The Engaged Citizen

Destabilizing Alberta’s Healthcare System

If you were already worried about our province’s health care system, you now have far more cause for concern. And if you weren’t worried before, it is time to feel alarmed.

On November 8, 2023, the UCP government announced a major restructuring of the health care system in Alberta. They announced plans to create four new provincial organizations to administer health care services in Alberta divided into the categories of Acute Care, Primary Care, Continuing Care and Mental Health and Addiction.

While health systems in other provinces are moving towards integration, our province is taking a huge step backwards by increasing fragmentation. With the creation of Alberta Health Services (AHS) in 2008, Ed Stelmach’s Progressive Conservative government introduced Canada’s first integrated health system. This approach reduced duplication in the system, closed gaps and increased access to services for rural and remote populations. Operating with a single governing body, it created administrative efficiencies, reduced costs and cut bureaucracy.

Alberta currently has the lowest health administrative costs of all provinces in Canada. Creating four entities to replace one in this restructuring plan will only increase expenses and bureaucracy. The budgeted $85 million dollars is a gross underestimation, and Albertan taxpayers will be paying a lot more for this futile exercise.

“Clearly, the intended outcome of restructuring AHS is to concentrate power in the hands of the health minister and premier.”

There is no doubt that our health care system is in crisis and that AHS needs to address serious issues related to capacity and timely access to care. But, the current proposal for restructuring does not address these issues and will likely make things worse. No plan or funding for recruitment and retention of healthcare workers have been announced. Bringing chaos and instability to the health system takes away from quality patient care as overburdened staff learn new systems and processes. At a time when other provinces, like Ontario and British Columbia, are putting their resources into making working conditions more attractive for health care workers, destabilizing the health care system seriously disadvantages Alberta in recruiting and retaining staff to provide care for Albertans.

Alberta is Canada’s richest province and we can afford adequate investments in healthcare. Instead of policies to subsidize fossil fuel corporations and provide tax breaks for the wealthy, Albertan politicians can use our collective wealth to build more public operating rooms, improve care in nursing homes and invest in health promotion and disease prevention to meet the needs of all Albertans. In this land of abundance, Albertans do not have to live in a constant state of health care scarcity.

Clearly, the intended outcome of restructuring AHS is to concentrate power in the hands of the health minister and premier. The government is poised to take over health care decisions and control over health care workers from AHS. As an agency operating at arm’s length from the government, AHS currently makes decisions that are not politically motivated. But restructuring leaves the health system vulnerable to decisions based on cold calculations of politics and power rather on what is best for the health of Albertans.

There is however some promise in the proposed changes. In the current state, acute care is prioritized while primary care, continuing care and mental health and addictions services get less attention. Having new organizations dedicated to each of these can lift their profile and should be accompanied by adequate resources for these critical components of health care.

Also, Danielle Smith’s promise that every Albertan will have access to a family doctor or nurse practitioner is one that we can embrace and hold her accountable for delivering upon. Her pledge needs to be backed up by action that supports team-based care, provides financial viability for primary care clinics (who operate as small businesses), and allows primary care providers to use their time and energy on patient care rather than paperwork.

We are living in a time of multiple health care crises: ambulance shortages, lengthy emergency room wait times, inadequate staffing and poor work conditions for health care workers and now the destructive restructuring of AHS. These health care crises are not inevitable but a result of political choices, interference and micromanagement. Albertans suffer from a crumbling health care system while politicians making selfish choices, profit and consolidate power.

Regardless of who we voted for, we have a responsibility to hold the current government accountable for providing high quality health care that is accessible, timely and maximizes the value of taxpayer money. We have to demand that health care decisions remain focused on what is best for the health of patients and populations and not on power and political gain.

We have to insist that Albertans experience health care that is seamless and not risk falling through the cracks of a fragmented system. We need to hold the government accountable for recruiting health care workers and treating them with respect so that they continue to provide excellent care right here in our province. We need to tell our government it is time to stop shuffling the chairs on the deck of a sinking ship and start correcting course.

Why a living wage matters

With soaring food prices, unaffordable housing costs and rising energy bills, a living wage becomes ever more relevant for Albertans. Referring to the hourly wage a full-time worker needs to make to pay for basic expenses while maintaining a modest standard of living, a living wage is about ensuring dignity for all those who work and contribute to our economy.

It is not a way of offloading affordability challenges onto employers, but a way for governments, businesses and civic organizations to take collective responsibility for creating livable communities. Living wage calculations are made for specific communities and take into account municipal, provincial and federal tax deductions, financial supports and social services.

Shelter, childcare and food are some of the biggest costs in the calculation of a living wage, and such basic expenses can be significantly higher than what minimum wage can provide. In Alberta, the $15 per hour minimum wage has not increased in the last five years and is not indexed to inflation. So, for Albertans, minimum wage effectively decreases year over year eroding their purchasing power for goods and services.

Figures recently released by the Alberta Living Wage Network show that living wage in several towns and cities in our province is much higher than minimum wage and calculated to be $23.70 in Calgary, $22.25 in Edmonton, and the highest in Canmore at $38.80.

