The Engaged Citizen

A Family Physician for Every Albertan

All some people want for Christmas is a family doctor. A report released earlier this month from the Canadian Institute for Health Information (CIHI) shows that 1 in 7 visits to the emergency department is for a condition that can be treated by a primary care provider – a family doctor or a nurse practitioner.

But more than 650,000 people in Alberta do not have a regular health care provider, and are sometimes forced to wait long hours in the emergency room for conditions better managed in primary care such as sore throats, viral infections and prescription refills.

With 5.4 million adults without a family doctor, a recent survey found that Canada ranks at the bottom of 10 high-income countries when it comes to access to primary care. About three-quarter of Canadians do not have same- or next-day access and after-hours and weekend care. People living in rural and remote areas are even worse off.

Primary care is the foundation of our health system and covers the everyday needs of patients. Primary care providers prevent, detect and treat illnesses; give advice regarding healthy living; and manage chronic conditions like diabetes, hypertension and asthma. They have trusted, long-term relationships with their patients and often provide health services from cradle to grave for 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 a more equal society.

In the last provincial elections, both the NDP and the UCP parties committed to better access to primary care. Current premier, Danielle Smith, promised every Albertan a primary care provider, but has not put forth a convincing plan to make good on her pledge.

Smith would do well to look toward her counterpart in Ontario. Doug Ford reached across party lines to appoint Dr. Jane Philpott, former federal health minister and member of the Liberal cabinet, to lead a primary care action team whose mandate is to attach every person in Ontario with a primary care provider within the next 5 years.

“Furthermore, there needs to be a sense of urgency in supporting family doctors currently in practice.”

Philpott was chosen for the job because she sets out a very clear proposal for universal access to primary care in her book Health for All, launched earlier this year. Since the book release, leaders from several province and of all political stripes, have courted her help to make reality the idea of a primary care provider for every person.

Philpott’s vision is simple but bold: everybody will be guaranteed access to a primary care team within a half hour of where they live. Just as every child is automatically assigned a public school in their neighbourhood, every person will have access to ongoing, comprehensive primary care even if they were to move residences.

In addition to family doctors and/or nurse practitioners, a “primary care home” will include other health professionals such as physiotherapists, social workers and mental health counsellors who can provide services that are customized to the needs of the local population.

Ontario already has the highest proportion of residents attached to a regular health provider and Philpott is going to take them across the finish line of attaching everybody to primary care. We in Alberta need to demand the same from our government.

We need to make our voices heard strong and clear through conversations with our MLAs, letters to Minister of Health Adriana LaGrange and unequivocal signals to Premier Smith that we too want the advantages of universal access to primary care. We need to urge our government to set up a primary care action team, chose the best person to lead that team, and give full support and adequate resources to get the job done.

Furthermore, there needs to be a sense of urgency in supporting family doctors currently in practice. It has been a year since the Alberta Medical Association and the provincial government agreed in principle to sustainable funding for primary care clinic overhead costs and fair compensation for extra time and effort spent in the care of complex patients.

However, twelve months later there is still no date for implementation of this funding. Meanwhile, over 90% of family physicians in Alberta are concerned about the financial viability of their practices and sixty-one percent of family physicians are thinking of leaving this province’s healthcare system.

The time for action is now. Instead of the expensive smoke and mirrors exercise of dismantling Alberta Health Services, our government needs to make meaningful change in the lives of Albertans. We need them to invest adequate resources into primary care to build a strong and reliable foundation for the rest of the health care system. Every Albertan deserves the right to be healthy, and universal access to primary care is crucial to achieving this goal.

Seasonal Vaccines Save Lives

The season of deadly respiratory viruses is here. While some people suffer minor inconveniences from respiratory infections, others can experience life-threatening events resulting in hospitalization, ICU admission or worse.

Respiratory viruses like influenza, COVID-19 and respiratory syncytial virus (RSV) are more prevalent in the months from fall to spring and can have very serious consequences for the very young, the elderly, and those with underlying medical conditions.

Influenza is one of the top ten causes of death in Canada, causing over 12,000 hospitalizations and approximately 3,500 deaths a year. While the peak of the COIVD-19 pandemic may have passed, over 4,000 people are still dying every month globally. RSV is another respiratory virus that tends to have serious consequences for young children and older adults. While RSV symptoms of runny nose, cough, sneezing and fever are similar to the common cold, in some people RSV can also lead to severe lower respiratory infections and RSV is a leading cause of hospitalization in Canadian children under 5.

The economic burden of respiratory illnesses is not insignificant – the common cold costs $1.4 billion dollars to our economy in lost productivity and influenza costs $1 billion dollars. Taken together, all respiratory viruses reduce production in our country by $2.8 billion.

“And with rampant misinformation on social media, many people are deterred by unfounded conspiracy theories and fail to take action to protect themselves and their loved ones.”

Fortunately, we have safe and effective vaccines for influenza, COVID-19 and RSV. We also have a good vaccine supply and an effective distribution system in our country. Influenza and COVID-19 vaccines are free in all provinces and territories, and public coverage of RSV vaccines is available for high-risk groups in certain areas. Yet, only 42% of Canadians received the influenza vaccine last season and 39% received the COVID-19 vaccine. Why are vaccine uptake rates so low?

