Addressing anti-Indigenous racism in our health care system

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended further reading:

Effective Policy Needed to Reduce Alcohol-Related Harms

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended further reading:

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

World Health Organization. Alcohol Fact Sheet

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

The opioid crisis rages on

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended further reading:

Canadian Drug Policy Coalition. Case for Reform

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

Canadian Mental Health Association Ontario. SOS Safer Opioid Supply. 

CBC News. Alberta safe supply committee starts work

Children and Youth in Mental Health Crisis

On October 19, 2021, the American Association of Pediatrics declared a national emergency in children’s mental health. They cited soaring rates of depression, anxiety, trauma and loneliness in American children and youth as reasons for this unprecedented declaration.

The picture is no less grim in Canada. Even before the pandemic, poor mental health was ranked second among threats to childhood in Canada. And suicide is the leading cause of death for children aged 10 to 14 in Canada and the second leading cause of death for youth aged 15 to 24.

Researchers in Ontario found that 70% of school-aged children and 66% of preschool-aged children experienced a deterioration in at least one of six domains of mental health – depression, anxiety, irritability, attention span, hyperactivity, and obsessions/compulsions – during the first wave of the pandemic.  Effects were not equal among all children and youth. Mental health deterioration was worse in those with preexisting mental and physical health problems, autism spectrum disorder and those living in adverse socio-economic circumstances and in racialized communities. Higher rates of social isolation were also associated with worse mental health outcomes.

Schools provide a safe, predictable and structured space for children and youth with opportunities for regular contact with peers and teachers. School closures and public health restrictions took this away. Studies show that symptoms of depression and anxiety in children aged 6 to 18 increased in proportion to time spent in online learning.

Mental health problems can negatively affect learning resulting in lower school engagement, lower academic achievement, and higher school drop-out. Research shows that reading scores worsened during the pandemic especially in younger children. A Dutch study starkly revealed that “students made little or no progress while learning from home.” This effect is particularly true for students from disadvantaged backgrounds.   

Academic achievement aside, children missed out on school sports and other extracurricular activities known to boost physical and mental health. They also missed out on other key health services provided through schools such as nutrition programs, counseling sessions, specialized learning supports, and vaccination programs. 

“We can all play a role in supporting children and youth whether or not we work with them.”

Children and youth are embedded in their families so it is not surprising that children from lower household incomes and lower parental education rates suffered from higher rates of mental health symptoms due to family stresses like parental job loss and food insecurity. Children whose parents were suffering mental health problems were impacted by their parents’ difficulties and vice versa. 

Children who suffer from mental health problems early in life are more likely to have future problems with education, family and social functioning. We need to prioritize their mental health now so that we have a healthy, well-functioning adult generation in years to come.

Educational and health professionals who work with children and youth need to take a family-centered approach. Children in crisis are often holding up a mirror to a family in crisis. Recognizing the root cause of a child’s problems – which may be parental job loss, depression or substance abuse – and supporting families to face this challenge will be more effective than a narrow focus on labeling children with psychiatric conditions and prescribing medication.

We can all play a role in supporting children and youth whether or not we work with them. A positive relationship with a trusted adult is a strong protective factor for adolescents and youth. Even adults who have short but regular, positive interactions with youth who are struggling can make the difference between crisis and resilience.

But it takes more than a village to raise a child. We need cooperation and collaboration at all levels of government – municipal, provincial, federal and Indigenous – to ensure that child and youth mental health and wellness are prioritized and supported.

A national strategy rolled out by the federal government with dedicated mental health funding will be key to reducing disparity in policy and practice across our country. Suicide prevention needs to be integral to the strategy particularly to improve the lives of First Nations, Métis and Inuit youth and adolescent boys who are disproportionately affected.

Provinces need to ensure that continuous and timely access to culturally safe and appropriate mental health services are available to children and youth during all phases of this and future pandemics. School-based programs are key to reaching all children no matter what their background. 

Knowing what we know about the adverse effects of school closures, provinces need to keep schools open safely during pandemics and other emergencies both for academic programs and for extracurricular sports and activities so vital for students’ mental and physical health. 

All levels of government have to support access to adequate social determinants of health – sufficient income, decent housing, healthy food and freedom from racism and discrimination – to make sure that our children thrive during and beyond the pandemic.
Mental health priorities need to be embedded into pandemic and emergency preparedness plans from the beginning, because there is no health without mental health.

