Skilled tradespeople essential to solving Canada’s housing crisis

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Skilled tradespeople essential to solving Canada’s housing crisis

Three ways to solve the housing crisis through skills training

Piers Young, QUOI Media

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

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

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

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

            •           Support enrollment in pre-apprenticeship and diploma programs

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

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

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

            •           Extend post-graduate work permits for international trades students

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

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

            •           Offset the cost of equipment and unlock industry investment

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

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

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

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

It’s time healthcare workers learned how to work in teams

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It’s time healthcare workers learned how to work in teams

by Ivy Bourgeault and Ivy Oandasan

Dr. Ivy Oandasan 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.

Canada is in the midst of a primary care crisis. Primary care is the first point of contact Canadians have with the healthcare system outside of hospitals – often via a family physician or nurse practitioner. Unfortunately, an estimated 6.5 million Canadians do not have a family physician or a nurse practitioner.

Provincial government plans to address the crisis have largely focused on increasing the number of health workers. But increasing numbers alone, by making more spots available in medical and nursing schools, and recruiting health workers from out of country, will not be enough to solve the crisis. 

We need to reorganize the work of healthcare workers to better use their expertise, reduce duplication and enhance the coordination of care experienced outside of hospitals to improve healthcare access.

No one practitioner can do it all because this no longer fits the reality of the kind of health issues people face today. Patients — especially those with chronic or complex health needs — are better served by a team of healthcare workers whose skills complement each other.

A team-based approach can better balance the workload among team members and enable each member to better use their skills and training. Not only can this help to reduce burnout, it can also improve job satisfaction.

Some provincial governments have been creating more practice opportunities for primary care teams working collaboratively. Many provinces are implementing new practice approaches like the Patient’s Medical Home with family physicians working in teams with other healthcare professionals providing accessible, high-quality care for their patients.

But effective teamwork doesn’t just happen magically without dedicated training and support.

Training healthcare workers to practice in primary care teams is a necessary part of any strategy to address the crisis.  Teamwork among healthcare workers must be fostered through knowledge about what each other can do and opportunities to practice working together.

It may come as a surprise to many Canadians that few healthcare workers learn explicitly about the roles each plays, or could play, in the care of patients. For example, various health professionals, including physicians, may not be aware that registered nurses can conduct annual wellness exams, including pap smears; that midwives have the authority to prescribe drugs; of the role that occupational therapists have in providing mental health services; that audiologists can help older adults with hearing problems develop new listening and communication skills; and that pharmacists have prescribing authority to collaboratively manage chronic diseases and minor ailments.

Team based care operates on the premise that enabling these primary care providers to complement rather than substitute each other in coordinated ways offers better access to care.

Without this critical knowledge, health workers don’t know how to work together most effectively. Lack of knowledge can lead to a lack of trust and duplications of services without coordination that can be costly and time consuming to patients and the health system.  

Like any team, successful primary care teams require training and practice together to learn how to leverage their strengths.

This idea is not new. Over 20 years ago the Commission on the Future of Health Care in Canada argued that:  “If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.”

A unique federally funded pilot project called Team Primary Care: Training for Transformation is working to address this foundational and outstanding gap. It brings together over 20 practitioner groups representing all aspects of primary care to create training content, tools and approaches that enable each team member to learn about, from and with each other, and enhance their ability to work better together delivering more and better primary care.

The project focuses on enhancing the training of specific primary care practitioner groups as well as practice-based training of existing primary care teams, bringing on new providers to accomplish transformational change at many levels.  Spreading and scaling the tools and approaches of this project is paramount and will begin with the support of over 100 health professional and educational organizational partners across the country.

It’s time healthcare workers learned how to work in teams. 

Now, all governments need to work with health provider educators to support necessary education reform as part of the transformation to primary care teams. Patients, health providers and the health system alike will benefit.

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. 

Dr. Ivy Oandasan 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.

They are co-leads of Team Primary Care.

Canada needs to ramp up skills for AI revolution

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Canada needs to ramp up skills for AI revolution

By Ricardo Arena

Like it or not, the age of artificial intelligence (AI) is upon us.  While Canada has every reason to be ahead of the implementation curve, with a highly educated workforce and excellent access to cutting-edge tech, history suggests Canada will be well behind on the path to AI adoption.

