We need to rethink how we treat older women in healthcare.

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We need to rethink how we treat older women in healthcare.

Paula Rochon, QUOI Media

Older adults need health care and social services that respond to their unique needs. For older women, however, research shows that this is not happening. They are often overlooked by the policy planners, researchers, and care providers whose decisions affect their well-being.

This is despite the fact that older women make up 55 per cent of the population of older adults in the United States and their numbers are expected to grow. In the coming decade, 20 per cent of the population in the U.S. and Canada will be over age 65, and most of them will be women. Older women may have different health and social needs than older men and fewer economic resources.

A new Women’s Age Lab is working to change the way society perceives and treats older women. Believed to be the first of its kind, the centre is using scientific research to address four under-studied areas that older women say are important to their health and well-being.

One is gendered ageism, which results in older women’s experiences and contributions being devalued.

Another is reimagining aging in place and in congregate care to ensure that the specific needs of older women are addressed whether they are living at home or in a long-term care facility.

A third focus is on researching ways to optimize drug treatments to reduce the incidence of adverse drug effects on older women.

The fourth area is on research to better understand loneliness in older women and develop strategies to foster social connection.

Through collaboration with healthcare providers, community organizations, and international experts, the lab is developing science-based health and social policy solutions to improve the lives of older women around the world.

Dr. Paula Rochon, MD, MPH, FCRPC, is Founding Director of Women’s Age Lab, a geriatrician and senior scientist at Women’s College Hospital and ICES in Toronto. She is a professor in the Department of Medicine at the University of Toronto (UofT) and is the inaugural RTOERO Chair in Geriatric Medicine at UofT.

Building a barrier-free benefit for people with disabilities

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Building a barrier-free benefit for people with disabilities

Leonard Baker and Elizabeth Mulholland

It has been three years since the government first proposed the CDB to much fanfare in its 2020 Speech from the Throne. The good news is that Bill C-22 was supported by every political party in our government.  The bad news is that since the idea was first introduced, people with disabilities have fallen even further behind.

It’s time to get the money flowing.

The federal government must also fulfill its commitment to collaborate with the disability community in the design and delivery of the benefit to make it truly accessible and responsive to their needs. A Benefit without Barriers, a new report by March of Dimes Canada and Prosper Canada, can help.

Developed with people with disabilities and disability organizations, the report sets out principles and recommendations for the design and administration of the new benefit that are rooted in the hard-won experiences of those who have had to navigate Canada’s disability income support programs and are intimately familiar with the challenges these entail.

Their advice is designed to ensure that we turn a page on past mistakes and deliver a CDB that leaves no eligible person with disabilities behind. Their voices must be heard.

The process of applying for benefits is fraught with barriers that cause many applicants to give up in frustration. Even those who are ultimately successful may also pay a steep personal price.

Barriers include lack of awareness and information, as well as long, onerous and costly application processes that are hard to understand and navigate, and undermine the self-respect, dignity and mental health of many applicants. Individuals with disabilities often feel government application processes are largely designed to drive them away, rather than help them access benefits they are entitled to. They and their families and caregivers feel distrusted by their own government.

Applying for disability benefits is also costly, requiring applicants to pay out-of-pocket for assessments by healthcare providers and associated travel if they live in a community without someone who provides this service. Other barriers like lack of government-issued identification, difficulty finding a physician, and housing insecurity, further compound these challenges, leaving people feeling discouraged and defeated.

In addition, most people with disabilities lack access to one-on-one help to complete applications, appeal decisions, and self-advocate – all of which are often needed to successfully access benefits. 

Proving one’s disability can be exhausting and dehumanizing, especially when you have to do it over and over again to access different benefits – or to requalify for them, even when your disability is permanent and irreversible.

The new CDB needs to be better than this if it’s going to meet its goal of eliminating disability poverty. if its going to meet the government’s goal of eliminating disability poverty. It’s time for a humane, empathetic, and respectful benefit experience that, above all, does no harm to the people the CDB is intended to help. 

Success requires that government engage directly with people with disabilities as it designs the benefit and its administration to understand and actively address the risks associated with different options.

Only then can we be sure that the result will be a benefit experience that  fosters respect and dignity and treats people with disabilities as valued members of society.

We can start by automatically deeming anyone receiving provincial/territorial disability income support, CPP-Disability, the Disability Tax Credit or Veterans’ disability benefits to be eligible for the CDB. The government can also ensure that all CDB delivery staff are trained to the highest standard in how to communicate with and support CDB applicants and recipients.

Finally, the federal government can harmonize the CDB with other federal disability programs and work with its provincial and territorial counterparts to protect CDB income from claw backs. Our goal is to reduce poverty – not fill provincial/territorial coffers or simply move money between federal programs.

We can build a disability benefit without barriers and now is the time to do it. People with disabilities in Canada have waited long enough. Let’s get on with the job.

Leonard Baker is President and CEO of March of Dimes Canada.

Elizabeth Mulholland is CEO of Prosper Canada.

