Primary health care in crisis

Primary care is the corner stone of a high-functioning health care system. Yet, many Albertans are struggling to find a family doctor, or if they are lucky enough to have a family doctor, to get an appointment in a timely fashion.

In response to this crisis, the UCP government announced the Modernizing Alberta’s Primary Health Care System (MAPS) initiative last month to identify immediate and long-term improvements to our primary care system. 

In Canada, primary care is provided mostly by family physicians with a small percentage of Canadians seeing registered nurses, physician assistants or nurse practitioners as their regular primary care provider. Primary care comprises services that prevent disease, promote health, treat common illnesses and manage ongoing medical conditions such as diabetes, arthritis and mental health conditions.

Primary care providers are usually the first point of contact with the health care system for most people. In addition to diagnosing and treating medical conditions, they also co-ordinate specialist care and treatment for patients. 

Importantly, primary care providers have trusted, long-term relationships with their patients and get to know them in fullness of their lives – often providing health services from cradle to grave for patients in their community.

Studies show that patients who see a regular primary care provider have better long-term health than those who don’t.  They experience better access to health care, less duplications of tests and referrals and have fewer hospitalizations. Ultimately, they live longer and in better health.

What’s more – primary care provides all these benefits while at the same time lowering health care expenditures, increasing patient satisfaction and contributing to are more equal society.

But these benefits are available to fewer and fewer Albertans as the number of family physicians accepting new patients in our province has dropped by half in the last two years. 

“Currently, family medicine is experiencing the lowest interest among medical students”

If we are to reverse these trends, governments, health care organizations and ordinary citizens have to acknowledge the crisis in primary care and take action.

Governments need to invest adequate resources into primary care to build a strong and reliable foundation for the rest of the health care system. Resources include properly funding the provision of primary care through recognizing clinic overhead costs paid by family doctors and addressing the administrative burdens they face. Compensation also has to take into account the extra time and effort spent in the care of complex, fragile or socioeconomically disadvantaged patients. 

Currently, family medicine is experiencing the lowest interest among medical students with only 31% of medical students choosing family medicine training as their first choice upon graduation from medical school. Proper support, reimbursement and recognition can make the practice of primary care attractive and prestigious for young health professionals. 

Governments also need to invest in a robust primary care workforce plan that includes plans for training, recruiting and retaining primary health care providers. The shortage of primary care providers will only get worse as Alberta’s population ages and the number of older patients with multiple and complex medical problems grows.  More seats in medical schools, and increased access to training programs for nurse practioners, physician assistants and other providers of primary care are needed now in order to meet current and future demands.

Additionally, the thoughtful integration of nurse practitioners and physician assistants into community clinics will allow patients to have timely access, choice of primary care provider and the opportunity to build long-term relationships. Such an approach should allow nurse practitioners and physician assistants to perform duties to the full extent of their training while at the same time providing support and pathways for referral to family physicians or specialists when required.

System changes to create multiple access points to primary healthcare can also help patients get access to timely and appropriate care. Whether the patient accesses care through a pharmacist, a physiotherapist, a public health nurse or an emergency room doctor, they should receive the care and treatment they need in the moment, but with a reliable system in place to ensure co-ordination, collaboration and information transfer back to the patient’s primary care provider.

We are told that the UCP government’s MAPS advisory panels will report back in Spring 2023 with advice from strategic, Indigenous and international perspectives on primary care reform in the province. But with the swearing in of new party leader, Danielle Smith, and her own willful ideas about health care in Alberta, we are left wondering if this government will follow through on a thoughtful and collaborative approach to improving primary care that is desperately called for in our province. 

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on October 20, 2022. Photo by Polina Tankilevitch on Pexels.com.

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Food for a healthy planet and healthy people

Agricultural land covers 40% of the global land mass and food production accounts for up to 30% of global greenhouse gas emissions. Now more than ever we have to pay attention to how we eat in order to keep ourselves and our planet healthy.

Agriculture continues to encroach into forests and other carbon rich ecosystems and is the number one reason for biodiversity loss. Fertilization practices used in agriculture causes nitrogen and phosphorus loss into waterways triggering undesirable ecosystem changes.  Furthermore, potent greenhouse gases such as methane and nitrous oxide are released into the atmosphere through rice farming and fermentation in the guts of livestock.

The Canadian federal government just completed consultations on a target of 30% reduction in greenhouse gases from fertilizer use. While this particular target and its implications for food production and food security has attracted controversy, it is indisputable that Canada needs a comprehensive food strategy that optimizes both human and planetary health.

Both over-nutrition and undernutrition are global health problems. Over 2 billion adults in the world are classified as obese or overweight, while at the same time, adults and children face starvation and nutritional deficiencies in some parts of the world. 

“Farmers have long been stewards of the land and have a crucial role to play in leading us in healthy and sustainable food production”

We have long known that overconsumption of calories, red meat and sugars in the Western diet causes diabetes, cancer and heart disease. If the entire global population adopted the Western diet, the demand for meat and dairy will also cause food production to exceed environmental boundaries on land use, freshwater use and greenhouse gas emissions.

To address both these issues, the EAT-Lancet report – written by 37 leading scientists from around the globe – recommends a mostly plant-based diet in order to optimize human health and environmental sustainability. The report calls for an emphasis on whole grains, fruits, vegetables, nuts and legumes and recommends meat and dairy in much smaller proportions.