Ensuring that people earn a living wage has benefits for both individuals and society. People who live in adequate housing and can afford to buy healthy food for themselves and their children enjoy better physical and mental health, and raise healthy children. This in turn reduces the burden on our healthcare, social service and justice systems. Additionally, a living wage allows workers to spend money in their communities, supporting local businesses and boosting economic activity.

For employers, paying a living wage is about more than “doing the right thing”, it is about making the right business decision. Savvy employers who pay living wages reap the rewards of their investment. In today’s climate of labour shortages, a living wage not only serves to attract workers during recruitment but also helps retain employees, thus decreasing the costs of rehiring and training. Living wages contribute to employee job satisfaction and overall health, and in doing so increase productivity. With loyal, happy and engaged staff, customers have a quality experience and keep returning.

“But ensuring a living wage is not the sole responsibility of employers.”

Over a hundred employers, from small family-owned businesses to multinational corporations, have joined the Alberta Living Wage Network and committed to paying the living wage. Being certified as a living wage employer gives businesses a leg-up on their competition, signaling to customers that they care about their employees, and want to build sustainable communities with strong local economies.

But ensuring a living wage is not the sole responsibility of employers. Governments need to contribute to reducing the living wage through programs that make housing, childcare, transit and healthcare more affordable.

The Alberta government needs to raise minimum wage to better reflect what it costs to live a decent life in our province. They need to establish better labour standards, guaranteeing paid sick leave to workers and protecting us from the insecurity of precarious work. In collaboration with the federal government, the provincial government needs to provide universally accessible child care and improve access to health services through pharmacare and dental care programs.

Both provincial and federal governments need to make sure that income tax structures support a dignified standard of living. This means a more progressive taxation structure that requires low-income earners to pay very little tax, and high-income earners who can afford it, to contribute more.

Municipal governments can work with other levels of government to further reduce the living wage in their communities. They can support affordable housing projects, expand or create public transit that is affordable, accessible or even free, and provide services that increase food security for residents in their area.

When communities invest the time and energy in calculating a living wage, they are able to provide context to the affordability concerns of their residents. They create an instrument to use in advocating with employers to pay a living wage, and with governments at all levels to provide programs, services and tax breaks to effectively reduce the living wage.

As thoughtful and caring residents in a community, we too have a role to play in patronizing businesses that are certified living wage employers and using our influence with other businesses we frequent to ensure they become certified. Through voting in elections, writing letters to our elected officials and other civic actions, we can call on governments at all levels to strengthen affordability programs.

We must all take responsibility for creating and maintaining communities that are livable and where people and families can thrive. The living wage takes a systems approach to show how businesses, governments and civic organizations can work together to make sure that we can all live a life of dignity and fully participate in our community.

Cleaning up our act in healthcare

The healthcare system is tasked with saving lives and improving the health of populations and individuals. But what if it is contributing to environmental degradation and global warming, and making us sicker in the process?

The healthcare system is the fifth largest producer of greenhouse gas emissions globally and contributes 4.6% to all greenhouse gas emissions in Canada. Comprised of hospitals, community clinics, pharmaceutical manufacturers and public health, the healthcare system is also a major contributor to waste production.

Greenhouse gases are emitted all along the supply chain of pharmaceuticals and medical equipment from manufacturing and transportation to consumption and disposal. Heating, cooling, ventilation and hot water systems of healthcare facilities further contribute to the carbon footprint of the industry.

Anesthetic gases such as desflurane emitted into the atmosphere from hospital rooftops have 20 times the climate warming effects of other greenhouse gases – using one bottle of desflurane is the equivalent of burning 440kg of coal.

With respect to solid waste, a study of 110 hospitals done in 2019 in Canada found they generated 87,000 tons annually. Plastic syringes, single-use surgical equipment, containers and packaging are sent to landfills or end up scattered on the land or in rivers and oceans.

Fifteen percent of healthcare waste is biohazardous – either toxic or infectious – and must be incinerated. In addition to greenhouse gases, incineration releases dioxins and furans which are carcinogenic to humans. Heavy metals emitted into the environment during incineration contribute to air pollution and increase the risk of heart attacks, strokes and death from cardiorespiratory causes.

Healthcare systems exist to prevent unnecessary deaths and treat illnesses, yet the way they operate can damage the health of our planet and our population. With direction from leaders and decision-makers and encouragement from consumers, healthcare systems can pivot to operating in ways that maintain the health of the planet and the people they serve.

Representing approximately 12% of Canada’s gross domestic product (GDP), the healthcare industry has immense purchasing power and can put pressure on suppliers to use sustainable practices in the manufacture of their products including reducing packaging, eliminating environmentally unfriendly chemicals in the manufacturing process and reducing the weight of items while maintaining quality.

The federal government can establish minimum environmental standards and practices for provinces and territories in healthcare provision as a condition of the Canada Health Transfer and hold provinces accountable for reducing healthcare-related waste and carbon emissions.

Provinces have set up health authorities to operate healthcare facilities, with Alberta Health Services being the single health authority in our province. The provincial government can stipulate that, in fulfilling its mandate, Alberta Health Services must follow environmental standards and practices that enhance the health of Albertans; that they must act to reduce greenhouse gas emissions, reduce waste and reduce the release of toxic and carcinogenic materials into the air we breathe.

