LATEST ARTICLES

We need an all-hands-on-deck approach to solve the primary care crisis

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Ivy Oandasan and Ivy Bourgeault

QUOI Media

Dr. Ivy Bourgeault is a Professor in the School of Sociological and Anthropological Studies at the University of Ottawa and leads the Canadian Health Workforce Network.

Every day we hear stories about the primary care crisis in Canada and the urgent need for a solution. Primary care is the first point of contact into the health system for routine healthcare needs. 

More than six million Canadians are not able to access a regular primary care provider. This number continues to balloon. 

Many family physicians are retiring, some reducing clinic hours, and others focusing their practices to address specific conditions. Coupled with a decreased interest in choosing family practice as a specialty, more communities are left vulnerable to the realities of limited access to primary care.

So, what’s the solution?  Governments are celebrating the opening of new medical schools, new nurse practitioner-led clinics and announcing increased scope of practice for pharmacists to manage minor ailments. Unfortunately, these piecemeal initiatives – focused on access alone — will not solve the problems of primary care.

A patchwork quilt only works when the pieces are put together into a collaborative design.

We need a primary care system designed to be coordinated, comprehensive and accessible. And we need a primary care health workforce committed to collaboration to make this happen.

A new way of working is needed.

Every person in Canada should have access to a primary care team, who can manage health issues faced by a patient collaboratively. Whoever is the first point of contact in the health system should ensure that a patient is treated, referred to, and coordinated to receive care by a team of providers who all document their care in a shared record to ensure seamless care.

There is an inherent accountability built in being part of a team, whether co-located or not, to deliver holistic patient care.

Without greater access enabled through coordinated team-based care, the health of Canadians will continue to suffer.

As a family physician and a health workforce researcher, we co-led the Team Primary Care: Training for Transformation initiative in partnership with over 20 primary care practitioner groups and 100 healthcare organizations across Canada to begin to stitch together a quilt of solutions. This taxpayer funded initiative had over 800 participants call on our governments to make sure future investments in primary care include coordinated training to enable Canadians access to a primary care team.

Another complementary taxpayer funded project, OurCare, collected the perspectives of thousands of people across the country calling for standards to define what every person in Canada should expect from primary care. These include being able to receive culturally safe care, from a primary care clinician, who works with others in a team, providing ongoing care, connected to community and social services, and accountable to the communities served.

Both Team Primary Care and OurCare initiatives launched appeals to the public asking them to urge their governments to support a vision for an integrated primary care system where “access alone” is not enough. We call for a primary care workforce who can provide a full complement of primary care services collaboratively in supported teams.

No one government, no one healthcare practitioner group, no one group of educators, regulators, accreditors or leaders can solve the primary care crisis alone.  We need an all-hands-on-deck approach, and we need it now.

The recent $25 billion bilateral agreements signed between the federal and provincial/territorial governments as part of “Working together to improve health care for Canadians” is a unique and timely opportunity for this kind of primary care system design. The agreements state that each province and territory must draft action plans to describe how they will use federal funds, identify and measure targets, and report annually on their progress.

It is critical that our governments build on the insights gleaned and partnerships developed from these two tax-payer funded projects which would enable a good return on investment into primary care redesign – especially given primary/family health care is identified by the federal government as a key area of shared priority. 

We need partners to bring those of us with evidence-informed solutions to fix Canada’s healthcare system together.  We’re interested in collectively solving the crisis in primary care with design solutions. Who else will join us?

Dr. Ivy Oandasan is a Professor with the Department of Family and Community Medicine at the University of Toronto and is Director of Education at the College of Family Physicians of Canada.

The secret sauce to turning interviews into job offers

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Real examples of how to craft a compelling answer to the job interview question, “Why do you want this job?”

Nick Kossovan, Troy Media

In my previous column, I outlined the steps for preparing for a job interview:

            •           Research the company and its leadership team.

            •           Consider why you want to work for the company.

            •           Identify the company’s pain points.

            •           Think of at least one genuine reason you’d like to work for the person you’d report to.