The authors of the report predict that if there was global uptake of their recommendations, approximately 11 million premature adult deaths (or 1 in 5) could be prevented annually. While this would mean significant progress in population health, changing our eating patterns will not be enough to reach the targets of the Paris Agreement on climate change. To limit average global temperature rise to 1.5 degrees Celsius, we will also need to change the way we farm.

Farmers have long been stewards of the land and have a crucial role to play in leading us in healthy and sustainable food production. We will need to support uptake of regenerative farming practices in larger numbers. These practices regenerate the soil for future use while increasing the nutrition density of foods and include methods such as reduced or no-till farming, planting cover crops, composting, and integrating animals into farms that grow plant crops. Regenerative practices allow farmers to reap the benefits of a healthier environment as well as increased crop health and productivity.  

Other policies that we need to adopt include stopping the expansion of farmland into carbon rich natural areas and focusing on improving productivity of existing agricultural lands. Precision farming techniques such as planting the right crop for the right environment and optimizing the timing and location for water and nutrient use can increase crop yields while minimizing nitrogen and phosphorus run-off in water and reducing water use.

Governments also have a key role to play in reorienting food systems. It is laudable that the most recent version of Canada’s Food Guide released in 2019 considers the health of the planet in its recommendations and is aligned with the EAT-Lancet report.

We now need policies to help Canadians adopt these guidelines. Taxation of unhealthy foods that are high in sugars or are highly processed, and subsidies for healthy, sustainable foods are needed.  More investment into the farming of fruits, vegetables, legumes and nuts will match food production levels to the largely plant-based diet that is recommended. 

We also need to call on our governments to implement policies that reduce food waste because discarded food contributes up to 10% of global greenhouse gas emissions. Such policies can include financial support for food rescue agencies as implemented by the Australian government, legislated composting for businesses generating organic waste as done in France or a ban on food retailers throwing away good quality food as practiced in Italy. 

As citizens we need to do our part as well to promote our own health and that of the planet. Following the EAT-Lancet diet for planetary health includes filling half our plates with fruits and vegetables, getting a quarter of calories from whole grain foods and reducing our consumption of fish and poultry to about 2 servings a week, our dairy consumption to the equivalent of 1 cup of milk per day and our red meat consumption to 1 serving a week. Choosing to be vegetarian or vegan, if that fits with cultural and personal values, will allow us to surpass the recommendations.

How we eat shapes both our own health and that of our life-sustaining planet. As such it is worth putting thought and effort into our everyday meals and our advocacy efforts with decision-makers. Bon appétit!

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on September 16, 2022. Photo credit: Tim Mossholder on Pexels.com

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Cleaning up our act on plastic pollution

They are convenient, inexpensive and versatile but plastics are harming our health and our planet. Recognizing the damaging effects of plastic pollution, the federal government recently announced regulations limiting single use plastics. But they do not go far enough to protect human health or ensure environmental sustainability.

Eighty billion tons of plastics have been produced since the 1950s and less than 10% have been recycled. Plastics have found their way into the bodies of fish and birds, into our soil, water and air and even the human blood stream.

Studies on the health effects of plastics are difficult to conduct given that all humans on the planet are exposed to plastic pollution and control subjects are hard to find. But there is good evidence that some components of plastics are harmful to human health – infants and children are more vulnerable given their smaller body weights and developing brains.

Phthalates are chemical plasticizers used to increase the flexibility of plastic products. They can leach into food from containers or out of infant soothers or other soft plastic toys children put in their mouths. Phthalates disrupt the endocrine or hormonal systems of the body leading to obesity and insulin resistance and affect the human reproductive system in males and females resulting in infertility. Some phthalates are known to be carcinogens.

Th detrimental effects of plastics are also evident in the environment. The Great Pacific Garbage Patch is well-known but it is only one of five plastic garbage patches found in the Pacific, Atlantic and Indian Oceans. Plastics take 100 to 1000 years to biodegrade and pollute our soil, water and air for a very long time. 

Plastic garbage breaks up into smaller pieces and are consumed by fish, birds and sea mammals. Toxic chemicals from plastics (lead, cadmium and mercury) get concentrated as the contaminants travel up the food chain, eventually reaching humans. 

“We need bolder regulation addressing a wider range of products with aggressive timelines …”

Plastic pollution is a global problem and requires a coordinated and concerted effort by all countries to reduce the number of plastic products manufactured, consumed and disposed worldwide. 

If we are to curb the harmful effects of plastics, we need governments to introduce regulations to reduce extraction of fossil fuels used in plastic production. Extraction and refining of fossil fuels contribute to greenhouse gas emissions and climate change. Governments will have to be resolute in the face of lobbying from fossil fuel companies looking to shift their target market to plastic manufacturing as the demand for fossil fuels as an energy source declines.

Banning single use plastics can have an impact on plastic pollution but the recent regulations announced by the federal government are woefully inadequate, banning a limited number of single-use plastic products and addressing just 3% of annual plastic use in Canada with many rules not going into effect until 2025. 

