New health deal needs transparent monitoring and evaluation process


Gail Attara and Louise Binder

The Canadian healthcare system is letting us down. Cancer care is just one of the many disease areas harmed by the pandemic resulting in a lack of access to doctors, hospital beds and operating rooms. We need to do better.

Patients are waiting longer than ever to receive medically necessary treatments.

Specialist physicians surveyed report a median waiting time of 27.4 weeks between referral from a general practitioner and receipt of treatment. This is the longest wait time recorded in this survey’s history – and it is a whopping 195 per cent longer than wait times reported in 1993, when it was just 9.3 weeks.

Lengthy wait times result in more cancer patients dying. For all patients, wait times have serious consequences, such as increased pain, suffering and mental anguish. In many instances, wait times can result in poorer medical outcomes, transforming potentially reversible illnesses or injuries into chronic, irreversible conditions or even permanent disabilities.

Canada also has a doctor shortage.  Many Canadian families might not even be able to access primary care. A recent Canadian Medical Association Journal survey found that more than one in five Canadians – an estimated 6.5 million people – do not have access to a family physician or nurse practitioner.

The devastating human costs behind the statistics should concern all of us.

Some organizations have put hard numbers around this.  A report from All.Can Canada predicts  that disruptions to cancer diagnosis and care alone could lead to 21,247 more cancer deaths in Canada over the next decade, representing 355,173 years of lost life.

For breast cancer screening, a six-month interruption could lead to about 670 additional advanced breast cancers and 250 more breast cancer deaths. For colorectal cancer, a six-month delay in screening could increase colorectal cancer cases by about 2,200 with 960 more colorectal cancer deaths.

The good news is that the federal government has taken steps to try to ameliorate the problem. 

In February, the Prime Minister announced an investment of over $198 billion to help improve the healthcare system, noting that the public will judge whether this deal is a success. The four key areas of investment include family health services, health workers and reducing backlogs, mental health and substance use services, and modernizing the healthcare system.

As the leaders of a new grassroots collective of patients and patient group leaders, Patients for Accountable Healthcare, we will hold the federal, provincial and territorial First Ministers accountable for this deal.

Of concern, the agreements do not have a transparent monitoring and evaluation process built in, so the federal government should take immediate steps to track and determine the success of these investments. Eventually, the data plan that the Canadian Institute for Health Information (CIHI) is leading will provide some answers, but that is years away. 

Canadians deserve accountability now.  We need to know how this money is being spent and we need to see direct improvements in healthcare quality and access as a result.  

Our healthcare system must provide timely, equal, and equitable access to resilient, safe healthcare, respecting the Canada Health Act, while being accountable to the public.

If the government doesn’t monitor progress of the new deal, you can be sure Canadians will.

At Patients for Accountable Healthcare, the underlying values guiding our work are respect, meaningful and ethical engagement, accountability, transparency, timely access, excellence, capacity building and mentorship, social justice and safety. We should expect no less from our health system.

We are enlisting the help of patients in urban and rural and remote parts of the country, and from all ethnicities and backgrounds, to join us in monitoring and sharing findings from each jurisdiction.

We will not shy away from undertaking relevant education to patients, caregivers, and the public. We will monitor and evaluate the progress of this new deal using measurable, transparent, patient-oriented outcomes, to assess changes that adapt to the needs of the individual.

It would be most effective if the government invited us to the table. After all, healthcare is for the people.

Gail Attara is the Chief Executive Officer of the Gastrointestinal Society.  Louise Binder is a Health Policy Consultant with the Save Your Skin Foundation.  Together they lead Patients for Accountable Healthcare.

What 20 newcomers and immigration experts have to say about Canadian immigration and how to improve it


Claudia Hepburn

QUOI Media 

When Dr. Binal Patel immigrated, she got a job assembling sandwiches in a fast-food restaurant to provide for her baby daughter. A dentist trained in India, Dr. Patel wondered how she was ever going to afford the fees for the Canadian dental exams and, if she did not, how she would ever regain her self-respect and provide adequately for her children in Canada.

Canada’s immigration numbers are rising year after year. During the 2021 census nearly one-in-four people identified as immigrants, the largest proportion of Canadian immigrants ever, and highest among G7 countries. A considerable portion of them, like Dr. Patel, are well-educated and highly skilled when they arrive.

According to a recent Bloomberg-Nanos poll, most Canadians agree, immigration is good for the Canadian economy. Many also acknowledge that, more than ever before, we need the talents and skills immigrants bring, especially in sectors like health care and IT.

