Transformative change needed in care for seniors

In the wake of horrors laid bare by the COVID-19 pandemic in our senior care facilities, the Government of Alberta commissioned a review of facility-based continuing care in the province.   Recommendations from the government-appointed panel were released at the end of last month.

The report makes several important recommendations on improving quality of life for residents, public reporting of audit results, keeping couples together and providing more choice in community-based continuing care services. It also addresses the importance of treating those working in care homes better by improving staffing levels, wages and work conditions.

These recommendations will be a huge improvement from the current state of affairs and Albertans should hold the government accountable for implementing these changes fully and expediently. For too long, seniors have endured unacceptable conditions that don’t meet basic human rights – the right to privacy, the right to nutritious food, and the right to live with their life partner. 

Where the report misses the mark is in calling for incremental rather than transformative change. What is needed is a fundamental cultural shift in how we envision and provide care for the elderly. 

We have to create living environments that support a meaningful life filled with purpose, dignity and opportunity to thrive for our seniors.  This should be the minimum set of expectations for senior care. It is not enough to provide care that avoids violations of human rights.

Senior homes today are based on medical models that over-emphasize safety and physical well-being to the detriment of mental, social and spiritual well-being. Health and safety are important considerations but we need to shift the focus to providing a home where seniors can continue to live purposefully and with dignity and autonomy. 

“Where residents are expected to be passive recipients of services, they lose their sense of purpose”

Dignity requires that seniors are not forced to share a room and a washroom with a stranger. Autonomy requires that seniors decide when they wake up, when they get dressed and when they eat. And most importantly, a meaningful life requires purpose and opportunity to make a contribution. 

Seniors need opportunities to care for themselves and others according to their physical and cognitive abilities. Where residents are expected to be passive recipients of services, they lose their sense of purpose and are unable to maintain their physical and cognitive abilities. 

Similarly, we need a cultural shift in how work is organized in continuing care facilities. In addition to good pay, work conditions and training, workers need more time to develop relationships with patients and autonomy to provide customized care. Given flexibility they can focus on relationship-building and meeting needs for social interaction.  Injecting joy and life into the residents’ days becomes the key objective instead of providing medical care to merely extend days of life.

The report also does not address the commercialization of seniors’ homes. For-profit businesses are obliged first and foremost to maximize profits for their shareholders and to turn a profit, they have to reduce what they spend on staff and residents. During the COVID-19 pandemic, we have seen this business model result in higher death rates in private long-term care facilities. These businesses cut corners by having lower staff levels and overcrowding of residents. Contracting out of cleaning, laundry and food services also created unnecessary portals of entry for the virus.

Primacy of profit margins makes the private operation of senior homes mathematically incompatible with quality care and decent work conditions.  This simple fact seems to have escaped MNP, the accounting firm commissioned by the government of Alberta to author the report.

The report also highlights the operational and capital cost savings that can be achieved by increasing home-based services for seniors. But aging in-place has benefits that go well beyond economic considerations. For most people, there is no place like home and home is where they want to live in their final years. 

With more home-based continuing care, we will need to be innovative in combatting the pandemic of loneliness that pre-dated the COVID-19 pandemic. Creating appealing indoor and outdoor community spaces; increasing intergenerational connectivity where children, working-aged adults and seniors interact regularly; and improving mobility for seniors through accessible public transportation and walkways will need to be key adjuncts to increasing home care supports in the community.

Care for seniors is far too important to be left in the hands of medical doctors and accountants. We all need to step up and call for a system that will allow our seniors (and our future selves) to thrive physically, mentally, socially and spiritually in the golden years.

By Vamini Selvanandan© 2021. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the RMOToday.com on June 17, 2021. Photo credit:Andrea Piacquadio on Pexels.com

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Federal-provincial cooperation a must in childcare

Canada is the weakest investor in early learning and childcare among wealthy countries and, not surprisingly, we rate last in meeting early childhood development objectives. However, this state of affairs may be dramatically altered by the $30 billion dollar investment in high-quality childcare announced in the federal budget last month.

Early learning and childcare are key in determining the future of our children. Early childhood development directly affects children’s health and their health as adults. It charts the life course affecting education, employment, income, lifestyle and status in society. High-quality early learning opportunities can lift children out of poverty and make societies more equal. 