We need bolder regulation addressing a wider range of products with aggressive timelines if we are to make any significant dent in Canada’s plastic pollution problem. In Denmark, the introduction of a tax paid for by retailers and manufacturers of single use plastids resulted in rapid decreases on over 70% of taxable plastic products.

Producers of plastics need to take responsibility for the reuse, recovery and recycling of their plastic products. When soft drink companies used to sell their products in glass bottles, they created and paid for a collection, cleaning and reusing system for their bottles as they were expensive to produce and there was an economic incentive to collect and reuse the containers. 

Since soft drink companies shifted to cheaper plastic containers, they have passed on the costs of collection and recycling to municipalities or other levels of government and have abdicated any corporate responsibility for the millions of tons of plastic pollution they create annually.

Extended Producer Responsibility shifts the onus back on the corporations that create plastic pollution to collect, recover, recycle or reuse their products. In Finland, for example, where all packagers or importers of packaged products were required by government policy to organize a collection and recycling system for plastic entering the markets, the recovery rate for polyethylene terephthalate (PET) – a completely recyclable plastic – was 92%.

As consumers, we all have a role in reducing our use of plastic products by choosing non-plastic alternatives, reusing plastic products and reducing our overall consumption of material things. However, to make a significant reduction in global plastic pollution we have to make it clear to let all levels of government through our voting, letter-writing and other forms of citizen engagement that we want action to reduce plastic pollution and that we want it now.

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on August 23, 2022. Photo credit: mali maeder on Pexels.com

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Rethinking our understanding of mental health and mental illness

Canadians were in a mental health crisis well before the COVID-19 pandemic. But as with many other things, the pandemic served to shine a spotlight on the depth and breath of this serious issue.

According to Statistics Canada, a shocking 1 in 3 Canadians suffers from mental illness during their lifetime. Five to 10 percent of Canadian children are said to have ADHD, over 10% of adults are reported to have a major episode of depression during their lifetime and 25% of adults are reported to have an anxiety disorder. 

But this has not always been the case. Before the 1970s, depression was a relatively rare condition and mainly associated with severe impairment and hospitalization. Bipolar disorder was even less common and attention deficit disorder did not exist at all.

Underlying today’s alarming mental illness statistics is a hidden epidemic of overdiagnosis of mental illness and overprescription of psychoactive medication to both adults and children. 

Much of what we are diagnosing and treating as mental illness today is the medicalization of normal life. Grief, emotional pain and being uncomfortable are a normal part of the human condition and are expected responses to life events such as the loss of a loved one or a stressful situation.

“There are no objective, scientific, or biological tests for psychiatric disorders”

Some of what we label as mental illness is a natural response to very difficult or unfair life circumstances. We characterize external problems such as poverty, oppression, or racism as internal problems requiring medication to “fix” the individual, rather than directing efforts at correcting the societal problems that put some people into situations that are toxic to their physical and mental health.

We know, for example, that Canadians in the lowest income bracket are 3 to 4 times more likely than the highest income Canadians to be labelled as suffering from mental illness. Data from the United States indicates that vulnerable populations are medicated with psychoactive medications at higher rates than the rest of the population. Children in foster care, those involved with the criminal justice system and black and Hispanic boys are systemically administered antipsychotics or other drugs to control their behaviour. 

There are no objective, scientific, or biological tests for psychiatric disorders. Difficulty in diagnosis of mental illness makes it easy for doctors and patients alike to confuse normal responses to difficult or toxic life situations with true mental illness. While physical ailments often have laboratory or imaging studies that can help confirm or refute a diagnosis, psychiatrists rely on symptom checklists based on the opinion of a few select psychiatrists.

Pharmaceutical companies have confounded the situation. Using sophisticated marketing techniques to manipulate study results, influence expert opinion and mislead the public, they have spun a story they want us to believe about mental illness. 

Even today many doctors and laypeople still think that chemical imbalances in the brain cause mental illness. But decades of neuroscience research have failed to find evidence to support the neurotransmitter imbalance theory, showing instead that psychoactive medications disturb rather than restore normal brain function.

Drugs provide a quick but temporary fix to mask or numb emotional pain and have serious side effects in the long-term. For a significant proportion of people psychoactive drugs are difficult to stop. So, how can we deal with mental health problems in a more evidence-based and less harmful way? 

Firstly, if we experience emotional pain or discomfort ourselves, we can accept that this might be a normal part of grieving a loss or facing a stressful situation. Most symptoms of anxiety and depression are time limited and are known to resolve spontaneously without medication. We can also lean into our social supports, connect with nature and participate in exercise – all interventions known to improve symptoms of depression and anxiety. Psychotherapy can also help alleviate many mental health problems.

Health care professionals have an important role in recognizing overdiagnosis and overprescribing in mental illness. They should base clinical decisions on good science and sound evidence while resisting undue influence of drug companies. Education for medical professionals needs to highlight the benefits of psychoactive medications in the subset of patients who will truly benefit, while also underlining that harms outweigh benefits in people with mild to moderate symptoms.

Communities can promote mental health by increasing social connectedness among residents, ensuring that no-one, particularly the elderly or others living on their own, suffer from loneliness and isolation. Municipalities can design towns and cities to bring people together, provide natural spaces for recreation and opportunities for safe and accessible physical activity.

