Rethinking our understanding of mental health and mental illness

Canadians were in a mental health crisis well before the COVID-19 pandemic. But as with many other things, the pandemic served to shine a spotlight on the depth and breath of this serious issue.

According to Statistics Canada, a shocking 1 in 3 Canadians suffers from mental illness during their lifetime. Five to 10 percent of Canadian children are said to have ADHD, over 10% of adults are reported to have a major episode of depression during their lifetime and 25% of adults are reported to have an anxiety disorder. 

But this has not always been the case. Before the 1970s, depression was a relatively rare condition and mainly associated with severe impairment and hospitalization. Bipolar disorder was even less common and attention deficit disorder did not exist at all.

Underlying today’s alarming mental illness statistics is a hidden epidemic of overdiagnosis of mental illness and overprescription of psychoactive medication to both adults and children. 

Much of what we are diagnosing and treating as mental illness today is the medicalization of normal life. Grief, emotional pain and being uncomfortable are a normal part of the human condition and are expected responses to life events such as the loss of a loved one or a stressful situation.

“There are no objective, scientific, or biological tests for psychiatric disorders”

Some of what we label as mental illness is a natural response to very difficult or unfair life circumstances. We characterize external problems such as poverty, oppression, or racism as internal problems requiring medication to “fix” the individual, rather than directing efforts at correcting the societal problems that put some people into situations that are toxic to their physical and mental health.

We know, for example, that Canadians in the lowest income bracket are 3 to 4 times more likely than the highest income Canadians to be labelled as suffering from mental illness. Data from the United States indicates that vulnerable populations are medicated with psychoactive medications at higher rates than the rest of the population. Children in foster care, those involved with the criminal justice system and black and Hispanic boys are systemically administered antipsychotics or other drugs to control their behaviour. 

There are no objective, scientific, or biological tests for psychiatric disorders. Difficulty in diagnosis of mental illness makes it easy for doctors and patients alike to confuse normal responses to difficult or toxic life situations with true mental illness. While physical ailments often have laboratory or imaging studies that can help confirm or refute a diagnosis, psychiatrists rely on symptom checklists based on the opinion of a few select psychiatrists.

Pharmaceutical companies have confounded the situation. Using sophisticated marketing techniques to manipulate study results, influence expert opinion and mislead the public, they have spun a story they want us to believe about mental illness. 

Even today many doctors and laypeople still think that chemical imbalances in the brain cause mental illness. But decades of neuroscience research have failed to find evidence to support the neurotransmitter imbalance theory, showing instead that psychoactive medications disturb rather than restore normal brain function.

Drugs provide a quick but temporary fix to mask or numb emotional pain and have serious side effects in the long-term. For a significant proportion of people psychoactive drugs are difficult to stop. So, how can we deal with mental health problems in a more evidence-based and less harmful way? 

Firstly, if we experience emotional pain or discomfort ourselves, we can accept that this might be a normal part of grieving a loss or facing a stressful situation. Most symptoms of anxiety and depression are time limited and are known to resolve spontaneously without medication. We can also lean into our social supports, connect with nature and participate in exercise – all interventions known to improve symptoms of depression and anxiety. Psychotherapy can also help alleviate many mental health problems.

Health care professionals have an important role in recognizing overdiagnosis and overprescribing in mental illness. They should base clinical decisions on good science and sound evidence while resisting undue influence of drug companies. Education for medical professionals needs to highlight the benefits of psychoactive medications in the subset of patients who will truly benefit, while also underlining that harms outweigh benefits in people with mild to moderate symptoms.

Communities can promote mental health by increasing social connectedness among residents, ensuring that no-one, particularly the elderly or others living on their own, suffer from loneliness and isolation. Municipalities can design towns and cities to bring people together, provide natural spaces for recreation and opportunities for safe and accessible physical activity.

Provincial and federal governments have the obligation to provide access to adequate mental health care, including psychotherapy, so that people have safe and accessible alternatives to pharmaceuticals. Policies also need to be enacted to ensure citizens receive resources to live a healthy life – adequate family incomes, decent housing, affordable education and healthy working conditions.

It is important to distinguish poor mental health from true mental illness. The latter is relatively rare and requires specialized treatment while the former is much more common but firmly within our power to address. 