We can change our own behaviour to reduce medical waste and decrease stresses on our overburdened healthcare system.

Operating rooms produce more than 30% of waste in healthcare facilities and use five times more energy per square foot than other parts of the hospital. Hospitals providing surgical services can reduce their environmental impact by reducing use of anesthetic gases (particularly desflurane), sterilizing and reusing all surgical instruments and using washable bed linen and gowns. Furthermore, sterilizing biohazardous waste prior to disposal in the landfill will have less environmental impact than incineration.

Ten to fifteen percent of hospital waste is food waste and buying policies that minimize waste, as well as composting and donation of excess food to rescue programs, can work to reduce the amount of food wasted.

Health clinics in the community, whether they provide primary or specialist care, dental care or physiotherapy, can do their part by reducing, reusing and recycling wherever possible including encouraging patients to return reusable products such as crutches and orthopedic boots, buying items in bulk to reduce packaging waste and sourcing products from ecofriendly manufacturers.

As clients of the healthcare system, we too have a part in reducing medical waste and we can make our concerns for personal and planetary health known to our healthcare providers and encourage the hospitals and clinics we visit to implement greener measures.

We can change our own behaviour to reduce medical waste and decrease stresses on our overburdened healthcare system. We can take care of minor self-limiting illnesses like colds at home and reduce waste by not asking for unnecessary medications such as antibiotics for viral illnesses.

We are all consumers of healthcare, starting most often with birth in a hospital setting and ending with needing health resources to deal with sudden disease, injury or prolonged illness at the end of life. Dedicated to improving the health of individuals and populations, the healthcare industry is also a contributor to negative environmental and human health effects. We need to acknowledge that human and planetary health are inextricably linked and work together to protect both. It is time to clean up our act.

Overtourism is crushing us

There is an elephant in the room, and no one dares name it. Instead, in the Bow Valley we prefer to talk about traffic congestion, housing scarcity, labour shortages and environmental degradation, as if these are discrete, unrelated problems that each call for a different set of solutions. Our denial of the root cause of all these problems will lead to our demise. We are treating each symptom in isolation, without diagnosing the cancer that is eating away at our very core.

When it comes to overtourism, we are in good company with many world-class destinations like Barcelona, Venice, Machu Picchu and Angkor Wat. With a growing world population, an expanding global middle class and cheap airline travel, overtourism is being recognized as a threat to communities around the world.

Overtourism manifests itself in many visible and invisible ways. Crowding, long-line ups, traffic congestion, and resident and visitor dissatisfaction are the more visible and palpable manifestations. However, there are impacts that are not so readily apparent: climate change, housing scarcity, lack of adequate health services, inadequate infrastructure, and loss of culture and heritage.

If we want our tourism industry to be sustainable into the future, we need to rethink the way we do business. We cannot destroy the very thing that makes the Bow Valley an attractive destination. We have to protect and preserve our natural environment and keep alive the magic of our mountains.

We need to value quality of visitor experience over quantity of visitors. Our communities are constrained by land, infrastructure, ecological carrying capacity and emergency, social and health services. This means we must plan for the optimal visitor volume we can comfortably and safely host for excellent visitor experiences.

Evidence from multiple sources tell us that this optimal visitor volume has been exceeded and needs to be recalibrated. We do not want our destination brand to be associated with congestion, costliness and negative visitor experiences. We will also need to take the long view and make sure that how we live today respects the needs and quality of life of generations to come.

We can start by calling on all levels of government to align their policy to support tourism that has true benefits to locals, our province and our nation without degrading our communities and the natural environment. We can insist that government organizations work together, and with businesses and civil society, in a purposeful and coordinated way to set and achieve common goals of nature conservation, climate action, economic prosperity and preservation of cultural heritage.

“How can we attract travelers who share our values of preserving and protecting nature and will leave our place better than they found it?”

We can look to places like Bhutan who base their tourism policy on high-value, low-volume tourism and clearly articulate how the tourism industry will benefit their people, protect their cultural treasures and conserve their natural environment for future generations.

We can ask ourselves what high-value, low-volume tourism looks like for the Bow Valley. How can we attract travelers who share our values of preserving and protecting nature and will leave our place better than they found it? How can we pivot from our high-volume industrial tourism to high-value regenerative tourism?

To do so we may have to redefine what success looks like. We have to monitor the environmental impacts of tourism on our destinations and adopt sustainability accounting to report not only the revenue generated by tourism but also the true environmental, economic and social costs. This is the only way to reveal the net benefit of tourism.

High-value refers not to expensive or exclusive destinations but rather the benefit we derive from tourism activity. We need to keep our mountain areas accessible to all Canadians irrespective of socioeconomic status.

To this end, we will need to rethink and reframe our economic model, realizing that endless growth cannot happen within fixed legislative, ecological and social limits and cannot support meaningful climate action. By all measures, the Bow Valley is an economically prosperous place, but wealth and prosperity needs to be better distributed to ensure that residents benefit equitably.