Provincial and federal governments have the obligation to provide access to adequate mental health care, including psychotherapy, so that people have safe and accessible alternatives to pharmaceuticals. Policies also need to be enacted to ensure citizens receive resources to live a healthy life – adequate family incomes, decent housing, affordable education and healthy working conditions.

It is important to distinguish poor mental health from true mental illness. The latter is relatively rare and requires specialized treatment while the former is much more common but firmly within our power to address. 

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on July 27, 2022. Photo credit: Andrew Neel on Pexels.com

We must live within our means

Two months ago, the federal government announced an increase to the percentage of temporary foreign workers (TFWs) that employers in Canada will be allowed to hire. Given a ready solution to the labour shortage problem, many businesses breathed a collective sigh of relief.

We can expect that employers in the Bow Valley will be taking advantage of this policy change. But we need to ask ourselves if TFWs are the most appropriate solution to our labour shortage problem and if we truly are ready to receive these workers into our communities. 

The Temporary Foreign Worker Program was started in 2005 by the federal government to provide seasonal and temporary workers for certain sectors in the economy. Low wages and poor working conditions in these sectors meant that employers were unable to attract Canadian workers to fill these jobs. 

Instead of increasing pay, or improving working conditions to make jobs more desirable for Canadians, employers lobbied the government for access to foreign workers. And instead of legislating higher minimum wages and enforcing workplace protections, governments granted employers this access. 

In an unspoken collusion, government and employers agreed to grow the economy and corporate profits by exploiting workers from low-income countries. Workers admitted into the country were forced to separate from their families, denied the security of knowing if they could remain in Canada and denied job or employer choice. 

Before the pandemic, the federal government was looking to scrap the TFW program for a number of reasons. Canadian employers were growing reliant on TFWs to fill permanent jobs. There was also serious concern over a lack of basic rights and protections for migrant workers with many reported incidents of verbal, physical, and sexual abuse. However, faced with current labour shortages, the federal government has done an about-face on their TFW policy and chosen the easy way out.

“Evidence that we have breached the social boundaries of sustainability in the Bow Valley is equally abundant.”

Even if the federal government is allowing recruitment of more TFWs, we have to ask ourselves if Bow Valley communities are ready to receive them. Do we have the capacity to support the people that we are asking to staff our businesses, service our tourists and ultimately generate our profits?

We know that the levels of tourism in the Bow Valley have already exceeded the boundaries of environmental and social sustainability. For anyone who spends time outdoors in the Bow Valley, the evidence of environmental degradation is plain to see. In popular areas, we see wide braided trails, trampled vegetation and soil erosion. We see litter on the side of our hiking and biking trails and an increase in human-wildlife conflict. 

There are other less visible impacts on our natural environment. Increased greenhouse gas emissions and climate change acceleration occur from ever more tourists arriving by air and ground transportation. And increased visitation also leads to adverse effects on air and water quality.

Evidence that we have breached the social boundaries of sustainability in the Bow Valley is equally abundant. We live in communities where housing is too expensive and food security is not guaranteed. The majority of jobs available in the Bow Valley are low-pay, low-skill jobs that do not pay a living wage to employees or allow them to achieve a decent quality of life.

The labour shortage has also resulted in overworked staff who are burnt-out and sustain physical injuries from working long hours in physically-demanding jobs. When workers are injured or simply want a family doctor to help them maintain their health, we are unable to provide them with the health services they need.

However tempting it might be to turn to TFWs as a Band-Aid solution to our labour shortage problems, we know we can do better. Our economic and labour policies cannot be built on a foundation of exploitation. If we are inviting foreign workers into our country to help grow our economy, we need to give them the same rights we enjoy – the right to live in Canada with their family, the security of permanent residency and choice of job and employer.   Governments and employers need to invest in job training, improving working conditions, and strengthening worker protections to benefit Canadian and immigrant workers alike.

We need to recognize, encourage and utilize the assets that immigrants bring to Canada. Many newcomers are leaders, innovators and entrepreneurs with professional training and experience far beyond the requirements of the menial jobs they are hired to do. If we really want to leverage the strengths of immigrants to fortify the Canadian economy, we have to provide pathways for their training and experience to be recognized and offer them employment that matches their competencies.

We also need to make sure that our communities are welcoming and inclusive. At a minimum this means ensuring that basic human needs are adequately met. We need to provide a living wage, offer decent and affordable housing and ensure access to healthy food and quality primary care. 

If we are unable to provide this for all Bow Valley residents, including newcomers, then we need to acknowledge that we have exceeded the limits of our communities to support current levels of tourism and the services they demand. For the sake of our planet and our people, it is time to stop living beyond our means.

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on June 17, 2022. Photo credit: Yury Kim on Pexels.com

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Road traffic deaths are preventable

When a pedestrian is killed crossing the highway on the way to “community” housing, it is not an accident. It is death by design – or some would say – a lack of design, and we all have blood on our hands. From the urban planners who designed the housing project in its current location, to the politicians who delayed funding for a safe pedestrian pathway to cross the highway to the citizens who didn’t make enough noise to make sure that human safety was a priority, we all have to take responsibility.

In 2015, the World Health Organization reported that more than 1.2 million people are killed each year from road traffic crashes and an additional 50 million are injured. The world car population, currently estimated at 1 billion vehicles, is expected to reach 2.5 billion by 2050. With this trend we can expect to see a compounding of health problems related to traffic.