Studies on very low-income American infants attending early learning and childcare programs show that these children commit fewer juvenile crimes, complete high school at higher rates, and earn more as adults than those children not able to attend such programs.

Poor children benefit more but all children, regardless of class, benefit from early childhood education. Swedish children who attended publicly funded childcare centres have better performance in school and are better socially and emotionally adjusted than those who did not, irrespective of family income.  

Almost all European countries have publicly funded universal childcare systems.  But in Canada, we have a patchwork of private operators providing childcare from the for-profit, not for-profit and informal sectors. Only 17% of Canadian families have access to government regulated childcare space. Most children are cared for in unregulated spaces where their health and safety cannot be guaranteed and the quality, or even existence, of developmental programming is unknown.

Everyone, no matter their political stripe, can agree that investing in children is worthwhile for both their inherent value and for the prosperity of our country.

To benefit from early learning and childcare, children need to receive high-quality services.  They need to have an adequate number of trained adults supervising them in a well-designed physical environment.  They need to be challenged by enjoyable, play-based learning activities.  And those taking care of them need to have decent working conditions and wages commensurate with the importance of the work they do. Taken together, these conditions need public funding and oversight, because they are seldom met in for-profit or informal childcare settings.

While directly benefiting children, early learning and childcare programs also provide much needed support for parents.  They allow parents, especially mothers, to participate in education, training and employment. They also provide caregivers with parenting support, social support and referrals to community resources at a time when they are struggling to balance work and family. 

Childcare programs strengthen communities by bringing together children and families from different backgrounds and foster inclusion and respect for diversity. Social cohesion is enhanced as parents from all walks of life come together for a common goal. The broader community also benefits by decreased crime rates, fewer high school dropouts, and increased contributions to economic, cultural and social productivity.  

Everyone, no matter their political stripe, can agree that investing in children is worthwhile for both their inherent value and for the prosperity of our country. Yet, it has been over 50 years since the Royal Commission on the Status of Women first recommended a national childcare program. 

We must make sure that the current federal proposal will be successful in meeting the needs of children, families and communities.  We must demand cooperation between provincial and federal leaders to make sure that no child or family gets left behind. 

In Alberta, the UCP’s response to the federal announcement of national childcare funding has been less than enthusiastic. Premier Kenney has said that not-for-profit centres to be funded by the federal program will not serve the needs of some Albertan families including those who live in rural and Indigenous communities and those who stop working to care for their children.

We cannot leave this money on the table to the detriment of our families.  The federal funding will go a long way in creating childcare centres in rural areas and on Indigenous reserves where such services may not have been viable in the past. Low-cost childcare will allow children whose parents chose to stay at home to care for them to still take advantage of learning opportunities offered by childcare centres even on a part-time basis.

The UCP government says there isn’t enough choice for parents in the federally proposed program.  We must let our provincial leaders know that Albertan families want to have the choice of low-cost, high-quality early learning and childcare. According to the United Nations, quality early childhood education is not a choice, it is a human right.

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 May 20, 2021, 2021. Photo credit: Anna Shvets on Pexels.com

Recommended further reading:

Taxes are wise and necessary investments

This is the time of year we are all compelled to think about taxes. A few of us might get excited about the prospect of receiving a refund, but most of us dread this annual chore and would rather do without it. This time of year also presents us with an opportunity to reflect on what taxes are and what purpose they serve in society.

Taxes are essential investments in public resources. Without taxes we would not have hospitals and highways, schools and satellites, or power grids and ports. Through taxes, citizens pool resources to create public goods for the use and benefit of all. Everyday, we benefit from the investments our parents and grandparents made to create quality health care, effective public
education, dependable transportation and reliable communication. These public goods are such an integral part of our everyday life that they are almost invisible to us.

We need to maintain these public investments and grow them for future generations so they too may enjoy the benefits that we have come to take for granted. The way we can do this is, firstly, by supporting a fair and robust taxation system; and, secondly, by strengthening government which is the system we have devised to combine, create and manage public resources for the common good.

What does a fair and robust taxation system look like? Simply put, it should support the idea that those who take more from public resources should pay more into them. This would include large corporations and very wealthy families and individuals who are heavier users of publicly funded
transportation infrastructure, utility grids and a workforce educated by public funds, than small businesses or middle-class families and individuals.
Taxation also needs to be redistributive and work to create a level playing field to reduce inequality in society. We know that income inequality adversely affects both rich and poor with unequal societies having higher crime rates, and increased physical and mental illness.

