not a new concept to wealthy nations like Canada. Countries including Australia, Sweden and France have all established a point person or office representing the interests of the child. This concept is also well known to the Canadian government. After Canada ratified the UN convention on the Rights of the Child in 1991, more than a decade’s effort to establish a Commissioner for Canadian Children and Young Persons was set afoot. Previous governmental reports have also produced recommendations for the appointment of a federal Commissioner

Twice, the UN Committee on the Rights of the Child has called on Canada to establish an ombudsman’s office. In 2009 and again in 2012, Parliamentarians’ introduced bills proposing the appointment of a Commissioner.  Despite this, we have yet to muster the political will to establish formal representation for Canadian children.

The need for a national champion for children is clear.  Will our future leaders heed the call?

IMG_1655Laura StymiestLaura Stymiest is a paediatrics resident at Dalhousie University. She previously completed training at the Coady International Institute and has been involved in research in the area of Social Paediatrics.

 

 

 

 

Ford Jones_LeeElizabeth Lee-Ford Jones is an expert advisor with EvidenceNetwork.ca, and Professor of Paediatrics at The Hospital for Sick Children and the University of Toronto.

Do Canadians Spend Too Much on Taxes?

October 7, 2015 10:05 am
Taxes

Here’s why that’s the wrong question

“There are lies, damned lies and statistics” is the well-worn phrase, but nothing better sums up the recent Fraser Institute scare mongering about taxes being the single largest budget item of Canadian households.  “Your family’s largest expense may surprise you,” the ideological-driven think tank wrote, with taxes as the punchline.  This perspective was picked up in headlines across the country with few media outlets taking the time to look critically at how the finding was reached.  

The truth is, as catchy as the headlines may be, it is alarmist spin.  

Of course, if you divide all household expenditures into a number of different categories like food and transportation, but leave all the different levels and types of taxation lumped together in a single category, the Fraser Institute finding is neither false nor surprising. If, instead, we also lumped all of Canadians’ (non-tax) spending together, the resulting discretionary amount is a larger portion of household budgets than the taxes the Fraser Institute claims we pay.  

But there is more obfuscating magic in their figures.  On the one hand, the Fraser Institute assigns the taxes paid by corporations to individuals and families, but they don’t assign the corresponding corporate profits to anyone.  This inconsistency inflates their tax rate numbers.  

Let’s tackle the issue another way.  If we examine Canada’s entire economy, the OECD pegs total taxes, including CPP and EI contributions, at about 31 percent of GDP.  This simply does not square with the Fraser Institute’s figure of 44 percent.  

And let’s not forget that governments in Canada actually account for about 20 percent of GDP if we focus on their direct purchases – from teachers’ salaries to hospitals to roads and public libraries.  Providing these kinds of public goods is why we have governments in the first place.  Presumably the Fraser Institute would rather have Canadians, at least those rich enough to afford it, pay for private schools, private health insurance and toll roads instead.  But where would this leave lower and middle income Canadians?   

Most of the rest of the economy’s taxes flow back to individuals and families as cash – ranging from child tax benefits to public pensions.  These forms of redistribution and social insurance are fundamental to Canada’s social fabric.     

But there may be a silver lining.  Such biased economic exercises raise a fundamental question: Just what indicators should we be using to keep score on Canada’s economic performance?

In the 1990s,  a cover story for the Atlantic Monthly was titled, “If the economy is up, why is everyone down?”, reflecting a widespread feeling that the most commonly used scorecard for the economy, gross domestic product (GDP), was  misleading.  The recent theological debate on whether or not Canada has been in a recession is also based on GDP trends.  

In 2009, then French president, Nicholas Sarkozy, frustrated with the focus on GDP, funded a group of Nobel laureates and internationally prominent economists to see whether there was a better economic scorecard. Their answer, in the area of incomes, was to focus on median family income – the income level that separates families into two equal sized groups when arrayed by income.  

For Canada, the trends in this measure of economic performance do not jibe with GDP per capita, nor with the family income figure used by the Fraser Institute.  In 1997, median Canadian family after-tax income (in constant 2014 dollars) for a four-person family was about $64,000, just a few hundred dollars higher than it was in 1976.  Nothing to celebrate, in other words. Over this same period, GDP per capita had grown by about 20 percent.  