            •           Throughout your interview, speak to B, C, and D, which speak to the two factors that influence hiring decisions:

            •           Reason, and

            •           Ego

I wrote it’s understandable for interviewers to be interested in a candidate’s reason(s) for being interested in the job. Therefore, ensure you have a solid grasp of why you want the job and can confidently answer, “Why do you want this job?” or “Why do you want to join our company?”

I also discussed the importance of mentioning your understanding of the company’s pain points and how your skills and experience can address them. Furthermore, I proposed a strategy to help you stand out from your competition, especially if your interviewer is the person you’ll be reporting to: speak to their ego.

In this column, I’ll share two examples of what speaking to B, C, and D looks like. I’ll start with Bob Nielsen, who’s interviewing for an outside pharmaceutical representative position. His interviewer, Titos Thanides, who’d be his boss, asks the inevitable question: “Why do you want to join Ottinger?”

Bob’s answer:

“I’ve been selling pharmaceutical products for over 15 years and have consistently exceeded sales targets due to my strong relationships with healthcare providers. At Nordstral Pharmaceuticals, I managed a territory spanning Kingston to Quebec City. In 2022, I received the Salesperson of the Year award for growing sales by 27 percent.

I’m attracted to Ottinger’s commitment to innovation and cutting-edge treatments. Ottinger’s focus on R&D and new product development reflects my values and goals. I became a pharmaceutical rep to contribute to people’s well-being.

Ottinger is looking to gain market share in the Ottawa area, a challenge that excites me. Since I have established relationships with healthcare providers throughout the Ottawa region, I’m confident I can increase the use of Ottinher’s pharmaceuticals, especially Serisone, a game-changing, innovative pulmonary fluid management drug.

Additionally, I heard you speak at the International Conference on Pharmacy and Pharmacology in Winnipeg in October 2018 about pharmaceutical companies’ societal role. It must have taken a lot of courage to publicly declare pharmaceutical companies should be less profit-driven and more socially responsible. You have a reputation for being one of the few leaders who speaks their truths, which would make working with you a privilege, and you’re known for being a results-driven sales director who’d bring out the best in me.”

Here’s how Ariana Darzi, interviewing for a Marketing Director position, responds to her would-be boss, Veronica Lodge’s question: “Why do you want this job?”

“I’ve been marketing consumer goods for over 22 years, from detergents to tissues to soft drinks to stationery. I’ve consistently delivered measurable results throughout my career, increasing brand awareness, market share, and profitability.

For example, as Marketing Manager at Acme Corp, I oversaw the relaunch of their flagship tissue paper brand. In 18 months, using data-driven segmentation, targeted advertising, and innovative product development, my team and I increased our tissue paper market share by 36 percent.

My interest in Sunshine Desserts is based on the company’s reputation for product innovation and market leadership. As someone with a sweet tooth, I’ve long admired how Sunshine Desserts consistently pushes the boundaries of what’s possible and understands sweet doesn’t have to equate to being unhealthy. Your recent line of sugar-free desserts, many of which I’ve tried, your peanut butter cookies being my favourite, is a prime example of the forward-thinking, consumer-centric approach I want to be a part of. I read in Canadian Living that you’re launching a gluten-free dessert line this fall, which I’m looking forward to trying.

Sunshine Desserts faces the same challenge as its competitors. Health-conscious consumers no longer consider desserts part of a healthy diet. Your lines of healthy dessert offerings I just mentioned make it possible, with my using the same strategic thinking and execution I used at Acme Corp, to market your desserts as part of a healthy diet because they’re “made right.”

Moreover, Veronica, your leadership in driving Sunshine Dessert’s North American expansion and your ability to adjust to rapidly changing market conditions is inspiring. Working alongside you would further expand my strategic marketing skills while making a meaningful contribution to Sunshine Desserts’ continued success in the North American market.

The combination of my marketing expertise, proven track record of success, and sweet tooth make me an ideal candidate to be Sunshine Desserts’ next Marketing Director.”