Finally, as travelers ourselves, we don’t want to be the problem in other places. We can book fewer airline flights, use public transit and visit popular destinations during shoulder or low season to ease congestion. We can also choose slow (and less frequent) travel, head to destinations closer to home and explore areas that are less visited but nonetheless special in their own right.

Other policy solutions include removing subsidies for airline fuel, and limiting access and activities to protect natural and cultural integrity when efforts to smooth tourists out over time and place don’t work. The latter strategy was recently adopted at the Acropolis in Athens, and Moraine Lake closer to home.

The Bow Valley is not the only place to suffer from overtourism, but we can set ourselves apart by how we respond to this challenge. We only have to look at Ankor Wat and Machu Picchu or the Galápagos and the Thai islands to see what horrific cultural and ecological damage results from uncontrolled tourism.

By acknowledging the problem early, working together to innovate solutions and fiercely protecting our natural environment, we can act within a narrow window of opportunity to ensure that generations to come will benefit from the bounty of tourism in our region.

By Vamini Selvanandan© 2023. 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 21, 2023. Photo credit: Cu00e1tia Matos on Pexels.com

Let’s get out and vote!

With a provincial election just days away, we can reflect on how far democracy has come in Alberta in the last decade.

For most of its existence, Alberta had only two parties in power (each for more than 35 consecutive years). But in 2015 and in 2019 the governing parties changed in rapid succession. Albertans started claiming their right to have choice in who best represents their interests.

In the 2023 provincial elections, there are fourteen parties running candidates. Two parties have candidates in all ridings (Alberta New Democrat and United Conservative) while two other parties (Wildrose Loyalty Coalition and Green) are running candidates in about half the provincial ridings, giving Albertans diversity of candidates and choice in representation.

On the campaign trail, we see the leaders of the two front-running parties passionate about policy, committed to winning and not afraid to make bold promises. They are also both women – another sign of progress. But healthy democracies need more than strong leaders, they also need engaged citizens – people who are willing to participate in the political process and elect decision-makers who can best represent them.

There are many factors that affect how people choose to vote. Voter demographics such as socioeconomic status, gender, education, religion and racial identity all play a role. Some people vote for a party from a sense of allegiance or loyalty, sometimes generational within families.

Others vote on the basis of the policies and platforms unveiled by political parties particularly related to issues that are most important to them such as healthcare, education, jobs or income. Still others consider the personal appeal of the party leader, the strength of their local candidate or their values or emotions.

Economic factors also play into people’s voting decisions. Economic upswings tend to favour the incumbent party whereas an economic downturn brings about change in power, even when economic fortunes are determined by global events and forces outside the influence of provincial governments such as oil prices, collapse of financial institutions or pandemics. Finally, people may choose to vote strategically, casting a ballot for their second choice knowing that their first-choice candidate does not have a chance of winning.

Given all these different factors affecting voting, how is one to decide?

First, you have to cut out the distractions – campaign advertisements that play on emotions such as fear and anger, media stories that focus on leaders’ perceived personality strengths or flaws and fluctuations in the economy that cannot possibly be influenced by provincial politics.

“There are resources you can turn to in making your choice.”

Second, you have to identify issues that truly matter to you and your fellow Albertans and inform yourself of how each party plans to address them if elected to power. Finally, you have to make a calculation as to how likely the party leader will be effective and sincere in following through on promises. If this sounds like a difficult task, it is. Exercising your civic duty of voting is a serious responsibility.

There are resources you can turn to in making your choice. Political parties have their election platforms on their websites for the general public to access. On-line tools such as CBC’s Vote Compass can help you asses which major political parties align with your views on election issues that are important to you. You can also reread previous columns of The Engaged Citizen (accessible online) to remind yourself of evidence for various social and health policies that political parties may be proposing.

In addition to getting out and voting, we need to make known our support for electoral systems and political practices that strengthen democracy. For example, our flawed first-past-the-post electoral system allows parties who may receive less than 40% of the popular vote to have 100% of the power (think about the Liberal majority win in the 2015 federal election).

Proportional representation is an alternative model that ensures fair representation for smaller parties who may garner for example 10% of the total vote, but only win a single seat in the legislature. This electoral system leads to increased collaboration and innovation in policy-making and less polarization among parties and voters.

Party practices that encourage women and people from diverse backgrounds to stand as candidates, and support them to win their campaigns, also benefit the democratic process. When people from traditionally underrepresented groups are at the governing table, they help make decisions that improve justice and fairness, helping create an equitable society that benefits all. When people see their identities represented, their sense of political efficacy increases and civic participation receives a boost. When diverse perspectives are represented, problem-solving is enhanced and creative solutions emerge. Democracy in Alberta has come a long way since the province was created in 1905. But there is still a lot of work to do. On May 29^th, no matter which party gets elected, let’s make sure that democracy emerges the clear winner.

By Vamini Selvanandan© 2022. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the RMOToday.ca on May 18, 2023. Photo credit: <someone> on <link>

Albertans deserve better protection

Since 2016, more Albertans have died of opioid poisonings than COVID-19 deaths in the province. While the provincial government, albeit reluctantly, followed public health advice to keep Albertans safe from COVID-19 deaths and hospitalization, their approach to the concurrent pandemic of opioid deaths completely misses the mark.