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

Further Reading 

American Academy of Pediatrics. AAP, AACAP, CHA Declare National Emergency in Child Mental Health

Children’s Mental Health Ontario. How the Pandemic Impacts Children’s Mental Health

UNICEF. Impact of COVID-19 on poor mental health in children and young people ‘tip of the iceberg

Help wanted in the hospitality industry

There is a scarcity of hospitality workers in Alberta and across Canada. According to Statistics Canada, the number of unfilled hospitality jobs in Canada have almost doubled since before the pandemic. How can we reconcile the labour shortage lamented by the hospitality sector with high unemployment rates across the country?

A recent study by the Canadian Centre for Policy Alternatives (CCPA) might have the answer. Their economic analysis shows that low wage jobs, such as those in the hospitality sector, have higher job vacancy rates and this effect has become more pronounced with the pandemic.

Finding themselves furloughed during the first, second and third waves of the pandemic, hospitality workers had time to take stock of their careers. Many decided that the low pay rate, long and unpredictable work hours, and lack of sick days and holiday pay were simply not worthwhile and have opted for a career change.

According to the CCPA study many have taken jobs in the professional, scientific and technical services sector. They have retrained, started businesses or focused on work that they previously did not have time to do.

Former hospitality workers are speaking out. Many service workers are women and racialized minorities. They endure sexism, racism and sexual harassment as common occurrences in their work day. 

In the United States, the restaurant industry has the highest rate of sexual harassment at five times all other industries. Paying workers less than a fair wage and expecting tipping by customers to top up earnings further entrenches sexualized and racialized exploitation in the industry. 

While many view tipping as a way of encouraging good service and hospitality, it forces a complex power play between workers, employers and customers. Workers have to tolerate mistreatment by customers to make sure they receive a tip to top up their below minimum wage, and employers can reward or punish employees by deciding which shifts they work and consequently how much tip they make.

Nearly half of service workers recently surveyed report symptoms of stress and burnout. Burnout leads to employee turnover and feeds the vicious cycle of worsening work conditions for the remaining workers. Service workers are also having to endure verbal abuse and threats from hostile customers when enforcing public health rules around masking and proof of vaccination. 

“If businesses in the hospitality industry want to survive and thrive after the pandemic, they will have to closely examine their business model.”

Some employers are shining examples of best practices in the industry. We are hearing from some small and medium-size restaurant owners that nearly all their staff came back to work for them after the furloughs forced by the waves of the pandemic. And they did so happily.

There are striking similarities in what these employers say about why. They talk about how much they valued their employees before the pandemic. They talk about having provided them with a living wage, extended benefits and predictable hours. These business owners now have a full workforce and a competitive advantage because they cared about supporting their employees before and during the pandemic.

If businesses in the hospitality industry want to survive and thrive after the pandemic, they will have to closely examine their business model. Businesses dependent on paying rock-bottom wages to undervalued employees and exploiting them for their physical and emotional labour may find that they are no longer viable.

Increasing wages, and passing on the expense to customers, is one option to improve the labour shortage and attract workers back to the industry. Another option is for individual businesses to cut back on hours and capacity so as not to burnout the staff that are currently willing to work in the business.

The provincial government can go a long way in helping out the hospitality industry by increasing minimum wage for service workers and eliminating the need for reliance on tips. This levels the playing field for all businesses and makes higher prices more acceptable to consumers. 

Businesses will still have to take into account that living wages vary across communities and some towns like Canmore have a living wage close to $31/hour for families of two working parents with two children.

No doubt many businesses will be looking to import foreign workers as an answer to their labour shortages. If there is no change to the pay, benefits or difficult work conditions in the industry this simply amounts to exchanging exploitation of Canadian workers for the exploitation of foreign workers. 

It is not sustainable or acceptable for an industry, or indeed a country, to build its economy on the planned and systematic mistreatment of immigrants. The Canadian government will have to provide foreign workers with protection of their labour rights, humane and family-centered immigration policies and a pathway to citizenship if they expect them to move to Canada to do work that Canadians, despite high unemployment rates, refuse to do.

If as a society, we don’t serve the needs of our workers, we may very well find that we will to have to serve ourselves the next time we dine out.

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 Oct 21, 2021. Photo credit by cottonbro on Pexels.com.

Recommended further reading:

Everyone deserves to share in the bounty of our land

As harvest time approaches, many of us look forward to sharing food-laden tables with close friends and family. It is a time of plenty and conviviality.

Sadly, this will not be the case for 13% of Canadians who are food insecure – those of us who do not have access to food of sufficient quantity and quality due to financial constraints.  

Food insecurity exists in a spectrum, from anxiety about not being able to access enough food to eating food of decreased quality to food deprivation. In 2012, 4 million Canadians were food insecure – the highest level since we started measuring food security in Canada.  