I can’t emphasize enough the importance of preparing your answer beforehand to the most common job interview question, “Why do you want this job?” or “Why do you want to work for this company?” and practicing delivering your answer effortlessly, so you speak to the two factors that influence hiring decisions: reason and ego.

Nick Kossovan, a well-seasoned veteran of the corporate landscape, offers advice on searching for a job.

Mark Carney needs to think more about growing wealth inequality destabilizing democracies around the world

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Matthew Mendelsohn

Mark Carney made a speech recently and many people had plenty to say about it. But one of his replies during the Q & A deserves more attention than it received.

MP Nate Erskine-Smith asked Carney what he would do about Canada’s growing wealth inequality. Carney’s answer was a bit unfocused, but he made two points clearly: 1) Let’s hope wealthy people give more to charity, and 2) We shouldn’t only focus on redistribution.

This was not a serious answer.

If Carney wants to play a constructive role in Canadian public life, he should have thought deeply about the staggering and growing wealth concentration in Canada and around the world. This concentration is creating anxiety and anger amongst many young people, it is destabilizing democratic societies, and he should have something meaningful to say about it.

Given his professional history, Carney knows that the benefits from economic growth in recent decades have increasingly gone to capital rather than workers. Even if he doesn’t want to serve up big pieces of blame pie, he should at least have critical reflections on the role of finance in producing obscene wealth alongside real hardship.

Unfortunately, Carney’s instincts on wealth inequality are reflective of what has been on full display from many business leaders over the past few weeks who have been bemoaning Canada’s ‘productivity emergency’ – and then having a bit of a fit about small changes in the capital gains tax.

We share these concerns about the long-term decline in productivity, which has real and negative consequences on our quality of life.

But Canada’s long-standing productivity challenges have been debated for three decades, their causes are not well-understood, and the solutions are not obvious. We certainly shouldn’t assume that realistic solution just happen to coincidentally line-up with all the prior positions and economic interests of corporate Canada.

We are even more concerned that many of Canada’s industry leaders who shape our public debate have seemingly missed the most important economic policy debates of the past 20 years. Around the world, almost no serious person continues to believe that cutting taxes on the wealthy will unlock growth for working and middle-income people.

Most advanced industrial democracies are dealing with inequality and challenges to economic growth by rejecting market fundamentalism and investing in things like public transit, childcare, affordable housing, and ensuring that low- and middle-income people have money to spend in the local economy.

So, Carney’s answer was disappointing.

When he was asked about wealth inequality, Carney could have talked about his views on this emerging consensus. He could have talked about housing, and its relationship to both inequality and productivity.

He could have shared his thoughts about global processes to confront wealth sheltering and corporate profit shifting.

He could have talked about how oligopolistic markets hurt working people, innovation and productivity and how we should break them up.

He could have discussed ways to get more capital into under-served communities or how we should confront the worst features of modern extractive capitalism and private equity.

And when he chose to toss the word ‘redistribution’ on the table, he could have at least noted that we are living through a period when concentration of ownership is redistributing upwards towards the extremely wealthy. Or that it is important that we stop talking narrowly about income redistribution and focus more deeply on how to broaden ownership of the economy.

But his instinct was to say none of these things, just as the instinct of our business community when talking of productivity is to discuss their taxes rather than the housing crisis.

Authoritarian populists are winning in many places because, in part, the benefits of economic growth have been accruing disproportionately to capital. Everyone who aspires to play a constructive role in public life needs to address this head on.

Highly unequal societies – with wealth, opportunity and privilege passed along intergenerationally – are not safe, healthy or happy societies. They are not in anyone’s interest, even the wealthy.

Matthew Mendelsohn is the CEO at Social Capital Partners and former federal and Ontario deputy minister.

Nurses need genetics in “their DNA” to improve patient care

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Nicole Letourneau and Jacqueline Limoges

Jacqueline Limoges PhD RN is an Associate Professor at Athabasca University and co-lead of the Canadian Nursing and Genomics Initiative.