How do we break the cycle and become technology leaders? 

In a country where small companies dominate and few have the capacity to explore new ideas without support, the federal government must play a bigger role in creating the conditions for success. 

We already have companies who understand the transformative potential of AI.  But we need to have a highly skilled talent pipeline to harness the potential of AI. This is where academic partners stand to play a much more integrated role in Canada’s innovation ecosystem. 

Canada’s polytechnics – our advanced technology post-secondary institutions – have capacity to both support business innovation and train next-generation talent.  Targeted government investments can magnify this potential.

As innovation intermediaries, polytechnics are able to walk companies of all sizes through the adoption of new technology.  Their applied research spaces offer labs and workshops equipped with tools and technology with which businesses should be experimenting.  Faculty, research staff and students are actively looking for opportunities to apply new solutions to today’s stubborn challenges.

For example, Sheridan’s Dynamic Digital Humans research is addressing critical gaps in dementia care through augmented and virtual reality.  Partners at Reimagine AI are working closely with the polytechnic to build enhanced and human-like digital characters for its mobile app, which will provide meaningful companionship for Alzheimer’s patients and others suffering from memory loss conditions.

That kind of hands-on approach ensures a polytechnic education is pragmatic and industry-aligned.  Most partners point to strings-free intellectual property as a major benefit of polytechnics, enabling them to build their businesses around new approaches uncovered during research.  Another benefit is student involvement, ensuring talented graduates are ready to fill the labour market gaps created when companies adopt new technology.

Yet, because federal funding for polytechnic applied research continues to significantly lag that available to their university counterparts, this isn’t happening at scale.  In an economy reliant on small businesses, Canada does not have an innovation ecosystem designed for their needs.

The challenge doesn’t end there. 

Canada equally requires a workforce that understands the potential of new technologies like AI and how to use them.  To address this need, polytechnics are finding ways to integrate emerging technologies into their classrooms.

At Saskatchewan Polytechnic, for instance, they are transforming mining engineering education by infusing 3D digital mining and simulation into their programming.  Their virtual mine is intended to simulate a real mining environment using virtual reality headsets, creating immersive simulations to explore mining environments without physical risk and fostering an understanding of safety protocols and procedures.  This initiative was undertaken in partnership with the International Minerals Innovation Institute, which invested more than $100,000 in the project to enhance learning among both students and industry.

This approach to training partnerships is increasingly common and we need more of them. 

Companies are recognizing that talent shortages are holding them back, faced with difficulty both recruiting new entrants with the right skills and keeping their existing workforce current.  Increasingly, businesses realize they need skin in the training game.

With the ever-increasing pace of technological change, unlocking industry investments in training will be critical to staying ahead of skills demand.  Here, the federal government could better incent industry co-investment by offering to fund half of the purchase of new equipment, tools and technologies.  The ability to train existing employees alongside new entrants is an added bonus.

Canada’s future productivity will rely both on the adoption of emerging technologies and the presence of a skilled workforce ready to capitalize on them. A couple of smart investments – in partners who can support business applied research and the equipment needed to train the technology talent pipeline – will go a long way in ensuring Canada is ready for an AI-enabled world.

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

Our clinical trials system is failing Canadians with cancer

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Our clinical trials system is failing Canadians with cancer

Dr. Rebecca Auer, QUOI Media

Canada’s clinical trials system is failing Canadians with cancer.

I know this as a cancer surgeon and researcher — and as the spouse of someone thriving despite advanced-stage cancer thanks to molecular testing, experimental therapies and enrolment in a clinical trial abroad at personal expense.

While unprecedented innovations in research have led to an explosion of novel cancer treatments — molecular, immuno-oncology and cell therapies — there have been almost no changes in the way we run clinical trials and approve new therapies for public funding in Canada.

This outdated approach hurts cancer patients. With so many new treatments coming down the therapeutic pipeline, it is critical that we transform the process for testing, approving and funding therapies, so the increasing number of Canadians diagnosed with cancer each year can benefit.