The opioid crisis is a poisoning crisis rather than an overdose crisis. Those who die of opioid poisoning do not intentionally take too much of their drug of choice. Rather, they take a usual amount of a toxic supply. Street drugs in distribution since 2016 contain potent, lethal and unpredictable doses of narcotics.

The UCP government recently announced an increase of 8,000 treatment beds for Albertans suffering from substance use disorders and five long-term treatment facilities to help people make lifestyle changes and build life skills. While these changes will increase access to Albertans seeking rehabilitation and treatment, they have limited value in reducing deaths from opioid poisoning.

Data from the United States shows that only 10% of people with active substance use disorders enter treatment, and less than half complete it. Harm reduction services are needed for the 90% or more people who cannot or will not enter treatment. A recovery-focused approach implies that if you cannot stop using, your life is not worth saving.

The UCP government is not preventing Albertans from dying due to the toxic street drug supply. They closed safe consumption sites in Lethbridge, Edmonton and Calgary precisely when more needed to be opened to keep Albertans safe. They limited access to a safe supply of pharmaceutical grade narcotics to specialized clinics in four cities. This effectively cut off access to rural Albertans and forced those with previous access from clinics and pharmacies, closer to home and across the province, to travel daily or go without this life-saving treatment.

“They recognized that decriminalization cannot be an isolated strategy”

A more comprehensive public health approach is needed for keeping people and communities safe and healthy. In July 2020, the Canadian Association of Chiefs of Police (CACP) endorsed a framework addressing the opioid crisis that consisted of supervised consumption sites, safe supply, diversion programs and decriminalization of simple possession of illicit drugs.

They recognized that decriminalization cannot be an isolated strategy, but one embedded in a framework of treatment, harm reduction, enforcement and prevention. With decriminalization, possession of small quantities of illicit drugs remains illegal, but fines and warnings rather than criminal conviction are the punishment. Production and trafficking of illicit substances will continue to be criminal offences that are actively enforced and prosecuted.

Decriminalization allows people who use drugs to access services and supports without fear of being arrested. It also provides police the opportunity to connect them with life-saving resources instead of charging or imprisoning them. Diversion from criminal consequences to important community resources such as treatment facilities, and housing and employment supports, will have a positive impact on the individual’s life. When people who use drugs get their health and social needs addressed, they are not forced into theft, trafficking or sex-work to maintain their substance use. Diversion enhances community safety by reducing crime.

Most fatal opioid poisonings occur when people use drugs alone. CACP and public health officials advocate for the establishment and continuation of supervised consumption sites. These provide a clean and safe environment for people to use drugs knowing that they have access to emergency services and trained personnel. Supervised consumption sites reduce the risk of overdose, decrease the spread of infectious disease such as HIV, and connect people with services like health care, housing and employment. They also have benefits for the community by reducing public drug use, fewer discarded drug use equipment littering streets and decreased strain on emergency medical services.

Ensuring a safe supply of opioids is also a crucial strategy in ending the overdose crisis. Being unregulated, street drugs were always at risk of being contaminated but the emergence of fentanyl in the illicit market has made the supply unpredictable and lethal. In 2018, the federal government committed to providing safer alternatives to the contaminated drug supply on the street, yet Canadians continue to die from opioid poisonings because access to these therapies is severely limited to a few isolated clinics across the country.

When people who use drugs have a secure and predictable supply of pharmaceutical-grade opioids they are much less like to die of opioid poisoning. They are also less likely to be forced into criminal activity to support their drug use, improving public safety for all in the community.

Alberta has the second highest per capita opioid deaths in Canada, after British Columbia, where simple possession of illicit drugs has been decriminalized following endorsements by the British Columbia Chiefs of Police and the CACP. It is perplexing then that the Alberta Chiefs of Police went on record a few weeks ago opposing decriminalization in Alberta.

We need to demand the same level of protection and public safety given to other Canadians. Albertans who use drugs deserve the chance first, to be alive and healthy and then, if they are ready, chose the path to recovery.

By Vamini Selvanandan© 2023. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on March 22, 2023. Photo credit: Anna Shvets on Pexels.com

Health care reform is within reach

Last week, the federal government pledged an additional $46 billion over 10 years to provinces and territories for health care delivery. Primary care, health care workforce, information sharing and mental health and substance use were cited as priority areas.

This much-awaited funding announcement left more than a few people disappointed. Provincial and territorial premiers were disappointed with the amount being offered. Indigenous leaders were excluded from negotiations despite their requests for to be included. And burnt-out health professionals did not receive the immediate help they needed to continue performing their demanding jobs.

Compared to resource-poor countries with low or middle incomes, we are indeed fortunate to have the universal health care system that we do, with access to well-trained health professionals, essential medications and cutting-edge technology. But if we compare ourselves to high-income peers, our health care system falls woefully short.

Despite being one of the top spenders on healthcare among OECD countries, Canada ranks near the bottom on availability of health professionals, hospital beds and equipment. Canadians spend 11.3% of GDP on health care (second only to Switzerland among OECD countries with universal health care), yet we rank near the bottom – 25^th out of 26 countries – in number of hospital beds per 1,000 people, and second to last in the number of physicians per 1,000 people.