Deaths and serious injuries caused by traffic collisions are the most immediate and obvious negative consequences but there are many other health consequences to road traffic. Air pollution leads to respiratory problems; green house gas emissions leads to global warming; vehicle use contributes to physical inactivity, higher rates of obesity, diabetes, heart disease and some types of cancer; noise pollution from road traffic can lead to poor sleep and psychological stress; and busy arterial roads can cut through communities reducing opportunities for social interaction.

Towns and cities can become safer, healthier places simply by implementing design changes to their streets and communities. Traditional approaches to road safety, focused on the road user and attempted to create a perfect error-free driver. But we know that human error is inevitable and using a systems approach that recognizes road crashes occur as a result of interactions between road users, vehicle design and road infrastructure is a more comprehensive approach. 

“We have to decide if we are the kind of society that will accept a certain number of deaths to have mobility and economic gain or the kind of society that values every human life and works to ensure that we reduce traffic deaths to zero. “

A safe systems approach recognizes that responsibility for traffic collisions lies with road users, system designers and policymakers. Road users are responsible for following traffic rules and regulations; designers, including road planners and car manufacturers, are responsible for creating safe commuting infrastructure; and policymakers are responsible for showing commitment and leadership in making road safety a priority in their jurisdiction and are responsible for providing funding, legislation and enforcement of road safety measures. 

We have to decide if we are the kind of society that will accept a certain number of deaths to have mobility and economic gain or the kind of society that values every human life and works to ensure that we reduce traffic deaths to zero. If we are the latter, then we are not alone. 

In 1997, the Swedish parliament adopted Vision Zero – the policy that sees the value in every human life and deems any loss of life to traffic incidents unacceptable. The Swedes have managed to reduce their originally low traffic fatality rate of 7 in 100,000 to less than half using this approach, despite a huge increase in vehicle numbers over the same time period. Several cities around the world, including many in Canada, have also adopted this vision. 

A number of evidence-based measures can be used to reduce traffic fatalities. Street design measures can be used to reduce vehicle speeds and chances of collisions. These include the use of roundabouts, speed bumps, islands for pedestrians to take refuge while crossing, and designated pedestrian and bicycle lanes. Other measures such as mandatory seatbelt use, helmets for bicyclists, and checkpoints for testing of blood alcohol levels are also key to reducing traffic fatalities.

Sustainable urban development that creates places that are connected, compact, and coordinated mitigates climate change and improves road safety. Urban sprawl on the other hand leads to more vehicles on the road, and higher rates of traffic fatalities. Developing mixed land uses, smaller blocks and easily accessible space for people such as parks, plazas and other public spaces promotes road safety and increases quality of life for people, while also being gentler on the natural environment. 

Designated bicycling lanes improve opportunities for physical activity and climate-friendly travel and are especially effective when part of a connected network. In Copenhagen, Denmark, bikes outnumber cars by more than a ratio of 5-to-1. A network of cycling paths and innovative bridges make Copenhagen one of the safest places to be a cyclist. Carefully designed roads that slow cars and forgive human error are also key to safety.

We have to realize that towns and cities are there for people, and not for vehicles, and we need to design and build them that way. When we put humans at the heart of designing and planning our urban areas, we create happier and healthier cities. We are less likely to accept traffic fatalities as the cost of doing business. And in doing so, we clearly affirm that every life matters.

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on May 20, 2022. Photo credit: Francesco Ungaro on Pexels.com

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Lessons Learned from the COVID-19 Pandemic

It has been two years since an invisible but formidable foe shook up our lives. Since the World Health Organization declared a global pandemic on March 11, 2020, we have all learned a great many things. We learned to bake bread, sew masks, use videoconferencing not only to get through our workday but also to maintain connection with friends and family.

We hope that we are now at the tail end of this crisis and that we will be able to live with this virus.  But we want to do more than just live with the virus; we want to make sure we thrive into the future. And to do so we need to reflect on the lessons learned from our pandemic experience and act on these learnings to make our society stronger and healthier for all.

At the most basic level, the pandemic has reminded us that simple hygiene practices are crucial to staying healthy. Washing or sanitizing hands frequently and staying home when sick are simple ways to keep oneself and one’s community healthy. We learned this in elementary school but forgot our lessons along the way and it has taken a deadly virus to remind us of the importance of basic hygiene.

Also, essential to keeping a community healthy, are adequately funded and resourced public health systems. Outside of global pandemics, public health systems do not get much public attention and do not make for glamorous funding announcements by politicians in the same way that promising money for ICU beds, operating rooms or new wings to hospitals do. 

“And when our leaders make decisions, they need to bring the public along with consistent and transparent messaging.”

Despite many years of preparation since the SARS pandemic, Canada was woefully unprepared to scale up testing, tracing and isolating to prevent the spread of a virus so similar to its predecessor. Canada needs to invest in a more robust public health system with the workforce, equipment and surge capacity to scale up to meet the demands of the next public health emergency.