Clinical trials are often the best or the only treatment option for cancer patients, offering novel therapies that may have fewer side-effects and better efficacy than traditional treatments and that would otherwise be inaccessible or unaffordable to most Canadians.

Participating in clinical research also gives patients hope.

As a new report from CONECTed — a network of oncology patient groups — notes, Health Canada regulations around trial design and monitoring are complicated and outdated, creating complexity and delays in initiating and completing trials. This discourages sponsors from opening trials in Canada and investigators from initiating these trials at their cancer centres.

A lack of molecular testing in Canada compounds the problem.

For many cancer clinical trials, patients need to have molecular testing on their tumour to determine if their cancer harbours the mutated gene the trial therapy is targeting. Unfortunately, no province funds comprehensive molecular testing and a recent report from the coalition Access to Genomic Testing states that most provinces are wholly unprepared to provide it, even if funding were available.

That leaves it up to cancer patients to pay for these costly tests themselves. For many, the $2-5K price-tag is simply unaffordable, leaving them unable to participate in the trial. This also discourages industry trials from even being offered in Canada because it is too challenging to find the specific patients who meet the eligibility.

Even when trials are open in Canada, they are often only available at one or two large-volume cancer centres. The burdensome regulatory Health Canada framework makes it too onerous and costly to open a clinical trial site that can only expect to enrol a couple of patients. While delegated or virtual treatment is acceptable for clinical care, it is not allowed for the oversight of clinical trial patients. As a result, cancer patients wishing to take part must travel to the location of the trial, which may be costly and inconvenient – or inaccessible.

Adding to these barriers is a mindset in government and hospital leadership that views research as separate from clinical care. While grounded in efforts to ensure patient safety, this separation is now creating obstacles for patients to access the best cancer care.

Fixing the system will require policy and practice changes at the federal, provincial and hospital level.      

The federal government must accept new ways of designing and administering clinical trials. While there must be no compromise on safety, there is room to imagine a system that is faster, more efficient, more cost effective and geographically accessible to all Canadians.

Canada should have a single, centralized research ethics board to review the ethical conduct, safety and privacy considerations of a clinical trial. Cancer centres should be allowed to form networks that enable operations as a single “site” for clinical trial administration and patient enrolment with delegated and virtual options for participation.

These changes would encourage sponsors to open trials in Canada and make it easier for patients to enrol at any site on a network’s list, enabling access to clinical trials closer to home.

Provincial governments must also be forward thinking in their approach to funding molecular and other diagnostic tests, supporting not just the proven targets of yesterday, but also those being evaluated in clinical trials today, many of which will define future therapy.

Hospitals must also need to embrace a culture of research and be incentivized to engage in clinical trials.

Hospital leaders must recognize the value of research and integrate it into their care paradigms and deliverables, so more patients have access to innovative cancer treatments. 

Cancer patients do not have the luxury of time. We need to transform all aspects of the clinical trials system now, so patients have the opportunity to participate and live with hope.

Dr. Rebecca Auer is a Surgical Oncologist and Director of Cancer Research at the Ottawa Hospital Research Institute.

Now is a good time to reassess your medications with your healthcare provider

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Now is a good time to reassess your medications with your healthcare provider

Paula Rochon, Lisa McCarthy and Jerry Gurwitz, QUOI Media

Now that we are embarking on a new year, many of us take on annual resolutions with a focus on diet and exercise.  Overlooked is another important way to improve our health: increasing awareness of our medications. 

An estimated two out of three Canadians over the age of 65 are prescribed five or more drug therapies, and one out of four are prescribed 10 or more medications over the course of a year.  Sometimes these medications are necessary.  But sometimes, they may need adjusting or they may even be unnecessary – medications we no longer need or that may have more possible harms than benefits. 

We need to check regularly with our healthcare provider that the medications we are on are necessary and at the right dosage. 

‘Polypharmacy’ is known as the use of five or more medications.  Polypharmacy is particularly relevant to older adults, especially women, because drug use increases with age, often to manage chronic conditions.

Polypharmacy poses risks such as unwanted and sometimes harmful side-effects, as well as possible interactions with other drug therapies, and problems with adhering to complex medication regimens. Women are more at risk for drug-related injuries than men. 

