LATEST ARTICLES

Let’s help grow more intergenerational connections

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Paula Rochon, Rachel Savage and Jen Recknagel

Rachel Savage is a scientist at Women’s Age Lab, Women’s College Hospital and Assistant Professor at the Institute of Health Policy, Management and Evaluation, University of Toronto.
Jen Recknagel is the Director of Innovation and Design at University Health Network’s NORC Innovation Centre.

There are few things more satisfying than seeing young people and older adults interacting with each other and building an effortless sense of community and belonging. Robust communities include all ages. But such spaces need help to develop and thrive.

Global Intergenerational Week, a celebration of the power of bringing together younger and older people for the benefit of all, has completed its third year.  Started in Scotland, this positive initiative has spread worldwide, and we are part of it here in Canada. 

Intergenerational connections lead to the creation of empathy, and in doing so, reduce loneliness, for both young and old, and address ageism that is so harmful to health and well-being.

We need to foster more intergenerational connections across the country. 

We already have spaces where older and younger generations live together.  They are called Naturally Occurring Retirement Communities (NORCs). NORCS are geographic areas — generally apartment buildings or condominiums — where at least 30 per cent of residents are older adults, mostly women.

In Ontario, there are approximately 2000 such buildings, and in Toronto alone, there are 489 NORCs.

More older adults live in NORCs than in retirement and long-term care homes combined, making NORCs an important yet largely ignored opportunity to create age inclusive communities that support healthy aging at home.

These spaces have large proportions of older adults, but they also have young residents too.

While much of the attention given to NORCs (when they are recognized at all) has focussed on the value of reorganizing services around these high-density clusters where older adults already live and want to stay, an under-recognized advantage is that they are where older and younger people live together. NORCs provide the ability to build intergenerational connections that are so beneficial to health and well-being. 

You might think of loneliness as primarily impacting older adults, but it is common among younger people too; new data show young people aged 15 to 24 are the loneliest group in Canada. Chronic loneliness is known to have a detrimental effect on health, contributing to the development of chronic conditions like diabetes and dementia, and robs us of the joy of shared experiences. 

Social connections are key to reducing loneliness.

NORCs provide opportunities for teenagers to meet with older adults and get career advice and mentorship; opportunities for older adults to help young families with childcare; opportunities for younger adults to share their technology expertise with those who want to improve their phone and computer skills – and so much more. 

Unfortunately, despite the proximity of intergenerational neighbours, there is often little opportunity or space set aside to facilitate the forging of much-desired social connections, and with it, a sense of belonging. 

That’s why Women’s Age Lab at Women’s College Hospital, along with University Health Network’s NORC Innovation Centre and Barrie Housing, are developing and evaluating a NORC program model that promotes community building, intergenerational connection, and access to care, and offers a vision for creating vibrant and healthy communities that are inclusive and accessible to all.

The World Health Organization has created a Global Campaign to Combat Ageism, and identified intergenerational connections as one of their three key recommendations to combat discrimination based on age.  NORC programs can be an important part of the solution.

Creating opportunities for people to get together, from yoga classes, community gardening activities, to simply sitting and having coffee with other people, can have invaluable benefits for residents of all ages.

NORC programs play a pivotal role in working with local communities to prioritize their interests and needs. They act as a catalyst for residents who desire change – from challenging the way care is traditionally organized and delivered, dispelling outdated notions of aging, to fostering vibrant, age-inclusive communities within our urban fabric.

By enhancing NORCs, already home to so many older and younger people, with activities that lead to social interaction, we have the ability to improve the social connections that reduce loneliness while addressing the all too pervasive impact of ageism.  

Paula Rochon is a geriatrician and Founding Director of Women’s Age Lab at Women’s College Hospital and RTOERO Chair in Geriatric Medicine at the University of Toronto.

Rachel Savage is a scientist at Women’s Age Lab, Women’s College Hospital and Assistant Professor at the Institute of Health Policy, Management and Evaluation, University of Toronto.

Jen Recknagel is the Director of Innovation and Design at University Health Network’s NORC Innovation Centre.

Patients inform new ‘map’ for health care transformation – now our policy makers just need to listen

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Timothy Woodford

As I prepare for my annual canoe trip, I marvel at the intelligence and ingenuity of the people who create maps, without which I would surely disappear into a portage never to be seen again.

Primary care transformation also needs a map.

Primary care is the name we give the health services that meet our day-to-day needs; it is typically our first point of contact in the health system, which includes family doctors and nurse practitioners. The primary care system across Canada has been under tremendous strain, and it needs an overhaul, not a quick fix.

Thankfully, a new ‘map’ has been created to address the challenges – and our policy makers and politicians need to take heed.

The recently released OurCare final report from Dr. Tara Kiran and team was created with input from a survey of over 9,000 Canadians, along with focus groups and roundtables from across five provinces; these are Canadians who reflect the patient populations doctors, like myself, serve. Their valuable input has been distilled to create an amazing roadmap — the OurCare Standards. 