Convenience, complacency and conspiracy are a few readily apparent reasons. If obtaining seasonal vaccines does not conveniently fit into one’s work day, or requires travel and effort, it may not get done. With the darkest days of the COVID-19 pandemic behind us, believing that it is no longer necessary to protect ourselves from respiratory viruses may also lead to not getting vaccinated. And with rampant misinformation on social media, many people are deterred by unfounded conspiracy theories and fail to take action to protect themselves and their loved ones.

But there is another very important reason for low vaccine uptake – trust in the product, the provider and the institution is key to vaccine acceptance. To get our shots every fall, we have to trust that the vaccines are safe and will not cause dangerous side-effects. We need to remember that vaccine approval requires stringent methods to prove safety and to monitor for ongoing ill-effects. Next, there needs to be trust that the vaccines will work and be effective in preventing the infections that they are designed to ward off. Again, the requirements for vaccine developers to demonstrate vaccine efficacy is a high bar that must be met to get approval in Canada.

Interpersonal trust between individuals and professionals who recommend and administer vaccines may be the most important kind of trust for protecting the public against vaccine preventable diseases and deaths. The relationship between individuals and their healthcare professionals usually rests on a strong foundation of respect and trust. When a trustworthy doctor, nurse or pharmacist recommends seasonal vaccination, people feel confident in the advice and act on it. Healthcare professionals also play an important role in addressing concerns about vaccines and providing reliable answers to legitimate questions that patients have.

Studies have shown that higher levels of trust in governments and institutions lead to more vaccine acceptance. Leaders at all levels of government have a role to play in encouraging the public to get their seasonal vaccines as do religious, social and cultural leaders who have earned the trust and confidence of their communities.

Vaccine uptake is also higher when there is trust in the institutions that are recommending the vaccines such as the World Health Organization or the Public Health Agency of Canada. Vaccine mandates, on the other hand, circumvent trust and result in lower vaccine uptake. A policy of free and voluntary vaccination results in increased vaccine acceptance.

Finally, we don’t want to shun those who have strong anti-vaccine convictions. The more we discount their conspiracy theories or reject them entirely, the more firmly they become entrenched in their position. People or communities with anti-vaccine views tend to be isolated from mainstream society and we need to find ways to include them and find common ground in our shared values. Building trust through engagement with respected religious or cultural leaders from these communities can go a long way to improving health outcomes and building trust. And when we trust each other, we remember that we are still all in this together.

Local newspapers strengthen democracy

Local newspapers are disappearing across the country. In the United States, a quarter of the country’s newspapers have shut operations in less than twenty years. And in Canada, there have been dozens of community newspaper closures in 2023 alone, with hundreds of workers laid off and several news outlets becoming insolvent. Along with decreased subscriptions, local newspapers face financial challenges resulting from advertising revenues migrating to digital platforms.

Yet, local newspapers remain an essential part of community life, especially for residents of smaller towns and communities. Studies in rural Saskatchewan and Manitoba show that they are the most trusted news source when compared to television news, internet websites and social media platforms. In Alberta, surveys indicate 80% of respondents read their local newspaper weekly. This percentage has not dropped since 2005, indicating that younger residents are reading local newspapers with the same interest as their older counterparts.

Local newspapers are key in letting people know what is going on in their community. They provide information so citizens can make knowledgeable decisions about key local issues and studies show that adults who read local newspapers participate in municipal elections at higher rates than those who do not. By publicizing community events, they also promote participation in community life and increase sense of belonging and connection among local residents.

Local newspapers can also be the catalyst for social change when they uplift voices that would otherwise go unheard. Toronto news media reported on how the police practice of carding (stopping, questioning and documenting those who have committed no offence) was disproportionately affecting Black and Indigenous men. Coverage in local newspapers amplified the advocacy efforts of Black and Indigenous community groups and eventually led to passing of provincial legislation banning the practice.

“Where newspapers have closed, studies in the United States show increased rates of corruption among politicians.”

Community newspapers encourage open dialogue and debate about important community issues and reduce political polarization by exposing people to different perspectives. They are important for the health and success of communities because they create common understandings and a shared sense of community. Local newspapers hold up a mirror in which the community can see itself reflected. At the same time, local newspapers shape community character through storytelling and portrayal of people and events. Community newspapers are also important for stimulating the economy – they provide advertising for local businesses thus connecting them with customers in their own community.

Often community newspapers are the lone agents covering town council meetings, court proceedings and other local public gatherings. Reliable media coverage keeps elected officials accountable and forces decision-makers to operate within the view of the public. Where newspapers have closed, studies in the United States show increased rates of corruption among politicians. Additionally, newspapers hold businesses and other community organizations to account on social, ethical and environmental issues.

Local journalism is a public good that benefits everyone and needs to be supported by individuals, governments and the private sector. We need to subscribe to our local newspapers and keep reading and engaging with issues and encourage our friends and family to do the same. We need to keep discourse in the newspaper, and in the community, civil and kind. We must take the opportunity to understand different perspectives and find common ground with our fellow citizens.