Canada is the only G7 country without a wealth, inheritance or estate tax

Progressive taxation – taxing individuals and corporations making more income or profit at higher rates – not only ensures that they pay their fair share for use of public resources but also redistributes resources to those who need them by strengthening financial, social and physical
infrastructure.

While many small family businesses have struggled or closed during the COVID-19 pandemic, several of the largest corporations have performed very well. An excess profits tax on these corporations will ensure that governments collect much-needed revenue to pay for the costs of
the pandemic while preventing these entities from profiting disproportionately from the pandemic.

Another form of fair taxation is a wealth tax such as the one that exists in Norway. Canada is the only G7 country without a wealth, inheritance or estate tax, and we allow money to become concentrated into the hands of a few ultra-rich families. During the pandemic, Canada’s top billionaires have increased their wealth by 28% (or $50 billion). And over the past decade, only the top 1% of Canadians have increased their share of wealth. Fairness requires that if you get wealthy using public resources that others paid for, then you should pay a share of your wealth in taxes so others are repaid.

In Canada, the federal NDP proposed a one percent tax on those with a net wealth of more than $20 million. This modest proposal would raise more than $5 billion dollars in federal revenue and would go a long way towards paying for services of value to Canadians such as national pharmacare and universal access to childcare. National survey data shows that 79% of Canadians are in favour of the 1% wealth tax, with support being strong across all provinces.

A number of tax loopholes act as barriers to fair taxation at the federal level. They result in wealthier individuals and families paying taxes at lower tax rates than middle-class and lower income families.

For example, when you work for a salary, you pay taxes on every dollar you make, but when you sell an investment at a profit, capital gains tax only applies to half the gain and the other half goes untaxed. Treating profits from investments like wages would raise an additional $17 billion
in tax revenue to invest in public resources. This would also prevent speculation, particularly real-estate speculation, that is making housing unaffordable for many Canadians.

As engaged citizens, we need to advocate for a combination of fair taxation policies and effective, accountable and responsible governance. This will ensure that our investments will provide dividends now and for years to come.

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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 April 15, 2021. Photo credit: Nataliya Vaitkevich on Pexels.com

Recommended further reading:

COVID-19 vaccine policies explained

Following a worrisome wait for a renewed supply of COVID-19 vaccines, many Albertans now have the opportunity to receive their vaccine much sooner than expected.  Many are pleased at the accelerated timelines and are ready to roll up their sleeves, but some are anxious or confused about the evolving COVID-19 vaccine recommendations.

COVID-19 vaccine guidelines are receiving much more interest by media and the general public than vaccination recommendations usually do during non-pandemic times. While this is helpful in informing and educating the public, it can also create high levels of anxiety if communication is not complete or clear.

To date, Health Canada has approved four different COVID-19 vaccines for use. All are safe and effective, but each has a different efficacy reported in clinical trials conducted by the manufacturer.  How is the layperson to interpret this information?

The key is understanding that reported efficacies for the four vaccines cannot be compared directly. No head-to-head trials were done to enable this comparison.  Each manufacturer conducted trials using different definitions of COVID-19 disease, in different countries, at different times with different levels of variants in circulation and in populations with varying demographic characteristics (age, underlying diseases such as diabetes, hypertension or heart disease, etc.).

What we do know is that all four vaccines protect very well against hospitalization and death from COVID-19 infection.

The Pfizer BioNTech and Moderna vaccine trials were conducted earlier when fewer variants were in circulation while the Johnson & Johnson trial was conducted later and enrolled more people over the age of 60 and with comorbidities such as HIV, diabetes and hypertension. These differences can affect the reported efficacy and make it impossible to compare vaccines directly.

What we do know is that all four vaccines protect very well against hospitalization and death from COVID-19 infection and all vaccines surpass the standard set by the World Health Organization for preventing any disease including mild illness.

What we don’t know is whether the vaccines can protect against long-term symptoms after COVID-19 infection. Similarly, we do not know if any of the four vaccines reduce the risk of transmission to others or how long immunity from vaccination will last. 

Concerns have been expressed around the National Advisory Committee on Immunization (NACI) recommendations for extending the dosing interval to 4 months from the shorter timelines used in the trials for vaccines requiring 2 doses.