There is less consensus on how well our immigration system is working or what needs to be done to improve it so that immigrants, like Dr. Patel, can integrate efficiently.

In the process of developing a new podcast, we asked 20 experts for their views on Canadian immigration, and for their ideas and initiatives to empower newcomers to integrate faster. Podcast contributors ranged from Canada’s Minister of Immigration, Refugees and Citizenship to business leaders concerned with productivity and labour supply, to immigrant sector CEOs working daily to support newcomer integration, and social entrepreneurs working to fix what they sometimes described as a broken system. We also captured the thoughtful insights of skilled newcomers, including Dr. Patel.

We heard creative perspectives on how to strengthen immigration to make it more equitable for newcomers. Arif Khimani, COO of Calgary-based IT staffing firm, MobSquad, talked about his company’s innovative approach. MobSquad identifies international tech professionals with the skills to match the needs of North America businesses. The company takes care of the immigration paperwork and find the immigrants lucrative roles so that they hit the ground running on arrival in Canada. Employers, immigrants and the economy all benefit.

Shamira Madhany, Deputy Executive Director and Managing Director for Canada of World Education Services (WES) reminded us that the speed of integration possible for IT talent needs to happen for healthcare professionals, too. Government, regulators and employers need to do a better job of ensuring that when internationally trained doctors, nurses and pharmacists choose Canada, we put them in a position to contribute their skills to our healthcare system as quickly as possible.

The perspectives shared with us were often inspiring but also, at times, dispiriting. Dr. Nnamdi Ndubuka, a public health physician and professor from Saskatchewan, shared his belief that Canada remains an incredible land of opportunity for newcomers. Meanwhile, Nick Noorani lamented the notion that in Toronto, “the best place to have a heart attack” was the back of an Uber, because of the number of internationally-trained doctors driving them. 

What resonated most for me from these conversations was the importance of creativity and cross-sector collaboration to address integration challenges for immigrants. As more countries around the globe experience population aging and skills shortages, that imperative is growing.

If Canada is serious about welcoming more immigrants and refugees each year, the status quo is not acceptable.

The next Dr. Ndbuka and Dr. Patel may decide the costs — in time and money — of integrating professionally in Canada are too high and choose one of the other countries working to fast-track the integration process for skilled professionals. Solving the challenges to integration our immigrants face will be key to our national prosperity, our healthcare system and Canada’s future.

Claudia Hepburn is CEO of Windmill Microlending, a national charity that empowers skilled immigrants and refugees to achieve economic prosperity through affordable loans and supports.

Why is being a patient a difficult pill to swallow?


Harvey Max Chochinov

While being treated for an aggressive hematologic cancer, the former Head of a Department of Medicine at a large teaching hospital told me he wished he could hang a sign on his headboard, reading P-I-P: Previously-Important-Person. Despite extraordinary achievements, skills, credentials, and status, being a patient made him feel like an amalgam of parts; limbs, bodily fluids, organs, and orifices, all now suspect, some more wayward than others — and most, for his taste, far too readily on display.

Why is being a patient such a difficult pill to swallow?

Besides whatever concern or ailment brings you to seek medical care, there is something about the very nature of being a patient that deeply rankles. Whether trying to arrange a medical appointment, waiting to be seen in a clinic or hospital, or being examined under the watchful gaze of a healthcare provider, being a patient disrupts our sense of intactness, gnawing away like an existential termite.

At its core is the erosion of personhood and a feeling that identity is under attack, threatening to displace the essence of who we really are. 

It doesn’t have to be this way.

Our sense of who we are as people is highly individualized, based on personal experiences and relationships; affiliations, attitudes, culture, beliefs, abilities; opportunities and connections; inclinations and foibles. In other words, who you are as a person is highly specific and unique; never has there been, nor ever again, will there be one exactly like you. Being a patient, on the other hand, is based entirely on things that are generic.

Bodily parts are supposed to behave in exact and predicable ways, irrespective of who their owner happens to be. With all due respect, whether prince(cess) or pauper, poet or pilot, your bits and bobs are pretty much identical, in form and function, relative to everyone else’s.

And herein lies the problem with being a patient. The moment we enter the healthcare system, the focus of attention shifts from who we are, to the ailment or problem we are now facing. This shift puts identity in jeopardy.

A long-time dialysis nurse once told me she eventually came to think of patients as kidneys on legs. Patienthood eclipses personhood, casting a shadow that undermines the essence of who we are. This is bad for patients and their families; it is also bad for healthcare providers since emotional disconnection and objectification of patients is a harbinger for professional burnout.