We also need to encourage our governments to support community-centered journalism. We need news agencies that work with citizens to find out what their information needs are and how best to meet these needs to build better communities. Governments can provide grants and tax deductions to newspapers. but they must remain at arm’s length to protect the independence of the media and maintain non-partisan reporting of events.

Local newspapers also need to diversify their funding models. Traditional for-profit models may no longer work in every community with digital media platforms taking away advertising and subscriptions from local newspapers. We have to look at nonprofit models that are funded by private donations and government grants, in addition to advertising and sponsorships. Nonprofit news outlets can deliver the type of journalism that prioritizes citizen needs and accountability from governments, businesses and the community over shareholder profits.

The co-operative ownership model is an alternative that workers at the Prince Albert Daily Herald in Saskatchewan adopted when their newspaper was threatened with closure. They bought shares in an employee stock ownership plan and continued operating the newspaper when the owning publishing chain was about to shut it down.

Finally, we need to keep our newspapers accountable. We need them to publish accurate and varied content and ensure that diverse voices are heard. We expect our newspapers to adhere to ethical journalism practices and provide us with unbiased reporting. They need to have the courage to challenge the status quo and generate healthy discourse within the community. Local newspapers create engaged citizens, and engaged citizens are essential to a healthy democracy.

Wildfire damage can be greatly reduced

Albertans are no strangers to the destruction of wildfires. Jasper, Fort McMurray, Slave Lake, and Sturgeon Lake Cree Nation are all communities devastated by wildfire in recent years. We empathize with those who lost their homes, their businesses or their jobs and bear witness to the challenges they face to rebuild their communities and their lives.

In 2023, wildfires burned 18.5 million hectares of land in Canada – three times the size of Nova Scotia. Two hundred thousand people were evacuated and the damages from insurable losses cost over $3 billion dollars. With 60% of Canadian communities being located near wildfire-prone areas, we can expect to face even more challenges in the future.

The risk of wildfire is increasing due to more residential and industrial development into forested and grassland areas, and due to accumulated vegetation from over one hundred years of fire suppression. Furthermore, climate change has increased the length of the annual fire season and created conditions for larger, hotter and faster-moving fires.

The economic, social and health impacts of the wildfires are far-reaching. Commercial activity and tourism decrease due to evacuations and structural damage. Businesses are forced to reduce operations and workers lose time at work. Loss of housing and disruptions to essential services such as electricity, drinking water, and communications put severe social stress on communities. Anxiety disorder and post-traumatic disorder are more common in those affected by wildfire damage and mental health issues can persist for many years after the event.

It is natural to feel helpless in the face of wildfire threat, but the reality is that there are many aspects we can control, both individually and collectively. As a society, we can make large-scale investments to ensure that our homes, businesses and communities can resist the destruction of wildfires.

Low risk vegetation in the immediate area surrounding homes was the single most important factor in differentiating homes that survived from those that burnt

Businesses, landlords and homeowners can reduce the risk of their buildings catching fire by up to 75 per cent through individual actions. Most structures at the edge of communities are not destroyed by direct contact with the fire, but by embers or burning fragments of vegetation showering on homes up to two kilometers ahead of the leading fire edge.

Relying on firebreaks and reduction of vegetation that can burn around communities is important to reduce direct contact with wildfire but is certainly not enough to protect homes from igniting due to embers. A study of the 2016 Fort McMurray fire found that low risk vegetation in the immediate area surrounding homes was the single most important factor in differentiating homes that survived from those that burnt, followed by uncluttered yards with few combustible objects and the use of firesafe building materials. These findings are consistent with the FireSmart guidelines for landscaping and building.

FireSmart is a national program designed to increase wildfire resilience of communities and it outlines several scientifically proven actions that can be taken to protect businesses, homes and neighbourhoods. FireSmart guidelines include avoiding planting shrubs and plants within 1.5m of buildings, removal of coniferous trees within 10 meters of buildings and relocating firewood and lumber stored within 10m of the house and under decks. The guidelines also recommend the use of fire-resistant roofing materials such as asphalt, metal or concrete; non-combustible siding (stucco, metal or fibre cement), and non-combustible materials for decks and porches. Following FireSmart guidelines reduces the chances of homes catching fire and helps firefighters defend structures if they do ignite.

But individual efforts can only go so far in preventing wildfire damage given what we know about how fire progresses. Vulnerable homes ignite first, then fire spreads to adjacent homes and when a critical mass of buildings catch fire, the fire coalesces and causes large scale destruction in the community. To protect our neighbours, neighbourhoods and communities, we all have to take action and view FireSmart implementation as a team sport.

Policymakers, government agencies and the private sector also have a role to play in reducing wildfire damage to communities. Fire protection and public safety agencies have to prioritize prevention initiatives and educate neighbourhoods and communities on how to prevent homes from catching fire due to embers. Housing developers and landscapers working in wildfire-prone areas should systematically follow FireSmart building and landscaping guidelines. Insurance companies need to help build back smarter after wildfire damage and support clients in rebuilding with fire resistant materials and design.