The committee analyzed real world data and found that there were sustained high-levels of protection at 2 months after the first dose for the Pfizer BioNTech and Moderna vaccines.  Noting that immunity wanes gradually and does not “fall off a cliff” at two months, and citing a clinical trial showing that delaying the second dose of the Oxford-AstraZeneca vaccine for 12 weeks or more provided better protection against symptomatic disease, NACI expresses confidence that it is safe and beneficial to extend the dosing interval to cover as many people as possible within the shortest time frame.

Eighty percent of the Canadian population over 16 years can receive one dose of a vaccine by June 2021 with the extended dosing interval.  This policy would minimize hospitalization and deaths which clearly comprise the worst outcomes for COVID-19 infection. Achieving immunity in a large proportion of the population will rapidly drive down numbers of COVID-19 cases and bring the end of the pandemic and a return to normal life within reach.

NACI is monitoring data being collected weekly on vaccine effectiveness and will adjust recommendations if concerns emerge around waning protection. Science is not static and understanding that evidence evolves and builds with time will help us in this time where studies related to COVID-19 are proceeding at breakneck speed.  We can be confident that recommendations will be refined or changed as new information comes forth and adds to the body of scientific evidence.

There are many uncertainties and nuances to COVID-19 vaccination policy, but this is clear:   all four Health Canada approved vaccines are safe and effective; all four vaccines are similar for outcomes we care most about – death and hospitalizations; getting any vaccine at the earliest opportunity makes the most sense.

To optimize vaccine uptake, government and public health officials need to build trust with the public through clear and transparent communication. Family doctors, public health nurses and other health care providers can put evolving information around vaccines into their patients’ personal health context and customize communication to address patients’ specific needs and allay their fears.  Trust and confidence will be as important to the success of this vaccine rollout as vaccine efficacy and safety. 

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 Thursday March 18, 2021. Photo credit: Thirdman on Pexels.com.

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Resilience and self-reliance key to pandemic recovery

COVID-19 vaccine shipments to Canada were reduced in recent weeks and Canadians have felt frustrated and helpless at being asked to wait.  We have watched with envy as other countries manufactured vaccines and inoculated their citizens.

Canada was similarly vulnerable at the beginning of the pandemic when countries scrambled to procure adequate supplies of masks, face shields and ventilators. With supply chains stretched out across the globe, we were at the mercy of other countries whose priority was to first provide for their own people.

But it doesn’t have to be this way.  Fifty years ago, Canada was a leader in vaccine production. A series of privatizations by the Mulroney government, followed by massive funding cuts to scientific research and development by the Harper government, eroded our ability to manufacture essential medicines and vaccines within our own borders.  Former and current Liberal governments have done little to rectify this situation.

Globalization and the desire to have efficient markets has resulted in Canada outsourcing and offshoring production of many essential goods and supplies needed for the well-being of Canadians. While cheap labour, less stringent workplace regulations and fewer environmental protections overseas might provide financial savings for governments, there is a cost to foreign procurement. When there is a spike in global demand for essential items, Canada has little control over when and if we will get what we need.

Our sovereignty as a country depends on being able to provide the basic necessities to all Canadians. Pandemic recovery requires that we invest more in Canadian production of vaccines, essential medicines and goods. Governments at all levels can support Canadian businesses by using public funds to purchase products and services locally. Investing in local research and development attracts business partnerships with scientific institutions and fosters job and economic growth for Canadians.

Resiliency and efficiency are desirable characteristics of systems. However, putting too much emphasis on efficiency at the expense of resilience can will leave us vulnerable and unable to respond to unexpected events. The COVID-19 pandemic has taught us that this is particularly true for systems like health care and long-term care.

We need to value quality and safety over economic efficiency.

Before the pandemic, cutbacks to the health care system have resulted in many large urban hospitals across Canada being over-stretched and operating at more than 100% hospital bed capacity on many days of the year. When the pandemic struck, we had no choice but to withdraw vital services like surgery or cancer treatment.

For decades, provinces have also been privatizing long-term care in the name of efficiency. But what we are getting through this process is unsafe care for our seniors and poor value for our money. Canada has the worst record among wealthy nations for COVID-19 deaths in long-term care homes.