The Standards are made up of six guiding principles to help us navigate the deep woods and confusing landscape of primary care. They are designed to empower our policymakers to improve primary care access, quality and equity.  Now we need action.

I have had the wonderful opportunity to train and practice as a physician for almost 44 years.  I started and spent much of my career as a general practitioner (GP) and am proud to be called a family doctor.  During my career, I have had many wonderful role models, but it’s not just physician mentors who have shaped who I am as a physician and as a person. 

Some of the most important examples in my life have come from individuals not connected to the medical field at all.  Many of those people I have had the privilege of calling my patients. 

Dr. Kiran and her team have gone to these same people, using their life experiences, ingenuity, intelligence and insights to shape the OurCare Standards.  The roadmap is a powerful message from the people we doctors have the privilege to serve. 

The Standards stress the importance of an ongoing relationship with a primary care provider who is part of a publicly funded health care team; the need for timely and culturally appropriate access to this team; that the team is part of a primary care system connected to community resources; and the need for a team that is accountable to the community it serves. 

For much of my career I was fortunate to work with colleagues and community leaders who shared a common interest in providing for the health care needs of the community in which we lived.  Over the years, through health care reform, community input and local decision-making has been removed. Communication has been mostly one way.  Budgets have been pinched. 

Communities have floundered. 

Family doctors and family medicine have suffered under a burden of increased complexity, diminishing support (both clinical and administrative) and increased expectations (system and patients). The ethos of working with like-minded colleagues to serve the communities in which we work and live, principles inherent in family medicine, has become more difficult to meet.  In many cases, it has become impossible. 

Yet I have been buoyed by groups of family doctors who have bent under the burden but not been broken.  I have been buoyed by the belief that many family doctors share — that we can do better. 

Belief in ‘we can do better’ and trying to live up to that ethos, in today’s world, has contributed to the burnout of many of my colleagues.  Many of us have gone into self-preservation mode.

Being lost in the woods is not a pleasant experience. Being lost with others, though, with a common plan, can be comforting. The OurCare Standards, a map drawn by our patients, provides us with a plan — guiding principles that will help lead us back to ‘doing better.’ 

Building accountability to the communities we serve will make our health care system stronger.  Being part of something bigger than ourselves, being part of ‘doing better’ is the medicine we all need. 

I hope you will read the report.  I hope health care decision makers will read the report.  I hope these standards will be adopted as the destination on the map for primary care in Canada.

Dr. Timothy Woodford has worked as a family doctor in rural Nova Scotia for more than 38 years and has, at different times throughout his career, provided office, ER, hospital, obstetrical, palliative care and nursing home care.

It is time to change the conversation and eliminate the stigma attached to diabetes

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Laura Syron

The federal government’s decision to cover diabetes medication and devices under its new pharmacare plan is a significant step forward in improving the quality of life for the millions of people in Canada who live with diabetes, especially those who struggle to afford treatments.

But access to medication and devices is not the only factor affecting the well-being of those living with diabetes. That title may be reserved for something we don’t often like to talk about – the stigma that can surround diabetes.

There are damaging misconceptions about diabetes in all corners of society and many judgments can accompany a diagnosis. Not only do these negatively affect the mental health of those living with it, but research shows that it can even hinder individuals from seeking the care they need to stay physically healthy.

It’s time to change the conversation around diabetes in Canada – and eliminate the stigma once and for all.

Diabetes is one of the most common chronic conditions in Canada. Every three minutes a person in Canada is diagnosed with diabetes, yet there is still so much misunderstanding about what diabetes is and how one develops it, not to mention the negative stereotypes about those who have it.

Those living with diabetes have heard it all: they’re lazy, they lack self-control, or they deliberately do not look after themselves. Not surprisingly then, people with diabetes are left feeling blamed and ashamed – that this life-changing diagnosis is all their fault.

I know how that feels. Literally.

When I was told that I had diabetes, I felt a wave of immense shame and immediately concluded that I had clearly, somehow, brought it on myself. Not only did I want to keep it secret from others, but I also needed to, so I could “take care of it myself.”

I found out much later that this is a common experience among people with diabetes. I also came to learn that, at that moment of diagnosis, my healthcare provider could have altered the course of my diabetes journey with four simple words: “It’s not your fault.”

A key step we’ve taken at Diabetes Canada to change the conversation is to field groundbreaking research to reveal how pervasive diabetes stigma is here and what the social experiences of living with diabetes looks and feels like for the more than four million of us living with it.

We’re asking thousands of Canadians with diabetes about their experiences; we want to learn how those experiences may be affecting their physical health as well as their emotional wellbeing.

Diabetes is a complex condition – with several types, including type 1, type 2 and gestational diabetes, and with many risk factors which are outside a person’s control, including genes, family history and environment.