Given this under-resourcing, it is no surprise that we perform poorly on measures of timely access to care. Canada ranked last or next to last on four of five indicators of timeliness of care such as time to see a specialist or time waiting for surgery.

But we have the knowledge and the tools to make positive changes in the health care system to improve the well-being of Canadians. In a report entitled Taking Back Health Care, Dr. Jane Philpott (former federal health minister), Dr. Alika Lafontaine (current president of the Canadian Medical Association) and colleagues map out the road to health care reform.

“Primary care, traditionally provided by family doctors, needs to be broadened”

The report calls for every Canadian to be guaranteed access to a primary care provider or team within 30 minutes of where they live or work. Access to primary care should be a universal right for all Canadians in the same way that access to schooling is a right guaranteed to all children in our country. This recommendation is based on evidence that people with a formal connection to a primary care provider live longer, healthier and happier lives.

Primary care, traditionally provided by family doctors, needs to be broadened to include care by nurse practitioners, physician assistants and teams of health care professionals. A team approach with other professionals such as dietitians, social workers and mental health counsellors further improves health outcomes. Virtual care also needs to be integrated in a way that improves access to care and supports continuity of care for all.

The second pillar of health reform outlined in the report rests on using health data to both identify the health needs of Canadians that require funding and to monitor improved health outcomes as accountability measures for funding. To achieve this, health data needs to be collected and shared seamlessly within provinces and territories and across the country.

Government leaders need to use legislation and regulations to set standards for safe, effective, high-quality care and mandate their health agencies to share data, research and best practices. Also, Canadians need to have access to their own health data and be empowered to use this information safely and effectively to improve their health.

The third pillar acknowledged in the Taking Back Health Care report is recognizing health as an important component of the Canadian economy. We saw all too clearly during the COVID-19 pandemic, that when the health of a nation is threatened, the economy suffers immensely. Protecting and reinforcing the health of Canadians through robust health systems and emergency responses is essential to keeping the economy thriving. Health investments pay dividends by providing healthy workers and a stable environment for economic activity.

Health care also plays an important role in the Canadian economy by providing jobs, income and purchasing power for many. Health care innovations in technology, pharmaceuticals and vaccine manufacturing provide reliable access to essential health supplies and therapies and make us less susceptible to supply chain and geopolitical disruptions.

Cracks in the very foundation of our healthcare system existed before the COVID-19 pandemic, but they have now been exposed in a most distressing way. Canadians are mounting pressure on politicians for change, and in the aftermath of the pandemic, every level of government wants to be seen acting to improve the health of its voters. We have the knowledge, the tools, and the collective will to make it happen. Now is the time for meaningful health care reform.

By Vamini Selvanandan© 2023. 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, 2023. Photo credit: Anna Shvets on Pexels.com

Canada must resolve to do better

It is a new year and a time of renewal. Many of us have made personal resolutions to eat healthier, produce less waste, and spend more time with family and friends. But what about as a country – what can we, as Canadians, resolve to do better in 2023 and into the future?

Certainly, there are things that Canadians do well. We have a resilient economy, a universal health care system and a policy of multiculturalism that celebrates and values diversity. But there are several areas in which we are distinctly underperforming and must seek to do better.

Take for example our relationship with countries less prosperous than Canada. We provide them with financial aid on the one hand, but on the other, we exploit their citizens to serve our own needs.

Before the pandemic, the federal government was looking to scrap the Temporary Foreign Worker program due to serious concerns over a lack of basic rights and protections for migrant workers. But due to labour shortages, the percentage of temporary foreign workers that employers are allowed to hire has now been increased.

A strong and resilient Canadian economy cannot be built on the blood, sweat and tears of workers from less prosperous countries. If we invite people from other countries to help bolster our economy, we have to treat them with the respect they deserve and give them the same rights we enjoy – the right to live in Canada with family, the security of permanent residency and choice of job and employer.

Ultimately, federal, provincial and territorial governments have the responsibility to ensure that our economy is built on the foundations of a well-trained, adequately paid Canadian workforce. Setting living minimum wages, providing adequate and affordable training opportunities for Canada’s youth and improving working conditions will address labour shortages in a more sustainable and effective way than turning to the exploitation of foreign workers.

“We need to focus on Canadians caring for Canadians”

Canadian provinces have been recruiting nurses and doctors from low-income countries such as South Africa and the Philippines to counter labour shortages within the healthcare system. These countries spend their scarce resources training health professionals to care for their own citizens only to have Canadian recruiters steal these precious human resources to work within the Canadian system.

We need to focus on Canadians caring for Canadians and make sure that we are training, recruiting and retaining our own health professionals to work in our healthcare system. Policies such as providing healthy working environments, decreasing administrative burden, and reducing tuition for post-secondary training programs can all contribute to a stronger homegrown workforce.

Turning to our record on the environment, Canadians are one of the highest per capita carbon emitters in the world. We consume more fossil fuels by the choices we make in terms of food, transport, housing and consumer products. The average Canadian produces six times more carbon emissions than the average Indian.

