LATEST ARTICLES

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

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

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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Sounding the alarm for a sustainable Canadian cancer preparedness plan

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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Walking toward health and well-being along the Via Matildica

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

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.

Too many older adults are taking risky sedative medications

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Too many older adults are taking risky sedative medications

Wendy Levinson and Christine Soong, QUOI Media

A recent investigation in Quebec uncovered a concerning trend: benzodiazepines — medications commonly used for sleep or anxiety — are being overprescribed. This investigation has prompted the Quebec College of Physicians to closely examine the usage of these medications.

But this issue extends beyond Quebec’s borders; across Canada, these medications are being prescribed at alarming rates.

Benzodiazepines and other sedatives are often prescribed to older adults, aged 65 and up, for sleep or anxiety problems. But long-term use poses serious risks for this age group, including memory problems, falls, and even an increased risk of death. When benzodiazepines are taken with other sedating medications, there is also an increased risk of overdose and over-sedation.

Despite these known risks, a 2022 report by the Canadian Institute of Health Information (CIHI) and Choosing Wisely Canada found that one in 12 Canadians over 65 are using these medications regularly.

The report also revealed significant variations in prescription rates across Canadian provinces and territories. For instance, in Saskatchewan, five per cent of older adults over 65 use these medications regularly compared to over 20 per cent in New Brunswick. These differences likely stem from differing prescribing habits among physicians. Initiatives such as providing feedback to doctors about their prescribing habits, as proposed by the Quebec College, can help address this issue.

The report also identified differences between groups, with women being nearly twice as likely as men to be prescribed these medications. Older women, particularly those over 90, are the most likely to be prescribed these medications, even though they are most at risk of problems.

Often, patients start these medications to address short-term sleep disturbances or anxiety. However, they may continue using them longer than recommended, leading to chronic use.

Patients may also receive these medications in the hospital to help them sleep, but this can continue even after discharged from the hospital.  There are simple and safe alternatives that exist, such as creating a healthy sleep environment, which studies show can be as effective as medications.

So, how can we ensure safer medication practices?

Studies show that when patients understand the risks of prescription medications, they are less likely to take them. Patients should engage in conversations with their doctors about potential side effects and explore safer alternatives. Pharmacists can also play a crucial role in reviewing medications and identifying those that can be reduced or discontinued.

Additionally, doctors can advocate for non-medication interventions, such as lifestyle modifications, to address sleep or anxiety issues. Simple lifestyle changes, like regular exercise or better bedtime habits, can help provide relief without the use of medications. These changes are often just as — and possibly more — effective than medications.

If prescriptions are started, they should be time-limited, and patients and doctors can consider whether they need to be continued.

Overprescription of risky sedative medications is a challenging and widespread issue in Canada. It’s important for health care providers, regulatory bodies that oversee clinician practice and patients to collaborate in promoting safer, more effective care for Canadians.

By raising awareness of the risks associated with these medications and encouraging open conversations between patients and healthcare providers to determine safer alternatives, we can reduce the risks and enhance the well-being of our aging vulnerable population.

Dr. Wendy Levinson is Chair of Choosing Wisely Canada and a Professor of Medicine at the University of Toronto.

Dr. Christine Soong is an academic hospitalist and Associate Professor in the Division of General Internal Medicine at the University of Toronto.

We need to create a culture of life savers to address cardiac arrest

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We need to create a culture of life savers to address cardiac arrest

Doug Roth, QUOI Media

If you saw a building on fire, would you do nothing? Not likely.

We’ve been drilled since childhood about what to do in the case of fire – and to do it quickly. Our buildings are equipped with special exits, properly maintained smoke detectors, alarms, sprinklers and fire extinguishers. As a society, we’ve made fire safety a top priority. And rightly so.

There’s a critical medical emergency – cardiac arrest – that should be similarly and systematically addressed. It is a very urgent, yet highly treatable condition. Cardiac arrest is sudden and often unexpected and can happen to anyone, at any age, anytime and anywhere.

Cardiac arrest is different from a heart attack. A heart attack is more of a “plumbing” problem where the blood flow is slowed or blocked but the heart keeps pumping. Cardiac arrest is often referred to as “an electrical” problem – as if the breaker switch in the heart has been turned off. A person experiencing cardiac arrest will collapse and be unresponsive, they may not be breathing normally or only making gasping sounds or not breathing at all.