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After this period of stagnation, there was a clear turning point in 1997, with median family income (again using a four person family as the point of reference) then growing quite steadily, reaching just over $85,000 in 2013.  This figure reflects real growth of 33 percent, faster than the roughly 26 percent growth in real GDP per capita over the same period.  

We have, then, three very different impressions of Canada’s economic performance:  The Fraser Institute has generated implausibly high average tax rates, using opaque methods, with the implication that Canadians are losing close to half their income to some ne’er do well — their governments.  The mainstream financial press focuses on short term wiggles in the GDP stats, and politicians try to score points on who is to blame or reward for particular wiggles in GDP.

But far less effort is devoted to producing and trying to understand data on how actual Canadian families are doing.  

We need to make more use of modern kinds of “big data” to estimate median family income and related indicators like the prevalence of low income, the size of the middle class, the share of the top one  percent and income inequality.  Such information would help paint a truer portrait of Canadian household prosperity — both improvements and declines – across the country.    

It’s time we stopped buying biased and second-rate economic indicators and took a thoughtful look at how Canadians are really doing.  
Wolfson_MichaelMichael Wolfson is an expert advisor with EvidenceNetwork.ca and holds a Canada Research Chair in population health modeling/populomics at the University of Ottawa. He is a former assistant chief statistician at Statistics Canada, and has a PhD in economics from Cambridge.

Blue Rodeo Slams Harper In New Protest Song

September 30, 2015 2:58 pm
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It’s been merely a month, but yet another anti-conservative diddy has gone viral.

Following the controversial suspension of federal government scientist Tony Turner, Superstar country-rock group Blue Rodeo are the newest band of Canadians protesting the Conservative party with their new hit, “Stealin’ All My Dreams.

In a recent trend, choruses of politically active Canadians have turned to YouTube to voice their opinions by creating snappy and opinionated tunes that are sure to be stuck in your head all day.

In Blue Rodeo’s newest contribution, the band features lines and lyrics attacking the Harper government, with jabs such as “Little King Stevie and his monarchy” and “(You’re) the biggest threat to my security.” Thus leaving little to the imagination on the band’s political standpoint.

If not for the Toronto band’s personal interpretation of Stephen Harper, the video is worth a watch for the many statistics projected throughout the video.

Blue Rodeo, along with dozens of other prominent Canadian artists, such as poet Shane Koyczan, will be performing their self made political anthems over the next 20 days leading up to the ballot box, asking voters to #ImagineOct20th, and create a change of leadership in Canada.

You can find the band’s ‘Stealin’ All My Dreams’ protest song on their YouTube channel.

Why Affordable Housing Should be a Federal Election Issue

September 29, 2015 9:54 am
Housing

It’s time to make affordable housing an issue in the federal election campaign.

Four million people are struggling to find affordable housing in Canada today.  By affordable, I’m using the Canada Mortgage and Housing (CMHC) standard rule of thumb of about 30 percent of income going to housing that is adequate and in suitable condition. In fact, many Canadians are paying much more than this for housing, which leaves little in the household budget for other necessities such as food and clothing.

According to Food Banks Canada, the cost of housing is a key reason for the rise in food bank usage. Did you know that a third of those who depend on food banks are children?  Despite this, one in seven children go to school hungry every day according to the Breakfast Club of Canada.

There are 235,000 Canadians who experience homelessness in the course of a year.  And 1.6 million more Canadians are at risk of losing their homes according to CMHC.  All this misery while study after study shows that it is cheaper for the public purse to house someone than leave them on the street, moving in and out of shelters, emergency hospital rooms and even jails in some cases.

I think we all understand intuitively the importance of having decent shelter.  A home anchors a person, anchors a family.  It provides a foundation for people to move forward toward greater stability in the work place or higher educational attainment.  Health experts also tell us that adequate housing is a key determinant of health and long-term health outcomes.

In Toronto, I chair a Mayor’s Task Force on Toronto Community Housing (TCHC) which has a waiting list of 90,000 households looking for decent, affordable accommodation.  That represents more people than are currently housed by TCHC now, which is already the largest social housing provider in Canada – and second only to the New York Housing Authority on the continent.

Toronto isn’t the only city struggling with this issue. The Federation of Canadian Municipalities said that “As a country, we are not keeping up with demand for housing options and Canadians from coast to coast to coast feel the housing crunch.”