There is abundant evidence that private for-profit homes provide inferior care compared to publicly-run seniors homes. Business practices such as inadequate staffing, overcrowding of residents and fewer health and safety protections are required to turn a profit for shareholders at the expense of quality care for our loved ones.

Instead, we need to build resilience into our systems. We need to value quality and safety over economic efficiency. We need to see the delivery of public goods like health care and senior care as the investments they are. We must not let politicians convince us that the well-being of Canadians, young or old, is a frivolous expense to be minimized.

We deserve to receive essential health services in a timely and dignified manner without long wait lists or care in hospital hallways due to lack of available beds. The health care system needs adequate staffing and funding so that it is not operating at or over capacity even in normal times. Creating a safety margin to accommodate unexpected or less frequent events like pandemics or natural disasters is part of good planning and emergency preparedness.

In the senior care sector, we need to hire adequate numbers of workers, provide them with appropriate training and ensure they have safe and decent working conditions.  We need to pay them wages and benefits to match the value of the services they provide.

Nobody knows when an end to the pandemic will be declared. But we don’t have to wait until then to build our capacity for resilience and self-reliance. The time to act is now.

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 February 18, 2021. Photo credit: Càetia Matos on Pexels.com.

Further Reading

CTV news. ‘We took our eye off the ball’: How Canada lost its vaccine production capacity

Unifor. Is Canada starting down the long road to long-term care reform?

Government of Canada. From risk to resilience: An equity approach to COVID-19 

Christopher Nemeth et al. Minding the Gaps: Creating Resilience in Health Care

Engaged citizens make a difference

Global pandemic. Economic collapse. Partisan politics. Albertans may well have reason to despair as we face 2021.  But there is hope. Hope that comes in the form of people like you and me.

Engaged citizens are ordinary people who do ordinary things to make extraordinary change. Engaged citizens build a better world by engaging with social issues, working with each other and transforming their communities.

Being informed about current issues and how they relate to us and our communities is the first step to being engaged. What are the problems? What are the proposed solutions? Do they fit with our values, our vision for a better life for all Albertans and our desperate need to sustain the planet that human life depends upon? Understanding and caring about the problems facing us can take us a long way down the road to addressing them.

Next, we can connect with like-minded people who care and want to make change. Whether this be through a group of friends, colleagues or one of the many organizations that exist in our communities. Collectively we can make our voices louder, make the work lighter and support each other in reaching our goals. What one person can achieve alone is limited, but working together we make so much more possible.

Engaged citizens volunteer their time, skills or knowledge to improve their own lives, the lives of people in their community and the resilience of the living world. They participate by voting in elections, volunteering in political campaigns of people who will represent them well in government and by running for office themselves. Ordinary citizens bring skills, experience and caring to political office that may be otherwise lacking in career politicians.

Engaged citizenship is about giving democracy legitimacy and strength. Thousands of ordinary but engaged Albertans took action in the past several months to object to funding cuts to education, health care and Alberta’s provincial parks. Through protests, meetings with their elected representatives and the media, they let the government know that Albertans’ interests were not being represented.

Engaged citizens held their government accountable and made them focus on serving the needs of the people. They provided a necessary counterbalance to elected officials who, between elections, may forget who they serve.

Engaged citizens make communities stronger, healthier and more connected.

Engaged citizens are also a necessary counterbalance to powerful corporate interests that threaten to undermine our democracy. Corporations organize to lobby for their collective interests with government, and if we don’t counteract this power, we risk our voices and interests being drowned out by the ultra-rich and powerful. In a democracy, government must be of the people, by the people and for the people.

Engaged citizens make communities stronger, healthier and more connected. They can meet needs of others in their community in a way that cannot be replicated by business or public services. In turn, engaged citizens enjoy an enhanced sense of belonging and well-being and a sense of agency in their ability to make change.

Engaged citizens can demand more direct involvement in decisions and policy-making. Through citizen juries, community advisory boards, and participatory budgeting we can ask that our values and experiences get incorporated directly into policy decisions.

Several municipalities in Brazil allow thousands of citizens a direct say in setting the municipal budget.  The result is improved quality and access to public services, increased support for democracy and increased tax revenues as citizens appreciate the value they receive for their contributions. Several major cities across the globe, like New York, Paris and Madrid have followed suite with participatory budgeting.