Do individuals need to be on so many medications? The answer might be yes.

But one way polypharmacy happens is because of something called “prescribing cascades.”  Prescribing cascades occur when a drug therapy is started and an adverse effect develops.  These new symptoms are often misinterpreted as a new medical condition which leads to the inappropriate beginning of a new drug therapy to treat the new symptoms.

Take, for example, an individual experiencing mild knee pain.  They may be prescribed a non-steroidal anti-inflammatory drug (NSAID) to manage the pain.  Subsequently, they develop stomach upset and an anti-ulcer medication is prescribed to treat this new symptom. 

By recognizing that this is a prescribing cascade, the healthcare provider can make choices.  They can decide whether the initial drug therapy, the NSAID is required, or whether a non-pharmacologic approach such as physiotherapy could manage the knee pain. 

Alternatively, if the initial drug therapy is required, the provider could decrease the dose or select an alternative medication with a lower risk of adverse effects to manage the knee pain.  In so doing, the need for the additional medication may be eliminated and a prescribing cascade could be avoided.

In our research into prescribing cascades, we initially described three common prescribing cascades. Now more than 160 prescribing cascades have been identified.  Highlighting the impact of prescribing cascades is essential because it demonstrates how potentially inappropriate medications could be avoided. 

Our recent study, published in the Journal of the American Geriatrics Society also raises another concern about prescribing cascades: the impact of a common prescribing cascade on healthcare use, including emergency room visits and hospital admissions.

Few things are absolute in medicine. When making prescribing decisions, it is always important for healthcare providers to consider individual circumstances and what matters most to a patient. 

In some cases, the use of the medication that starts the prescribing cascade is absolutely necessary, the new symptoms are recognized as adverse effects of the drug, and the decision is made that it is best to continue with the drug therapy and treat the side effects as best possible.

The important point is that prescribing cascades are recognized, and the options are considered as part of the drug prescribing or the medication review process.

Here is what you can do as a patient or caregiver to increase awareness of your medications and the potential prescribing cascades that may contribute to polypharmacy:

            •           Keep a list of all your medications.

            •           Write down the date they were started,

            •           the clinician who started them,

            •           why they were started. 

            •           Review your medications regularly with your healthcare provider.

This information is important as medications may have been started years ago and the provider reviewing the medications may not have this information.  Understanding the sequence of events can help to identify prescribing cascades and to decide if action is needed.

By keeping track of this information and regularly reviewing your medications with your healthcare provider, you may reduce the use of medications that you don’t need and the risk of drug-related adverse effects and polypharmacy.

Paula Rochon is a geriatrician and the Founding Director of Women’s Age Lab at Women’s College Hospital. Lisa McCarthy is a pharmacist, Associate Professor at the University of Toronto and a Lead with deprescribing.org. Jerry Gurwitz is Chief of the Division of Geriatric Medicine at UMass Chan Medical School in Worcester, Massachusetts.

Put the brakes on allowing Medical Assistance in Dying for those with mental illness

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Put the brakes on allowing Medical Assistance in Dying for those with mental illness

by Harvey Max Chochinov

It’s time to put the brakes on Medical Assistance in Dying (MAiD) in Canada for those whose sole underlying medical condition is mental illness.

The federal government has tasked the Special Joint Committee on Medical Assistance in Dying to determine if Canada is ready to extend MAiD eligibility, starting in March 2024, to patients with mental illness alone. Despite those convinced it is time, and safe, to launch what amounts to ‘psychiatric euthanasia,’ the Special Committee must pay attention to a murmur of protest that has grown to a roar: “Ottawa, we’ve got a problem.”

There are two main reasons to abort this mission. Current MAiD eligibility requires a person have a grievous and irremediable medical condition. Unlike some cancers, and many neurodegenerative disorders, no mental disorder can be described as irremediable. To be sure, there are individuals whose mental affliction won’t improve, despite myriad treatments or psychosocial interventions. But there is currently no way to predict which patients won’t get better.

