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 29th, 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 – 25th 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

Recommended further reading:

Primary health care in crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Food for a healthy planet and healthy people

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Cleaning up our act on plastic pollution

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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