If you think sudden cardiac arrest is an unlikely event, think again. New data from Heart & Stroke show that approximately 60,000 cardiac arrests occur in Canada outside of hospitals every year, far more than previously estimated. That’s one cardiac arrest every nine minutes. Unfortunately, only one in 10 Canadians survives an out-of-hospital cardiac arrest.

And in most cases, if you witness a cardiac arrest, it will be happening to someone you know. 

It happened in my own family. My brother-in-law had just returned home from a bike ride when he experienced cardiac arrest. Very fortunately for all of us, a neighbour recognized what was happening and knew what to do: she performed CPR for more than 10 minutes, until the paramedics arrived. He received incredible care and thankfully made an amazing recovery.

This drove home for me on a very personal level, what I already knew professionally: when someone goes into cardiac arrest only fast action will save their life – every second counts. CPR keeps the blood pumping to keep the brain alive and an automated external defibrillator (AED) will shock the heart to help it restart.

There are three things to remember. First, call 9-1-1 and shout for someone to bring an AED. Second, immediately start hands-only CPR. Third, use an AED as soon as one becomes available. AEDS are safe and simple to use and will only deliver a shock if needed.

It seems easy, but to improve cardiac arrest survival rates and improve outcomes we need to build a culture of cardiac safety.

Everyone should learn CPR and how to use an AED, starting at an early age – both are easy to learn and simple to do. But people need to be empowered to take action. This means increasing awareness around cardiac arrest and equipping people with both the skills and the confidence to act. Finding new ways to create generations of lifesavers is key, such as Heart & Stroke’s CardiacCrash program, which takes an immersive, real-life approach to learning CPR and AED skills.

AEDs should be much more widely available – and they should be registered, linked to 9-1-1 dispatch, and properly maintained. The public needs to be able to find them and access them. Better data will support quality improvement across emergency response systems. New research will drive innovation and improve survival rates and outcomes, including by helping to better identify those at high risk of experiencing cardiac arrest. Governments have a big role to play; legislation is an important lever to ensure much of the necessary change happens.

Other jurisdictions, such as Seattle and some cities in Europe, have made addressing cardiac arrest a priority and have implemented these types of policy steps. The result is they have much higher survival rates.

If we set our mind to it, we can do the same in Canada. We know what we have to do across society to save more lives and keep more families together.

Doug Roth is Chief Executive Officer at Heart and Stroke.

Canada’s health system needs to be prepared to support the Canadian Armed Forces in this time of crises

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Canada’s health system needs to be prepared to support the Canadian Armed Forces in this time of crises

Margaret Bourdeaux and David Pedlar, QUOI Media

This month 1,000 Canadian Armed Forces (CAF) personnel are participating in the largest NATO military exercise since the end of the Cold War. This extensive exercise, which will involve over 90,000 troops from 31 countries and continue for four months, is in response to growing alarm that armed conflict between NATO and Russia is increasingly likely.

Russia’s strategy of gaining territory by waging wars of attrition has, however costly, paid off over the last two decades. Now that U.S. support for Ukraine is wavering and the possibility that Donald Trump, who has stated the U.S. will not come to its allies’ aid if invaded, may win the presidency, NATO allies are facing the real possibility of having to counter Russia without U.S. military involvement.

For the CAF, the focus of the NATO exercise will be on military logistics and coordination. However, Canadian leaders should not overlook another critical, if surprising, aspect of action in preparedness: an “all hazards approach” to increasing the resilience of Canada’s health system.

It has long been recognized that maintaining the health of fighting forces is critical to success on the battlefield. Like every NATO member nation except the U.S., the CAF depends on the civilian health care system especially for all levels of hospital services, specialist and diagnostic services, and long term rehabilitation, outside of the deployed setting. Thus, it stands to reason that Canada’s health system needs to be prepared to support the CAF’s rising healthcare needs, should hostilities commence.

However, there is another reason to worry about Canada’s healthcare system as confrontation with Russia escalates: Russia has made attacking the civilian healthcare systems of its adversaries its calling card.

Russia has bombed over 200 hospitals in Syria and more than 600 clinics and healthcare facilities in Ukraine. While these bombings have made headlines worldwide, Russia has executed many other less visible and arguably more destructive attacks in these countries and in others; including ones targeting the healthcare workforce, medical supply chains and patient transport; and prosecuting cyberattacks on health information systems. 

Russia’s intent with these attacks is not merely to degrade the fighting capabilities of its adversaries, but to exact a high price from the civilian population, demoralize and humiliate it, spark mass displacement, and drain it of the material resources and morale necessary to continue the fight.

NATO member countries should anticipate Russia will continue this practice and take measures to prepare their respective health systems for attacks, large and small. 