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 July 27, 2022. Photo credit: Andrew Neel on Pexels.com

We must live within our means

Two months ago, the federal government announced an increase to the percentage of temporary foreign workers (TFWs) that employers in Canada will be allowed to hire. Given a ready solution to the labour shortage problem, many businesses breathed a collective sigh of relief.

We can expect that employers in the Bow Valley will be taking advantage of this policy change. But we need to ask ourselves if TFWs are the most appropriate solution to our labour shortage problem and if we truly are ready to receive these workers into our communities. 

The Temporary Foreign Worker Program was started in 2005 by the federal government to provide seasonal and temporary workers for certain sectors in the economy. Low wages and poor working conditions in these sectors meant that employers were unable to attract Canadian workers to fill these jobs. 

Instead of increasing pay, or improving working conditions to make jobs more desirable for Canadians, employers lobbied the government for access to foreign workers. And instead of legislating higher minimum wages and enforcing workplace protections, governments granted employers this access. 

In an unspoken collusion, government and employers agreed to grow the economy and corporate profits by exploiting workers from low-income countries. Workers admitted into the country were forced to separate from their families, denied the security of knowing if they could remain in Canada and denied job or employer choice. 

Before the pandemic, the federal government was looking to scrap the TFW program for a number of reasons. Canadian employers were growing reliant on TFWs to fill permanent jobs. There was also serious concern over a lack of basic rights and protections for migrant workers with many reported incidents of verbal, physical, and sexual abuse. However, faced with current labour shortages, the federal government has done an about-face on their TFW policy and chosen the easy way out.

“Evidence that we have breached the social boundaries of sustainability in the Bow Valley is equally abundant.”

Even if the federal government is allowing recruitment of more TFWs, we have to ask ourselves if Bow Valley communities are ready to receive them. Do we have the capacity to support the people that we are asking to staff our businesses, service our tourists and ultimately generate our profits?

We know that the levels of tourism in the Bow Valley have already exceeded the boundaries of environmental and social sustainability. For anyone who spends time outdoors in the Bow Valley, the evidence of environmental degradation is plain to see. In popular areas, we see wide braided trails, trampled vegetation and soil erosion. We see litter on the side of our hiking and biking trails and an increase in human-wildlife conflict. 

There are other less visible impacts on our natural environment. Increased greenhouse gas emissions and climate change acceleration occur from ever more tourists arriving by air and ground transportation. And increased visitation also leads to adverse effects on air and water quality.

Evidence that we have breached the social boundaries of sustainability in the Bow Valley is equally abundant. We live in communities where housing is too expensive and food security is not guaranteed. The majority of jobs available in the Bow Valley are low-pay, low-skill jobs that do not pay a living wage to employees or allow them to achieve a decent quality of life.

The labour shortage has also resulted in overworked staff who are burnt-out and sustain physical injuries from working long hours in physically-demanding jobs. When workers are injured or simply want a family doctor to help them maintain their health, we are unable to provide them with the health services they need.

However tempting it might be to turn to TFWs as a Band-Aid solution to our labour shortage problems, we know we can do better. Our economic and labour policies cannot be built on a foundation of exploitation. If we are inviting foreign workers into our country to help grow our economy, we need to give them the same rights we enjoy – the right to live in Canada with their family, the security of permanent residency and choice of job and employer.   Governments and employers need to invest in job training, improving working conditions, and strengthening worker protections to benefit Canadian and immigrant workers alike.

We need to recognize, encourage and utilize the assets that immigrants bring to Canada. Many newcomers are leaders, innovators and entrepreneurs with professional training and experience far beyond the requirements of the menial jobs they are hired to do. If we really want to leverage the strengths of immigrants to fortify the Canadian economy, we have to provide pathways for their training and experience to be recognized and offer them employment that matches their competencies.

We also need to make sure that our communities are welcoming and inclusive. At a minimum this means ensuring that basic human needs are adequately met. We need to provide a living wage, offer decent and affordable housing and ensure access to healthy food and quality primary care. 

If we are unable to provide this for all Bow Valley residents, including newcomers, then we need to acknowledge that we have exceeded the limits of our communities to support current levels of tourism and the services they demand. For the sake of our planet and our people, it is time to stop living beyond our means.