One approach designed to decrease this kind of existential trauma is beginning to take hold, coined the Patient Dignity Question (PDQ). The PDQ asks patients, “What do I need to know about you as a person to take the best care of you possible”? This question forms the basis of a brief five-to-ten-minute conversation, focused on personhood. What matters to you? What are your core beliefs? What or who are you most worried about? What roles and relationships matter most?

In answering the PDQ, patients are being asked how they want to be seen or understood as a person by their healthcare team. These conversations are summarized into a few paragraphs, and with the patient’s approval, placed on their medical chart.

While mostly used in patients with serious illness, the PDQ is relevant across all of medicine.

Whether you are being seen for routine medical care, or find yourself moving towards the end of life, or somewhere in between, who you are and acknowledgement of who you are as a person, matters. And the things that people disclose by way of the PDQ profoundly change the way healthcare providers see them. I’m a survivor of childhood abuse. My son is battling cancer. I am afraid to die alone. I am a former department head of medicine.

During the COVID-19 pandemic, the daughter of a women on a ventilator in intensive care shared that her mother had survived the likely murder of her first child and was a spiritual leader in her community. She said that responding to the PDQ gave her a way of letting the healthcare team know that her mother “was no ordinary person.”

These kind of disclosures profoundly and forever change the healthcare provider’s lens, bringing an appreciation of who patients are as persons, above and beyond whatever ailment brought them to medical attention. This is good for healthcare providers, helping stave off emotional indifference that can lead to professional burnout, while restoring human connection with the potential for them to be more whole themselves.

It is also good for patients and families, ensuring that patienthood doesn’t overshadow personhood.

Being a patient is hard, especially when it undermines your feeling that you are still you. That, it turns out, is the hardest pill to swallow of all.

Dr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba, and author of Dignity in Care: The Human Side of Medicine, recently published by Oxford University Press.

How much money does Canada’s health system really need?

Michael Wolfson

As usual, Canada’s provincial premiers have been demanding the federal government give them tens of billions more per year than they’ve just been offered for health care, while at the same time claiming (incorrectly) that health care is solely their jurisdiction. 

But if health care is solely a provincial responsibility, with taxing powers of their own, why do they demand massive federal cash transfers with no strings attached?  There are several possible reasons.

One is that health care costs are increasing too rapidly.  This is not a new argument.  In 1977, the federal government cut federal income taxes, giving “tax room” for the provinces to raise theirs by equal amounts, leaving overall taxes for Canadians the same, while shifting billions of dollars of revenue from federal to provincial treasuries – the infamous “tax point transfer.”  The provinces could thereby fund more of their health care from revenues growing in line with the economy.

But the provinces conveniently ignore this major reform and count only federal transfers in cash – then blame the federal government for being stingy, while avoiding raising their own taxes.

Of course, the federal government does have a national role in health care and needs to be accountable to Canadians — so why shouldn’t they attach strings to any additional cash transfers to the provinces, ensuring the funds are being used to improve health care and Canadians’ health?

Another reason provinces say they need more money is that health care is so expensive.  However, Canadians do not know whether the provinces are managing health care cost-effectively.  Indeed, evidence suggests not.

Internationally, Canada spends more per capita on health care than many other OECD countries, but performs poorly.

There are also worries about an aging population.  But many OECD countries both spend less on health care per capita than Canada, and already have more elderly populations.

So, the real solution is not throwing more federal money to the provinces.  Rather, it is overcoming decades-long blockages preventing meaningful health care reforms to contain costs and improve outcomes. 

Broadly speaking, there are four main areas of health care: hospitals, drugs, doctors and long-term care.  Long-term care has been seriously underfunded for decades, so the federal proposal to increase pay for personal support workers is most welcome. 

But within long-term care, there is a huge imbalance between home care and nursing homes. 

Provinces seem keen to build new nursing homes, while continuing to starve home care of funding.  This is not what Canadians want or need, nor is it cost effective.

Other than for long term care, there is no need for health care costs to rise dramatically over the coming decades – if there are appropriate structural reforms and better more integrated management. 

Of course, “you cannot manage what you can’t measure.”  Canada generally lacks data to understand one of the most important signals of inefficiency – “postal code medicine,” the often large variations across regions in numbers of surgeries and other kinds of health care, but these are inputs, not outcomes. 

Data to provide explanations why c-section rates and stenting after heart attacks can vary threefold across health regions are generally lacking.  In the rare cases where we have the data, there are health regions with no obvious benefit in terms of health outcomes – hence wasting money. 

