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.

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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.

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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
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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.

Back to the Future

October 22, 2015 3:10 pm
Trudeau Jean Marc

Photo by Jean-Marc Carisse.

Last night Liberal leader Justin Trudeau won a majority government in a historically long three-way race. Moving into his father’s old house, Trudeau has created what many are calling Canada’s first political dynasty.

The Liberals swept across Atlantic Canada early on, taking every available seat in Newfoundland and Labrador, Nova Scotia, New Brunswick and Prince Edward Island. Those wins predicted their takeover of the rest of the country, and it seemed like news organizations were predicting a Liberal win before the election had even begun. By the time all of the votes had been counted, the Liberals controlled 184 seats, 150 more than they had at the end of the 2011 race that shattered them.

The Conservative Party of Canada did maintain strongholds Saskatchewan and regained almost every riding in Alberta, aside from a few urban centres. Overall, they lost 67 seats compared to the last election.

Like the polls predicted, the NDP suffered a huge defeat across the country. They were even lost most of Quebec, the source of last election’s ‘orange wave.’ The NDP lost 59 ridings, but leader Thomas Mulcair kept his seat and remains leader of the party.

More than an election for one party though, many saw the election as a referendum on Stephen Harper. Last night Canadians made a clear choice and voted for change. The reasons why are all in this song by Blue Rodeo.  Watch the video and sing along, today begins a new song:

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.”

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