These are tough times in Alberta and it is only understandable if we find our strength and resolve wavering after these long months of hardship.  But let us remember this: together we are stronger and we can harness our collective power to make a difference.

By Vamini Selvanandan© 2020. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on Thursday January 21, 2021. Photo credit: Belle Co on Pexels.com

Recommended further reading:

COVID-19 vaccine brings hope for the new year

Last week, Health Canada announced approval of the first vaccine against COVID-19 infection for use in Canada. The development of highly effective vaccines against a virus that we couldn’t name a year ago will surely go down in history as an unequalled biomedical triumph.  

The vaccine development process normally takes decades, not months, to accomplish.  However, unprecedented levels of collaboration between international governments, researchers and pharmaceutical companies led to the production of COVID-19 vaccines at astonishing speed.

It is perfectly justifiable to wonder if this is too good to be true. Is the approved vaccine safe and effective? Have corners been cut in the vaccine development process? Are approval processes for COVID-19 vaccines rigorous enough? 

We know that the recently approved Pfizer-BioNTech vaccine cannot cause disease.  It does not contain SARS-CoV-2, the virus responsible for COVID-19 infection.  The messenger RNA vaccine works by instructing our own cells to make spike proteins found on the outside of the disease-causing virus. These proteins in turn stimulate our bodies to make protective antibodies.

The design and size of the study proving the vaccine’s safety and efficacy meet the rigorous standards of testing required for vaccine approval.  The vaccine was studied in a randomized controlled trial enrolling over 43,000 people from United States, Germany, Turkey, South Africa, Brazil and Argentina.  Data show that the vaccine is 95% effective and the effect is consistent across gender, race, ethnicity and age. We can have confidence that the vaccine will work in different populations, under various conditions and in places with higher and lower rates of COVID-19 infection. 

Implementing vaccine roll-out will be challenging but there are promising signs that we can do this successfully.

The swiftness of approval for the Pfizer-BioNTech vaccine is also unprecedented.  The United Kingdom, first to approve the vaccine, had several teams conducting assessment of the vaccine simultaneously, to ensure speed and rigor in the process. In our country, Health Canada was able to review safety and efficacy data expediently because they received data from vaccine manufacturers as it was collected.  The regulator concluded that the evidence met strict standards for quality, safety and efficacy.

However, there is still work to be done. Trials are needed on vaccine safety and efficacy in pregnant women and children before approval in these populations. It is also too early to know how long immunity will last after vaccination or what long-term side effects, if any, there might be. A Health Canada vaccine registry to monitor and collect data on those being immunized will help answer these and other questions.

Implementing vaccine roll-out will be challenging but there are promising signs that we can do this successfully.  The federal government is coordinating and paying for vaccine administration and will ensure that Canadians across the country will have access to the vaccine. Provinces have agreed that those who need the vaccine most will get it first and will follow national guidelines on how to prioritize populations. 

Governments, community organizations and health care professionals will work to make sure that people have accurate information that they can trust about the safety and the effectiveness of the COVID-19 vaccine. Everyone deserves the best information to ensure they can protect themselves and their loved ones.

For some of us, getting the COVID-19 vaccine will be the best Christmas present we receive this year.  For the rest, the gift is the promise the vaccine brings for better things to come in the new year. In the meantime, we need to continue taking care of ourselves and others by following all public health restrictions in place and knowing that it is up to every one of us to keep each other safe.

By Vamini Selvanandan© 2020. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on December 17, 2020. Photo credit: Thirdman on Pexels.com

Further reading:

Privatizing health care is no panacea

Alberta’s UCP government is looking to privatization as a cure for what ails Alberta’s public health care system.

Bill 30 allows for-profit corporations to bill the government directly for medical services and 30% of surgeries conducted in Alberta will be done in private facilities by 2023.  Despite ample evidence suggesting the opposite, the Kenney government believes that private health care will cut costs and decrease wait times without compromising quality.

The Canada Health Act legislates that all Canadians should have equal access to publicly-funded, medically-necessary physician and hospital services. Health care is to be provided on the basis of need and not ability to pay. To receive federal health transfer payments, provinces have to abide by the principles of the Canada Health Act.