We can cut our carbon emissions by reducing our use of fossil-fuel cars and opt for electric cars, public transit, walking or biking. We can also choose to live in smaller houses thereby reducing the amount of carbon emissions from construction and heating of our living spaces. Eating less meat and dairy, particularly beef and cheese, will help reduce our per capita carbon footprint from food. We can also buy fewer things and support corporations that offer consumer products that last longer, are reparable and emit less carbon in their construction and operation.

Governments cannot simply sit back and wait for individuals and corporations to make changes to meet the targets of the Paris Agreement. They can pitch in with policies to accelerate change.

Governments need to provide regular and dependable public transport and they have to eliminate oil and gas subsidies immediately, putting that funding towards renewable energy sources. Canada also needs to assume accountability for the disproportionate impact we have on global warming and make reparations to lower-income countries who are most affected by our carbon-rich lifestyles.

Turning to Canada’s relationship with Indigenous peoples, it is notable that only 13 of the 94 calls for actions from the Truth and Reconciliation Commission have been completed in the seven years since the report was released. The snail’s pace of progress makes one question Canada’s commitment to reconciliation with Indigenous people.

Sincere commitment would involve data sharing and transparency on the part of the federal government so that the true picture around issues such as Indigenous poverty, child welfare and funding for First Nations schools can be known.

Adequate resources, not empty promises, need to be made available to Indigenous communities to make a tangible difference in their well-being. And most importantly, the federal government needs to abandon its paternalistic “we know best” approach and trust in Indigenous peoples’ ability to self-govern and take care of their own people.

This year, Canada needs to do better in treating our people and our planet with deserved care and respect. This responsibility lies squarely on our collective shoulders. Are we up to the challenge?

By Vamini Selvanandan© 2023. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on Jan 24, 2023. Photo credit: Kaique Rocha on Pexels.com

Higher education is worth the investment

Fewer students are enrolling in postsecondary education since the onset of the COVID-19 pandemic. Increasing tuition, high debt loads and uncertain COVID-19 learning environments are discouraging young people from pursuing higher education. But what are they missing out on and what is society losing by this disturbing trend?

We know that people with higher levels of education – be it from university, college or polytechnic – have higher earning power throughout their lifetime. They have better access to housing, nutrition, and healthcare and live longer, healthier lives. They can afford better educational opportunities for their children and for those who start off with few advantages, postsecondary education represents the best chance at breaking the cycle of poverty.

Society too benefits. Increased levels of innovation and creativity are seen in countries where citizens have better access to higher education. People who earn more money as a result of postsecondary education pay more taxes throughout their lifetime, more than paying back the public investment made in their education.

Despite this, government funding for universities and colleges has been decreasing steadily. In Alberta, we have seen a 31% drop in funding over the last 5 years. Operating grants provided to universities by the provincial government has dropped from 81% to below 50% since the mid-1980s. This is in contrast to the province of Quebec where funding has increased by 16% in the last five years and the province funds well over half the operating budgets of universities and colleges.

When funding is cut, postsecondary institutions resort to tuition hikes and recruitment of high-paying international students to make up the shortfall. High tuition fees are the biggest barriers to entry into higher education for students from disadvantaged socioeconomic backgrounds. This only increases the divide between haves and have nots in our society. Also, inequality on a global level is worsened when exorbitant fees are collected from students coming from lower-income countries, like India and Nigeria, to subsidize Canadian students.

When public funding is reduced, postsecondary institutions increasingly turn to corporations and private donors to fund operations. This results in the public good of higher education becoming more corporatized.

With corporate-style management, high-salaried executives, managers and consultants are hired by postsecondary institutions while cuts are made to operational and faculty positions. Workers suffer from low pay and difficult work conditions, and retiring tenured faculty are replaced by sessional instructors without job security or benefits. Postsecondary institutions also become beholden to their funders allowing corporations and donors to become decision-makers on campus and set the research agenda of universities.

Higher investment by governments and the introduction of a federal Post-Secondary Education Act can limit corporate and private donor control over universities and colleges. Principles such as universality, accessibility, comprehensiveness and public administration, similar to the Canada Health Act, can be specified in this legislation as well as freedom of speech protections for learners, researchers and workers.

“Several countries such as Norway, Denmark, Germany, Ecuador, Venezuela and Cuba provide free postsecondary education.”

Canada ratified the International Covenant on Economic, Social and Cultural Rights in 1976 acknowledging that education was an essential public good that needs to be accessible to all. Canadian officials recognized the right of every person to obtain free primary and secondary education, and promised free postsecondary education. Nearly 50 years later, the latter has not been realized.

However, several countries such as Norway, Denmark, Germany, Ecuador, Venezuela and Cuba provide free postsecondary education. While there is huge disparity in wealth between some of these countries, what they have in common is the political will to act on the understanding that postsecondary education benefits their citizens and their societies.

Tuition fees are considered a regressive tax levied on students because those from lower socioeconomic backgrounds pay relatively more for their education than students from richer families. Progressive taxation on the other hand recognizes that corporations and the wealthy should pay their fair share for public goods like education which has benefited them in accumulating their wealth through their educated workforce.