Yet, people with diabetes are often subject to negative and judgmental comments and reactions from family, friends, co-workers and others about how they should manage their weight, what activities they should do and what foods they should and should not eat.

They also face prejudice and discrimination at work – being denied meal breaks or the ability to check their blood glucose levels, being overlooked for promotions, or even  losing out on jobs because they have diabetes, if employers worry that  the benefits  may cost  too much, or that the job may be too taxing for them.

Worse still, they can face prejudice in public or in healthcare settings when their self-care practices, like checking blood glucose levels or injecting insulin for a health emergency due to high blood glucose is mistaken for illicit drug use or being intoxicated.

This can all take a damaging psychological toll. Research shows that people with diabetes are at risk of low self-esteem, anxiety and depression. This is often called diabetes distress.

So, how do we change the conversation around diabetes?

We need broad education across our society to dispel the misconceptions – what I sometimes called the triple threat of diabetes beliefs – misinformation, apathy and stigma. And we need more targeted education too – in workplaces and healthcare settings to ensure they are more supportive of people living with diabetes.

We also need to consider our language and image choices when we talk about diabetes, moving from “if only you could…” to “how might I support you….”.

Perhaps most importantly, we must start having a more open dialogue about diabetes in Canada, so that those of us living with it are more comfortable talking about it.

It’s time to eliminate the stigma around diabetes so that the millions of us living with it get to enjoy full and healthy lives.

Laura Syron is President & CEO of Diabetes Canada.

Patients inform new ‘map’ for health care transformation – now our policy makers just need to listen

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Timothy Woodford

As I prepare for my annual canoe trip, I marvel at the intelligence and ingenuity of the people who create maps, without which I would surely disappear into a portage never to be seen again.

Primary care transformation also needs a map.

Primary care is the name we give the health services that meet our day-to-day needs; it is typically our first point of contact in the health system, which includes family doctors and nurse practitioners. The primary care system across Canada has been under tremendous strain, and it needs an overhaul, not a quick fix.

Thankfully, a new ‘map’ has been created to address the challenges – and our policy makers and politicians need to take heed.

The recently released OurCare final report from Dr. Tara Kiran and team was created with input from a survey of over 9,000 Canadians, along with focus groups and roundtables from across five provinces; these are Canadians who reflect the patient populations doctors, like myself, serve. Their valuable input has been distilled to create an amazing roadmap — the OurCare Standards. 

The Standards are made up of six guiding principles to help us navigate the deep woods and confusing landscape of primary care. They are designed to empower our policymakers to improve primary care access, quality and equity.  Now we need action.

I have had the wonderful opportunity to train and practice as a physician for almost 44 years.  I started and spent much of my career as a general practitioner (GP) and am proud to be called a family doctor.  During my career, I have had many wonderful role models, but it’s not just physician mentors who have shaped who I am as a physician and as a person. 

Some of the most important examples in my life have come from individuals not connected to the medical field at all.  Many of those people I have had the privilege of calling my patients. 

Dr. Kiran and her team have gone to these same people, using their life experiences, ingenuity, intelligence and insights to shape the OurCare Standards.  The roadmap is a powerful message from the people we doctors have the privilege to serve. 

The Standards stress the importance of an ongoing relationship with a primary care provider who is part of a publicly funded health care team; the need for timely and culturally appropriate access to this team; that the team is part of a primary care system connected to community resources; and the need for a team that is accountable to the community it serves. 

For much of my career I was fortunate to work with colleagues and community leaders who shared a common interest in providing for the health care needs of the community in which we lived.  Over the years, through health care reform, community input and local decision-making has been removed. Communication has been mostly one way.  Budgets have been pinched. 

Communities have floundered. 

Family doctors and family medicine have suffered under a burden of increased complexity, diminishing support (both clinical and administrative) and increased expectations (system and patients). The ethos of working with like-minded colleagues to serve the communities in which we work and live, principles inherent in family medicine, has become more difficult to meet.  In many cases, it has become impossible. 

Yet I have been buoyed by groups of family doctors who have bent under the burden but not been broken.  I have been buoyed by the belief that many family doctors share — that we can do better. 

Belief in ‘we can do better’ and trying to live up to that ethos, in today’s world, has contributed to the burnout of many of my colleagues.  Many of us have gone into self-preservation mode.

Being lost in the woods is not a pleasant experience. Being lost with others, though, with a common plan, can be comforting. The OurCare Standards, a map drawn by our patients, provides us with a plan — guiding principles that will help lead us back to ‘doing better.’ 

Building accountability to the communities we serve will make our health care system stronger.  Being part of something bigger than ourselves, being part of ‘doing better’ is the medicine we all need. 

I hope you will read the report. I hope health care decision makers will read the report. I hope these standards will be adopted as the destination on the map for primary care in Canada.