The COVID-19 pandemic has also taught us that when faced with a significant threat we need to act fast in the face of uncertainty and before all the information is available. Then, we have to be willing to change strategy as new events develop and more data becomes available.  Everyone from individuals to communities, scientists to business owners, and governments to not-for-profit organizations had to be flexible in their thinking and nimble on their feet when it came making the changes required to deal with the ever-mutating SARS-CoV-2 virus.

And when our leaders make decisions, they need to bring the public along with consistent and transparent messaging. They need to provide reliable and timely information that explains their actions and the reasons for their actions. This applies equally to scientific and medical leaders as well as political leaders. Poor communication can lead to an erosion in public trust and a lack of support for key public health measures and social policies.

To reach communities, especially ones that are disadvantaged or marginalized, health and social service providers need to engage with existing leaders in these communities. Community leaders already have the trust of their people and an understanding of what they need and how best to deliver much needed services. When leadership and assets within communities were supported and leveraged during the pandemic, for example in a number of First Nations communities, the results for improving vaccination rates or reducing case rates were remarkable.

During this pandemic, Canadians also learned the importance of self-reliance. At the beginning of the pandemic when countries were scrambling for masks, ventilators and vaccines, Canada had to get in line behind those with domestic manufacturing. Governments have to reinvest in Canadian production of essential goods and support medical research and vaccine development within our borders.  

One cannot ignore the importance of daily conditions that people live, work and play in on their ability to stay healthy. Housing, income and work conditions are all social determinants of health that had a huge impact on the spread of COVID-19 infection during this pandemic. 

The pandemic exposed deep inequities in our society when it came to access to resources for living. We need to urge our governments to make sure that proper housing, adequate income and safe work conditions are met for all Canadians. We live in a rich nation with sufficient resources for all to live comfortably and safely, now and in the next pandemic.

We also learned that our democracy can be threatened by those within our own borders and that we need to stand up and defend this cornerstone of our society. Our governments need to act swiftly and decisively to disarm any such threat, and as citizens, we must continue to strengthen our political rights and responsibilities through civic engagement and community action.  

Finally, we have to acknowledge that we live in an interconnected world where one country cannot recover in isolation from the pandemic and expect to thrive. Canadians have a responsibility to help low-income countries in their pandemic recovery by improving access to much-needed vaccines, health infrastructure and economic opportunities. After all, we are citizens of a global village.

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on March 18, 2022. Photo credit: NEOSiAM 2021 on Pexels.com

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Addressing anti-Indigenous racism in our health care system

Joyce Echaquan, Gordon Sinclair, Jordan River Anderson – our health care system failed these Canadians in the worst possible way. All three suffered unduly and died within a health care system that did not give them the care they deserved simply because of their Indigenous identity. Their powerful stories are not isolated anecdotes but part of a systematic problem. 

A recently published study examined over 11 million emergency department visits in Alberta and found that First Nations’ patients were assigned lower priority for treatment than non-First Nations patients. This was true for conditions such upper respiratory infections and anxiety but also for obvious and painful diagnoses such as long bone fractures. 

It has been well-documented that Indigenous people have worse health outcomes in Canada – from lower life expectancy to increased rates of chronic disease. Most of these differences can be explained by poverty, lack of access to clean water, substandard housing and other social determinants of health. But they are also in part related to how Indigenous people in Canada are treated by the health care system.

Take the case of Gordon Sinclair, an Indigenous man referred to a Winnipeg hospital emergency room for urgent treatment. He sat in the emergency waiting room for 36 hours before dying of a treatable urinary tract infection. At the inquest into his death, nurses testified that they noticed him in the waiting room but did not check on him because they assumed that he was drunk or homeless or waiting for a ride to pick him up.

Stereotyping of Indigenous people as alcoholics or homeless or not deserving of urgent care is unfair and dangerous. It can lead to fatal outcomes as it did for Gordon Sinclair. Health care professionals, either unconsciously or overtly, often blame Indigenous people for their medical problems.

We are all guilty to some extent or another of assuming that the world works for other people in the same way that it works for us. If we are lucky enough to be born into social privilege, we may blame Indigenous people for their misfortunes and be blind to the racism and injustices faced by them. 

Joyce Echaquan posted a video recording of health care professionals insulting her in her dying moments at the hospital in Joliette, Quebec. As painful as it was to witness the interpersonal racism she experienced, it was only one source of her unnecessary suffering. 

“We must start with acknowledging that systemic racism exists within our healthcare system”

Systemic racism and discrimination embedded in the policies and practices of the Canadian health care system can have an even greater negative effect on the health outcomes of Indigenous people. These systemic effects can be invisible to other Canadians, even to those who work within the health care system. 

The federal-provincial jurisdictional debate over health care provision for Indigenous peoples contributes to Indigenous people receiving substandard health care in Canada. Provinces are responsible for health care provision. But the federal government has control of “Indians” and “Indian lands”, and has a duty to provide health services for Indigenous people. Interpretation of which level of government provides what health care service to Indigenous people varies from province to province. It is often arbitrary and results in both federal and provincial jurisdictions denying responsibility for key services. 

Jordan River Anderson was born into and died within the confines of this debate. He was born with multiple medical conditions and disabilities, and died 5 years later having spent his entire life in hospital. Why? The province of Manitoba and the Government of Canada could not agree on who would pay for home-based medical care for Jordan, thus denying him the right to live at home in the community like every other child in Canada. 