The health effects of food security are wide-ranging.  Children may experience short stature, anemia, asthma or even depression or suicidal ideation from lack of access to sufficient nutritious food.  Adults experience a host of physical and mental health problems including heart disease, diabetes, hypertension and depression.  

Even infants suffer from food insecurity because mothers who are nutritionally deprived stop breastfeeding sooner and are forced to switch formula brands constantly based on availability from food banks, sometimes consuming expired bottles of formula due to poor supply.

The relationship between food insecurity and health goes in both directions. Poor food access gives rise to poor health and those who have poor health or chronic disease have less money to pay for food due to decreased ability to earn an income and increased expenses for medications and rehabilitation services.

In adopting the Universal Declaration of Human Rights in 1948, Canada recognized the right to food as an inviolable human right. In 1989, the House of Commons passed a resolution committing the government to the elimination of child poverty by the year 2000. 

“Canada’s main response to food insecurity has been to treat it as a charitable issue rather than a social injustice.”

Yet in 2021, far too many children go hungry in Canada. This is a shocking and shameful state of affairs in a country where economic growth has continued to increase unabated in this same time period and the top 1% of wealthy Canadians have continued to accrue wealth at increasing rates.

Why do we see this paradox of increasing wealth and prosperity on one hand, and deepening hunger and poverty on the other? 

In Canada, as in many other high-income countries, we have adequate resources to support decent living conditions for our entire population but we have a problem with unequal distribution of those resources.

Canada’s main response to food insecurity has been to treat it as a charitable issue rather than a social injustice. 

Prime Minister Trudeau summed up this response succinctly at Thanksgiving last year when he urged Canadians to “consider grabbing an extra item or two for the local food bank” while at the grocery store because “it’s the Canadian way”. 

Food insecurity is not a food problem but money problem. And people who are food insecure are not to be pitied and deemed deserving of our charity, but to be recognized as members of our society who are disadvantaged as a result of prevailing social and economic policies. 

Food insecurity needs to be addressed at its root cause – income inequality.  Policies to improve food security are policies that guarantee an income that individuals and families can live on in a healthy, safe and dignified manner. 

There is no better proof that this works than when we look at the introduction of a guaranteed minimum income for seniors. When the Old Age Benefit was paired with the Guaranteed Income Supplement, rates of food security in seniors plummeted from 28% to 5%.

Raising the minimum wage to make it a living wage, increasing worker’s compensation and social assistance payments to cover the essentials of life and providing a basic guaranteed annual income for all Canadians are policies that are certain to reduce food insecurity.  

Policies to create increased employment opportunities and provide robust universal programs for childcare, pharmacare and affordable housing will also increase the ability of Canadians to spend more on nutritious food.

It should be not the Canadian way to take away people’s dignity so that they are forced to rely on food banks. It should not be the Canadian way to keep people in poverty so that others can feel good by doing charity. The Canadian way is to respect our fellow citizens’ dignity and give everyone an opportunity to share in the bounty of our land.

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 September 16, 2021. Photo credit: Engin Akyurt from Pexels.

Recommended further reading:

Human values unite us

We hear much about polarization in society these days, and with upcoming federal and municipal elections, the rhetoric around what divides us will become heightened. But the truth is that when it comes down to it, Canadians and Albertans have much more in common with each other than politicians and the media will have us believe.

We want to live a healthy, happy and comfortable life. We want fresh air and clean water and a healthy planet that will nurture and sustain us. We want a bright future for our children.

It is hard to argue with these values because they are universal human values. And right now this is very apparent in every community in Alberta. Seeing these values threatened, Albertans are speaking up to defend them. 

The lawn signs say it all. Protect Our Water. Defend Alberta Parks. Protect Education in Alberta. Don’t pull the plug on public health care.

Behind the lawn signs are very concerned Albertans who realize that the people who promised to preserve what’s most important to Albertans have forgotten this now that they are in political office. 

“We need to educate ourselves on the roles of the three main levels of governments, their responsibilities and how they operate.”

Dedicated and engaged citizens are committing to protecting our values, our land and our collective well-being. Faced with a common threat, we are reaching out to other Albertans with similar concerns. But advocating for what we believe in can be difficult and time-consuming. Using strategies to maximize impact will be crucial. 

We can connect with like-minded people who care and want to make change. Collectively we can make our voices louder and make the work lighter by building coalitions.  When people and organizations join together and promote a common cause, our voices become amplified and much harder to ignore.  