Studies of prognostic accuracy show psychiatrists are wrong half the time. I have cared for patients struggling with chronic suicidality; patients I worried might one day take their lives. I recall a woman with mind-numbing depression, who teetered precariously between life and death. One day, after years of countless drug trials, hospitalizations, electroconvulsive therapy, and various psychosocial interventions, she arrived for her appointment — three weeks into starting a new antidepressant — with a grin on her face.

 “The door is purple” she declared. I told her the door had always been purple, to which she replied, “I know, but now I care.”

Before that moment, no one — not me, not her friends or family and not anyone on The Special Joint Committee on Medical Assistance in Dying, nor any MAiD assessor — could have predicted her recovery.

Intensive, unwavering, compassionate care and caring – not MAiD — offers the most effective way to address this kind of suffering.

The other reason not to launch psychiatric euthanasia is our inability to determine suicidality from those requesting MAiD whose sole underlying medical condition is mental illness. According to the Canadian Association for Suicide Prevention, someone not dying because of their condition, such as a mental disorder alone, seeking death is, by definition, suicidal.

Similarly, the first item listed by the American Association of Suicidology differentiating physician hastened death and suicide is the patient must be dying. That certainly does not characterize patients who are mentally ill.

Despite this, the Special Joint Committee is being told by some MAiD expansionists, “suicidality and having a reason to want to die are not at all the same.” We can say ‘six’ and ‘half-dozen’ are not the same as many times as we like. If we repeat it frequently, consistently and without equivocation, it might even sound convincing, but that doesn’t make it true.

Patients struggling with suicidality often have a reason to want to die, based on, for example, self-loathing, feeling a burden or becoming worn down pursuing care and support that could sustain them. In those instances, the line between MAiD and suicide simply vanishes.

Most proponents of psychiatric euthanasia are prepared to overlook all of this, claiming failure to expand MAiD to the mentally ill is discriminatory. Avoiding discrimination does not mean everyone is treated the same, but rather, that everyone gets equal access to what they need to thrive.

Claiming a lethal injection for mentally ill patients is a respectful, compassionate, and necessary response to their suffering is akin to arguing the virtue of helping people to the balcony of a burning building so they might choose death, rather than sorting out how to control or extinguish the fire.

Time and again, committee members have asked witnesses when Canada’s psychiatric euthanasia program can be launched. I would suggest they behave like NASA. When a potentially catastrophic problem is identified before blast-off, space engineers don’t set an arbitrary new launch date, no more so than Health Canada announces a random release date of a new drug discovered to have unacceptable side-effects.

Members of the Special Joint Committee must listen and exercise reason, wisdom, and restraint in the face of fierce opposition. 

“Ottawa, we have a problem.”  The federal government would be well advised to scrap this mission. But if it insists on moving forward, launch should proceed only when the problems are solved, and not a moment sooner.   

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.

Successful universal pharmacare must address equity in prescription drug access

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Successful universal pharmacare must address equity in prescription drug access

by Louise Binder and Dr. Naheed Dosani

The federal government’s commitment to table the Canada Pharmacare Act by the end of March 2024, including the development by the Canadian Drug Agency of a national formulary of essential medicines, may well help at least some of the millions of Canadians without access to prescription medications or with insufficient prescription drug coverage. 

At least in theory.

However, for pharmacare to truly succeed in providing more comprehensive prescription drug coverage for people in Canada, federal, provincial and territorial governments must also work together to address the existing inequities for people actually accessing medications from public reimbursement plans – plans they are theoretically entitled to but cannot access because of practical challenges.

Provinces and territories determine not only the drugs to be reimbursed in their jurisdiction but also the conditions under which people can access them. These conditions often include co-pays, premiums and deductibles – in other words, some money to be paid out-of-pocket by the person needing the medications.

For people with low to modest incomes, any premiums, deductibles and copayments can make many medicines unaffordable. In fact, one in five Canadians struggle to pay for prescription drugs.

Thus a person’s employment, age, income and province of residence can determine their prescription drug access as a result of their ability or inability to contribute to public reimbursement coverage. This sets up inequities in access that can have serious consequences.

To cope, some people delay, skip or cut doses of prescribed medicines in half to make them last longer. Others cut back on food and heating costs to afford the medication and some simply go without and do not fill needed prescriptions.