The federal government also has to take leadership and be responsible for creating nationally-accepted building standards to safeguard against wildfire damage. Provincial and national park agencies with jurisdiction over lands adjacent to communities must reinforce the efforts of property owners by ensuring that trees are thinned and pruned and accumulated vegetation and deadfall removed.

Municipalities need to protect communities by creating appropriate firebreaks and requiring greater separation of buildings in wildfire-prone areas to limit the spread of fire from one structure to another. Municipal governments in high-risk communities should consider making FireSmart measures mandatory in urban developments, and at the very least, make sure that municipally-owned buildings, social housing, and landscaping in urban parks and open spaces follow FireSmart guidelines.

Through effective leadership, collaboration between public and private sectors and community action we can learn to live with the threat of wildfire.

Climate change is a health crisis

As we cope with extreme heat waves and unpredictable wildfires this summer, it is hard to deny that climate change is a reality. With record setting high temperatures in many places in the West, this stretch of hot weather is a searing reminder of how human actions are affecting our planet. If global warming continues unabated, it is easy to imagine how life will become unbearable.

The health of humans and the health of our planet are inextricably linked. The effects of climate change on human health are already evident in Canada and so many other places in the world. Our northern latitude exaggerates the effect of climate change and disproportionately affects populations living in the Far North including many Inuit communities whose livelihoods are intertwined with the conditions of the land.

Climate change is the biggest public health threat of the 21^st century. The World Health Organization estimates that 5 million deaths will occur due to heat, malnutrition and diarrheal diseases attributable to climate change between 2030 and 2050. The scale and severity of the impact of global warming on human health can put health systems, economies and even global security at risk.

Climate change has both direct and indirect impacts on health. Heat waves, hurricanes and wildfires result in heat-related illness, trauma and death. Warmer temperatures increase the range of insect-borne diseases such as Lyme disease, malaria and West-Nile virus resulting in their spread to parts of the world they were not found in before. Climate change also has significant effects on mental health as extreme weather events can increase anxiety, post-traumatic stress disorder and suicide risk.

Fortunately, we have the technical and policy knowledge to avert climate disaster. What we need to do is create political will for immediate action and push our decision-makers to make use of the tools we have to keep us, and our planet, healthy.

“Carbon tax is about choice and freedom for individuals and businesses to decide how we want to reduce greenhouse gas emissions through the products we buy or sell.”

The carbon tax is the cheapest and most effective way of fighting climate change. But it suffers from a serious public relations problem. Due to poor communication by policymakers, many Canadians have an immediate and negative reaction to this highly efficient policy to fight climate change.

Carbon tax is about choice and freedom for individuals and businesses to decide how we want to reduce greenhouse gas emissions through the products we buy or sell. Unlike regulations, which force people to take certain actions, carbon taxes affect prices and create incentives for environmentally-friendly behaviours. We know very well that price affects consumer behaviour. Tax the sale of cigarettes, and the percentage of Canadians who smoke drops. Raise taxes on alcohol, and people choose to drink less.

Similarly, the carbon tax works by providing financial incentives for individuals to pollute less and encourages companies to offer products and services that result in fewer greenhouse gas emissions. It works by creating an economic incentive for reducing carbon reductions while maintaining a strong economy. This is why supporters of the carbon tax include Preston Manning, founder of the Reform Party; Elon Musk, investor and entrepreneur; and Steve Williams, former CEO of Suncor – Canada’s largest oil producer.

In British Columbia and California, where the carbon tax has been in place for many years, there is evidence that greenhouse gas emissions have been reduced while maintaining a strong economy and creating quality jobs. Not only does the carbon tax reduce present emissions, but it also affects future emissions as engineers and entrepreneurs innovate to develop technologies that reduce emissions even further, encouraged by strong cost incentives provided by rising carbon taxation.

Many Canadians believe that the carbon tax is taking money out of their pockets, but in reality, 8 out of 10 families in Canada receive more through the Canada Carbon Rebate – previously known more enigmatically as the Climate Action Incentive Plan – than they pay in carbon taxes. Recent polling shows that less than half of Canadians who are eligible for the rebates realize they are being getting back what they paid out and often more.

Pierre Poilievre and other “ax-the-tax” politicians are taking advantage of everyday Canadians’ knowledge gap about effective climate change policy and want us to believe that removing the carbon tax will save us money, and magically avert us from climate catastrophe at the same time.

Once we understand the economic principles behind the carbon tax, we will all join Preston, Elon and Steve in embracing the tax, and joyously visit the bank to retrieve our Carbon Tax Rebate.

By Vamini Selvanandan© 2024. This work is licensed under a Creative Commons CC BY 4.0 license. This article is an updated article and was published in various papers in July, 2024. Photo credit: Photo by Pixabay on Pexels.com

Avoiding low-value healthcare: sometimes less is more

You can’t get enough of a good thing. Or can you? In Canada, we use public funds to pay for diagnostic tests, surgeries and many medical treatments so it is natural to assume that more medical care is better. The more you get tested, diagnosed and treated, the healthier and longer your life will be. No, not necessarily! Some medical tests and treatments can be a waste of precious healthcare dollars and can result in harm to patients.