So why do provinces continue to fund health care that has no benefits in terms of peoples’ health? This may take the form of inappropriate diagnostic imaging, unnecessary lab tests, repetitive doctor visits, overly expensive “me too” prescription drugs, excessive invasive surgeries, and doctors providing services more than adequately provided by less costly nurse practitioners in primary care teams. 

And why do hospitals have so many beds occupied by patients who could be more appropriately and less expensively cared for by long-term care? 

One reason is that too many Canadians are overly wowed by new drugs and diagnostics.  Putting public monies into home care and collecting and analyzing the data needed for cost-effective management of health care is not as sexy.

Let’s also “follow the money.”

Overall doctors may see their own incomes fall if funding were to be redirected to primary care teams. Hospital budgets would fall if some of their funding were reallocated to long-terms care.  Pharmaceutical firms would see declining profits if a national pharmacare program were implemented. 

Before more is spent on health care, Canadians need to insist on evidence that they are getting better value for the existing expenditures, and demand their politicians exercise the leadership to implement needed structural reforms. 

Michael Wolfson, PhD, is a former Assistant Chief Statistician at Statistics Canada and an adjunct professor in the faculties of medicine and law at the University of Ottawa.

Maya’s Plastic Pollution Campaign

(Ottawa) Ten-year-old Maya Thiru, who lives in the greater Toronto area (GTA), has turned a visit to the grocery store with her mom into a Friends of the Earth Canada environmental campaign. Maya’s Plastic Pollution Campaign hopes to mobilize kids, parents and teachers across Canada in the struggle to rid the planet of plastic pollution.

Maya is supporting Friends of the Earth’s call to Environment and Climate Change Minister, Stephen Guilbeault to expand the single use plastic ban to include stickers on fruits and vegetables. 

“They are just little bits of plastic but they are on everything and cause lots of problems for the environment,” said Maya. 

Maya is inviting kids and schools– and everybody — to join her over March and April to learn about plastic pollution from Price Look Up stickers and make their own album of PLU stickers by removing the stickers from their produce.

Her campaign goal is to get lots of kids and families to collect and make their own album of PLU stickers to send to their Member of Parliament asking for their support to ban plastic PLU stickers. You can watch Maya’s campaign video at

 “Maya is part of the upcoming generation of environmental activists dedicated to protecting people and the planet.  All of us here at Friends of the Earth Canada are inspired and excited to be working with such a bright and dynamic young woman,” said Beatrice Olivastri, CEO of Friends of the Earth Canada.

When Maya and her mother went shopping, they didn’t dash through the store to get grocery shopping done. They took the time to examine the attractive displays of fruit and vegetables.  They were shocked to notice, for the first time, that rows upon rows of produce carried these little oval stickers with code numbers.  These are called Produce Look Up stickers or PLUs. 

Produce stickers carry a price look-up code (PLUs) to help grocery stores track their inventory and, at checkout counters, identify the product and its cost. The problem is they’re made out of plastic or paper coated with plastic. Plastic PLUs don’t break down. They become plastic pollution in our soil and water.

Susan Antler, the Executive Director of the Compost Council of Canada, says that these stickers present a major issue when they show up in their compost facilities across Canada. If PLUs are put in the compost bin, they will end up at the municipality’s composting or anaerobic digestion facility where sorting them out is time-consuming and expensive.

The stickers are extremely thin and pliable so they can pass through screens designed to catch them and other non-compostable items. When a load of organic material from green bins and other sources contains many plastic PLUs, as well as other non-compostable items, it can get sent to a landfill site instead of the composting facility.

In a landfill, the organic matter will break down creating methane, a greenhouse gas that contributes to climate damage. 

Barry Orr, a member of the Canadian Water and Wastewater Association, says that if PLUs go down your sink when you’re washing fruit or vegetables, they can help to create “fatbergs” in the sewer lines. A “fatberg” is a wad of waste matter in a sewer line formed by a combination of non-biodegradable solids from sinks, tubs and toilets. This can include fat, oil and grease as well as PLUs, supposedly “flushable” wet wipes and non-flushable wipes plus paper towels and many other items that should never be put down drains. 

Also, PLUs are thin and flexible so they can pass through the wastewater plant’s screens ending up in rivers and lakes. Fish and wildlife can mistake the plastic PLUs for food and eat them. 