Dr. Timothy Woodford has worked as a family doctor in rural Nova Scotia for more than 38 years and has, at different times throughout his career, provided office, ER, hospital, obstetrical, palliative care and nursing home care.

Canada needs a workforce action plan to tackle overlapping crises in mental health and overdose deaths

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Kathleen Leslie and Jelena Atanackovic

Canada is grappling with overlapping crises in mental health and overdoses that are outpacing the capacity of the mental health and substance use health (MHSUH) system to respond.

While governments across the country are taking steps to increase access to MHSUH services – including a recent federal government announcement of $500 million to support community-based youth mental health organizations – these measures often overlook the MHSUH workforce itself  – the psychologists and social workers, counselling therapists and addiction counsellors, peer support and harm reduction workers, nurses and physicians, occupational therapists and other practitioners who are the backbone of the system. 

Canada cannot close the gap in access to MHSUH services unless it develops a MHSUH workforce action plan to co-ordinate planning across jurisdictions, provider types and the public and private sectors.

Although the mental health and overdose crises pre-dated COVID-19, the pandemic exacerbated them. Fears of infection, financial stress, shutdowns, isolation and interruptions in work, education, family, social and healthcare routines in the early stages of the pandemic led to an alarming increase in mental health and substance use concerns.

One in three people reported moderate-to-severe mental health concerns and one in four Canadians who used alcohol or cannabis said their use was problematic.

Staffing shortages, restrictions on in-person visits and the need to move to virtual care challenged the capacity of the MHSUH system to respond to growing population needs. The pandemic also further burdened MHSUH providers, many of whom were already dealing with difficult working conditions, low pay, stigma, stress and burnout.

While some MHSUH providers – particularly those in the private sector – increased their capacity to provide services during the pandemic, overall MHSUH workforce capacity decreased, widening the gap in access.

There have been some recent improvements reported in overall population mental health; however, the number of people reporting symptoms of depression, anxiety and post-traumatic stress disorder has not declined.

The toxic drug supply that is fueling the overdose crisis is compounding the lingering MHSUH impacts of the pandemic, putting further strain on the capacity of the MHSUH system and its workforce to provide timely access to needed services and supports.

To strike at the heart of these issues, Canada must develop a MHSUH workforce action plan. Other countries – including the United States, United Kingdom, Australia and New Zealand – have already adopted plans to tackle issues such as workforce planning, recruitment and training.

It is time for Canada to do the same.

The federal government needs to work with the provinces and territories to develop an action plan that focuses on priority areas for the MHSUH workforce, including hiring more workers, diversifying the workforce and implementing measures – including fair remuneration and support for wellbeing – to improve retention. The recent expansion of the Canada Student Loan forgiveness to social workers and psychologists working in rural and remote communities is a step in the right direction.

The plan must also prioritize better data collection.

Despite the vital work of the MHSUH workforce, significant data gaps exist – especially for unregulated providers that hinder workforce planning.  Without robust data on all occupations providing MHSUH services across the country, decision makers do not have a clear picture of gaps in service delivery and how to close them. The new federally funded Health Workforce Canada could play an important role in bridging these gaps.

The action plan must also include regulatory changes that develop and expand roles, scopes of practice and the skill mix of MHSUH workers throughout Canada – including a flexible approach to quality assurance for some currently unregulated provider groups.

It must also address inequities in access and the need for more public funding of MHSUH services. There are often long wait lists for publicly funded MHSUH services, leaving people to either wait longer for the support they need or turn to the private system if they have employer-provided insurance or the financial means to pay out of pocket.

Education, training and ongoing development must also be important components of the plan, as must integrated team-based care so that mental health, substance use, primary care and other health sectors work together collaboratively.

Finally, given the shift to virtual care it is also essential that the plan include funding to ensure that MHSUH workers have the digital infrastructure and training to provide virtual care in an equitable way.

With the mental health and overdose crises showing no signs of abating, Canada needs a MHSUH workforce action plan now more than ever so that Canadians can have timely and equitable access to these critical services. Federal, provincial and territorial governments must make this a priority.

Dr. Kathleen Leslie is an associate professor in the Faculty of Health Disciplines at Athabasca University.

Dr. Jelena Atanackovic is a senior research associate at the University of Ottawa.

Federal government did not listen to disabled people in Canada

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Rabia Khedr and Michelle Hewitt

Michelle Hewitt is the Chair of Disability Without Poverty.

QUOI Media

The federal government has been promising a federal disability benefit since 2020 – touted as a game changer for the many persons with disabilities living in poverty in this country. It has not lived up to its promise.

It took three years to turn that promise into legislation, with cross-partisan approval, paving the way for the historic Canada Disability Benefit (CDB). And it took another year for that legislation to be included in last week’s federal budget. 