In the United States, it is estimated that around $100 billion per year is wasted on unnecessary medical care. This money could have been used to provide medical care that people really need. Furthermore, eliminating low-value diagnostic tests and treatments can reduce the healthcare sector’s carbon footprint and contributions to global warming.

Low-value care refers to tests and treatments that have no evidence of providing benefit to patients and may cause physical or psychological harm. They can take the form of blood tests, imaging, medications or surgical procedures. For example, getting x-rays or CT scans for low risk back pain within the first 6 weeks of symptoms will not change how the patient is treated, as most back pain will improve in this time frame, but exposes them to unnecessary radiation.

Antibiotics can save lives when used appropriately but can cause unwanted side-effects, serious complications or even death in some people. Antibiotics do not work against viruses, the cause of all colds and flu infections, almost all sinus infections, and most cases of bronchitis. So, the risks of antibiotics outweigh their benefits when used for most cases of nasal congestion, cough, or sinus pain.

Opioids are potent pain killers and can help in situations of severe pain like immediately after surgery or cancer pain. However, they are not the best option for chronic pain related to arthritis, low back pain or migraines. Opioids can lead to addictions, withdrawal symptoms and side effects like decreased alertness, nausea and constipation. Similarly, sleeping pills may be appropriate in acute situations of poor sleep for a few days, but when used over long-periods, lose their effectiveness and can cause falls and cognitive decline in seniors.

“The decision to have a screening program is based on the benefits of lives saved at the population level, but the risks may not be acceptable at an individual level.”

The media, the medical establishment, and not-for-profit cancer organizations have for years unequivocally broadcast the message that cancer screening saves lives. But the reality is more nuanced. A recently published paper analyzing 18 studies involving 2.1 million people and looking at six common cancer screening tests for breast, colon, lung and prostate cancer showed that only one test – sigmoidoscopy for colon cancer – increased overall lifespan, and that by only 110 days. The other cancer tests did not result in people receiving cancer screening living longer.

Patients, and even some doctors, assume that cancer screening tests are always beneficial and can cause no harm. But we know that all medical tests, procedures and treatments come with risks and benefits. Cancer screening can result in false positives requiring more invasive testing – like biopsies, with bleeding and infection as potential complications. Screening can also result in overdiagnosis and overtreatment – meaning providing unnecessary treatment for a condition that is not life-threatening or would never have caused symptoms. In fact, people participating in cancer screening are many times more likely to experience a false positive, overdiagnosis or overtreatment than having their lives saved by screening.

The decision to have a screening program is based on the benefits of lives saved at the population level, but the risks may not be acceptable at an individual level. For example, screening 1000 women aged 50-69 for breast cancer every two years with a mammogram for 7 years, saves one life, but results in 3 women treated unnecessarily for breast cancer because we don’t know which cancers once diagnosed will progress to cause serious illness or death.

Does this mean that one should never participate in cancer screening? No, because some individuals do benefit from early cancer detection and treatment. It may be your life that is saved. So shared decision-making needs to take place between individuals and their doctors to explore the risks and benefits of testing, the patient’s specific risk profile and their values and preferences.

To keep our healthcare system sustainable and accessible for effective and medically necessary care, we need to eliminate low-value care and transfer those resources to high-value health investments.

Investing in the health of children whether it be in early childhood education, prenatal nutrition, or childhood immunizations pays high dividends for lifetime population health. Similarly promoting healthy lifestyles and preventing diseases such as hypertension, diabetes and heart disease has big payoffs. Boosting the social determinants of health by providing adequate income, quality education and decent housing, improves health in ways that many low-value tests and treatments do not. Let’s choose wisely in how we spend our healthcare dollars.

Is our government working for Albertans?

This month marks a year since the United Conservative Party won the provincial elections under Danielle Smith. Affordability and health care were the top issues identified by Albertan voters in the lead-up to the election. Now a year later, Albertans continue to face high food prices, a lack of adequate and affordable housing and difficulty accessing health care. It is time to take stock of what this government has done in the past year to help improve the daily lives of Albertans.

The New and proposed legislation page of the Government of Alberta’s website inventories a list of what has kept our government busy in the legislature in recent months. This catalogue shockingly and painfully highlights the lack of work being done to improve food security, housing or access to health care for Albertans.

Instead, the website proudly lists several pieces of legislation that concentrate power in the hands of the government without regard for the struggles of average Albertans. The Public Health Amendment Act came into effect in December 2023 and strips the provincial Chief Medical Officer of Health of the ability to issue population-wide public health orders in future public health emergencies. Instead, it gives the authority to make final decisions “based on scientific and medical public health factors” to elected officials. Akin to seeking help from a local politician for treatment of a heart attack instead of rushing to a medical doctor with the knowledge, skills and tools to treat the medical condition, this new legislation puts Albertans at increased risk of suffering and death in the next public health emergency.

“It seems that our provincial government is more interested in consolidating and concentrating power into their own hands than governing for Albertans.”