Maya went looking for an environmental group that would help her make a difference to stop pollution that harms wildlife.  Maya is 10 years old and the conservation and environmental groups she approached said that’s too young.  Friends of the Earth Canada took a different approach and assembled a team of staff and volunteers to work with Maya on a serious and growing environmental crisis – plastic pollution.  

You can read about how to join Maya’s Plastic Pollution Campaign at

Beatrice Olivastri is the Chief Executive Officer of Friends of the Earth Canada.John Bennett is the Senior Policy Advisor to Friends of the Earth Canada.

Students’ plea: Vaping is a youth crisis, and we want our government’s help


Growing up in Southern Ontario in the 2000s, it was rare to see someone smoking. We were very fortunate to enjoy a childhood where our air was mostly free from second-hand cigarette smoke, especially since one of us struggles with asthma. 

Unfortunately, vaping changed all that. As e-cigarettes grew in popularity among our fellow middle and high school students, so did our concerns around these new products. 

A few years ago, e-cigarettes or ‘vapes’ became extremely popular in high school.  They became increasingly accessible and sold in appealing flavors such as Mango Tango and Vanilla. While there’s a mistaken perception among our generation that these products are harmless, many people who started years ago are still vaping to this day and some experience health issues.

Now, around our university campus, we see loads of students vaping, controlled by a habit they didn’t expect would become an addiction. This addiction comes with real consequences, which many young people are already seeing. Vapes can impact breathing, damage lung tissue and increase risk for cardiovascular disease.

Because of what we’ve experienced with our peers — and our resulting worry for the future health of our generation — it is painfully obvious to us that as a society, we should be doing everything in our power to prevent young people from starting down the road of vape addiction.

We believe that our province should do more to keep young Ontarians from starting or continuing to vape.

There’s a simple but effective step for the province to take.  Our government should participate in a federal vaping taxation plan, which would increase the price on e-liquids used for vaping. The federal government has set a vape duty which is in effect already, and this plan also allows the provinces to add their own tax of the same amount.

Research already demonstrates that taxes on harmful products limit consumption because of the rise in price, which discourages use; that means fewer young people becoming addicted to nicotine and vaping.

As university students on limited budgets, we can attest that price matters. A tax can also signal to people that e-cigarettes are not simply harmless “vapourized water” but that they are addictive and carry real health risks.

Eight Canadian provinces have already introduced a vape tax or have signaled interest to opt-in to the federal vape tax collaboration. Ontario and Manitoba are the only provinces to date that have not. The federal government has developed an implementation plan and has structured the tax in such a way that would provide much-needed revenue to the provinces.

We can’t understand why Ontario is delaying or even passing up a plan that not only would improve the health of young Ontarians, but also raise money that can be used to fund important services. Instead, the Government of Ontario seems content to let both the money and young people’s health slip away.

Because of our concerns around vaping and our generation’s health, we decided to co-found the McMaster Cardiovascular and Resuscitation club, an initiative started this year which aims to promote e-cigarette awareness and knowledge, increase CPR and automatic defibrillator training, and support cardiovascular research.

As young people with an interest in healthcare, we want to do everything in our power to help make Ontarians healthier and reduce the demand on the health care system in the long term.

We need the government of Ontario to do the same, and one of the easiest and best places it can start is by joining the federal vape tax program.

We would all then breathe easier.

Bianca Mammarella, third-year Integrated Science concentrating in Biologyand Mika’il Visanji, second-year health science students at McMaster University in Hamilton, Ontario.

Person-centric health data should be front and centre for First Ministers’ Agreements on Healthcare


Canada’s first Ministers have finally reached an agreement, not only on Canadian health transfer payments, but just as importantly, on strategies to remedy major failings in Canada’s health sector.  These include lack of access to primary care, over-crowded emergency rooms, prohibitive wait-times for surgery, and perhaps the worst record in the OECD for COVID deaths in long term care facilities.

There is another less obvious, but arguably more crucial failing: major shortfalls in collecting, sharing, and making effective use of health data to support health care and public health quality. 

Sharing personal health data immediately raises fears about privacy. Yet, when confronted with this question over a year ago, in the context of the pandemic, Canada’s federal privacy commissioner stated, “during a public health crisis, privacy laws still apply, but they are not a barrier to appropriate information sharing.” The inability to share not only data on the genetics of the evolving waves of COVID-19, but also to connect these waves to something as basic as whether an individual had been vaccinated, has imperiled governments’ capacity to control the pandemic.

“Privacy chill” extends well-beyond the pandemic. 