But several provinces are allowing a private health care system to exist alongside the public one and turning a blind eye when private clinics charge patients user fees in blatant contravention of the Canada Health Act

Private health facilities are not the cheaper alternative.  When Alberta contracted with the private Health Resources Centre to perform orthopedic surgeries under the Stelmach government, Albertans paid more per surgery than for procedures delivered publicly, and were left with outstanding costs when the business declared bankruptcy. Private businesses tend to take the profit but leave the risk with taxpayers. 

Private clinics can also choose less complicated patients to serve, leaving more complex (and costly) patients to be looked after by public facilities.  Private clinics further add burden and cost to the public system when patients who develop complications from privately delivered surgery have to be admitted and cared for in public hospitals. All these factors do not add up to cost savings for governments.

The primary obligation of for-profit businesses is to maximize profits for their shareholders.

Private health care does not decrease wait times.  Health care professionals for public and private facilities are draw from the same finite pool.  Moving surgeons from the public to the private sector does not mean that procedures will be done faster. 

Cataract surgeries have been performed in private clinics in Alberta for many decades, yet wait times are higher than the national average and less than half of Albertans receive their surgery within the 16-week national benchmark. 

Also, training physicians and surgeons comes at a considerable cost to the public purse.  Allowing for-profit businesses to siphon valuable human resources from the public system amounts to providing them with generous subsidies to erode the public workforce.

Private health care does not encourage quality care. The primary obligation of for-profit businesses is to maximize profits for their shareholders. If private facilities are paid no more than public facilities, in order to turn a profit, they have to reduce their expenses by cutting corners or increase their revenue by charging patients.

There is evidence that both these strategies are used. During the COVID-19 pandemic, we have seen higher death rates in private long-term care facilities that cut corners with lower staffing levels and over-crowding of residents. Private clinics often charge patients overhead or facility fees up to two times higher than overhead costs incurred by private hospitals in order to increase their revenue. 

How then can we strengthen the health care system in our province? 

We can encourage our government to adequately fund upstream efforts in health promotion and disease prevention because we know that prevention costs less than cure.  We can insist that our governments look closely at publicly-funded medical services and cover only necessary and effective therapies.  Finally, we can encourage the government to collaborate with physicians to implement fair and efficient models of physician compensation.  

Albertans are fiercely proud of our world-class publicly funded health care system. We need to make sure that it endures for future generations.

By Vamini Selvanandan © 2020. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on November 19, 2020. Photo credit: Karolina Grabowska on Pexels.com

Further reading:

National Pharmacare: A prescription for change

Canada is the only developed country with universal health care but no national pharmacare program.  In the recent throne speech, the federal Liberals pledged to change that.  But Canadians have heard this before from our government with little action to date. It is time that we hold them to their promise.

Drugs account for the second largest component of health system expenses (behind hospital care) and are the fastest area of cost increase.  Currently, prescription drug coverage in Canada remains an incomplete patchwork of federal, provincial, territorial and private plans that leave a significant number of Canadians with no insurance.  Approximately 1 in 10 Canadians cannot afford to take their medications as prescribed.  

Public plans pay for 42% of drug expenditures and private drug plans account for 36%, leaving 22% percent of prescription drug costs to be covered out-of-pocket by patients.  Approximately 11 percent of Canadians have no prescription drug coverage whatsoever, while many with private or public coverage face significant deductibles or other user fees.  

Public support is also overwhelmingly in favour of a national pharmacare program with 91% of Canadians supporting universal prescription drug coverage. 

When people cannot access the prescription medications they need, studies show that they are at risk of getting sicker or dying prematurely.  Without prescription drug coverage, people report worse overall health status, more people with HIV infections die and the number of premature deaths from diabetes increases. 

Other health care costs such as hospitalizations or emergency department visits also go up.  Lack of comprehensive prescription drug coverage leads to increased financial burden on patients, difficulties with access to lifesaving drugs and higher overall costs to the health system.

These are not new insights.  Numerous commissions since the 1960s have recommended a national pharmacare program to provide coverage for medically necessary drugs for all Canadians. 

Experts in the medical field including physicians, nurses, and academics have endorsed national pharmacare for decades.  Public support is also overwhelmingly in favour of a national pharmacare program with 91% of Canadians supporting universal prescription drug coverage.  

So why do we not have a national pharmacare program today? 

Some think it is because the costs of a universal prescription drug program will be prohibitive.  However, the weight of evidence suggests that universal prescription drug coverage will in fact save Canadians money.  With a single-payer universal system, administrative costs are reduced, purchasing power is increased through bulk procurement and Canadians will stop paying some of the highest prices for medications in the world.  