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 June 17, 2022. Photo credit: Yury Kim on Pexels.com

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Road traffic deaths are preventable

When a pedestrian is killed crossing the highway on the way to “community” housing, it is not an accident. It is death by design – or some would say – a lack of design, and we all have blood on our hands. From the urban planners who designed the housing project in its current location, to the politicians who delayed funding for a safe pedestrian pathway to cross the highway to the citizens who didn’t make enough noise to make sure that human safety was a priority, we all have to take responsibility.

In 2015, the World Health Organization reported that more than 1.2 million people are killed each year from road traffic crashes and an additional 50 million are injured. The world car population, currently estimated at 1 billion vehicles, is expected to reach 2.5 billion by 2050. With this trend we can expect to see a compounding of health problems related to traffic.

Deaths and serious injuries caused by traffic collisions are the most immediate and obvious negative consequences but there are many other health consequences to road traffic. Air pollution leads to respiratory problems; green house gas emissions leads to global warming; vehicle use contributes to physical inactivity, higher rates of obesity, diabetes, heart disease and some types of cancer; noise pollution from road traffic can lead to poor sleep and psychological stress; and busy arterial roads can cut through communities reducing opportunities for social interaction.

Towns and cities can become safer, healthier places simply by implementing design changes to their streets and communities. Traditional approaches to road safety, focused on the road user and attempted to create a perfect error-free driver. But we know that human error is inevitable and using a systems approach that recognizes road crashes occur as a result of interactions between road users, vehicle design and road infrastructure is a more comprehensive approach. 

“We have to decide if we are the kind of society that will accept a certain number of deaths to have mobility and economic gain or the kind of society that values every human life and works to ensure that we reduce traffic deaths to zero. “

A safe systems approach recognizes that responsibility for traffic collisions lies with road users, system designers and policymakers. Road users are responsible for following traffic rules and regulations; designers, including road planners and car manufacturers, are responsible for creating safe commuting infrastructure; and policymakers are responsible for showing commitment and leadership in making road safety a priority in their jurisdiction and are responsible for providing funding, legislation and enforcement of road safety measures. 

We have to decide if we are the kind of society that will accept a certain number of deaths to have mobility and economic gain or the kind of society that values every human life and works to ensure that we reduce traffic deaths to zero. If we are the latter, then we are not alone. 

In 1997, the Swedish parliament adopted Vision Zero – the policy that sees the value in every human life and deems any loss of life to traffic incidents unacceptable. The Swedes have managed to reduce their originally low traffic fatality rate of 7 in 100,000 to less than half using this approach, despite a huge increase in vehicle numbers over the same time period. Several cities around the world, including many in Canada, have also adopted this vision. 

A number of evidence-based measures can be used to reduce traffic fatalities. Street design measures can be used to reduce vehicle speeds and chances of collisions. These include the use of roundabouts, speed bumps, islands for pedestrians to take refuge while crossing, and designated pedestrian and bicycle lanes. Other measures such as mandatory seatbelt use, helmets for bicyclists, and checkpoints for testing of blood alcohol levels are also key to reducing traffic fatalities.

Sustainable urban development that creates places that are connected, compact, and coordinated mitigates climate change and improves road safety. Urban sprawl on the other hand leads to more vehicles on the road, and higher rates of traffic fatalities. Developing mixed land uses, smaller blocks and easily accessible space for people such as parks, plazas and other public spaces promotes road safety and increases quality of life for people, while also being gentler on the natural environment. 

Designated bicycling lanes improve opportunities for physical activity and climate-friendly travel and are especially effective when part of a connected network. In Copenhagen, Denmark, bikes outnumber cars by more than a ratio of 5-to-1. A network of cycling paths and innovative bridges make Copenhagen one of the safest places to be a cyclist. Carefully designed roads that slow cars and forgive human error are also key to safety.

We have to realize that towns and cities are there for people, and not for vehicles, and we need to design and build them that way. When we put humans at the heart of designing and planning our urban areas, we create happier and healthier cities. We are less likely to accept traffic fatalities as the cost of doing business. And in doing so, we clearly affirm that every life matters.

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 May 20, 2022. Photo credit: Francesco Ungaro on Pexels.com

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Lessons Learned from the COVID-19 Pandemic

It has been two years since an invisible but formidable foe shook up our lives. Since the World Health Organization declared a global pandemic on March 11, 2020, we have all learned a great many things. We learned to bake bread, sew masks, use videoconferencing not only to get through our workday but also to maintain connection with friends and family.