To make matters worse, current federal investments in social housing are being phased out. These investments come in the way of federally subsidized “operating agreements” with social housing providers and co-ops who deliver affordable housing to those in need. This year that means a $1.6 billion reduced investment. Without renewal the subsidies will, one by one, end by 2040 – a slow bleed.  When these agreements end, over 300,000 households will be at risk of eviction or possible homelessness according to a report by the Canadian Housing and Renewal Association.

Affordable housing is an enormous challenge — but it’s solvable if there is political will to do so.   So why isn’t more being done to keep existing housing affordable or provide new affordable housing?  The different levels of government along with community organizations are doing something, but it is insufficient to meet the need.  Also, the different players are not working together on a comprehensive plan.

What we need now is a ‘national housing strategy’ with all hands on board. Canada needs federal leadership on affordable housing.

In this federal election campaign, the effort to achieve political will needs to be focused on the federal candidates. In each federal riding there are social housing and co-op providers.   If residents got together, visited each candidate, told them about the housing crunch, and sought their support, it would go a long way in bringing this need into the election campaign limelight.

So let’s make our federal political candidates aware that affordable housing is not just something that Canadian cities and towns have to struggle with on their own, but requires federal leadership and investment.

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

Response to Refugee Crisis Must Include Expanding Refugee Healthcare

September 24, 2015 2:50 pm
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The haunting image of Alan Kurdi’s lifeless body lying face down on a Turkish beach, and the subsequent revelation of the Kurdi family’s intention to seek asylum in Canada, have prompted many Canadians to ask what we can do as a country to help Syrian refugees. So far, our search for an answer has rarely moved past the issue of refugee resettlement as we continue to debate how many Syrian refugees we should admit, how soon and by which means.

This is unfortunate. While there is no question that refugee resettlement should be an important component of our collective action, our humanitarian response to the Syrian refugee crisis must go beyond this.

What is largely missing in the public discussion is an appreciation that refugees face extraordinary challenges throughout their migration process, including before and after their resettlement, and this equally demands our attention. One challenge in particular – access to proper healthcare – is critical, both for Syrian refugees remaining in the region and many of those who have arrived in Canada.

Lack of healthcare has dire consequences for the well-being of refugees and can also stand in the way of their integration into new environments.

For the four-million Syrian refugees living in the neighbouring countries, their access to healthcare has been severely hampered by the funding shortage facing aid agencies. Take this year as an example; as of June, the UN High Commission for Refugees and its partners have secured only 17 percent of the 369 million U.S. dollars needed for the health-related humanitarian initiatives in the region. As a result, UN-operated clinics in 10 of the 18 Iraqi districts have been forced to close. In Jordan, only half of the war-wounded have been able to access necessary nursing care. Refugees in Lebanon in need of certain life-saving treatments, including kidney dialysis, chemotherapy and care for extremely pre-term infants, have lost UN subsidies and must now find ways to pay for their medical costs privately.

Syrian refugees that arrive in Canada, those sponsored by private groups as well as those awaiting refugee status determination, also encounter barriers accessing medically necessary services owing to cuts to the federal refugee healthcare program since June 2012. Although the Federal Court ruled in July last year that these changes to refugee healthcare were cruel and unusual — and therefore unconstitutional — the government is now appealing the decision. Meanwhile, gaps in refugee healthcare coverage persist.

According to the current federal policy, most privately sponsored refugees and refugee claimants are entitled to neither supplemental benefits nor prescription drugs unless they are required to treat conditions that pose a threat to public health or public safety. As such, Syrian refugees injured in the war and in need of prostheses or mobility aids must pay for them out of pocket. Those seeking support for mental illness, which is common among refugees, receive no financial assistance when consulting a clinical psychologist or when requiring psychotropic drugs. Refugees living with chronic diseases like diabetes and hypertension must also shoulder the cost of their medications on their own. This latter point is especially salient in the context of Syrian refugees. In 2011, before the onset of the civil war, over three-quarter of all deaths in Syria were reportedly attributable to non-communicable diseases.

There are, however, immediate steps that the Canadian government can take to facilitate Syrian refugees’ access to healthcare — both abroad and here at home. As a country, we must boost our humanitarian aid to frontline organizations that work tirelessly to meet the needs of refugees in Syria and adjacent countries. The government’s recent announcement to match private donations made between now and the end of the year is a crucial first step, but with the refugee situation becoming protracted, we must commit to longer-term funding support.