Canada’s healthcare system, already struggling with staff shortages, overrun clinics, and delays in care in the wake of the COVID-19 crisis, may be particularly vulnerable to disruption. And the decentralized nature of the health system, with each province and territory governing and financing its own health system, makes undertaking unified planning and collective action challenging.  Nevertheless, there are multiple steps Canada’s government can take to address this issue.

One possibility is for Canada’s Emergency Management and Public Safety Offices to spearhead an effort to bring CAF and provincial/territorial health system leaders together to tackle two critical issues. The first involves developing the processes and procedures for how injured CAF personnel deployed to Latvia or other European NATO countries will be evacuated and receive medical care.

How will this process be scaled should the numbers of injured personnel swell? How will this be coordinated with other ally nations? How will it be made resilient to intentional efforts to disrupt it? These processes can be modeled on the CAF’s experience delivering tactical combat casualty care to wounded soldiers in Afghanistan, but anticipate higher numbers of wounded over shorter periods of time in a NATO-Russia war.

Secondly, Canada’s Emergency Management group should jointly undertake a comprehensive analysis of Canadian health system vulnerabilities to generate mitigation strategies from an “all hazards approach.” This health crisis management strategy, which must include a framework that can adapt to large scale casualty movement from overseas, would be beneficial to the entire Canadian health care system and may also be used for other military-civilian cooperation in natural disasters. 

Four issues should be examined: 1) roles and responsibilities of different agencies during emergencies 2) flexible and scalable health financing 2) the surge capacity of the healthcare workforce 3) health and emergency information security and 4) supply chains and patient transport resilience.

We are living in an age of crises — from climate shocks, refugee crises, pandemics, and cyberattacks. Shoring up Canada’s health system so it is nimbler and more resilient is a good long-term investment, as well as an immediate imperative.

Dr. Margaret Bourdeaux is the Research Director of the Program in Global Public Policy and Assistant Professor at Harvard Medical School.

Dr. David Pedlar is the Scientific Director of the Canadian Institute for Military and Veteran Health Research and Professor in the School of Rehabilitation Therapy at Queen’s University.

Adding more doctors and nurses alone won’t improve healthcare wait times

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Adding more doctors and nurses alone won’t improve healthcare wait times

by Irving Gold

There is an emerging consensus that Canada’s healthcare system is in crisis.  

Stories appear in the media daily describing the horrors Canadians are experiencing trying to access timely and quality healthcare. It is tempting to assume the media is being histrionic, that representatives of healthcare professions, such as myself, are over-stating their case.  

I can assure you – the crisis is real. And it may be worse than most people think. 

It is equally tempting to think of our failing healthcare system in the same way we think of supply chain issues, inflation and the challenges being faced in the service industry – as remnants of the effects of the pandemic that will get better on their own with time.  

Unfortunately, our health system breakdown is not only the result of the pandemic. COVID-19 was simply the straw that broke the camel’s back.  

Healthcare in Canada is on the verge of collapse because of decades of willful ignorance and inaction by healthcare decision-makers at all levels of government, and throughout the country. Not only was it all predictable — it was predicted.  

Health policy researchers, healthcare professionals, think tanks and others have been sounding the alarm for years. One of the very first meetings I went to when I started my career in 1998 was about the challenges facing healthcare and what needed to be done to avert catastrophe. Even then, it was not a new conversation.   

So, if our current crisis isn’t the result of the pandemic, what exactly is the problem?  

Governments have too often ignored the fact that healthcare is people. That is, without healthcare workers, we have nothing but empty healthcare facilities. While this might seem obvious, governments routinely ignore the people who actually deliver healthcare.  

Announcements made touting large investments in new hospitals, machines and other infrastructure are often devoid of any mention of the people required to transform these investments into actual increases in healthcare delivery capacity.  

When governments do bother to include the people who deliver healthcare in their proposed solutions, they are almost exclusively physicians and nurses. Of course, we need more nurses and doctors. Having more of them, however, will not result in meaningful improvements to our system until the number of other healthcare professionals is also addressed.  

Our health system delivery is complex and includes a wide range of health workers.   

For example, wait times in hospital emergency rooms are often used as a metric for the health of our healthcare system but the bottleneck is not only doctor and nurse care. If you add more doctors and nurses, patients might be triaged more quickly (an important metric), but then they will likely wait just as long — merely at another stage in the process.  