Costs to governments are estimated to increase by $1 billion with national pharmacare, while the private sector (i.e. you, me and our employers) would save $8.2 billion, resulting in estimated net savings of $7.3 billion or 32% per year. 

There is good news for governments too, because increased costs to them will be offset by improvement in health outcomes and reduced demand on other health services which have not been included in the above calculation.

Some fear that the profits and livelihoods of private insurance and pharmaceutical companies may be threatened by a national pharmacare program.  But private insurance companies have showed us their resilience before when Canada adopted universal coverage for hospital and physician services.  They pivoted, diversified and expanded into other areas of health benefits and remained a viable industry. 

Similarly, evidence from other countries shows that pharmaceutical companies will not abandon Canada as a place to do business or decrease their important contributions to research and development.

A national pharmacare plan is essential to the health of Canadians and in ensuring that everyone can access life-improving and life-saving medication. Federal, provincial and territorial governments must collaborate to fill this prescription for change.

By Vamini Selvanandan© 2020. 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 15, 2020. Photo credit: Miguel Á. Padriñán on Pexels.com

Further reading:

Basic Income: An idea whose time has come

The Canadian Emergency Relief Benefit comes to an end in a few weeks, putting many Canadians in a state of anxiety and insecurity about how they will pay for basics such as food, housing and transportation.

Rather than moving back to the Employment Insurance program fraught with problems, the Government of Canada has the opportunity to move forward towards an income support program that reaches everyone in need and lets people live their lives with dignity.

Income and wealth are known to be strongly associated with health.  People with lower income suffer from mental and physical illnesses at higher rates than those with higher socioeconomic status.  They are at higher risk of developing diabetes, experiencing chronic stress and even dying earlier than their wealthier counterparts. Poverty also affects a person’s ability to access education, employment, safe housing and nutritious food.  

Unfortunately, current income support programs do not provide adequate funds for people to lead a healthy and dignified life.  They are restrictive in their eligibility criteria, leaving many people in need without support.  Current programs trap people in poverty by requiring them to deplete savings and other resources before being able to access social assistance.

The idea of a basic income, also known as minimum income or guaranteed income, has been around since the 1960s.  It refers to unconditional payments from governments to individuals regardless of employment status.  Some basic income models are contingent upon need while others are universal, providing a basic amount to every individual.   Canada has examples of both for some populations:  the Canada Child Benefit which has lifted hundreds of thousands of families out of poverty is income-tested, but old age security payments are universal for Canadian residents aged 65 or greater.

We all deserve to live with dignity and basic income

can help achieve this.

Basic income pilot projects conducted in Manitoba in the 1970s, and more recently in Ontario, have shown the benefits of this approach to poverty reduction. In Manitoba, the MINCOME project decreased the high school drop-out rate and reduced hospitalizations for accidents, injuries and mental health problems.  Participants in the Ontario pilot project reported fewer visits to the emergency room, increased physical and mental well-being and less use of alcohol and tobacco.

Many argue that providing a basic income reduces incentive to work.  This was not the case in the Ontario basic income project where 83% of the participants continued working and, of those who stopped, nearly half went back to school or university to upgrade their skills and increase their employability.

It may seem daunting or even impossible to use public funds to finance basic income for Canadians.  But experts have crunched the numbers and shown that Canada can indeed afford a basic income program.  Rolling current income support programs such as employment insurance, child benefits and senior payments into one basic income program will provide access to these existing financial resources and reduce administrative costs.  In addition, shifting resources from refundable and non-refundable tax credits into basic income and modifying the current taxation system to make it fairer, will provide sufficient funds to pay for Canada’s basic income program.

Reducing income inequities benefits rich and poor alike: more equal societies have less mental illness, fewer crimes, less substance use and more trust among strangers.  The current global pandemic has shown us that even those who had good jobs or healthy businesses can have our financial security threatened severely and unexpectedly.  Having a robust social safety net that provides the necessities for a healthy life and is respectful of who we are is more important now than ever before.  We all deserve to live with dignity and basic income can help achieve this.

Vamini Selvanandan© 2020. 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 17, 2020. Photo credit: Suzy Hazelwood on Pexels.com

Further reading:

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