Critically, at home, the federal government should discontinue its appeal of the Federal Court’s ruling and fully reverse the cuts to the refugee healthcare program in Canada.

These measures will not only attend to the basic needs of refugees, but also contribute to the success of Canada’s resettlement program. Restoring healthcare access will reduce the out-of-pocket healthcare costs of refugees and ease the financial burden of private refugee sponsors. Access to healthcare will also help maintain or even improve refugees’ well-being and sense of hope which can only help to encourage their active participation in the host community.

The protection of healthcare access for refugees must be a key element of Canada’s humanitarian response to the Syrian refugee crisis. We can’t start too soon.

YYChen_headshotY.Y. Brandon Chen is an Assistant Professor at the Faculty of Law, University of Ottawa. He is a member of University of Ottawa’s Centre for Health Law, Policy and Ethics.

Bringing Order to Chaos in the Debate on Marijuana?

September 23, 2015 10:01 am
marijuana

In the midst of Presidential Primary races in the USA, a federal election in Canada and myriad internationally supported and jurisdictional laws in place on the issue elsewhere on earth, marijuana has quietly dominated the media, political and business landscapes. Yet little, it appears, seems to be understood by the general public as this particular industry continues to grow and political agendas seem to be firming up

This essay purports to clear the air or shed some light on the matter.

Whether through the creation of new laws to protect its cultivation from illicit organizations, arresting criminal elements who distribute it, helping to create a framework for compassion clubs for patients who need it, or assisting governments in Canada, the United States, Uruguay, Mexico and Caribbean nations draft new laws or manage through the complexities of creating a new licensed producer regime, marijuana has been part of my life for over thirty years. Yet after all my media rants about its decriminalization, only now has this heretofore socially vilified plant become mainstream politically.

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Medical marijuana users protest crackdowns in California. Photo courtesy of Wikimedia Commons.

As context, in the early part of the new millennium, many states in the USA – starting with Colorado – passed legislation to make the cultivation and distribution of marijuana legal for either its recreational or medicinal use.  These laws, initiated specifically in state legislatures, have provided great commercial benefit to growers and distributors in States like Colorado, Oregon and Washington, but there seems to remain no national and coordinated legislation for cultivation and distribution despite repeated claims from the White House.

As a result, I travel more and more to states that have adopted marijuana laws to advise those State governments or regional law enforcement agencies and even state regulated marijuana producers on issues of financial administration, security and best practices in marijuana growing and distribution.  More and more, however, I am convinced that politics seem to be getting in the way of practicality and this may inhibit or hamper future benefit for licensed producers and ultimately those who need it throughout the USA.

To be specific, the lack of a national law for either recreational or medicinal use of marijuana has hampered opportunity for some patients who require it for medicinal purposes to even access it in states where there are no such laws in place. More startling is the fact that current licensed producers and distributors remain unable to actually deposit funds into FDIC banks – creating a virtual sit and wait opportunity for criminal elements.

In New York State Governor Cuomo reluctantly created regulations for the growing and distribution of medicinal marijuana.  In his vainglorious attempt to appease every single side of the issue, he created a system where a literal handful of licensed producers would grow and cultivate cannabis for medicinal use – only as oils and edibles. The initial plan was heralded as innovative and was a boon for my consulting business, but when reality sunk in for potential license applicants, it became apparent that the benefit Governor Cuomo had wanted to create was seemingly as fleeting as his popularity.

Until the US comes up with a national law, the situation for cannabis will remain fluid in the United States.

In contrast, Canada’s new national marijuana regulation, the first in the world – MMPR, passed by the House of Commons in 2013, has been a success.  The new Regulations were designed to limit the number of growers licensed to grow and distribute marijuana for medical purposes regulations (MMPR) to the general public. The essence of the new Regulations curtailed the opportunity for those who heretofore had dominated the marketplace with smaller and possibly illegal grow operations. Legitimate operations functioned under a set of regulations called the medical marijuana access regulations (MMAR) and were originally passed by the House of Commons in 2003 and designed to regulate the growing and cultivation of marijuana for a qualified patient – with a prescription – for access to the plant for his or her own personal use. The marketplace for marijuana in Canada, under the original MMAR was like the Wild West – illicit organizations controlled the small growers – making my job in law enforcement tougher.