In the vast majority of cases, emergency room physicians need diagnostic tests to determine what is going on with a patient. And these tests are done by medical radiation technologists (MRTs) who conduct X-rays, CT scans and MRIs. Ultrasounds are done by sonographers. Bloodwork and other tests are done by medical laboratory technologists and medical laboratory assistants.  Diagnostic testing is also central to the healthcare Canadians get in other settings. 

Effective healthcare requires teamwork. Any effort to get us out of the mess we are in will need to reflect this fact and address the staffing needs of many healthcare professions.

And this situation is everywhere, not only in diagnostics. Many of the MRTs in our association work as radiation therapists, treating patients with cancer.  The shortages in their ranks over the past months have led to reductions in cancer care services for patients. 

The list of what I call ‘invisible healthcare workers’ is long.  

We have a shortage of them too – and those who are working are experiencing an unprecedented level of burnout, job dissatisfaction and leaving for early retirement.  

We are at a crossroads: governments can continue to do what they have long been doing — they can even do it harder and spend more money. But as the saying goes, the definition of insanity is doing the same thing over and over again and expecting different results.  

Our healthcare system is on life support. Coming off of life support only happens for one of two reasons: either the patient is showing signs of improvement or it is determined that there is no hope of recovery.  

Right now, the patient is our healthcare system. Its fate will be determined by the willingness of those who have the capacity to implement change — and to include all healthcare professionals in their strategies.

Irving Gold is the Chief Executive Officer of the Canadian Association of Medical Radiation Technologists.

How to achieve accountability in long-term care

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How to achieve accountability in long-term care

Michael Wolfson, QUOI Media

Memories of the tragedy in Canada’s long-term care (LTC) homes from the pandemic are fading all too fast.  However, this tragedy was not an accident; it was the result of a series of deeper problems with the ways LTC is funded, managed and understood.  Without concerted action, these problems will continue to fester, and indeed grow with Canada’s aging population.

Addressing these problems requires actions on a number of fronts, from operating standards to staffing, to assuring the human rights of LTC home residents.  The most important actions form the core recommendations of a just-released report from the Royal Society of Canada (RSC).

One reason for the failures in Canada’s LTC homes is their general invisibility. It has only been the unnecessary spike in residents’ deaths from the pandemic that brought these to light.  With this tragic visibility, there has been a flurry of government actions. But as myriad experiences have taught us, as soon as the light fades, actions weaken.

One of the core recommendations of the recent RSC report is the creation of a robust “accountability framework,” in turn, based on strong data reporting.  This is not a new idea; the 2003 First Ministers Health Accord also spoke repeatedly about accountability. However, governments’ support for the underlying data waned over only two or three years, as did support for the short-lived Health Council of Canada a few years later.

In order to avoid yet another failure, we must understand what an accountability framework involves, and why it has failed in the past.

One fundamental reason for failures is the constitutional division of powers. The provinces and territories, with primary jurisdiction for healthcare, do not want to be “accountable” to the federal government, even though the federal government channels billions of Canadian taxpayer dollars to them. However, they should be accountable to their own populations. 

The only way Canadians can learn what works and what doesn’t from each region, no matter their differences, is if the data are comparable – this is a legitimate role for the federal government.

Here we come to the reason for past failures: no provincial/territorial government wants to be shown to have poor performance in any area of its jurisdiction, certainly including healthcare.  In a phrase, “why shoot the messenger if instead you can prevent there ever being a messenger?”

In the face of such self-interested resistance, an obvious response is for the federal government to incent the needed standardized data generation across jurisdictions, and then assure these data flow in ways that can populate a well-designed accountability framework.

Such a framework should include key indicators, such as the levels of direct care staffing per resident on LTC homes, and the frequencies of falls leading to fractures and hospitalizations.  But the data flows must be much more than a handful of indicators. Analysts need to be able to drill down in the data to see, for example, what kinds of staffing levels and mixes are associated with the lowest rates of hospitalizations for falls, and other factors, including language and broader social determinants of health.

The federal government has ample constitutional powers to give effect to the needed data, not least from its spending powers and its power for “peace, order, and good government.” 

The federal government does appear to be going through the right motions here. The major cash transfers announced in 2023 to the provinces and territories include $500 million for data and assign the Canadian Institute for Health Information (CIHI) a central role.

Yet in the 2017 First Ministers Health Accord, where billions of dollars were transferred from the federal government focusing on LTC and mental health and addiction, all governments agreed that CIHI should be given the mandate to develop relevant indicators.  Three years after the Accord, CIHI had published only one indicator relating to LTC, and it was based on hospital rather than LTC data. 