How can we understand physician and nurse shortages without data on their training, where they are working or why they are relocating or quitting their jobs?  How can we understand if novel “innovations” in health services, such as private for-profit joint replacement facilities, are not luring away publicly financed hospital staff? How can physicians provide competent health services without knowing the health histories of their patients?  These essential tasks require robust and appropriate sharing of personal health data.

These are not new observations. First Ministers’ Health Accords both in 2003/2004 and 2017 included commitments by all jurisdictions to improve health data.  These Accords connected health data to “accountability.”  But this was not accountability by provinces and territories to the federal government; rather it was to their publics.

Unfortunately, these First Ministers’ commitments have largely failed.  Among the reasons are a perception that investing in data takes away from “front line health care,” “short termism” posed by electoral cycles, fears that data sharing and the resulting analyses may reveal embarrassing under-performance, and widespread gaps in health data literacy across the health sector and among the public more generally.

Fortunately, there has been a sea change in attitudes regarding health data since the 2003 and 2017 Health Accords – many more organizations and members of the public have seen, especially as a result of the pandemic, just how important high quality health data and actionable analysis are.   

There is finally some cause for optimism, after decades of reports and recommendations.

The most recent is the report of the Expert Advisory Group on a pan-Canadian Health Data Strategy, which was comprised of diverse experts from across Canada and the health sector. The keystone of the report is the recommendation for a Health Data Charter that can serve as a unifying vision around which all health sector stakeholders, including governments, First Nations Inuit and Metis, health care providers and the public, can frame a common approach to health data design and use. 

Crystalized in 10 concise points, the Health Data Charter starts with the premise that health data should be “person-centric,” with the collective obligation to maximize the health and wellbeing of individuals and populations. While sounding simple, truly person-centric health would dramatically alter Canada’s health data by transforming the current architecture from being largely provider-centric, which too often fragments individuals’ health data between family doctors, hospitals, labs, pharmacies, private clinics, nursing homes and so on.

The foundational importance of health data to the quality and sustainability of Canada’s health care sector is clear. Optimizing Canada’s health data will require a strong harmonized approach centred on the welfare of individual Canadians. 

Following the First Ministers meeting, the various bilateral agreements should all include a common pan-Canadian commitment to cooperation across jurisdictions and specific resourcing for advancing health data transformation. The Health Data Charter provides a clear framework upon which to build such cooperation.Michael Wolfson, PhD, is a former Assistant Chief Statistician at Statistics Canada and an adjunct professor in the faculties of medicine and law at the University of Ottawa. Bartha Maria Knoppers, PhD, JD, OC, OQ is Professor, McGill University; Canada Research Chair in Law and Medicine. Ewan Affleck CM, MDCM, CCFP is a practicing physician and health informatician. All three authors were members of the Expert Advisory Group of the pan-Canadian Health Data Strategy convened by the Public Health Agency of Canada.

New health funding requires ‘commitment’ to improved health data – but is it enough?

Michael Wolfson and David Castle

Quoi Media

The federal government has just offered the provinces and territories substantial new funding to address the obvious failings in Canada’s health care sector. They have also rightly coupled reform with major improvements in health data collection, including the need for new and better indicators to measure progress. As Prime Minister Justin Trudeau has repeatedly said, “What gets measured gets done.”

But as with all data, the devil is in the details.

What exactly are health outcomes? Are they the same as health indicators? How will they be measured, and how can we ensure they are reported meaningfully and transparently for all Canadians? And most importantly: Will new health data meaningfully improve health care for Canadians?

In health care, for example, indicators can include the percentages of Canadians who have access to a family care team and the number of new family care practitioners; in fact, these are two of the indicators specified by the federal government. But while these are valuable, neither measures a health outcome. Instead, these indicators provide information on volume and accessibility for a key input in health care, namely primary care.

To the extent that these indicators can provide more detail – for example, by ethnicity or socioeconomic status, which should be essential lenses – they can shed light on important issues of equity and timeliness of health care. And as these indicators are tracked over time, they can provide a partial picture of whether health care is improving.

But health-outcome measures go beyond indicators and require more detailed kinds of data.

A health outcome needs to consider a patient’s health status both before and after an intervention, such as a knee replacement or cataract surgery. It’s not just the waiting lists that matter; we also need to know how often a knee replacement has to be redone within a short period of time, or how frequently a cataract surgery fails to improve vision as much as anticipated.

Regularly measuring these kinds of health outcomes is fundamental to learning how well different parts of health care are performing, and whether we are receiving quality health care in the most cost-effective manner.

So how does this understanding of outcomes align with the federal government’s proposed “indicators” and data initiatives requirement? Short answer: we don’t know.