QUOI Media

Genetic testing is now the standard of care for common diseases such as cancer and heart disease, predicting risk and enabling earlier and more effective patient care. It’s an exciting revolution in patient care that has far-reaching potential and continues to grow and expand. But in Canada, we are not using all of our health human resources to take advantage of this important transformation in healthcare. 

What’s missing are nurses. 

Nurses are consistently rated the most trusted health profession and are the largest health care workforce in Canada, providing care to the most vulnerable and remote patients.

At the beginning of the revolution in genetics, nurses were educated to offer genetic care to patients. But the educational opportunities have not kept pace. Genomics services have become siloed, and Canadians are now unnecessarily waiting for care and answers to their common genetics questions.

Nurses are ideally positioned to ensure that patients have access to accurate genetic information about their disease conditions and care options – but they no longer receive adequate training.  Our governments, professional societies and post-secondary institutions need to work together and find resources to address this significant gap.

According to the Canadian Nursing and Genomics Initiative (CNGI), Canadian nurses lack crucial supports in their basic and continuing education about genomics when compared to nurses in other countries, such as the U.S. and the UK, where nurses are expected to provide information on condition, inheritance and treatment options for patients using relevant genetic counselling skills.

A recent survey of more than 1000 Canadian nurses revealed that while many patients seek nurses’ knowledge about genomics, nurses report wanting to learn more to better help their patients. Canadian nurses and their patients are missing out. 

Basic nursing education should ensure new nurses are prepared to help patients understand their genomic test results and offer strategies for talking about results with family members. Basic nursing education should also prepare nurses to identify people who might benefit from genomic services, answer questions on genetic testing, and help people make lifestyle changes to lower risks.

To deliver this education, nurse educators need programs, supports and incentives to develop their own competency in genomics.

A health care system that expects nurses to provide genomics-informed care must provide proper training. Canadian health systems are ripe for re-design to better utilize nurses to meet the needs of patients, families and communities affected by genetic conditions and risks.

Nurses in the workforce need to be equipped with genomic knowledge about their patients through continuing education courses, toolkits and clinical decision support aids. These resources are available to nurses in other countries, and they are making a difference to the quality, accuracy and safety of patient care.

Canada is falling behind.

Armed with genomics knowledge, nurses could work more effectively with genetic counsellors, physicians and pharmacists to provide care to thousands of people requiring genomics services.

Imagine the impact of Canada’s nearly half a million nurses, once armed with genetics knowledge. Genetic testing can only improve health when health care professionals can employ the results.

Knowledge about genetic testing, risks, and therapies needs to be better integrated into nurses’ basic and continuing education programs, to get into the “DNA” of the nursing profession.

Nurses are poised to deliver the world-class health care Canadians expect — employing their knowledge of genetics to provide the best patient care.  

Nicole Letourneau PhD RN FRSC is a Professor and University of Calgary Research Excellence Chair in Parent and Child Health. Jacqueline Limoges PhD RN is an Associate Professor at Athabasca University and co-lead of the Canadian Nursing and Genomics Initiative.

Canada has an investment problem — and an investment opportunity

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Mary W. Rowe and Zita Cobb

QUOI Media

Mary W. Rowe is CEO of the Canadian Urban Institute and a Community Economies Fellow at Shorefast.

Much debate continues to greet the latest statistics indicating Canada’s productivity – measured as economic output generated per hour of work – has continued to decline, dramatically lagging other G7 countries. What began as a rant by pundits, has now shifted to a steady lament. Instead of joining the choir, wouldn’t our time be better spent looking upstream?

If we want to improve productivity in Canada, we should be investing in our own businesses and essential community infrastructures to support them. 

The search for foreign direct investment has long been a Canadian preoccupation. Instead of doubling down on creating conditions to ensure any capital generated in Canada continues to be invested in Canada, we have pursued investments from other places. Too often, money that is made here is quickly whisked off to be invested elsewhere.

Nowhere is this more ironic than following the money of our pension funds, which defend their obligation to their members to pursue highest returns outside of Canada, even as the infrastructure and services upon which the communities in which they live depend – such as affordable housing, access to capital, transit and mental health services – are starved of investment.