CIHI does the best it can, but it is seriously limited by the data provided to it by the provinces and territories. For example, data about LTC residents are not connected to staffing levels, hospitalizations and other kinds of healthcare utilization, nor to surveys of all those waiting to access homecare or LTC homes.

It is impossible for provincial/territorial residents to hold their governments accountable for their responsibilities in LTC if the data available are biased, and the most important kinds of data are completely absent.

We take for granted in other areas, such as GDP, unemployment and inflation, that there are ample underlying data enabling a dissection of the observed trends.  We deserve the same for LTC.

It’s long past time the federal government used all its constitutional powers.

Michael Wolfson, PhD, is a former assistant chief statistician at Statistics Canada and co-author of the Royal Society of Canada report, Repair and Recovery in Long-term Care.

Skilled tradespeople essential to solving Canada’s housing crisis

Quoi Media
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Skilled tradespeople essential to solving Canada’s housing crisis

Three ways to solve the housing crisis through skills training

Piers Young, QUOI Media

Canada is facing its worst housing affordability crisis in more than 40 years, putting home ownership out of reach for many young people looking to get a foothold in the market.

Despite federal investments designed to boost housing supply and expedite building approvals, the need for millions of new homes comes with additional challenges.  At least as urgent as freeing up land and issuing building permits is the need for skilled tradespeople able to turn blueprints into bathrooms and concepts into kitchens.

Attracting young people to apprenticeship training and supporting their success requires a major rethink in government policy.  Wage subsidies under the Canada Apprenticeship Strategy have done little to mitigate the wave of retirements in Canada’s construction sector and less to address poor completion rates in the skilled trades.

To ensure major new investments in housing are effective, we offer three policy recommendations to develop the talented tradespeople so desperately needed to address Canada’s long-term housing and broader infrastructure requirements:

            •           Support enrollment in pre-apprenticeship and diploma programs

Young people often struggle to convince employers to hire and register them as apprentices without the benefit of previous experience.  Pre-apprenticeship and diploma programs in Canada’s polytechnics are designed to build foundational trades skills and provide some certainty that apprentices are both workplace-ready and committed to making a career in the field. 

Governments could make these programs more appealing for youth by offsetting tuition in high-demand trades and linking employer wage subsidies to registering program graduates as apprentices.  Bonuses should be applied to employers of record who remain so until the apprentice is certified.

There are a number of polytechnics experimenting with low- or no-cost programs in the skilled trades as a way to attract and engage young people.  For example, Humber in Toronto offers six different tuition-free pre-apprenticeship programs in high-priority trades.  Since trades programming is generally expensive to deliver, government and industry support is critical.

            •           Extend post-graduate work permits for international trades students

With more than 245,000 construction workers set to retire in the next 10 years, domestic students are unlikely to fill the gap.  Attracting international students to apprenticeship via diploma programs offers a potential solution but only if post-graduate work permits are of a duration that enables the completion of an apprenticeship.  This approach stands to attract international students to, and retain them in, occupations experiencing acute labour market demand.  With a stated desire to reform post-graduate work permits, Immigration, Refugees and Citizenship Canada might want to look at skilled trades pathways more closely.

Conestoga in Waterloo, Ontario has a head start in this area, with an impressive new trades training facility and a track record for enrolling international talent in the skilled trades.  The institution provides international students with additional resources associated with immigration, travel and housing, easing their transition to life in Canada.

            •           Offset the cost of equipment and unlock industry investment

Like many sectors, technology in the skilled trades is changing at a rapid and challenging pace.  To ensure apprenticeship training continues to evolve to meet industry needs, educational providers must provide learners with access to relevant equipment as well as systems and tools that reflect an ever-changing landscape of environmental and building codes.  The federal government should consider offsetting the cost of purchasing new training equipment in high-demand occupations and encourage industry to do the same through beneficial tax measures.

The scope of what’s possible is illustrated by the British Columbia Institute of Technology’s recent announcement that 45 different industry partners have contributed a combined total of $33 million towards a new Trades and Technology Complex expected to house cutting-edge training facilities and equipment across a variety of trades.

The supply and availability of housing is a multi-faceted challenge, one being experienced in every corner of the country.  Municipal zoning regulations and expedited building permits will be ineffective in the absence of skilled tradespeople to fill labour needs.  Governments working in partnership with industry and Canada’s technical training partners can come together to help solve the crisis.

Piers Young is a policy analyst at Polytechnics Canada, a national association of the country’s leading polytechnic institutions.

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