Free tuition can also be paid for by restructuring current government spending on education tax credits and Registered Education Savings Plans that tend to benefit richer families. Students from low-income families are unable to take advantage of these initiatives and rely on student loans to finance their higher education. With loan interest included, indebted students pay two to three times more for their education than those who were able to pay for their education up front.

Student loans need to be eliminated and replaced with non-repayable grants for students in need. The government of Newfoundland and Labrador eliminated student loans for an entire cohort of students in 2015 and this allowed them to contribute to the economy sooner upon graduation by starting businesses, working in jobs for which they were qualified and purchasing cars and houses – all milestones they would have had trouble achieving if they were weighed down by high debt loads.

If we don’t act now to bolster the ability of our young people to access postsecondary education, we risk negative economic and societal effects that will continue well into the future. While individual students enjoy the private returns of scholarship, society as a whole reaps the public rewards of wise investment in education.

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 December 19, 2022. Photo credit: Photo by Pixabay on Pexels.com

Alberta Health Services needs strengthening, not dismantling

During her campaign for leadership of the UCP party, Danielle Smith made clear her plans to overhaul Alberta Health Services (AHS). She threatened to fire the entire AHS board and appoint an interim health commissioner reporting directly to herself and the health minister. While concentrating power into her hands, she says she wants to decentralize health care delivery to local decision-makers.

To understand the implications of her proposals, we first need to understand the history of health care delivery in Alberta and how Alberta Health Services came about.

In the early nineties, health services in Alberta were delivered by over 200 separate administrative bodies including hospital, long-term care and public health boards. In 1994, these were replaced by seventeen regional health authorities and then further consolidated to nine a decade later.

Alberta Health Services was established in 2008 by the conservative government of the time as Alberta’s single health authority, making it Canada’s first integrated health care system. Providing health services to more than 4.3 million Albertans, AHS remains the largest health authority in the country. AHS is governed by a single board of directors, and carries out the health mandate set by Alberta Health (the provincial ministry of health) while operating at arm’s length from government.

A single structure for health care governance and delivery has its advantages. A single authority can streamline health care services thus eliminating duplication and addressing gaps in services. This approach increases access to services for rural, remote and difficult-to-reach populations and improves equity in service delivery across the province. Administrative efficiencies are created and accountability is increased when governance is limited to a singular board.

The COVID-19 pandemic put the effectiveness of Alberta’s health service delivery system to the test. A review of Alberta’s COVID-19 pandemic response conducted by KPMG in 2020 highlighted the structural advantages of a single integrated provincial authority.

The review found that decision-making was swift and AHS had the ability to make system wide-changes to increase capacity in acute care beds province-wide and assure patients in small communities that ICUs in bigger cites would receive them. One set of leadership ensured one decision-making process and fair and equitable access to COVID-19 testing and treatment for all Albertans.

“Overhauling the health care system during multiple health care crises will be disastrous.”

With centralized procurement and distribution of PPE by AHS, health care workers even in remote parts of Alberta were supplied with high-quality PPE at all stages of the pandemic. Similarly, distribution of COVID-19 testing kits, vaccines and medications to treat COVID-19 has been efficient and AHS has exercised its significant purchasing power leading to cost savings and efficiencies.

AHS has health data from across the province and uses real-time evidence for pandemic modeling and informed decision-making. As a single health authority, AHS has been effective in creating and disseminating treatment pathways for COVID-19 infections to health care providers, ensuring that all Albertans receive the most up-to-date, evidence-informed treatment.

As we enter the third winter of the pandemic, we are facing a surge in COVID-19 cases as well as resurgence of severe influenza and children’s respiratory illnesses. Hospitals are filling up, staffing shortages loom large and burnout among health care workers is high. At the same time, Albertans are finding it increasingly difficult to find family doctors in the community.

Overhauling the health care system during multiple health care crises will be disastrous. It will lead to unnecessary added burdens for staff and remove the focus from providing quality patient care. Instead, now is the time to strengthen Alberta Health Services.

The provincial government needs to implement policy to increase recruitment and retention of health care workers. It needs to invest more in training health care professionals so that current and future gaps can be addressed and the government needs to build respectful relationships with organizations representing health care workers so they continue working in our province.

AHS too needs to do its part in reviewing and learning from its handling of the pandemic response. Patients delayed seeking care for serious symptoms like chest pain early in the pandemic and this led to poor outcomes and preventable deaths. Messaging to the public about seeking care for urgent conditions should have been stronger and clearer in the early days of the pandemic.

AHS also needs to increase connections to local communities and work with them to identify local issues and provide public health solutions that are context-specific. Public health doctors are concentrated in big cities and not on the ground in rural and remote areas to understand the unique circumstances of these communities.

The health care deficit has worsened during the pandemic as surgeries were cancelled, cancer screening declined and opioid-related deaths increased. AHS needs to focus on increasing resources to address these care gaps and ramp up services in surgery, cancer treatment and screening, and addictions and mental health treatment.

Supporting and strengthening health care is going to be a key issue in the spring provincial elections. All Albertans want a high-quality health care system that is there for them when they need it. Any party hoping to win the election will have to have a robust plan to strengthen – not dismantle – our health care system.

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 Nov 17, 2022. Photo credit: Photo by Pixabay on Pexels.com