Time to speed up the pace of gender parity in politics

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Time to speed up the pace of gender parity in politics

by Susan Franceschet and Jennifer M. Piscopo

The Alberta election has come and gone. Two powerful women engaged in a closely fought battle, guaranteeing a woman premier no matter which party triumphed. Still, all-women contests in provincial elections are the exception, not the norm. 

Canada is falling further behind when it comes to women in politics, particularly in federal elections.

Canada ranks a pitiful 61st globally for women in parliament, far behind countries in Europe, Latin America and Africa.  How did we end up here?

Canadian women campaigned for the right to vote over more than three decades. Activists began organizing in 1876 but didn’t win voting rights until 1918. Indigenous people would wait several more decades.

Hard work and creativity were key. Women established provincial and national suffragist organizations. They gathered signatures on petitions. They staged mock parliaments to demonstrate their political knowledge and debate skills. And they were opposed and scorned at every turn.

But revisiting the suffragists’ playbook to demand parity in political representation might be a good idea. It’s been more than 100 years since Agnes Macphail became the first woman to be elected to parliament. Yet men still hold 70 per cent of seats in the House of Commons.

This underrepresentation matters, because when women hold political power, governments are much more likely to develop policies and prioritize spending on issues that affect them.

Consider that feminist organizing and lobbying ensured that gender equality was enshrined in the 1982 Charter of Rights and Freedoms. But having guarantees on paper was not enough.

Women also staged multiple protest marches to gain full reproductive rights and to call public attention to the ongoing problem of violence against women, including missing and murdered Indigenous girls and women.

The lesson keeps repeating itself: change doesn’t just happen. Those with political power don’t easily concede the needs or perspectives of those who are not represented.

Change happens when advocates mobilize others to join campaigns that call public – and then politicians’ – attention to problems of injustice, insecurity and inequality.

Other countries offer inspiration too.

In 1975, the women of Iceland went on strike. Instead of going to work or tending to their families, they took to the streets, paralyzing the country. Within a year, the government adopted the Gender Equality Act. Iceland has ranked number one in the world on gender equality for more than a dozen years.

More recently, on International Women’s Day in 2018, five million Spanish women workers staged a “feminist strike.” They marched in protest of the gender wage gap and ongoing violence against women, chanting slogans like “if women stop, the world stops.”

Today, Spanish women hold 42 per cent of parliamentary seats and a majority of cabinet posts. A proposed “Equal Representation Law” will preserve these gains. Spain already has a 40 per cent quota for women candidates, and the new law would elevate this quota to 50 per cent for parliament, cabinet, and boards of directors. 

Hard work and strategic alliances among women in Latin America also resulted in gender parity. Both Mexico and Argentina require parties to divide candidacies equally among men and women. And in Chile, women chanting “we are half, we want half” in the streets and in Congress resulted in the world’s first constitutional convention where women held exactly 50 per cent of the seats.

When women come together — especially across political lines — they get heard. In the U.S., men legislators accepted meetings with women lobbyists only when they realized that the women had mobilized constituents. And collaboration among women’s organizations was key in getting African parliaments to adopt gender quotas.

Of course, all these women faced hurdles when seeking quotas and parity. After all, securing the right to equal representation means that some men will have to stand down to make way.

But when women unite, they can win rights to political parity. A concerted campaign using the suffragists’ tactics — letter-writing, marches, and mock parliaments made up of women — would help to show that a status quo where men hold 70 per cent of seats in parliament is completely unacceptable.

Canadian women have come together and fought for basic rights before. To speed up the glacial pace of their political advancement, they probably need to do so again.

Susan Franceschet is Professor of Political Science at the University of Calgary, @sufranceschet. Jennifer M. Piscopo is Associate Professor of and Chair of Politics at Occidental College in Los Angeles, California, @Jennpiscopo.

New health deal needs transparent monitoring and evaluation process

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New health deal needs transparent monitoring and evaluation process

Gail Attara and Louise Binder

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Claudia Hepburn

QUOI Media 

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

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

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

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

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

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

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

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

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

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

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

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

Why is being a patient a difficult pill to swallow?

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Why is being a patient a difficult pill to swallow?

Harvey Max Chochinov

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

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

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

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

It doesn’t have to be this way.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Michael Wolfson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let’s also “follow the money.”

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

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

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

Maya’s Plastic Pollution Campaign

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<strong>Maya’s Plastic Pollution Campaign</strong>

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

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

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

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

Her campaign goal is to get lots of kids and families to collect and make their own album of PLU stickers to send to their Member of Parliament asking for their support to ban plastic PLU stickers. You can watch Maya’s campaign video at https://foecanada.org/water-and-plastics/mayas-plastic-pollution-campaign/.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We would all then breathe easier.

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

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

Quoi Media
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<strong>Person-centric health data should be front and centre for First Ministers’ Agreements on Healthcare</strong>

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

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

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

“Privacy chill” extends well-beyond the pandemic. 

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

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

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

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

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

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

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

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

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

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