We have a lot of work to do in improving health care for Indigenous children and adults. We must start with acknowledging that systemic racism exists within our healthcare system. We need policy makers, healthcare leaders, and health care workers to use multiple strategies to counteract the harms created by racism. We need to examine existing policies and practices to make sure that they are not oppressive nor perpetuate negative health outcomes for Indigenous people.

Anti-Indigenous racism and cultural safety training for all working in health care is essential. Education on the colonial history of Canada, and the consequences of policies to eliminate or assimilate Indigenous people, will provide context for understanding why Indigenous people experience the health and social problems they do. 

Access for Indigenous people to traditional healing practices and acknowledgement of Indigenous worldviews will help Indigenous people heal on all levels – spiritual, emotional, physical and social. Furthermore, reviving culture, language and connection to the land will be crucial to promoting the health of Indigenous people.  

Policies to provide clean water, adequate housing, and other social determinants of health have to be put into place if we are to eliminate inequalities between Indigenous and non-Indigenous Canadians. And finally, ensuring that Indigenous communities and people have adequate funding and decision-making power over their health care services will ensure anti-racist and culturally-safe health services.

Racism kills and it has no place in a health care system tasked with saving lives.

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on February 18, 2022. Photo credit: Photo by Pixabay on Pexels.com

Recommended further reading:

Effective Policy Needed to Reduce Alcohol-Related Harms

Many of us welcomed in the New Year with a glass of our favourite alcoholic beverage, even if in muted celebration this year. Alcohol is an ubiquitous and accepted part of our culture, associated with times of festivity, socializing with friends and family and relaxing after a hard day at work.

While there are social, psychological and economic benefits to the consumption of alcohol, the problems caused by alcohol are also undeniable. According to the World Health Organization, more than 200 disease and injury conditions are caused by alcohol with both immediate and chronic consequences such as fractures, head injuries, heart disease and liver failure. In Canada, almost 15,000 people die from causes attributed to alcohol each year.

The economic and societal costs of alcohol are also are steep:  lost productivity at work, damage to property, family violence and increased crime including homicide and sexual assault. About 20% of violent crimes are associated with alcohol use and crime rates are higher in places with increased alcohol availability and lower pricing.

Alcohol is the most commonly used substance in Canada, and in 2017, the economic costs of alcohol-related harm totaled $16 billion dollars. Governments bear direct costs within the health care and criminal justice systems, but indirect costs are largely borne by employers and family members. For most adults, alcohol poses a bigger risk to health than other drugs and many of the previously touted health benefits of moderate drinking have largely been disproven.

According to Statistics Canada, a quarter of Canadians have reported an increase in their alcohol consumption during the pandemic. Hospitals are seeing an increase in younger patients with alcohol-related liver disease, and alcohol treatment and rehabilitation programs are experiencing an increase in demand for their services – a need that they are largely unable to meet. 

Alcohol, being a legal psychoactive substance, needs a well-regulated and government-controlled system of sales and distribution. Publicly owned and controlled liquor retail outlets can minimize alcohol-related harms while recuperating some of the societal costs of alcohol through taxation. 

“Data shows that there is increased consumption of alcohol in geographic areas with a high density of liquor stores”

All provinces, except Alberta, have some degree of public ownership and operation of alcohol retail outlets.  Even relatively small changes in who sells alcohol can have negative consequences. Ontario witnessed an increase in hospitalizations when it expanded alcohol sales into grocery stores. And Alberta made a big mistake in the 1990s by privatizing all liquor sales, causing rates of alcohol consumption to increase in Alberta when consumption in the rest of the country was in decline. 

Privatization also led to more drunk driving charges in Alberta and to reduced government revenues. Excess capacity in the system created by privatization caused alcohol prices to increase and the government felt that it had to cut taxes on alcohol to bring liquor prices more in line with the rest of the country. Government costs for regulation and enforcement also went up. Effectively, taxpayers were subsidizing the private companies that were now tasked with selling alcohol in the province.

Data shows that there is increased consumption of alcohol in geographic areas with a high density of liquor stores, and that this is particularly true for younger people. Some of the most effective methods for minimizing the negative health consequences of alcohol involve restricting access to minors and reducing the number and hours of operation of retail outlets. Limiting alcohol licences and density of retail outlets in municipalities reduces drinking and its harms. 

This is exactly what the City of Edmonton did when presented with data from the Edmonton Police Service that showed increased criminal activity in areas with a high density of liquor stores. The City of Edmonton brought in a by-law requiring liquor retail outlets to be at least 500m apart within municipal limits. 

Other high impact alcohol policies are related to price control and marketing. Setting a minimum unit price on alcohol (not a buck a beer!), and adding taxes, increases the price of alcohol and reduces demand and consumption.  Also, people drink less when they are exposed to fewer advertisements that promote drinking as a desirable social activity.

A variety of treatment approaches are known to help people living with alcohol use disorder: medications such as naltrexone, behaviour change strategies and mutual support groups. However, governments need to provide ready and equitable access to these services. Currently, many Canadians experience barriers to accessing treatment. These include a lack of detoxification and rehabilitation beds, a lack of services in rural areas and a lack of culturally appropriate treatment services for diverse populations.