We need to make investing in Canadian businesses – and investing in our communities – a top priority again. 

In the last century, Canada invested heavily in major transportation, mass transit, housing, energy generation and distribution, health systems, post-secondary institutions and cultural infrastructure – the underpinnings of an economy able to grow and diversify, and a society able to integrate significant numbers of immigrants each year. We built power plants and public libraries, transit systems, hospitals and concert halls. This enabled millions of Canadians to work productively in many places, many sectors, create businesses, provide services and make meaningful lives and vibrant communities.

It’s time our economic policies prioritized buttressing and building vibrant communities so that money stays in Canada and so that we are investing in Canadian ideas, services and industries.

One of our greatest strengths is our small and medium enterprise (SME) sector which employs close to 90 per cent of Canada’s labour force working in the private sector. SMEs absorb newcomers, providing a path to economic inclusion, skills development and social integration.  Yet getting investment into smaller enterprises – where most Canadians work to support their ‘productivity’ — can be quite challenging, where the transaction costs, and more modest returns, deter investors.

Canada is a country rich in natural assets and a myriad of environmental, civic and cultural assets. Investing in them with our own resources – private and public investment funds, corporate returns, philanthropy and good old-fashioned taxation – may render a slower growth rate and a smaller rate of return in the short term, but over the longer term, will generate returns for investors.

It would also support the necessary conditions for a resilient economy, better equipped to adapt to rapidly changing conditions. Government policies should incentivize various forms of sticky investment.

Take for example, the impending fate of Chateau Montebello, one of Canada’s most iconic hotel destinations, with the financial collapse of China’s Evergrande conglomerate. This typifies the risks of surrendering our key assets to offshore investors. 

Contrast this with Fogo Island Inn, where the beneficial owner is the local community, upon which its continued success entirely depends. Fogo Island Inn was created by Shorefast (a registered charity) as a part of a process to invest in the development of the natural and cultural assets that exist in the place. The Shorefast model reinvests in the assets of the place along with Canadian investors from the private, public and philanthropic sectors. 

Further, strategic, modest government investment can strengthen local economies from the ground up. My Main Street is an application-based program to invest in independent businesses and place-making activities along main streets in Canada. It is administered by the Canadian Urban Institute with support from the Federal Economic Development Agency for Southern Ontario and offers streamlined, direct-to-business and community placemaking support to help attract visitors and locals to main streets.

Canada’s economy is distributed across many communities — cities and towns of different sizes and across many regions in the country. Despite differences in scale between urban and rural communities, we must invest our resources in creating the enabling conditions to support businesses, and the people and places that support them. 

To develop a country as geographically vast as ours we must become masters of many scales.

Canada is made up of thousands of places, rich with assets that are ripe for investments to strengthen their capacity to self-fuel. This is an opportunity to make investments that will create distributed economic momentum for our country.

Zita Cobb is Founder and CEO of Shorefast and Innkeeper at Fogo Island Inn.

Mary W. Rowe is CEO of the Canadian Urban Institute and a Community Economies Fellow at Shorefast.

Carbon capture and storage technologies experience setbacks – Why carbon utilization is the game-changer we need right now

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Madison Savilow

Traditional carbon capture and storage (CCS) has long been touted as a way to help Canada achieve our global commitments to a reduced carbon footprint. Unfortunately, the technology has experienced setbacks which push deployment timelines further into the future.

We don’t have time to wait. Scientists have sounded the alarm that global warming is happening faster than projected. Fortunately, there are other options we can employ.

It’s time governments and industries turn to carbon capture and utilization as a solution we need to sequester CO2 emissions permanently. Many of the technologies utilizing or converting CO2, rather than storing it underground, offer implementable, economically viable alternatives to address our urgent climate targets. 

So, what’s the hold-up? Lack of awareness of the options available may be one reason. 

Carbon capture, utilization, and storage (CCUS) encompasses a trio of strategies aimed at reducing atmospheric CO2 levels, each addressing different stages of carbon management. Each offers a means to reduce our carbon footprint and achieve our climate goals significantly.