Of course I was particularly pleased when the MMPR came into being and immodestly helped to push its passage. But, despite this good work and vision from Ottawa, the marketplace and the entire Canadian medicinal marijuana industry continues to be rife with issues as it transitions to the new Regulations.

In a very stark example, in the early goings of the process of the new MMPR, someone forgot to tell the courts that former MMAR growers (some 40,000 across Canada) would fight to keep their status quo and, as such, would band together to form a class action against the government.  The subsequent court proceedings in BC Federal Court rendered a decision by Mr. Justice Michael Manson in favour of the class and cast the entire MMPR program into chaos all the while embarrassing the federal government. Had the government of Canada’s Health Canada simply stolen a page out of the myriad provincial governments’ prescription drug reform efforts, it would have created a more effective transition program to the new order.

More startling is that most newly minted licensed producers grow and sell as if they were still MMAR growers. Simply put, many newly licensed producers are seemingly too small in scale for a national program. Scale or lack thereof, has, in fact, created the unintended consequence of limiting supply to qualified patients – projected to be about 400,000 in Canada according to Health Canada – because newly licensed producers do not and cannot produce the scale of marijuana for such a large patient base. Little wonder the illicit marketplace and its organized cohorts remain entrenched in the Canadian market and continue to make it a considerable challenge for law enforcement.

Perhaps the most dramatic issue facing the new market, however, remains the failure of some municipalities to curtail the illegal distribution of marijuana at illegal dispensaries.  My very public fights with Mayor Gregor Robertson of Vancouver are over the very public disregard he seems to have for controlling or curtailing this illegal activity, claiming that doing otherwise would drive the industry underground. If Canada is prepared to embrace new regulations for marijuana it must maintain the highest of standards for its distribution. The illegal sale of marijuana on Hastings Street in Vancouver is likely an even bigger embarrassment for the mayor of one of Canada’s greatest cities rather than the federal government.

Some Caribbean and South America countries like Jamaica, Chile and Uruguay have recently passed national laws to allow private companies to bid on licenses to grow, process and distribute marijuana. Seemingly the intent is to stave off efforts from the illicit cartels that have taken over the distribution of marijuana throughout those countries. It seems, too that the ancillary attempt with the creation of these new laws is to attract a spate of bidders from all over the world hoping to garner a license and reap the benefit of growing and selling legally in those jurisdictions.

Caribbean nations like Jamaica and St. Vincent, for example, have attracted investment from Europe, US and Canada seeking to take advantage of the export opportunity there. Stark reality may creep in when these investors begin to realize that these countries may not qualify to export into the lucrative US and Canadian marketplaces due to growing practices and scale issues.

Possibly the most startling example of good intentions and failed outcomes is Uruguay. Its quirky former President thought correctly that a national plan to legalize marijuana would stave off efforts by other South American to infiltrate its borders with illegal marijuana. It passed its legislation to totally legalize marijuana nationally and launched a global licitation, all the while electing a new President – a physician – who signaled a change in direction to medical marijuana while continuing down a path for bids for recreational marijuana. Full disclosure, I am involved in a bid in the country with a Canadian organization with experience in the cultivation and distribution of cannabis.  To suggest that the process managed by Uruguay’s Institute of Regulation for Recreational Cannabis or IRCCA is both confused and opaque is understatement, which may render the unintended consequence of derailing the program altogether.

There are many moving parts to the entire regulating global marijuana market, including a shift in process and regulation in Canada as a result of the federal election, in the United States as pressure mounts for a federal law there and greater scrutiny on rogue international governments. Throughout one thing is clear – the growth of the market will continue as benefit of the plant continues to be ascribed in science and medicine and as money can be made. From my perspective, though, the best way to manage these issues without allowing the proliferation of nefarious elements and chaos is to ensure that law-makers have courage and that remedies for violators –including those in foreign jurisdictions – are established.  Demonstrated courage by law-makers comes in the ability to create Regulation that demands good probity for all those who participate in the industry, to ensure that there is adherence to good quality in people and processes, that there is extraordinary oversight in place and above all, that the most effective security measures around are in place to keep the system and communities safe.

Remedies should include prison sentences for violators and for those who grow without a license and who seek to distribute without a license and sanctions for governments who are not transparent. Similarly, those who are licensed and violate any of Regulations or laws stand to lose their license and face the prospect of never being allowed a license again.