Given how pervasive alcohol is in our society, it is easy to get lulled into a sense of complacency about its effects. But the harms alcohol causes to individuals and society are real. We need to give the issue the attention it deserves and advocate with municipal, provincial and federal governments to put in place progressive policies that will keep us all safe. Here’s to your health!

By Vamini Selvanandan© 2021. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on January 21, 2022. Photo credit: Photo by Ketut Subiyanto on Pexels.com

Recommended further reading:

Canadian Centre for Policy Alternatives. The 10-year hangover:  Albertans are paying the higher social, financial costs of liquor retail privatization

World Health Organization. Alcohol Fact Sheet

Global News. Buck-a-beer a ‘lousy idea’ for public health, alcohol experts say

The opioid crisis rages on

In the last five years, there has been an alarming increase in deaths related to opioid overdoses. Over 22,000 Canadians – the majority of them in the prime of their lives – have succumbed to fatal overdoses since 2016.

These numbers are comparable to lives lost in Canada due to COVID-19 infections, yet we are not seeing the same urgency or coordinated action by governments to protect Canadians and prevent loss of life.

Already a public health crisis in its own right, the opioid overdose crisis has been further exacerbated by the COVID-19 pandemic. With border closures and travel restrictions, the illegal drug supply has grown unpredictable and more toxic and access to vital services such as counseling supports, supervised consumption sites and medical treatment has grown more difficult for people with substance use disorders. 

We know that throughout history, people have used substances for a variety of reasons including recreation, ceremony and overcoming physical and emotional pain. As a society, we need to accept that people will continue to use mind-altering or psychoactive substances, and provide regulations and protections to reduce the harms. 

We already accept the use of some psychoactive substances such as alcohol, tobacco and cannabis. Legislation and regulatory frameworks put into place by governments for these substances protect consumers, and reduce harms to individuals and to communities.

But Canada’s drug policies relating to opioids are nearly 100 years old and need to be updated to reflect current evidence and present-day realities. These policies based on prohibition contribute significantly to individual and societal harms.

“With the threat of prosecution removed, they are more likely to seek out services that support their goals in recovery”

Prohibition encourages organized crime and illegal activity arising from individuals and groups operating in an unregulated market. It also leads to a more toxic drug supply as drug traffickers find it is easier to hide and import smaller, more potent quantities of opioids. 

Law enforcers claim to target high-level production and distribution of drugs, but an analysis of 2016 Canadian statistics on drug arrests showed that 73 percent of arrests were for simple possession of drugs with youth and people from impoverished or racialized communities (particularly Indigenous communities) being over-represented in the arrests. 

Prohibition and criminalization also divert much needed resources from health and social services to fund enforcement and incarceration. The health and social services sectors are better equipped than the criminal justice sector to help people with substance use disorders manage their medical condition and enable them to lead productive and fulfilling lives.

Decriminalizing simple possession and use of drugs can help people with opioid use disorders access the life-changing treatments that they desperately need. With the threat of prosecution removed, they are more likely to seek out services that support their goals in recovery whether that be related to abstinence, reducing harm or avoiding death by overdose.

Through the health service organizations they fund, governments need to provide a full spectrum of proven interventions to help people who use opioids.  Supervised consumption sites are one intervention supported by a wealth of evidence. They have been shown to connect people with the treatments they need, reduce crime in surrounding communities and save money within the public system. And most importantly, supervised consumption sites save lives. Consider that not a single life has been lost due to drug use within such a facility.

There is also a strong body of research that supports treatment with opioid agonists, such as methadone or Suboxone, to decrease withdrawal symptoms and lower cravings. Making opioid agonist treatment available and accessible to people with opioid use disorder is key to promoting and enabling their recovery.

However, for some people at risk of fatal opioid overdoses, opioid agonist treatments are not effective, or not appropriate. For them, there is evidence from a number of countries including Switzerland, Germany, the United Kingdom and Canada, that providing a pharmaceutical-grade supply of opioids prescribed by a health care practitioner is beneficial. Safer supply, as this practice is known, lowers the rates of overdose deaths, visits to emergency departments and hospitalizations. Furthermore, safer supply reduces criminal activity and improves connections to medical care, social supports and housing for people with opioid use disorder. 

In August 2020, the federal health minister wrote to her provincial and territorial counterparts instructing them to set up access to safer supply of opioids as one option in a spectrum of services for people who use drugs. In response to this, the UCP government in Alberta recently announced plans to establish a committee to look at “both sides of the issue” of safer supply. The weight of scientific evidence supports one side, but it leaves one wondering what could possibly support the other side. 

Finally, it is important to recognize that many with opioid use disorders are suffering from the pain of childhood trauma, homelessness or social exclusion. To reduce opioid overdose deaths, we also need to work upstream to support healthy, well-functioning families; reduce poverty; and build societies based on equity and justice. Because we are all in this together.

By Vamini Selvanandan© 2021. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on Dec 17, 2021. Photo by Anna Shvets on Pexels.com

Recommended further reading:

Canadian Drug Policy Coalition. Case for Reform

Global News. There are growing calls for drug decriminalization. Could it solve Canada’s opioid crisis?

Canadian Mental Health Association Ontario. SOS Safer Opioid Supply. 

CBC News. Alberta safe supply committee starts work

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