Bill 17 introduced in April 2024, looks to establish a new crown corporation to build an abstinence-oriented system of care for people with substance use disorders. While treatment and recovery services for people struggling with addictions issues are necessary and welcome, they have to be a part of a continuum of services that can serve all people with substance use disorders no matter their stage in the course of illness. Just as cancer patients require a suite of options including surgery, chemotherapy, radiation and palliative care to treat their type and stage of cancer, those with substance use disorders require access to a full spectrum of services that include prevention, harm reduction, treatment and rehabilitation to meet them where they are at in their health journey.

Recently introduced Bills 18 and 20 will enshrine in legislation the current government’s refusal to work with other levels of government for the betterment of Albertans. Bill 18 requires municipalities, universities and colleges to obtain approval from the provincial government before accepting help from the federal government. This will result in layers of red tape, delays and a waste of taxpayer money.

With Bill 20 – and no small measure of irony – the UCP government is legislating provincial intervention into municipal governance, while at the same time touting Bill 18 as a pushback against federal overreach. Once enacted into law, Bill 20 will give the provincial cabinet power to remove councilors and mayors in any municipality and to repeal and amend any local bylaw – a clear affront to the democratic rights of municipal voters who have elected local politicians to create bylaws in the best interest of their community.

It seems that our provincial government is more interested in consolidating and concentrating power into their own hands than governing for Albertans. They have not shown an interest in addressing the issues that matter most to Albertans – food security, housing and quality health care. We need to express our displeasure with them and make it clear that they need to address the issues of importance to Albertans or at least get out of the way when other levels of government are providing solutions.

More than 1 in 4 Albertans lives in a household that is food insecure. In a province of abundant food production and availability, food insecurity is not about a lack of food but a mark of poverty. The Government of Alberta has three readily available policy levers to reduce food insecurity: increasing minimum wage, increasing welfare payments and lowering the income tax rate for the lowest income bracket. Each of these measures will independently reduce the risk of food insecurity for Albertans and all three lie completely within provincial jurisdiction.

The Alberta government also needs to take bold and decisive steps in health care reform. They must ensure that every Albertan has access to a primary care provider and a supporting health care team close to home. Alberta needs to build more quality publicly-funded long-term care homes to take care of aging Albertans and reduce the burden on acute care hospitals. Additionally, health care personnel and infrastructure in public health care facilities need to be bolstered to provide timely and high-quality acute, emergency and surgical services to Albertans.

Furthermore, our provincial government needs to take urgent action to address the housing crisis by collaborating with municipal and federal levels of government and making sure that all Albertans can realize their basic human right to housing. Immediate actions include using public lands for building social housing, establishing rent control to keep housing costs affordable, and protecting tenants from unfair and predatory practices by corporate landlords.

No matter how we voted in the last election, we need to hold this government accountable and working for Albertans. They have another three years to show they are worthy of governing for Albertans. If they fail, they will suffer the consequences in the next election.

By Vamini Selvanandan© 2024. 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 27, 2024. Photo credit: Joshua Woroniecki on Pexels.com

Housing is a human right

With asylum seekers dying waiting for shelter space in Mississauga and single mothers denied rental housing in Halifax, Canada’s lack of affordable housing is becoming a frank violation of human rights.

Housing, like the need for food and water, is a basic human need. International law recognizes the social right to housing in the Universal Declaration of Human Rights and the International Covenant on Economic, Social, and Cultural Rights and Canada has ratified several international treaties on the right to adequate housing.

But according to the 2021 Census, more than 1 in 10 households in Canada live in core housing need, meaning they live in housing that is unsuitable (overcrowded), inadequate (in need of major repairs) or unaffordable (costs more than 30% of pre-tax income).

Housing is an important determinant of health. Overcrowded living conditions increase the spread of infectious diseases and people living in damp, moldy conditions have higher rates of asthma and allergies. Extreme indoor heat or cold is associated with increased cardiovascular disease, and poor living conditions can increase psychological stress in adults and children.

Having decent housing is important to living a healthy life. We also know that affordable housing is key to a strong economy. It creates more disposable income, GDP growth, higher productivity and job retention and more tax revenue for governments.

So, when the benefits of decent, affordable housing are so clear, why do we find ourselves in a nationwide housing crisis? This predicament did not arise overnight. It is the result of over 30 years of disinvestment in affordable housing by the federal government as well as the insidious financialization of housing.

In the decades post-World War II, the federal government invested heavily in building affordable housing, creating up to 20,000 new units a year until the late 1980s. But in 1993, the federal government cancelled its housing program and social housing dropped from 20% of annually built housing stock to 1 to 2% by 1996.

“We need to emphasize that towns and cities are for people living and working there, and disincentivize second homes, real estate speculation and short-term rentals.”

Around the same time, the financialization of housing began creating a significant barrier to realizing people’s right to affordable and decent housing. Financial instruments such as mortgage-backed securities and Real Estate Investment Trusts (REITs) have transformed housing from a basic need into a vehicle for investment. Investors look at housing as a commodity and a way of extracting wealth from the basic human need for shelter.