As for other jurisdictions, like South America, until those governments can demonstrate that they, above all, are not implicit or complicit in illicit activity or non-transparent behaviours, we will continue to have a lack of confidence in their programs or laws no matter how well intended they may appear.

Kash Heed is a former Solicitor General for the province of BC, retired Chief of Police in the West Vancouver Police Department and the former head of Drug Section and Gang Task Force with the Vancouver Police Department.

Should Eye Exams be Mandatory for School-Age Kids?

September 21, 2015 11:06 am
Eye exam

Most Canadian children never have their eyes examined, yet one in six may have a vision problem.

Currently only 14 per cent of Canadian children under the age of six receive professional eye care. Since the measles outbreak in North America a few months ago, more school districts and provinces are considering mandatory immunization in order to attend school.

Should eye examination be added to the list of school entry requirements?

It’s been done elsewhere.  Since 2004, all children in Massachusetts entering kindergarten must provide proof that they have undergone a vision screening within the last year. The government explains that school entry is the perfect “safety net” that ensures a proper start to academic life.

Canada only has a partial safety net for eye care for kids at best.

According to the Canadian Association of Optometrists (CAO), one in every six children may have a vision problem that makes it difficult to learn and read. For this reason, the CAO strongly recommends a comprehensive eye examination for every child before entering school. The medical journal, The Lancet, recently published a paper on whole population vision screening in children to detect amblyopia (lazy eye). The authors recommend that there should be screening of all children age four to five years at school entry since this “confers most benefit and addresses inequity in access to timely treatment.”

So if professionals are so clear on the need, why aren’t kids getting eye exams in Canada?

The CAO believes the costs associated with eyeglasses can be a barrier for many families – and many parents are simply unaware that eye examination for children is both recommended and free in most provinces (covered by the publicly funded health system).

Some steps are underway to improve the situation. For example, Ontario has recently joined six other provinces in offering a program that is financed by both public and private purses. The Eye See…Eye Learn program provides no cost, comprehensive eye exams for kindergarten students, and importantly, offers a free pair of eye glasses if the child requires them — something that would normally cost parents around $250.

Initiatives like the Eye See…Eye Learn program are a great step in the right direction, but it’s a half measure. Provinces are already partially funding this program, so why not take it a step further? Why not put in place a comprehensive eye health system so that children of all ages are systematically benefiting from vision care?

We need health ministries to make sure that children who need glasses get them, and have access to professional eye care throughout their education trajectory. And maybe it is time to consider the requirement of documentation that a free eye exam has taken place before school entry.

Children’s education at stake

Vision problems have serious consequences for a child’s development; reading, writing, motor skills and behaviour can all be affected. Bottom line: early detection and timely treatment of eye conditions are effective and cost effective.

Many parents and teachers have mistaken vision problems for behavioural issues or learning disabilities. But a child will not tell a parent if they cannot see properly (if they don’t know themselves). Systematically detecting vision issues in children will not only help them avoid unnecessary academic struggles, but it will also reduce the burden on schools, who must spend huge resources to help students who are falling behind.

The Quebec Order of Optometrists says that 61% of Canadian parents are wrong when they believe they can detect their child’s visual problems without a professional.  It may be highly instructive to know that high-IQ society Mensa’s youngest U.S. member is a two year old girl who was originally misdiagnosed with “unspecified learning delays.”  All she needed were glasses to correct her far-sightedness and amblyopia.

Seeing through the costs

Learning that your child needs glasses can be challenging for a parent with low-income.

Philanthropic initiatives exist across the country to pay for the exorbitant cost of glasses; the Bonhomme à lunettes in Quebec, the Toronto Foundation for Student Success, the Vision Institute of Canada, for example, all provide a helping hand for vision care. But their capacity is often limited and families should not have to rely solely on the good will of such organizations in order to see.

In the coming months, the CAO will meet with Members of Parliament and Senators in Ottawa in the hopes that early detection and treatment of eye and vision problems will become a public health priority. If Canada is serious about education – and serious about the health of Canadian children – it should move to make complete eye care part of the health care system.

Hear an audio podcast on this issue with the authors here.

rsz_ford_jones_leeElizabeth Lee-Ford Jones is an expert advisor with EvidenceNetwork.ca, and Professor of Paediatrics at The Hospital for Sick Children and the University of Toronto.