You’d think the disability community would be ecstatic that long-awaited financial relief is finally coming our way. Instead, some of us are deeply disappointed, and many of us are angry – but we are ready to put our stories before our legislated officials once again, urging they heed the call of disabled people.

The federal budget only set aside $200 per month/person for the CDB, which it will not roll out for another year, and which will only reach a fraction of those living in disability poverty (those few who have disability tax credit (DTC) status).  This falls far short of the grandstanding the Liberal government made about ending the spiral of disability poverty in Canada. 

At Disability Without Poverty (DWP), an organization led by disabled Canadians for disabled Canadians, we have been doing the groundwork to help ‘Shape the CDB’ and address the needs of Canadians with disabilities. 

In our recently released report, Disability With Possibility: What We Learned From Disabled People Across Canada on Shaping the Canada Disability Benefit we asked thousands of disabled Canadians how a properly funded CDB could change their lives for the better. We learned a substantive CDB would allow them to thrive rather than struggle to survive.

We heard from disabled people who live in the most marginal, vulnerable situations, including racialized people, refugees and newly arrived immigrants, the 2SLGBTQ+ community, from those in precarious housing or homeless, from the Indigenous community, from people living in institutions and from people who have been incarcerated.

Using our network of grassroots activists, we were able to hear from a range of voices that are usually ignored.  But their numbers are not small. 

Disability comprises 27 per cent of the Canadian population. It is the largest minority that anyone can join at any time. Disability crosses all socioeconomic and racial divides. Importantly, in our study, we found that over one-third of disabled participants were also carers to other disabled people.

So, what do they need? Our research found an adequately funded federal benefit could make massive changes to their lives.

One person told us he would buy medication that is not funded by his province. It costs $9 a day and not taking it constantly puts him back in hospital. In a 30-day month, $9 is $270. This new benefit would not even cover this most modest, life-changing need.

Andy told us an adequately funded CDB, “would revolutionize my life, making basic necessities accessible rather than luxuries.”

Tammy from Nova Scotia says, “Receiving the CDB would make such a difference between struggling to exist and having a life worth living. People shouldn’t have to decide between paying rent and buying groceries.”

This benefit has never been about access to fancy cars or vacations. It is about dignity and autonomy for Canadians who need help. They are not asking for a handout, but a hand up.

Instead, the government pulled its hand away.

Our report identified eight areas where people said they would spend the benefit ranging from Health and Nutrition to Personal Care to Mobility and Transportation.

On Housing Stability, Indigo said: “Living so far under the poverty line is exhausting, trying to hustle to have enough money to pay rent frequently makes my disability worse.”

Unfortunately, the $200/month budgeted by the federal government will do little to help those we spoke with for our report – and keeps disabled people in Canada in legislated poverty.

The CDB could open up a world of possibility for disabled people, but to make this happen, to allow disabled people to thrive as independent, active members of our society, it must be funded adequately.

The federal government must reduce poverty and support the financial security of persons with disabilities – as they promised. $200/month doesn’t get us there.

In a just society, we would help people like Paula who dreams “about the possibility of a future where I’m a valued and contributing member of society.”

They have opened the door. We won’t let them close it. Grieve, be mad. Then keep fighting. What kind of Canada do you want to live in?

Rabia Khedr is the National Director of Disability Without Poverty.Michelle Hewitt is the Chair of Disability Without Poverty.

We need to address the mental health and wellbeing of Canada’s women entrepreneurs

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Rosalind Lockyer, QUOI Media

Canadian women are not standing on the sidelines when it comes to owning and operating their own businesses. Whether it is in retail, food services, communications, the trades, technology or other areas, the number of women entrepreneurs in Canada is growing and their contributions are having a positive impact on the economy.

Women business owners have created over 1.5 million jobs and have contributed about $150 billion to the Canadian economy, according to research.  Despite this success, a recent survey of women entrepreneurs by the non-profit PARO Centre for Women’s Enterprise (PARO) finds that women entrepreneurs are facing challenges that negatively affect their mental health and wellness.

While entrepreneurship on its own can be a difficult – especially when faced with the current economic uncertainty, impacts of inflation and the aftermath of a pandemic – being a women entrepreneur adds an extra layer of complexity. To help women succeed as entrepreneurs, governments at all levels must support policies that address the specific challenges they face.

One of the biggest obstacles for women entrepreneurs, it turns out, is accessing funding for their businesses. In the PARO survey, 86 per cent of women entrepreneurs said financial factors caused them significant stress.

This is not surprising, given that studies show that half of women business owners face challenges when trying to access financing for their business and that financial applications for women-owned businesses are more likely to be rejected outright than men-owned businesses.

Compared to men, women entrepreneurs also report more difficulty finding, qualifying and applying for government support programs.

Another challenge is the struggle to balance work and family life. Due to out-dated gender norms that often situate women as the sole or primary providers of caregiving and household duties, women entrepreneurs can feel overwhelmed as they strive to care for their children and/or aging parents while simultaneously running their business.