Three million Canadians have reported not filling their prescriptions because they could not afford the cost. None of these options is acceptable. All are required for good health including prescription drugs essential for treating and managing many illnesses and health conditions.

Skipping or delaying medications for chronic diseases such as diabetes can have catastrophic consequences leading to hospitalization or even death.

Another example of inequity in practical access to drugs is in the area of cancer treatments. Most provinces pay for take home cancer treatments while a few do not. Two patients with the same type of cancer in a province that does not cover oral cancer treatments could have vastly different out-of-pocket expenses if one is offered an intravenous drug in hospital, while the other receives a prescription for a take-home oral medication. 

While most jurisdictions have implemented catastrophic drug coverage for those not able to access public plans who face high out-of-pocket prescription drug expenses in relation to their income, the annual deductibles required — often a percentage of household net income — can still render the prescription unaffordable.

To eliminate barriers, federal and provincial/territorial governments must co-operate on finding solutions and be willing to fund them adequately. The federal government’s recent $35-million agreement with Prince Edward Island to help the province lower co-payments for certain medications under its provincial drug plan, reduce the deductible for its catastrophic drug program, and expand the number of drugs covered under its public health plan, shows how governments can work together to reduce inequities in access.

We need to see more partnerships like this.

Provincial and territorial governments must also work together to harmonize the medications they cover under their public health plans — a national formulary may well help with this — and to close the gaps in coverage between medications taken in hospital versus those taken at home.

All people in Canada deserve access to lifesaving medications regardless of where they live and how much they earn.

In reforming drug coverage, it is essential that governments consult with relevant stakeholders, including those with lived experience, those who serve them, and experts in health equity, who understand the problems and have solutions to fix them. 

By working together, we can build a strong universal pharmacare program that does not leave anyone behind.

Louise Binder is the health policy consultant for Save Your Skin Foundation. Dr. Naheed Dosani is a palliative care physician and health justice activist.

Set the CBC free

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Set the CBC free

by Peter MacLeod

The closing months of 2023 have not been kind to CBC/Radio Canada. Despite steady increases to its budget since the Liberal government was elected in 2015, CBC/SRC president Catherine Tait announced the loss of 600 jobs — fully 10 per cent of its workforce — on a budget shortfall of $125 million. 

Canada’s public broadcaster is struggling alongside most other broadcasters and media organizations as new technologies and viewing habits make mincemeat of forecasts and strategic plans. 

But the current cuts are just a taste of what will happen if the Conservatives form the next federal government. Pierre Poilievre has promised to defund the CBC and Radio-Canada too.

In response, the Heritage Minister, Pascal St. Onge has suggested that it may be time to review the CBC’s mandate to ensure it is still fit-for-purpose. Cue the summoning of expert panels to grind through a dispiriting Solomon’s choice: local and national news or popular entertainment, as though a self-respecting country and G7 economy can’t have both. 

Perhaps the real question is whether 88 years since its founding there is still a legitimate role for any government in determining the focus, much less the existence, of Canada’s public broadcaster?

After all, following what were critical and often overdue reforms, few today believe that governments should have a role in setting interest rates or involve themselves in the work of the judiciary or police investigations. The reason is understood: some public institutions work better — or can only work at all — when insulated from political interference. Why isn’t the same true for public broadcasting?


Despite various safeguards that protect journalists from management and management from government, the federal government’s budgetary control of CBC/SRC remains almost absolute. This is why, as CBC/SRC approaches its Centennial, the time has come to set it free.

On its own, CBC/SRC’s budget might seem lavish — a cool $1.4 billion. But according to a 2018 report, compared to 20 international peers, the federal funding is miserly. Per capita, we spend about $33 on our public broadcaster each year. The international average is closer to $90.

The fact is that Canada has been massively underspending on its public broadcaster for decades.

Now that the bottom has fallen out of the media industry, the federal government has offered various forms of support, including the Journalism Labour Tax Credit and the Online News Act, which require social media and search platforms to pay up for the news they display.

So, it’s not only CBC/SRC that is supported by federal tax dollars. An additional $600 million now flows annually to privately owned media companies — and still, layoffs are coming from all directions.

The hard truth is that even with these new dollars, we are just barely hanging on to local and national news in this country, much less to high quality cultural and entertainment programming in both official languages.