 

 

 

 

 

melanie_holubowskiMélanie Meloche-Holubowski is a journalist intern at EvidenceNetwork.ca and journalist with Radio-Canada.

Opinion: Something is Rotten in the State of Ottawa

September 16, 2015 1:47 pm

It has been said that the reason nothing changes in the criminal justice system is due to the ‘four horsemen’ of political inaction: inertia, ignorance, apathy and cost. When it comes to the Ottawa Police Services Board and their lackadaisical attitude to the issue of carding, it appears all four of these elements apply. How else can you explain the fact that the Ottawa Police Services Board has done next to nothing to address this city’s carding problems?

The role of a police services board should not be to rubber stamp decisions made by the chief of police.  The issue of street checks or carding was first brought to the attention of the Ottawa Police Services Board back in 2012 when university student Andrew Tysowski was stopped by an Ottawa police officer and given a ticket because six years previously he had the temerity to exercise his charter rights under Canadian law.

In 2006 Mr. Tysowski had been asked by officers to get off an OC Transpo bus and answer some of their questions. Someone thought he resembled a robbery suspect and had called police. After answering their questions and producing valid identification, Mr. Tysowski inquired as to why the officers asked him to get off the bus. When one of the officers reacted negatively to his request Mr. Tysowski indicated he had studied police foundations at Algonquin College and that he was legally entitled to receive an answer to his question.

In 2012 when Mr. Tysowski was stopped by an Ottawa police officer for an alleged infraction under the Highway Traffic Act, he was asked to provide the registration certificate for his vehicle, which he did.  The officer checked with dispatch and discovered a report about his interaction with police on the OC Transpo bus six years earlier. As a consequence, he informed Mr. Tysowski that because of his attitude towards police back in 2006 he was giving him a ticket for failing to provide registration for his vehicle even though the officer was actually holding the certificate in his hands.

Following this incident Mr. Tysowski filed a complaint against the officer with the Office of the Independent Police Review Director (OIPRD). When the OIPRD finally released their report into the complaint, Mr. Tysowski was shocked to learn that back in 2006 the officers had produced a report on the incident where they stated that they were making a note of his negative attitude in the event he should ever apply to join the Ottawa Police Service in the future.

This case raises a number of issues. First, it illustrates the extent of police ignorance when it comes to the Canadian Charter of Rights and Freedoms. Every day in courtrooms in the City of Ottawa and across the province criminal lawyers make charter applications claiming that officers have violated their clients’ rights. The costs involved in processing these applications are in the millions, and the applications invariably lead to charges being dropped or dismissed in court. So why is it that police officers do not seem to have the foggiest notion of Canadian law and the charter rights of citizens?

Second, upon what basis in law are police in this country allowed to surreptitiously record prejudicial information on individuals and keep it secreted away in their police files without any due process or avenues of accountability for the affected person? What are the consequences when police engage in this behaviour?

Third, why are oversight bodies like the Office of the Independent Police Review Directorate not imposing severe penalties on officers who engage in this kind of conduct?

In the case involving Andrew Tysowski the OIPRD ruled that the officer’s actions were only minor in nature and therefore did not warrant a more stringent penalty than being talked to by a senior officer.  There is something wrong with this picture. Tell that to the hundreds of people who have had their lives negatively impacted by the racial and discriminatory practice of carding or street checks that was documented in a series of articles published in the Toronto Star. Many people told the Star that they were unable to travel to the US, obtain volunteer positions and in some cases even secure employment because they had been subject to carding by the Toronto Police Service.  The fact that all of this was done by the police without the knowledge of the individual affected should be a concern to all people who value their freedoms and civil liberties.

In 2012, I wrote to the Ottawa Police Services Board and made them aware of Andrew Tysowski’s case. In typical fashion they did nothing.

In Ottawa we have a police services board appointed under the Police Services Act of Ontario. This board is supposed to provide the Ottawa Police Service with direction when it comes to issues of policy and other matters affecting policing in the city. Mayor Jim Watson sits on this Board, as does former Mayor Jim Durrell. What is the purpose of these boards if the people who sit on them are going to collect their per diems and say nothing about issues that negatively impact the freedoms of people they are supposed to represent and protect?

Preserving the status quo is not an option. The Police Services Act needs to be amended so it sets out very strict rules and guidelines governing carding or street checks in the province of Ontario. The OIPRD needs to be abolished and replaced with a genuine oversight body that holds police accountable for their actions. Last but not least, the role of police service boards needs to be clarified so that the people who sit on these boards are actually required to do something to earn their per diems even if that means protecting citizens from policing practices that undermine the rule of law in a democracy.