The securitization of mortgages (pooling mortgages to create a financial instrument sold on the stock market for profit) has created large amounts of debt for Canadian homeowners and delinked house prices from income. Purchase of rental housing by REITs has led to systemic practices of rent increases, higher rates of eviction, reduced on-site services, and poor investments in maintenance and repair of housing units to maximize shareholder profits.

In 2017, the federal government created the National Housing Strategy, and, in 2019, passed the National Housing Strategy Act, marking a return to the housing arena after decades of absence. Now they have a lot of catching up to do – the Canada Mortgage and Housing Corporation (CMHC) estimates that Canada needs to build 5.8 million new homes by 2030.

It may seem like a large number, but we know it is possible to achieve this goal. Canada built over 1 million Homes for Heroes between 1943 and 1960 – the equivalent of 6 million homes today. All levels of government, the private sector and civic organizations will have to pitch in to get the job done.

To ensure housing for all, we need to let go of the North American dream of a single-family home and instead embrace density and community by creating an adequate supply of housing close to workplaces, schools and other important amenities and services. We need to emphasize that towns and cities are for people living and working there, and disincentivize second homes, real estate speculation and short-term rentals.

The only way to counter financialization of housing is for the public to claim back a sizeable share of the housing market. France has legislated 20% of total housing stock in each municipality as public housing and in Vienna about 60% of the population lives in social or co-op housing.

We too can set and meet targets to keep housing a public good. The federal government has to invest far more money than it has so far to build housing, and vacant public lands need to be provided to municipal governments and non-profit housing providers free of charge for building affordable housing.

Provincial governments can protect existing housing stock by creating first right of refusal for municipalities to purchase affordable housing at risk of being bought by REITs. Municipal governments can retain control or transfer ownership to not-for-profits, co-ops or land trusts to administer below-market housing programs.

Municipal governments, with their smaller tax base, need to be creative in raising money to build housing. Progressive property taxes levy higher rates for more expensive properties and can be a way to create an affordable housing fund. Vacancy tax for homes that are unused create another revenue stream and encourage absent homeowners to sell or rent their homes to those who live in the area.

When we understand housing as a human right, we acknowledge that decent, affordable housing is the responsibility of all levels of government and civil actors in society. Everyone deserves to live in dignity and security and have a place to call home.

We are sick of sick notes

There is one thing doctors and patients can readily agree upon: we both hate sick notes. Patients loathe waiting long hours in overcrowded waiting rooms to request a note and doctors detest the added burden on the healthcare system in providing one.

Sick note policies increase use of scarce healthcare resources as employees are forced to visit the emergency room or their family physician’s office for the sole purpose of getting a sick note. Sitting unnecessarily in waiting rooms with minor viral illnesses, they put other vulnerable patients – like the frail elderly, pregnant or immunocompromised – at risk of serious complications.

Having to obtain a sick note also creates a strain on the worker, and does not respect a person’s right to rest when they are sick. The World Health Organization and the Public Health Agency of Canada advise people with the flu to stay home to recover and prevent infecting others. Common colds and gastroenteritis are also self-limiting illnesses which get better without medical treatment.

So why do employers insist on sick notes? It appears that some feel it as an effective way of policing employee absenteeism. Either by having a doctor verify illness in an employee or by creating a barrier for employees to taking days off when they are sick, they feel that it will improve employee attendance and ultimately, business productivity and profit.

“Not surprisingly, several physician organizations are pushing back against sick note policies.“

But this logic does not bear out. Doctors do not verify minor illnesses in patients through testing or other objective means before providing sick notes. They simply listen to the patient and believe the symptoms that patients report. Trust is central to the doctor-patient relationship and doctors do not take on the role of policing or disciplining truant employees. Such responsibilities lie squarely with the employer or their human resources department.

Creating barriers to employees staying home when sick can also backfire. A recent study showed that 82% of Canadians would rather go to work sick than get a sick note. Slower recovery and increased infections of customers and co-workers can lead to workplace outbreaks of disease and seriously affect a business’s bottom-line. When a critical number of employees get sick, businesses temporarily shut down operations or reduce their hours or services.

Not surprisingly, several physician organizations are pushing back against sick note policies. The Canadian Association of Emergency physicians is advocating for a ban on sick note requirements by employers and schools through federal or provincial legislation. The Canadian Medical Association and the Ontario Medical Association are also taking a stand against sick notes. In 2023, Doctors Nova Scotia succeeded in getting provincial legislation to limit employers to asking for a sick note only if an employee has been absent more than 5 days or absent twice within the previous year.

Paid sick leave is an alternative policy to requiring sick notes and has benefits for workers, employers, and society. Most Organization for Economic Co-operation and Development (OECD) countries have national permanent paid sick leave policies, but Canada is a laggard by comparison. In 2020, fifty-eight percent of Canadian workers reported not having paid sick leave, and this number increases to seventy-five percent among those making less than $25,000 per year. Workers in precarious jobs at hotels, restaurants, and grocery stores are less likely to have paid sick leave than those in secure office jobs.