We need to look for windows of opportunity that open up for a specific issue. Even if we are advocating for our cause all the time, we need to be prepared to leap at a window of opportunity that presents itself. For example, the COVID-19 pandemic presented an opportune time to ask for improved conditions in Canada’s senior care homes. The tragic death of George Floyd provided an opening to demand action to address structural racism within the police force.

We need to educate ourselves on the roles of the three main levels of governments, their responsibilities and how they operate. This allows us to focus our advocacy on the right audience and tailor our requests to the powers invested in the policymakers we are addressing. For example, changes to senior care homes will need to come from provincial and federal policymakers rather than municipal politicians.

We can identify a policymaker at the suitable level of government who is willing to sponsor our policy request. If we want our town to fluoridate drinking water to prevent tooth decay in children, we can meet with individual town councillors and educate them on the benefits to children’s health from this intervention. It will become quite clear if one or more councillors are sympathetic to the issue and if they will be willing to turn our request to fluoridate drinking water into a motion at a council meeting. Making our request specific to legislation, regulation, programming or funding will align with how councils operate.

Finally, we don’t have to take no for an answer. If we are met with disinterest or opposition, we can reframe our request – if town councillors won’t fluoridate drinking water, then we can ask them to support children’s dental health in other ways by providing funding, services or regulation that ensures that all children can develop healthy teeth. 

And, we can keep making our request at different times and in different ways. The political cycle is four years but our time horizon is much longer. When in the election cycle we make our request can make a difference to the answers we get. A politician vying for election or re-election has different motivations from one who has just been elected.

Let us remember that we all share the same core human values and that there is more that unites us than divides us. When we act as engaged citizens, we are ordinary people who do ordinary things that make an extraordinary impact.

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 August 19, 2021. Photo by Artem Podrez on Pexels.com

Recommended further reading:

Prosperity Now. How Do I Advocate for Policy Change?

Courtney Harris Coaching. 20 Ways to Be An Advocate for Social Change and Transformation

American Dental Association. 5 Reasons Why Fluoride in Water is Good for Communities

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 21st 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. 

Labour productivity is reduced during natural disasters and heat waves and these economic losses can lead to poverty and widening of inequality in society. Globally, climate change causes food insecurity, migration of populations and conflict between groups competing for the same resources such as water and fertile land. 

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. 

Any attempt to modernize Alberta’s coal policy should have the phase out of coal as its focus.

The federal government’s Strengthened Climate Plan to reduce greenhouse gas emissions falls well short of what is required to stay below the 1.5oC target outlined in the 2015 Paris Agreement. To achieve this critical goal, we need to decarbonize quickly with at least a 45% reduction in greenhouse gas emissions from 2010 levels by 2030 and net zero by 2050. Sadly, our greenhouse gas emissions are higher today than they were in 2010 and are not projected to reach even the modest target set by the federal government for 2030.

Carbon pricing is a vital policy tool that forces the fossil fuel sector to pay for environmental and health costs resulting from their profitmaking activities. It also helps level the playing field for the renewable energy sector whose newer technology is currently more costly to develop and put into operation. 

Fortunately, all major federal parties now support carbon pricing but the effectiveness of the policy depends on setting a high enough price on carbon to discourage fossil fuel use and on directly supporting renewable sources of energy. Setting minimum requirements for carbon-free sources of energy in the energy mix and increasing incentives for renewable sources of energy will accelerate a transition away from carbon.

Fossil fuel subsidies are on the decline but still overshadow incentives for renewable energy sources. Income from carbon pricing and a reduction in fossil fuel subsidies can be used to pay for a just transition for individuals and communities that currently rely on the fossil fuel sector for their livelihood. 

The Government of Alberta’s website proudly claims that “coal-fired plants currently generate most of Alberta’s electrical power.” Yet, electricity generated by coal results in more air pollution, mercury release and greenhouse gas emissions than any other source of electricity.

Any attempt to modernize Alberta’s coal policy should have the phase out of coal as its focus. The United Kingdom has shown the world that this can be done quickly and effectively. By dramatically reducing coal use from 40% in 2012 to less than 5% today, they reduced greenhouse gas emissions to the lowest levels seen since 1890. The United Kingdom is projected to be completely coal-free by 2024.

For decades, politicians have heard about the reality of climate change from scientists and about the threats of climate change to our natural world from environmentalists. Yet they have not acted. It is time they heard from us, the people that elect them. We don’t want our government to mount a weak and inadequate response to the biggest public health threat of the 21st century. We need to make our demands for policies to reduce global warming clear to our elected officials at all levels of government. Because healthy people need a healthy planet.

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 July 15, 2021. Photo credit: Anna Shvets on Pexels.com

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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

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