Darryl T Davies is a criminologist with the department of sociology and anthropology at Carleton University. The views expressed herein are those of the author in his personal capacity.

Arrested for Sleeping?

September 11, 2015 10:55 am
Sleeping

The struggle to occupy public space.

As humans, we need to sleep. It is biologically unavoidable. Yet, on both sides of the border, sleeping can be considered a criminal act, especially if you are homeless and have no place to rest your head other than in public spaces such as parks.

How have cities and states been able to impose and enforce by-laws and ordinances that clearly violate one’s right to occupy public space for this very purpose? This summer several cases are putting this longstanding question to the legal test. The outcome might just change the way we view homelessness.

In the City of Abbotsford, British Columbia, a civil court case is pitting a group known as the “Drug War Survivors” against the state in a fight over what is being viewed as further evidence of the criminalization of homelessness. The group’s lawyer has argued that his clients (and all persons homeless) have the right to occupy park space for the purpose of temporary dwelling and sleeping. The case argues that a set of by-laws prohibiting such uses of public spaces is unjust given there is no alternative.

Perhaps the real fight is also about who is responsible for the provision of adequate shelter in Canada, especially for those most in need.

Across the border, the United States Department of Justice has intervened in a case in the District Court of Boise, Idaho by filing a Statement of Interest. The filing clearly articulates that the act of sleeping, when there is no shelter available, should not be considered a criminal act, yet they cite that among the nearly half a million annually homeless, 42 percent slept in unsheltered public locations.  The Boise filing may become a landmark case in finally ending the debate on whether it is constitutionally just for any citizen without shelter to seek a public space for the right to sleep – without fear of being arrested.

Interestingly, neither the Abbotsford case nor the Boise filing are new as cities have always struggled with the inability to shelter all those in need since the dawn of modern urbanization. However, what is new is the criminalization of homelessness.

In the North American context, it was not until the late 1970s when the United States saw a spike in the numbers of citizens without homes, largely attributed to the economy, the deinstitutionalization of persons from mental health facilities and increasing veterans on the streets that actions began to take place.  For most jurisdictions, the fight was not about affordable housing but how to deal with the “vagrants” who shuffled about the streets, causing well-minded citizens to demand steps be taken to end public intoxication, curb panhandling and the visibility of poverty, mental health and severe addiction.

In a case that took place in the winter of 1979, Supreme Court Judge Andrew Tyler delivered a landmark decision in the case of Callahan vs. Carey. Robert Callahan was homeless and resided in the notorious Bowery neighbourhood of New York City. Justice Tyler’s brave decision was clear: the State was obligated to provide shelter to those most in need and his decision also included the clear articulation of necessary shelter standards and intake and monitoring provisions.

The decision resulted in the state of New York being required to shelter those in need. The case would also impact other jurisdictions to consider whose responsibility it was to provide temporary shelter. While the decision did not end homelessness, it did place the burden on the State to provide shelter spaces while also setting a strong precedent.

In the late 1990s, Toronto’s “Tent City” plight became ground zero for a Canadian resistance movement that drew in many including the late Jack Layton, a City Councillor at the time, who grappled over the same question: Who is responsible for the provision of adequate shelter in Canada during a time of crisis? The Toronto story ended with a mass eviction on the occupied private lands while a media storm brewed among social housings activists, governments and citizens all fighting over how shelter should be provided and what rights Canadians have to occupy land.

The Tent City movement did not result in the legal outcomes of Callahan vs. Carey but it did see the federal government acknowledge the homeless crisis with an investment of nearly a billion dollars in funding to overhaul Canada’s inadequate shelter system.

As the North American summer simmers with high temperatures evoking heat warnings, several legal proceedings are quietly brewing. Perhaps the boiling point has been hit — with governments on both sides of the border on the verge of acknowledging the right of people to sleep in public spaces when no other option exists.  Let’s hope these legal cases also determine that this fundamental right cannot be deemed a criminal act. And let’s hope what follows is further government investment in the range of supports needed to end homelessness.

Distasio_JinoJino Distasio is an expert advisor with EvidenceNetwork.ca and Director of the Institute of Urban Studies, University of Winnipeg.

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