The survey found women entrepreneurs also lack mentoring and support networks, depriving them of coaching and guidance that can play a crucial role in their success. At the PARO Roundtables following the survey, women entrepreneurs spoke of the need for an entrepreneurial buddy system so that they do not feel alone as they deal with work and family challenges.

The survey also found that women entrepreneurs who seek mental health support find that they have to pay for expensive private services themselves or face long waitlists for government-funded resources. This leaves many feeling defeated and uncared for during difficult times.

The challenges are even greater for Indigenous and visible minority women entrepreneurs, who also contend with the effects of colonialism, systemic discrimination and racism.

Compounding these issues is the lack of representation of women in decision-making positions in government and private business. When women entrepreneurs do not see themselves represented adequately in leadership roles, it can restrict their ability to envision and pursue their own entrepreneurial endeavours.

The lack of diverse role models also results in fewer opportunities for guidance and peer support, creating additional barriers for women to circumnavigate the complexities of the entrepreneurial space.

The good news is that there is a lot that governments can do to develop a robust support system for women entrepreneurs and reduce or eliminate the mental health and wellbeing challenges they face.

Governments must ensure that women entrepreneurs have equitable access to business funding opportunities. They must also support financial programs with criteria and applications tailored to women’s participation, so that women entrepreneurs can more easily access the funding they need. Governments must evaluate their current measures for qualifying applicants to ensure equal access to diverse populations.

Governments must also provide funding for organizations to create more opportunities for networking and mentoring for women entrepreneurs, particularly those that promote diversity, inclusivity and the visibility of successful women entrepreneurs of all backgrounds.

Additionally, they must address issues such as gender stereotypes and improve access to resources such as childcare to help improve work-life balance.

Governments must also increase access to essential mental health resources – especially timely access – so that women entrepreneurs can get the support they need when they need it.

Within their own ranks, governments need to create more opportunities for women in decision-making positions. Having more women in leadership roles can spur societal progress and empower women entrepreneurs to achieve their aspirations.

Women entrepreneurs create wealth and jobs, benefitting their communities and the Canadian economy. To help ensure that they succeed, we must address the mental health and wellbeing challenges that they face.

Rosalind Lockyer is founder and CEO of PARO Centre for Women’s Enterprise-Ontario, PARO Canada, and board member for Women’s Enterprise Organizations of Canada (WEOC).

Sounding the alarm for a sustainable Canadian cancer preparedness plan

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Sandeep Sehdev and Louise Binder, QUOI Media

Cancer remains the leading cause of death in Canada. An estimated two in five Canadians will be diagnosed with cancer in their lifetime and about one in four will die from cancer. In 2023, the most recent statistics we have, it was expected that 239,100 Canadians will be diagnosed with cancer and 86,700 will die from the disease.

This is why it was so surprising that a February World Health Organization (WHO) report on cancer went largely unnoticed and unremarked upon.  The report predicts a staggering global increase in cancer cases of 77 per cent by 2050.

What’s Canada doing to prepare?  Not enough – and certainly nothing with a long-term focus.  It’s time our governments crafted a concrete and sustainable cancer preparedness plan.

In addition to the recent WHO report, there are specific cancer predictions for Canada in a 2023 issue of the journal, Preventive Medicine. The authors estimate an increase in new cancer cases of 40 per cent from 2020 to 2040, and by 45 per cent in some of the mostly commonly diagnosed cancers: breast (27 per cent), colorectal (45 per cent), lung (45 per cent) and prostate (34 per cent). These are due to demographic factors including aging of the population, greater longevity, better detection, immigration and the true increased risk of certain cancers.

The authors also project the number of cancer deaths will increase by 44 per cent from 2020 to 2040. The journal article concludes that these estimates highlight the importance of planning for increasing investment and capacity in cancer control in Canada.  This is clearly an understatement.

Canada is facing a cancer cataclysm with strategies, tactics and policies that are inadequate to control the present cancer crisis, let alone these dire predictions.

Future estimates can easily sound just like numbers and more numbers. But, no! Each number is a family member, friend, coworker, neighbour, person in stores where we shop — and on and on goes this tragic list. It would be difficult to find anyone in the country who has not known someone in their life who has been impacted by cancer, Canada’s biggest killer.

We must have a long-term preparedness plan. Though we already have not prepared for the predictably increased numbers we face today, we have time to prepare for the upcoming wave; we must not squander it.

To date, both the federal government and our provincial/territorial governments lack a robust and comprehensive cancer control strategy. 

So, what do we have?

The federal 2019 Canadian Strategy for Cancer Control is a 10-year action plan which aspires to achieve equitable access to quality cancer care in Canada, and promises to ensure a sustainable system for the future.It has eight priorities, all laudable, and a budget to help meet them – but it’s set to expire in a few years time. 