Carbon capture is the process of collecting carbon dioxide from industrial emissions before it can contribute to global warming. Once captured, the carbon dioxide can either be stored or utilized.

Storage involves sequestering the captured CO2 in underground geological formations to prevent its release into the atmosphere.

Utilization involves sequestering or converting the captured CO2 into valuable materials and products. This not only prevents the CO2 from entering the atmosphere but also creates economic benefits by turning CO2 into a raw material feedstock.

The extensive infrastructure and geological storage requirements of carbon storage have resulted in delays in implementing this carbon management technology. The recent decision by Capital Power to withdraw from the Genesee CCS project highlights the economic and logistical obstacles inherent in such large-scale CCS endeavors. This underscores the need for decarbonization pathways that offer a return on investment and are less regionally tied.

CCU technologies can enable a new route for captured CO2 and are ideal for regions without geological storage options. In regions with CCS compatible geology, CCU is a complementary solution that transforms captured CO2 emissions into valuable products.

In both scenarios, these technologies can create dual benefits for the environment: it prevents carbon from entering the atmosphere by sequestering or converting it for permanent use, and it replaces raw, carbon-intensive materials in various industries.

For example, ex-situ mineralization is an aboveground process that converts gaseous CO2 into solid minerals. It can then be used in industrial processes such as the concrete sector as supplementary cementitious materials (SCMs). SCMs replace traditional, more carbon-intensive materials in concrete production, significantly reducing the carbon footprint of buildings and infrastructure.

Multiply this with the current global building boom and this could have a massive impact on our climate goals. 

The versatility of CCU also extends beyond construction materials.

Innovations in the sector are producing sustainable aviation fuels, regenerative plastics, and even synthetic fibers for clothing — all utilizing captured carbon. These products not only mitigate carbon emissions but also foster new industries and markets, contributing to economic growth while supporting global sustainability goals.

Of course, different CCU technologies each have their limitations and benefits. For these methods to be truly sustainable, they must be economically viable, scalable, and offer improvements over the conventional materials they replace, thus providing solutions that are both environmentally and economically advantageous.

A common theme across CCU methodologies is their ability to integrate into existing industrial systems. By utilizing waste CO2 from power plants and industrial processes, CCU technologies reduce the CO2 released into the atmosphere and support circular economy principles. With the displacement of carbon intensive materials, they enable decarbonization and reduce reliance on fossil fuels.

The economic impact of CCU is significant. By creating markets for carbon-enhanced products, CCU aids in decarbonizing various sectors and spurs investment in green technologies. This market-driven approach fosters innovation, reduces costs, and promotes the adoption of sustainable practices on a wider scale.

As we confront the urgent deadlines of climate targets, it is crucial to utilize every available technology. CCU emerges as a practical, impactful, and economically sound strategy that complements long-term CCS goals. With its capacity for immediate implementation and versatility in applications, CCU is an essential tool in our environmental strategy.

Embracing CCU is key to transforming the daunting challenges of carbon management into powerful opportunities for growth and sustainability, paving the way for a healthier planet and a thriving global economy.

Madison Savilow is the Director of External and Corporate Affairs for Carbon Upcycling.

Let’s help grow more intergenerational connections

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Paula Rochon, Rachel Savage and Jen Recknagel

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

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

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

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

We need to foster more intergenerational connections across the country. 

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

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

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

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

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

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

Social connections are key to reducing loneliness.

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

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

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

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

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

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

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

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

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

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

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

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Timothy Woodford

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

Primary care transformation also needs a map.

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

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

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

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

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

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

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

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

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

Communities have floundered. 

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

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

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

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

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

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

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

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

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Laura Syron

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

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

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

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

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

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

I know how that feels. Literally.

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

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

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

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

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

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

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

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

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

So, how do we change the conversation around diabetes?

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

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

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

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

Laura Syron is President & CEO of Diabetes Canada.

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

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Timothy Woodford

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

Primary care transformation also needs a map.

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

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

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

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

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

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

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

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

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

Communities have floundered. 

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

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

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

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

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

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

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