Provinces and territories have control over what health care data are routinely collected. For example, if we really want to know about health outcomes related to primary care, we first need to understand the various ways primary care is currently delivered – whether by solo fee-for-service doctors, or by teams, which include nurse practitioners as well as physicians who are remunerated by capitation, or some other model.

There is enough variety in primary care delivery across Canada that it should be possible to learn what works best by careful and probing comparisons across and within jurisdictions.

We then need to follow samples of individuals over time, to track which mode of primary care organization has patients with fewer illnesses, fewer hospitalizations and longer lives.

It is only with these kinds of longitudinal, person-level data that we’ll be able to produce evidence on which we can base valid indicators of health outcomes and connect them to jurisdictions’ current and evolving ways of providing primary care to their residents.

Will the provinces collaborate, agree on standardized definitions and, with federal financial support, make the investments needed so these critical data become available?

The federal government’s wording on this is ambiguous: “To access their share of the federal funding, including the guaranteed 5 per cent growth top-up payments to the CHT, for the next five years, provincial and territorial governments are asked to commit to improve how health information is collected, shared, used and reported to Canadians to promote greater transparency on results.”

Is this general statement merely cajoling, or is the federal government actually waving a serious fiscal stick? That will ultimately dictate the data outcome because past decades of federal initiatives have repeatedly shown that if Ottawa fails to wield meaningful fiscal penalties, the momentum on serious health care reform is bound to face disappointment.

Michael Wolfson is a former assistant chief statistician at Statistics Canada and an adjunct professor in the faculties of medicine and law at the University of Ottawa.

David Castle is professor of public administration at the University of Victoria. They both served on the Expert Advisory Group of the Pan-Canadian Health Data Strategy convened by the Public Health Agency of Canada.

It’s time we listen directly to the voices of disabled persons living in poverty Canada Disability Benefit bill moves to the Senate for consideration


Late last year, a federal government committee met to hear directly from persons with disabilities living in poverty

One hundred and fifty-three separate submissions were provided in support of the need for the federal government’s proposed Bill C22, also known as the Canada Disability Benefit, which would provide a much-needed income supplement to Canadians with disabilities.

The Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities (HUMA) heard these submissions and responded with a number of amendments to strengthen the Bill which has just recently been adopted by the House of Commons and moved to the Senate for consideration.
But lost in the long, bureaucratic process are the actual voices of persons with disabilities. These voices need to be heard by all Canadians as Bill C22 winds its way through legislative red tape.

They spoke about employment.
Patricia Scrafield talked about the challenges and expenses faced by disabled people when they apply for jobs and sums it up by saying: “to be disabled IS to work hard,” while Barbara Rose stated the simple fact: “I am poor because I’m disabled and can’t work.”

They spoke about the reality of the poverty line.
Allan Mills from Extend-a-Family Waterloo region said that “when a doctor diagnoses a disability, Canada responds by providing a prescription for poverty. It’s really that simple, automatic, and tragic.”

Laurie Molin says that living in poverty is more than a statistic: “What those numbers omit, however, are their families that struggle alongside them…It can be difficult for us, but the webs of income instability go beyond ourselves. Everyone is [a]ffected,” and goes on to describe the isolation poverty creates.

They spoke about the lack of food and healthy nutrition.
The Daily Bread Food Bank collected comments from a number of disabled people. One person said they can’t remember the last time they ate an apple or a salad, while another said they only eat one or two meals a day and without the food bank they’d have no food for eight or 10 days a month.

Mitchell Tremblay shared that, “this past September I turned 40 and with no other way to celebrate I ran a GoFundMe for emergency grocery support.”

They spoke about the lack of dignity in their lives.
Angela Browne said people with disabilities are tired of having to deal with “last resort” welfare type programs that strip them of their dignity. Paul Hutlet talks of being legislated into poverty for his seven years as a disabled person, saying these years “have been filled with demeaning, demoralizing and retraumatizing experiences, not only due to my disability, but due to navigating my way through Canada’s unrepairable four decade old disability and income support system.”

They spoke about suicide and Medical Assistance in Dying (MAiD)
Paul Martin says, “how many of the disabled are not being heard because they do not have someone to assist them in giving them a voice, or have simply given up[?] For some, life as it is, is simply not worth living and suicide emerges as yet another issue.”

Sarah Baker links Bill C22 to her decisions on MAiD, saying “the decisions made during this process and it’s outcome will be a high factor in whether or not I apply for Medical Assistance In Dying due to the added mental health issues from living in abject poverty for years.”