This is at a time when Canadians find themselves inundated by misinformation and exposed to deceptive campaigns sponsored by hostile foreign governments. Rapid advances in artificial intelligence are poised to make this situation much worse which is why ensuring quality information in our media ecosystem has become so critical.

So, what happens when a future opposition leader threatens to defund not only the CBC/SRC but decides to pull public support for private media too? In a democracy, some institutions belong above the political fray, especially when the market fails to deliver key public goods. The fifth estate is one of them.

This is why we need a radical new approach — an end to annual appropriations and ministerial oversight for the CBC/SRC in exchange for an endowment fund that would see public and private media adequately supported in perpetuity.

A newly established Canadian Media Trust could operate independently from government and abide by a charter that would ensure that its resources were spent on high quality journalism, cultural programming and entertainment. Additional revenue, like those from the Online News Act could flow into the Trust to grow its endowment over time.

Let future governments woo voters by promising to top up the endowment and strengthen Canadian media, or else to withhold new investments and diminish but not dismantle it.  The underlying question of whether Canada needs a strong, independent mix of public and private media, much less a public broadcaster, would be settled.

Canada would be stronger for it.Peter MacLeod is the principal of MASS LBP and chair of the Canadian Citizens’ Assemblies on Democratic Expression which called for sustained public investment in high quality media.

We need to talk about patient safety

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We need to talk about patient safety

Jennifer Zelmer, QUOI Media

When someone says, “we need to talk,” it’s rarely a good sign.  Well, we need to talk about patient safety.

Patient safety trends have moved in the wrong direction in recent years in Canada and elsewhere.

When we are sick or injured, we turn to the healthcare system for help. Most receive safe care, but that’s not true for everyone. For instance, new data from the Canadian Institute for Health Information (CIHI) show that one in 17 people admitted to hospital in 2022-2023 was unintentionally harmed during their stay. They experienced problems with medications, post-surgery infections, pressure injuries, falls or other issues.

Patient safety has always been important, but the COVID-19 pandemic exposed and exacerbated safety gaps in healthcare. Last year was the third year in a row with a rate of potentially preventable harm at or close to six per cent in Canada. That’s up from rates of 5.3 and 5.4 per cent in the six years before the pandemic began.

The conditions of care and the conditions of work go hand in hand.

Patient safety and the physical and psychological safety of the people who work in healthcare are deeply intertwined.  The pandemic added incredible strain to people who provide care. At the same time, as CIHI data show rates of potentially preventable harm to patients rising, there were higher staff absences, more overtime work and increased use of agency staff to fill gaps.

We need to talk about these tough realities.  And, as we move ahead, talking about safety is also an important part of the solution.

That’s true for individual patients and families. For example, we’ve worked with dozens of organizations across the country to improve the safety of care transitions, such as from hospital to home. They introduced discharge summaries designed with patients for patients, used teach-back approaches between patients and healthcare providers to ensure care plans and next steps for treatment were clear, actively involved patients and families throughout the process, and had formal plans for post-transition follow-up.

The result? Both patients and healthcare providers report better care transition experiences, and fewer patients were readmitted to hospital.

It’s also true for healthcare teams. Regular safety conversations allow staff to work together to prevent problems before they occur.

Research shows that places with positive safety cultures tend to have less patient harm and higher staff satisfaction. Staff from organizations we partnered with to implement regular safety huddles, for instance, looked forward to them as opportunities to come together to proactively discuss how to make care safer for all those involved. They told us that being involved in safety gives meaning to their work and gives value day-to-day.

We can build positive safety cultures at the health system level too.

In the past, the focus has usually been on measuring and responding to past harm. But safety is not just about the absence of harm. While we still need to ask how safe care was in the past, we also need to ask whether care is safe today and how it could be safer tomorrow. In doing so, we need to consider all forms of harm – such as over- or under-treatment, delayed or incorrect diagnoses and psychological harm caused by culturally unsafe care – not just physical harm.

Everyone involved in care contributes to safety – patients, families and other care partners, healthcare providers, and leaders. So we can all be part of building positive safety cultures. To get started, Healthcare Excellence Canada has a free Rethinking Patient Safety Discussion Guide and safety conversation resources for patients and providers.