Paid sick leave increases income security for workers, protects public health, and helps business continuity by reducing disease transmission in the workplace. It is also an effective strategy for recruitment and retention of employees, making them feel valued and less likely to turnover. Paid sick leave reduces costs of training for rehires and saves money in the long run for businesses. Research shows that concerns of abuse of sick leave policies are unfounded: 45% of workers with paid sick leave did not take even a single paid day off work in the previous year.

We may not be directly affected by sick note policies or already have paid sick days ourselves, but we all have a stake in this matter. If we want to ensure a sustainable healthcare system with timely access for all those who have medical needs, we need to make our opposition to sick notes heard in workplaces and ask our provincial government to ban sick note requests by employers.

If we want to remain healthy and safe as customers and clients, we need to advocate for paid sick leaves for workers so they may stay home and not spread infections. If we want to increase productivity and profit as business owners, we must build healthy relationships with our workers and show that we value and trust them by providing paid sick leave and not requiring sick notes.

Businesses, healthcare workers and governments should work together to ensure a quick and painless demise of the sick note.

By Vamini Selvanandan© 2024. 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 21, 2024. Photo credit: Andrea Piacquadio on Pexels.com

We only have one planet

We live in a time of multiple environmental crises: global warming, natural resource depletion, pollution and biodiversity loss. Far from being unrelated, these environmental disasters share the same root cause. Overconsumption has surpassed population growth on our planet as the driver of environmental degradation.

Put simply, overconsumption refers to taking more than what we need from the planet, and doing so at a rate faster than the planet’s ability to regenerate. In 2019, the United Nations Environment Program reported that our natural resource consumption has increased more than three times between 1970 and 2010. Rich countries like Canada consume on average 10 times as much as the poorest countries. If everyone in the world consumed as the average Canadian does, we will need five planets to feed our ravenous consumer appetites.

Canadians have not always consumed as we do now. In the 1950s, our lifestyles were consistent with one-planet living. But since the turn of the millennium, our consumption rates of everything from materials goods, to fossil fuels, to the use of rare earth metals have soared. All this consumption has not increased our well-being. If anything, quite the opposite. The pressure to consume has increased levels of anxiety and depression and decreased life satisfaction and levels of happiness.

Inequality is one of the great drivers of consumption. There is immense social pressure for conspicuous consumption in our society, as we use the display of our possessions and wealth to maintain position in society and assert social status. This pursuit of materialistic goals means we spend so much of our time earning and spending money that we have less time for things like close relationships and time spent in nature that increase our well-being.

Climate change is the most pressing health emergency of our time and overconsumption is driving climate change by pumping greenhouse gases into the atmosphere at alarming rates. If we are to keep global warming to 1.5⁰C, and maintain a habitable planet, we will have to limit our consumption.

Impactful actions we can take as individuals is to limit airline flights, and travel by car, train or bus instead. During holidays, we can opt to explore an interesting area close to home or take one longer vacation instead of several shorter ones that require distant travel.

“We must not fool ourselves into thinking that simply purchasing green technology is good for the environment”

We can also buy less things, especially avoiding big-ticket items like personal vehicles and holiday homes (the latter also contribute to the current housing crisis). When deciding to buy something, we can consider if it is really needed and if so, we can buy used items; well-made, longer-lasting items; or rent, borrow or share things used only occasionally.

Greener options are preferable for an item that is needed, or to replace one that is near the end of its lifecycle, but we must not fool ourselves into thinking that simply purchasing green technology is good for the environment. Our total consumption determines how much damage we cause the environment and it is only through reducing consumption across all products, green or otherwise, that we can have a smaller footprint.

Solving our converging environmental crises is going to take more than lifestyle changes, it will require system change. We have to let our politicians know that we want to see policies to reduce overconsumption. We need federal, provincial and municipal governments to set policy on supporting investment in high-quality, long-lasting, net-zero infrastructure whether they be homes, office buildings or public facilities.

Asking our governments to address inequality will ensure that people do not have to consume conspicuously to maintain their status in society. A decrease in consumption will inevitably cause an economic slowdown and job loss unless countered by a rethinking of our current economic model. Fair taxation for wealth redistribution, four-day work weeks and universal basic incomes are components of an economic system that will see prosperity for all in a setting of lower consumption.

The private sector has an important role in addressing overconsumption, too. Companies should once again take pride in manufacturing high-quality, long-lasting products. They can make their products repairable and grow their operations to include departments to repair, refurbish and recycle their products.

Where there is a lack of voluntary initiative in the business sector, governments need to step in with right to repair policies, regulations prohibiting planned obsolescence of products, and mandatory recycling of components. Governments also need to regulate advertising to ensure that people are not coerced to spend frivolously on items that will cost them their health and that of the planet.

None of us wants to hear that we cannot take as many vacations to exotic places as we want or buy all the things we can afford (or at least get on credit). But we have to admit that our current five-planet living amounts to stealing resources from future generations to enrich ourselves. Overconsumption is not something that politicians, corporations or individuals want to talk about. However, if we want to maintain a planet habitable by humans, the time to curb overconsumption is now.