Most of our provinces have cancer programs with similar goals and aspirations. But generally, the plans include tactics to control cancer in specific ways, for specific disease areas, in the short term.  There are also limited bilateral health agreements between provinces/territories and the federal government on cancer control. They also have specific and important short-term objectives. 

These plans are not going to prepare us for a cataclysm – they are not even adequate for today’s cancer reality. They are not fit for purpose.  None of these existing plans constitutes a country-wide, coordinated and sustainable long-term cancer preparedness strategy, which is what we need.

The cancer plan must be comprehensive, created in collaboration with all relevant stakeholders and experts. It must include increased investment and capacity in cancer control. And it must be heavily weighted toward prevention, early diagnosis and appropriate testing and treatments. Prevention is always sorely underfunded.

We need a realistic plan that recognizes discrete strategies for different cancers. In order to ensure early diagnosis, we also need direct, effective pathways from a first doctor’s visit to diagnosis. Governments must pay for proven tests and treatments, thereby saving significant amounts in other parts of the healthcare budget through prevention and early diagnoses.

By investing wisely and equitably, cancer cases and deaths could be prevented.

What it must not be is a political exercise, considering short term “wins” for political gain. It must be a properly resourced and coordinated multisectoral, multidisciplinary approach based on relevant data.

The WHO has sounded the alarm with plenty of time for us to prepare.  If we do nothing different than present tactics, the Cassandra-like warnings of WHO will surely come true.

Dr. Sandeep Sehdev is an oncologist at The Ottawa Hospital. The views here are his personal views and not those of the University of Ottawa or The Ottawa Hospital.

Louise Binder is the health policy consultant for the Save Your Skin Foundation.

Walking toward health and well-being along the Via Matildica

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Paula Rochon, QUOI Media

I just walked about 90 km in six days along the Via Matildica del Volto Santo between Mantua and Lucca through the Appenine mountains in the Emilia Romagna region of northern Italy.  This beautiful, lesser-known route, crossing regions once ruled by the formidable Countess Matilda of Canossa,offered a unique blend of physical challenges and the opportunity to connect with history.

As a geriatrician committed to enhancing the health and well-being of older women, this walk illuminated for me both the story of one of the most powerful women of the Italian middle-ages and underscored to me the vital interplay between social connections and mental and physical health.

Walking the Via Matildica connected with me in a very physical way as we traced the path of the Countess, an incredibly powerful woman, who played such an important role in the history of the region and someone who defied the odds and broke from the constraints and expectations of gender so prevalent in her day – an important recognition we don’t often grant women historically.

Every day, along with my small group, we walked through and immersed ourselves in history in a way that transcends what any lecture or book could provide.  From castle to castle, and church to church, we travelled back a thousand years.  The physical effort of these long days and countless hills, while difficult, still seemed trivial compared to what people experienced in the past.

As we progressed on our journey, the personal impact and benefits of this trip unfolded in various ways. At a very physical level, with our long days on the trail, and at a social level, with all of the rich connections made with my fellow walkers – and with history.  The rewards of walking were apparent. The effort challenging but rewarding. 

As a geriatrician whose work addresses discrimination women face based on their sex and age, this trip gave me much to reflect on — specifically, how a woman born in 1046 could become one of Italy’s most important rulers. 

The Countess was able to govern lands that stretched from Lombardy through Emilia Romagna to Tuscany.  She left a rich legacy along the mountainous route, including the promotion of new forms of agriculture in the region. 

Recognized and revered over the past 10 centuries, she is one of the very few women entombed in Saint Peter’s Basilica in Rome, celebrated by a monument by Bernini. Thinking about her accomplishments and how she achieved them in an era where women’s roles were generally very different, gave me much to think about.

Far from the grandeur of Rome, we continued our walk along cobblestone roads with cliffside houses through small mountain towns.  Our views were breathtaking.  Our walking group of primarily women was accompanied by two wonderful Italian-speaking guides who were local to the region.  They helped us first and foremost to not get lost on the ancient path.  They shared stories about the villages we were walking through, the history of the castles and churches that we saw along the way, the people who lived there now and how Matilda influenced all of this. 

This experience transcended language barriers, as we started to understand some Italian phrases and reciprocated by providing guidance on some of the intricacies of the English language that arose from conversations along the way. 

While walking is one of the most beneficial activities for your physical well-being, equally important are the social connections that effortlessly form when you jointly experience the discovery of unfamiliar times and places together. 

In this case, walking through many chestnut groves, we learned of their importance as they could be grown on the steep mountainsides where grains could not. Chestnuts were used to make flour and became a staple food source promoted by Matilda to help sustain the local population.

Fortunately, our trip coincided with the chestnut season, so they were a key ingredient in our dinners and the focus of a festival we encountered in a hill town where townspeople gathered to sing, dance and roast chestnuts over enormous open fires.

Emilia Romagna, the home of parmesan cheese, was covered in fields of the special grass and grains used to feed the cows that make the milk used for this famous cheese.  We were regularly given small packages of parmesan cheese as our energy food for snacks along the hike to help fuel us as we hiked for miles passed these beautiful fields.

If you are fortunate to go on a trip in the near future, consider making it a walking adventure.  But don’t wait for a trip.  Recognize the power of walking wherever you are.

Dr. Paula Rochon is a geriatrician and the founding director of Women’s Age Lab at Women’s College Hospital.

How my sister’s rights were taken away, like thousands of others with developmental disabilities

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Franke James

My sister’s life was written off 10 years ago with the stroke of a pen — just like thousands of others with developmental disabilities.

Teresa has Down syndrome and was 49 when the capacity assessment took place in Ontario.

I saw her as happy, healthy and active, enjoying living nearby with my 91-year-old father, who often said, “We’re a team. We help each other.”

But that’s not how the social worker saw her.

Teresa didn’t understand what the assessment was for, and according to the records, she did not agree to be tested. But she didn’t say, “No.” So, the social worker asked her about her “activities of daily living.” When Teresa said that she could shower and dress herself, he concluded that her claims of independence were evidence of her “cognitive deterioration.” Others had told him she couldn’t do these things. Then, he ticked the “not capable” box on his form.

Teresa immediately lost her right to decide where she lived.

When I first heard this, I was shocked. What about Teresa’s human rights? Wasn’t her right to live in the community protected by the Charter or the UN? Article 19 of the UN Convention on the Rights of Persons with Disabilities states that persons with disabilities have the right to live in the community, have the right to choose where they reside, and should not be isolated or segregated. And yet, these declarations didn’t protect Teresa.

Three years after Teresa’s assessment, a news exposé revealed that 2,900 young people with developmental disabilities were in nursing homes in Ontario.

Across the border, Disability Rights New Jersey reported in 2023 that over 2000 young people with developmental disabilities were in NJ’s long-term care “contrary to their wishes…because the state does not properly evaluate their needs.” Just like Teresa.

Last year, the Premier of Nova Scotia apologized to citizens with disabilities for the “historic, systemic discrimination” which denied them the right to decide where they lived. The UN’s Special Rapporteur, Catalina Devandas-Aguilar, wrote, “The deprivation of liberty on the basis of disability is a human rights violation on a massive global scale.

Nursing homes have quietly become dumping grounds for people with developmental disabilities.

After the capacity assessment in 2013, Teresa was admitted to a nursing home — despite my offers to have her live with me. She was shocked. I was horrified. And our father, her primary caregiver, was heartbroken. Teresa was trapped, unable to get out without external help.

I heard many excuses: There aren’t enough group homes! Teresa’s been on the waitlist for five years! A bed in a nursing home is not great, but it’s not terrible. The government will pay for everything! And the unspoken assumption, what kind of future will she have anyway?

Four days after Teresa was put in, I went to the nursing home with my father, who signed her discharge, and Teresa was released “against medical advice.” Teresa moved in with me the next day.

I was appalled that the system had failed Teresa. I wanted politicians to make sure it didn’t happen to anyone else. Two months later, Teresa and I appeared before Ontario’s Select Committee on Developmental Services. We told Teresa’s story by weaving her pictures and health records together. I said, “Teresa is an active, strong-willed and able-bodied adult. Teresa should never have been admitted to a nursing home.”

At the end of our testimony, the vice-chair MP Christine Elliott said, “I think I can speak for all of us on the committee when I say that this is a truly shocking story.” In the final report, published on July 22, 2014, it said: “Long-term care homes are pressured to accommodate young and middle-aged people with developmental disabilities without any medical need for this type of care or any training to support this group of clients.”

It has been 10 years since Teresa was discharged, and she is thriving. Her artwork is now on a T-shirt celebrating World Down Syndrome Day 2024.

The system bungled Teresa’s assessment, and she narrowly escaped. But Teresa fought back and got her rights restored. In 2014, on World Down Syndrome Day, Teresa said, “It’s my human right to decide where I live.” She asked the government to “say sorry.” Two years later, Ontario’s Minister of Health publicly apologized to Teresa.

Despite sounding the alarm 10 years ago, thousands of young people with developmental disabilities are in nursing homes today, and more are being funneled in. That’s not fair. Nursing homes aren’t intended for people who have decades of life left. The average stay in nursing homes is 2.3 years, and most residents don’t get out alive.

Most vulnerable people, including those with developmental disabilities, can’t fight back against a system of forced care. Existing laws are not preventing this tragedy. We need education about ableism to change social attitudes and be genuinely inclusive.

Franke James is an award-winning activist, artist, and the author of Freeing Teresa: A True Story about My Sister and Me. She lives in Vancouver, BC, with her husband and her sister, Teresa.