Now is the time to talk about healthcare safety. By redoubling our efforts to promote safety with and for patients and healthcare workers, everyone benefits.

Jennifer Zelmer is President and CEO at Healthcare Excellence Canada, a not-for-profit charity funded primarily by Health Canada, focused on improving the quality and safety of healthcare.

Substance only gets you so far

Quoi Media
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Substance only gets you so far

Peter MacLeod

One of the surprising aspects of the Trudeau government is that according to its earliest critics, the lightweight Prime Minister would prove to be all style and no substance. Nine years later, it turns out the reverse might be more accurate. 

Like it or loathe it, the government has proved itself substantial on many fronts: reducing child poverty with a targeted benefit and extending affordable childcare across the country,  introducing and successfully defending a world-leading approach to carbon pricing, hammering out a new funding agreement for health care, renewing the free trade agreement in the face of an erratic American presidency, and steering the country through a once in a century pandemic. 

Yes, there have been failures, delays and missteps. Pharmacare and electoral reform are broken promises. The longstanding consensus on ambitious immigration quotas is straining against a deepening housing crisis. The carbon pricing pause is a genuine self-own.

What’s missing, however, is not principally a lack of policy ambition but a lack of cultural imagination — of the kind that pulls communities and people together.

Despite the promise of sunny ways, the government’s nine years have passed with few uplifting or unifying cultural touchstones. 

Of course, no Prime Minister chooses their time, and Trudeau’s tenure has been marked by many calamities: from the pandemic to the slow-to-come recognition of unmarked graves at residential schools in many parts of the country, to harrowing wildfires that first burned Fort McMurray, then Lytton before blackening skies across the country this summer.

Whether by disinclination or in part because of these events, there have been few inventive, generous moments that have helped Canadians connect with one another and see themselves in a new and positive light. 

After all, Canada is the country that in 1967 showed the world how transformative a major event like a Centennial can be. Yet, the government’s lackluster Canada150 celebrations passed without any lasting memory or impact. 

Despite initially naming himself Youth Minister and establishing the Canada Service Corps to give young people a chance to explore the country and serve communities, at most just 5,000 people — in a country with more than 7 million 15-29-year-olds — participate in its programs each year.

Canada’s prized and internationally admired citizenship ceremonies have begun migrating online — as though a mouse-click ‘virtual attestation’ can replace the memories and goodwill that flow from the thousands of community events and oath-swearing ceremonies that take place each year. 

Incredibly, for almost a decade major new sports centres and cultural venues have gone unbuilt. Even the Prime Minister’s residence, 24 Sussex, has been left to rot.

This stands in contrast to the cultural ambition of the Prime Minister’s father, Pierre Elliot Trudeau, who along with Prime Minister Lester B. Pearson before him, gave Canadians nothing less than a new anthem, flag and national honours system alongside dozens of new cultural programs and institutions.

It’s too easy to say this was simply the spirit of the times. But in a country as vast as Canada, we will always need to create both iconography and opportunities that supersede our geography so that we can share experiences that kindle pride, belonging and optimism.

One moment that did stir Canadian hearts came during the early days of the Syrian refugee response when more than 100,000 Canadians volunteered to help newcomers escape their war-torn country.  At its height, Toronto Pearson reopened its infield terminal to help handle daily flights. The Prime Minister and other dignitaries — including opposition MPs — welcomed refugees as their children got fitted with snowsuits alongside the other necessities of life in Canada. 

Here was a moment that brought a purposeful culture — in the form of mass volunteerism — and policy together, and which illustrates what’s possible when governments support the capabilities of publics to do big things.

This was also the lesson of the 25,000 volunteers who ultimately brought the 2010 Vancouver Olympics to life, and the lesson we recite each fall as four million Canadians lace up their sneakers to support the Terry Fox Foundation.

Purposeful and participatory, not passive and remote: this is the style of a high energy, popular politics that brings people together and provides an antidote to the belief that strangers can no longer find common ground or that good policies are all a country needs.

Peter MacLeod is the principal of MASS LBP, a democracy organization based in Toronto.

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