However, they also spoke about hope.
Returning to Barbara Rose, she talks of her hope for the Canada Disability Benefit, saying “I hope the creation of this bill will help end the poverty I live with and give me the ability to live and enjoy life as we all in our society deserve to do.”

Time is of the essence.

We cannot take any more time on these bureaucratic processes than is absolutely necessary, because to do so would be a dishonour to those disabled people who continue to live in poverty.

We must remember these voices, remember these people who have shared their most personal stories in the hope for the most basic chance in life – to live without poverty.

Michelle Hewitt is the chair of Disability Without Poverty. She is a PhD candidate at UBC Okanagan, examining why some younger disabled adults have no other option than to live in long-term care facilities unsuited to them, and she lives in the Central Okanagan with her husband and their dog.

The paradoxes of Canada’s conservation policies


John Bennett
Quoi Media

I still love them. Is that Crazy?

In the pilot episode of the Big Bang Theory, Penny revealed that even though she hated her lying cheating ex-boyfriend, she still loved him. “Is that crazy?” she asked.

“No,” said Leonard, “it’s a paradox. A paradox is part of nature!” Two opposing things can be true at the same time. It is certainly true for conservation in Canada. 

Prime Minister Trudeau kicked off the recent Biodiversity Conference in Montreal announcing $800 million for Indigenous led conservation projects. Like the Big Bang Theory, United Nations’ sponsored biodiversity negotiations have been going on for a long time. 

Climate change and biodiversity were recognized as important global issues at the 1992 Rio Earth Summit. Since then, nearly 200 countries have been negotiating targets and protocols while greenhouse gas (GHG) emissions and loss of biodiversity have continued to grow.  

Traditionally, the host country kicks off each session with a positive announcement, so the Prime Minister’s announcement was no surprise.  He said Canada is committed to preserving 30 per cent of our territory by 2030, one of the targets set by previous biodiversity conferences. However, none of this preserving will interfere with business as usual nor be close to any urban area. 

Paradoxically, the announcement came on the heels of Ontario’s Premier Ford gutting the Greenbelt around Toronto after promising he wouldn’t touch it. The Greenbelt was seen internationally as a groundbreaking achievement in preserving our natural environment. A paradox within this paradox is the fact that the Ontario government’s own Housing Affordability Task Force report states, “A shortage of land isn’t the cause of the problem (lack of affordable housing).”

By the way, Ontario is touting its investment in a car battery plant as a major contribution to fighting greenhouse gas emissions, but it cancelled all its renewable energy projects and plans to replace them with gas fired power plants and unproven experimental small nuclear reactors. 

Meanwhile in Alberta, the newly minted Premier, Danielle Smith, began her tenure with the “Alberta Sovereignty Act.” This is a law to “protect the interests of Alberta” that gives her the power to ignore federal laws she doesn’t like. Isn’t this just double-speak for protecting oil and gas production from imminent federal emissions regulations? 

Even as the federal government says Canada is moving to conserve more of our natural environment, two of its largest provinces are moving in the other direction.

Then there is the paradox within the federal government itself.

The Montreal Port Authority (an arm’s length federal agency) is pushing ahead with a huge expansion to facilitate increased marine traffic. Not only will it mean significant increases in carbon and other air pollution (ships burn the dirtiest types of oil), the site is one of the last bits of habitat of the copper redhorse – a species of fish native to Quebec and the first species identified as threatened in the province. Scientists have told us for almost 20 years that urban development, agricultural practices and building dams have severely reduced the numbers of this fish.

Federal Environment Minister Steven Guilbeault, the activist turned politician who is the epitome of a paradox, won’t intervene. He says the federal government wants to get politics out of environmental decisions. So why were all the politicians, including the minister, at the Biodiversity Conference in Montreal? 

Isn’t it pretty clear that politics are behind the federal government deciding to buy and build a pipeline across British Columbia, approve the Bay du Nord offshore oil development and give the nuclear industry a billion dollars for unproven experimental technology? 

I’m with Penny. I hate our “lying cheating” politicians, but I’d love to believe they’ll act on their new promises especially the new Global Framework for Biodiversity, which sets targets to protect and restore 30 per cent of the world’s land and ocean by 2030 and commits to addressing plastic waste and reducing the use of pesticides and hazardous chemicals by 50 per cent by 2030.

Is that crazy? Or am I just stuck in endless reruns too?
John Bennett is a Senior Policy Advisor at Friends of the Earth Canada.