We hope that we are now at the tail end of this crisis and that we will be able to live with this virus.  But we want to do more than just live with the virus; we want to make sure we thrive into the future. And to do so we need to reflect on the lessons learned from our pandemic experience and act on these learnings to make our society stronger and healthier for all.

At the most basic level, the pandemic has reminded us that simple hygiene practices are crucial to staying healthy. Washing or sanitizing hands frequently and staying home when sick are simple ways to keep oneself and one’s community healthy. We learned this in elementary school but forgot our lessons along the way and it has taken a deadly virus to remind us of the importance of basic hygiene.

Also, essential to keeping a community healthy, are adequately funded and resourced public health systems. Outside of global pandemics, public health systems do not get much public attention and do not make for glamorous funding announcements by politicians in the same way that promising money for ICU beds, operating rooms or new wings to hospitals do. 

“And when our leaders make decisions, they need to bring the public along with consistent and transparent messaging.”

Despite many years of preparation since the SARS pandemic, Canada was woefully unprepared to scale up testing, tracing and isolating to prevent the spread of a virus so similar to its predecessor. Canada needs to invest in a more robust public health system with the workforce, equipment and surge capacity to scale up to meet the demands of the next public health emergency.

The COVID-19 pandemic has also taught us that when faced with a significant threat we need to act fast in the face of uncertainty and before all the information is available. Then, we have to be willing to change strategy as new events develop and more data becomes available.  Everyone from individuals to communities, scientists to business owners, and governments to not-for-profit organizations had to be flexible in their thinking and nimble on their feet when it came making the changes required to deal with the ever-mutating SARS-CoV-2 virus.

And when our leaders make decisions, they need to bring the public along with consistent and transparent messaging. They need to provide reliable and timely information that explains their actions and the reasons for their actions. This applies equally to scientific and medical leaders as well as political leaders. Poor communication can lead to an erosion in public trust and a lack of support for key public health measures and social policies.

To reach communities, especially ones that are disadvantaged or marginalized, health and social service providers need to engage with existing leaders in these communities. Community leaders already have the trust of their people and an understanding of what they need and how best to deliver much needed services. When leadership and assets within communities were supported and leveraged during the pandemic, for example in a number of First Nations communities, the results for improving vaccination rates or reducing case rates were remarkable.

During this pandemic, Canadians also learned the importance of self-reliance. At the beginning of the pandemic when countries were scrambling for masks, ventilators and vaccines, Canada had to get in line behind those with domestic manufacturing. Governments have to reinvest in Canadian production of essential goods and support medical research and vaccine development within our borders.  

One cannot ignore the importance of daily conditions that people live, work and play in on their ability to stay healthy. Housing, income and work conditions are all social determinants of health that had a huge impact on the spread of COVID-19 infection during this pandemic. 

The pandemic exposed deep inequities in our society when it came to access to resources for living. We need to urge our governments to make sure that proper housing, adequate income and safe work conditions are met for all Canadians. We live in a rich nation with sufficient resources for all to live comfortably and safely, now and in the next pandemic.

We also learned that our democracy can be threatened by those within our own borders and that we need to stand up and defend this cornerstone of our society. Our governments need to act swiftly and decisively to disarm any such threat, and as citizens, we must continue to strengthen our political rights and responsibilities through civic engagement and community action.  

Finally, we have to acknowledge that we live in an interconnected world where one country cannot recover in isolation from the pandemic and expect to thrive. Canadians have a responsibility to help low-income countries in their pandemic recovery by improving access to much-needed vaccines, health infrastructure and economic opportunities. After all, we are citizens of a global village.

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 March 18, 2022. Photo credit: NEOSiAM 2021 on Pexels.com

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Addressing anti-Indigenous racism in our health care system

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Effective Policy Needed to Reduce Alcohol-Related Harms

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended further reading:

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

World Health Organization. Alcohol Fact Sheet

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

The opioid crisis rages on

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended further reading:

Canadian Drug Policy Coalition. Case for Reform

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

Canadian Mental Health Association Ontario. SOS Safer Opioid Supply. 

CBC News. Alberta safe supply committee starts work

Children and Youth in Mental Health Crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further Reading 

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

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

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

Help wanted in the hospitality industry

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended further reading:

Everyone deserves to share in the bounty of our land

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Vamini Selvanandan© 2021. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on September 16, 2021. Photo credit: Engin Akyurt from Pexels.

Recommended further reading: