Teri Price

QUOI Media

May 19^th was the 10-year anniversary of my brother Greg’s death. Greg was a healthy, intelligent 31-year-old who had only told us of his potential diagnosis of testicular cancer days before. Our family was shocked and devastated.

A major factor in my brother’s early death was Canada’s poor health data infrastructure. 

Greg and his various health providers didn’t have access to all his health information. A red flag for testicular cancer was in his electronic medical record at one clinic but wasn’t available to the walk-in clinic doctor Greg saw when he started having back pain. One of his doctors moved his practice; the clinic didn’t have a process in place for follow-up. A specialist he was urgently referred to — via fax — was out of the office for an extended period and the referral sat there until Greg finally called the specialist’s office.

When my family wanted to learn what happened so we could help prevent this from happening again, we asked questions about how common cases like Greg’s were. The system couldn’t provide what we thought was basic information. We asked for statistics on surgeries like Greg’s and the frequency of blood clots for the hospital, region, province and nationally – which didn’t seem like a big ask at the time – and learned the information doesn’t exist.

Since Greg’s death, we’ve learned a lot about healthcare and have realized that we made a lot of dangerous assumptions.

In the first year after Greg’s death, Dr. Ward Flemons and the team at the Health Quality Council of Alberta investigated what happened, releasing the Continuity of Patient Care Study. Five years later, we partnered again to produce the film, Falling Through the Cracks: Greg’s Story. To date, it has been screened more than 470 times and we’ve participated in almost every screening’s post-film discussion. These conversations have been an opportunity to deepen our understanding of healthcare and refine what we believe is crucially important for its future.

We have learned a few things that we believe are fundamental truths:

            •           We need a health system that puts patient safety as a real priority and that doesn’t harm patients.

            •           Safe care is provided by teams.

            •           Teamwork requires information to make safe decisions.

            •           We need a health system that uses information to continuously learn, improve and innovate.

Everyone deserves safe care, yet Canada has an unacceptable level of harm. One in every 17 hospital stays results in at least one unintended harmful event — and that is just hospital stays.

Harm impacts the entire care team. It’s not okay to put people in a position where a single mistake could result in patient harm. We need a system that enables health providers to do their best work, where they’re surrounded by a team that relies on each other, and where the whole team, including patients, have access to the information they need. 

As Dr. Ewan Affleck puts it, “information is the currency of care.” Health information systems must be intentionally designed to enable teams to provide safe care by giving access to information whenever decisions are being made.

For patients to be engaged partners who participate in making decisions in their own care as contributing members of their team, they also need access to their information.

A recently released series of reports from the Pan-Canadian Health Data Strategy Expert Advisory Group honestly outlines the current problems in health information in the country and provide an actionable strategy to create the healthcare system that we need and deserve. They call for a learning health system that uses interoperable data standards and person-centred data architecture, with collaboration across health jurisdictions and stakeholders. This would create a robust health system based on data-supported insights and evidence-based decisions. 

Bold collaboration is needed for success, and we all have a role to play.

Before Greg’s death, we assumed that healthcare, like other sectors, had evolved over time to adopt tools for effective communication and information sharing. We were wrong.

As citizens across Canada, we need to support the system changes and mindset shifts needed. This isn’t going to happen overnight. There isn’t a single sector, organization, or jurisdiction that can independently cause this change. Just as a team is required for patient care, we need collective action to prevent more people from falling through the cracks.Teri Price is the Executive Director of Greg’s Wings Projects.

Linda Wilhelm
QUOI Media

In 1983, after two years of living with unexplained symptoms, I received a diagnosis of rheumatoid arthritis. My prior experience with healthcare was limited to an annual visit to my family doctor to renew a prescription for birth control. Like most Canadians, I thought my care providers had all the answers within a well functioning system of care that would meet my needs.

Unfortunately, I learned the hard way – like many Canadians with complex chronic conditions — that much of the care coordination and management of my health information would fall on my shoulders.

The first hint of the problems I would face began when we moved between provinces, from British Columbia to Ontario to New Brunswick with an infant and a toddler, and discovered we had no medicare while establishing residency. My health data also did not follow me.

Fortunately, my arthritis was in remission until my daughter was born in 1987, and I was lucky to find a family doctor and a specialist. Then the cycling through various treatments began, none of which were very effective until 1999, when I gained access to a biologic. It was through this long process that I realized just how badly our health system is broken.

I needed access to a new treatment that was approved in America in 1998 but, nearly two years later, still had not become available in Canada, while I watched the few joints not yet affected by the disease slowly degrade and contribute to irreversible disability.

I became responsible for ensuring the flow of my health information, tasked with educating healthcare providers on rheumatoid arthritis and my needs, although few would listen to me. Having to explain to an emergency room doctor that, because I’m on a biologic I require an antibiotic for upper respiratory infections, is the norm because, even though I show my health card and my information is entered into a computer, they have no access to my health information.

I had such hope with the arrival of an electronic health record that some of the weight of health data management would be lifted from my shoulders. It’s enough just living with an incurable, disabling disease but to be responsible for ensuring the flow of information often makes life overwhelming.

Now it’s 2022 and I still have no access to my recorded health information and health history, and neither do most of my practitioners. My health data remains scattered across computerized systems of different health silos, specialists, institutions and provinces. This means my health providers are often working in the dark.

The past two years have reinforced how important it is for individuals themselves to have seamless access to their health data.

Immunocompromised patients have received so much conflicting information on COVID-19 vaccination, with eligibility differing between regions; we had to get letters from our doctors verifying our status and take these to vaccine clinics where we were often challenged on our eligibility. As high-risk patients, we are supposed to be a priority for new COVID-19 treatments that lessen the severity of the illness but few of us know how to access them.

In an era of “self-management,” patients are expected to play an even bigger role in managing their care but if we’re not given the tools we need, this is an impossible ask.

The Pan-Canadian Health Data Strategy Expert Advisory Group (PCHD) recently released the third report in a series outlining the foundational changes needed to achieve the healthcare system that Canadians deserve. The report calls for a ‘learning health system’ where data-driven insights lead to evidence-informed decision making across all health programs, services, surveillance and care delivery.

Central to this idea is the call for a ‘person-centred’ data system, where all health providers – and the patient — have timely access to an individual’s health data organized around the individual. The data would not be siloed by institution or provider but follow the patient. This would eliminate problems Canadians often encounter now, such as duplicative services, missed diagnoses, and inferior care.

It’s time to make this happen.

We need to finally make high quality and continuously improving healthcare possible through accurate, accessible, and meaningful health information.

Linda Wilhelm is President of the Canadian Arthritis Patient Alliance.

An act to develop a national framework for a guaranteed livable basic income has been introduced to the House of Commons (C-223) by MP Leah Gazan, and in the Senate (S-233) by Senator Kim Pate. The Bill is a response to the years of neglect that have undermined our social safety net to the point where medically assisted death seems preferable to legislated poverty among people with disabilities, where people are without housing shelter in city parks and bus shacks, and food banks are over-run.

Despite years of evidence demonstrating the health and social benefits of basic income, there are critics. Some, like the QAnon-inspired whose emails flooded the inboxes of Senators recently, claiming that basic income is a plot by a shadowy global elite intent on transhumanism. Others trot out the more usual criticisms, based on deeply held suspicions rather than evidence.

Some, such as Senator Diane Bellemare, have argued that basic income would only be feasible at an astronomic cost, bolstering their argument by reporting gross rather than net costs, and (alternatively) by imagining that the same amount would be paid to all Canadians, rich or poor, when the entire conversation around basic income in Canada has focused on a modest basic income targeted to those with low incomes.

Some claim a basic income would require a complete transformation of our income tax system at the federal and provincial levels. Hardly.

A basic income would require negotiated contributions from the federal government and each province, independently, all of whom could reconsider the dozens of inconsistent ways they now attempt to address poverty by delivering cash to individuals. Replacing the GST credit, reimagining the Canada Workers Benefit and harmonizing benefits is challenging, but not inconceivable — and long overdue. Some provinces have already begun that work.

Would a basic income mean paying everyone the same amount making it impossible to respond to differential needs? The Bill explicitly says otherwise.

People with disabilities are hard at work designing a basic income that meets their needs. Did BC and Quebec declare that a basic income was not feasible as has been recently claimed? They only investigated a provincial program – not a federal basic income.

Many critics forget that current programs (such as provincial social assistance) also have a hefty price-tag attached to them. Some claim massive labour market disincentives, even though the Parliamentary Budget Office estimated that a basic income might lead to a reduction in hours worked of 1.3 per cent — hardly an immense effect.

Would a basic income impose intractable constitutional difficulties?

Provinces, in this country, have authority to deliver social assistance. Yet, they also have the authority to deliver childcare, and we just saw provinces and territories sign on to a federal childcare initiative that respected the different goals and capacities of each province. Healthcare is a provincial responsibility delivered in the context of national standards and shared funding.

Why would basic income be less feasible?

Canadians need to have a real conversation about poverty – without fearmongering or invented “data.” We need to know how different levels of government can cooperate to best respond to real social needs. The Bill is an invitation to that conversation.

As it happens, I didn’t draft the Bill. If I had, I might have made some changes. I, personally, would not extend a basic income to Temporary Foreign Workers (TFW), not because I don’t recognize the deplorable conditions in which many live and work, but because I think the TFW program needs to be completely rethought so that it doesn’t keep Canadian wages artificially low.

Nor would I extend a basic income to everyone over 17 on the same terms. I recognize the toll that poverty takes among young people; young parents are almost uniformly living on less than the poverty line, and the struggle of young people forced to live without parental support has encouraged many provinces to extend support to youth aging out of foster care. However, others under 25 earn little on their own account yet live comfortably with their parents’ help.

These are the sort of surmountable challenges that policymakers should turn to rather than debating the already established merits of a basic income.

It makes little sense to report strong public belief that all working-age adults in Canada should work to earn a living when 70 per cent of social assistance rolls are comprised of people with disabilities, some of whom can’t work at all and others of whom need supports to make work possible.

Let’s get past the ideology and think about how we can make life better for all Canadians.

Evelyn L. Forget is an Officer of the Order of Canada, an economist and professor at the University of Manitoba. She is author of Basic Income for Canadians: From the Covid-19 emergency to financial security for all, and (with Hannah Owczar) Radical Trust: Basic Income for complicated lives.

Diane Bellemare QUOI Media

There’s much to say about ‘basic income’ Bill S-233 tabled in the Senate. The bill promotes an unconditional guaranteed basic income program (GBI), which strives to eliminate poverty and establish social equity — laudable goals. There’s also no doubt about the positive effects of a stable basic income on an individual’s physical and mental health, as ample research has demonstrated.
But a GBI is not the only way to achieve these noble ends. In fact, GBI is among the most constitutionally complex and prohibitively expensive ways to tackle poverty and inequity. Its blanket approach also lacks fairness and important public buy in.
Of course, that doesn’t mean we do nothing and settle for the status quo. Issues of poverty, chronic unemployment or under-employment, training and education deficits, among other social problems, can be better addressed through targeted social programs delivered through all levels of government working together. It’s also simply more feasible.
Bill S-233 proposes to oblige the federal Minister of Finance to develop a national framework to implement a basic income that unconditionally guarantees sufficient income (equivalent to or near the low-income threshold) for all Canadian citizens over age 17, as well as Canadian residents, refugees and temporary workers.
Let’s first address cost. According to the analysis of the Parliamentary Budget Officer (PBO), the gross cost of a guaranteed minimum income program for Canada, similar to the one adopted in the Ontarian basic income pilot, varies, depending on the preferred recovery rate, between $95B and $196.2B per year. Similarly, the Basic Income Canada Network estimates that a guaranteed income through a negative tax program of $22K per adult over 17-years-of-age would cost $187B per year.
Whichever figure you go with, these ballpark ranges are near the equivalent of all the federal personal income tax paid in 2021-22 ($189.4B). In another scenario, the Network estimates a tax-free universal allowance of $22K per adult at $637B. That’s almost twice all the budget revenue of the federal government (in 2021-2022, $394B).
Financing a GBI would put an end to personal tax exemption and all other tax deductions. It would involve a complete transformation of our income tax system at the federal and provincial levels.
It would also have detrimental economic effects that would likely hamper participation in the labour market – not because people are lazy but because they are rational. Fewer working hours in the labour market would mean less revenue for governments. A GBI, in other words, would be financially unsustainable.
Not surprisingly, both Quebec and British Columbia recently rejected the feasibility of a GBI after extensively studying the issue. They also raised issues of fairness.
A basic equal income for all is not necessarily fair because it does not guarantee equal opportunities. Individuals and families have different needs that the actual social system acknowledges. According to the PBO analysis of the redistributive effects of a basic income, a low-income single-parent family would lose $5,315/year with a basic income program. These families are exactly the ones we want to help.
A GBI lacks the ability to target diverse needs and circumstances so as to provide for equal opportunities.
And then there’s politics.
Bill S-233 raises real constitutional issues. The abolition of Canada transfers for social programs that would be necessary to afford a GBI would require negotiations with the provinces/ territories, who would not easily abandon their responsibility for social assistance to the federal government.
Canadians are also not willing to finance a basic income.
In March 2022, I commissioned a public opinion poll on the topic from Angus Reid. Seventy-nine per cent of the over 1500 respondents believe all working age adults in Canada should work to earn a living. While just under half (46 per cent) of respondents said they’d support a federal GBI, that number dropped to 19 per cent when presented with the budget implications of financing such a program.
That doesn’t mean Canadians aren’t interested in giving each other a helping hand. On the contrary.
When asked about targeted programs, such as a Youth Guarantee Program, that would support a job pathway program for unemployed Canadians under age 30, 59 per cent of respondents were in favour; a Job Path Program for all unemployed Canadians was supported by 65 per cent; while a Professional Training Program for all Canadians, was supported by 74 per cent of survey respondents.
There are many solutions we can work on to eliminate poverty and inequity in Canada. But a GBI should not be one of them. It’s time we abandoned this utopian dream for pragmatic, rigorously tested, targeted programs that will reduce poverty, provide skills and training and create an inclusive labour market.

If the health workforce was a patient, it would be in critical condition. The public seems to get it.

New results of a nation-wide survey by the University of Ottawa, conducted among members of the Angus Reid Forum (March 4-8, 2022) paint a troubling picture of how we feel about health workers. Overall, nine out of 10 Canadians (87 per cent) say they are concerned about the mental health of health care workers. This level of concern is even higher than ratings of our own worsening mental and physical health. When asked how things have changed since March 2020, 54 per cent of Canadians say their own mental health has worsened, and 53 per cent say their overall physical health and well-being has worsened.

After two years of pandemic stress, we are much more likely to express concern about the mental health of health workers than to say we’ve experienced a worsening of our own health.

People are not only concerned about how health workers are doing; they also express concern about what this means for their access to, and quality of, health care. Overall, four out of five Canadians (79 per cent) say they are concerned about being able to access health care services because of the shortage of health workers. Slightly more (84 per cent) say they are concerned about the quality of health care services.

Women are significantly more likely than men to express concern about the mental health of health workers, health access and quality of care. Perhaps this is because the health system is primarily a women’s workforce, with 82 per cent identifying as women, and growing, each year.

Regionally, half of those in Atlantic Canada (53 per cent) expressed strong agreement that they are concerned about being able to access health care services because of labor shortages — by far the highest rate in the country. Perhaps the importance of health care to provincial elections is most salient in this region.

If the public gets it, why doesn’t it seem to be the case for our politicians? The recent federal budget was like crickets about these growing concerns.

The pandemic has caused remarkable increases in rates of burnout and other mental health concerns, already prevalent among nurses and doctors before the pandemic, due to health and safety concerns and unsustainable workloads. Health workers have faced 16+ hour days, cancelled vacations and forced redeployment.

And then there is the violence.

We were warned pre-pandemic of the increasing violence nurses experience in health care, caused by understaffing, inadequate security and increased patient numbers, and how even in medicine, women faced incivility, bullying and harassment.
In its 2019 report, Violence Facing Health Care Workers in Canada, the House of Commons Standing Committee on Health noted that health care workers are four times as likely to face workplace violence than any other profession, yet most goes unreported due to a culture of acceptance.

Few of the critical recommendations from the report have ever been implemented. We are still waiting for the recommended public awareness campaign about the violence faced by health care workers or the pan-Canadian prevention framework. We are also still waiting for the much-needed update to the Pan-Canadian Health Human Resources Strategy to address staffing shortages and reflect the well-being of health care providers.

While health care workers care for us, they have not received the support and care they need from our governments through supportive public policy.

As more than 65 health care organizations and 300 health workforce experts and organizational leaders stated in an open Call to Action last year, the time is now for the federal government to take the lead in supporting provinces, territories, regions, hospitals, health authorities and training programs with an investment in better health workforce data and decision-making tools.

Canada needs to make informed staffing decisions, optimize contributions of the available workforce and enable safer workplaces. Right now, we are working in the dark.

There is both a sound economic argument for such an investment — with the health workforce making up eight per cent of Canada’s GDP, or over $175 billion in 2019 – and a sound humanistic argument in support of health workers.

The status quo must be seen for what it is — the most expensive and least tenable option going forward.

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

Linda Silas – Quoi Media

Like many nurses in Canada, I welcomed last week’s announcement that Prime Minister Justin Trudeau and NDP Leader Jagmeet Singh had reached an agreement with health care at its heart. As nurses, we have long advocated for national pharmacare, long-term care standards and dental care, and we recognize affordable housing as an essential social determinant of health.

While these measures will most certainly improve Canadians’ health outcomes, the deal fails to recognize the perilous state of our health care system. A decades-long health care worker shortage continues to grow unabated and has left our health system on life support and on the verge of collapse.

Nurses are now hinging their hopes on the agreement’s promise of immediate “additional ongoing investments” in Canada’s health system, including more nurses. They are desperately hoping to see significant targeted funding aimed at proven retention and recruitment initiatives, reinforced by real accountability measures.

Yes, we need more health care workers, nurses, and doctors. At the same time, we also need to keep the nurses we have in their jobs to train, mentor and retain a new generation of nurses. Retention and recruitment are two sides of the same coin.

In the fourth quarter of 2021, Statistics Canada reported 126,000 vacancies in the health care and social assistance sector, an all-time high. Nationally, the number of vacant nursing positions surpassed 34,000, a 133 per cent increase over a two-year period.

Late-career nurses are revising their retirement plans. Meanwhile, new nurses are shocked by the untenable working conditions on the front lines and are reassessing their career choices.

Grueling workloads and staffing shortfalls have taken their toll. A national Viewpoints Research Poll commissioned by the CFNU found that severe burnout among nurses had risen to 45 per cent. Nurses are grappling with high levels of stress. Polling indicates that just over half of nurses are considering leaving their jobs this year. Of those, one in five may leave nursing altogether. Even if nurses don’t leave immediately, over 20 per cent of health care workers are eligible to retire by 2026.

Along with more than 60 other health care organizations, the CFNU also supports the agreement’s commitment to better data, which we hope will inform a robust approach to health human resources planning. To this end, the federal government must establish a dedicated coordinating body to address critical health workforce data gaps.

Without a commitment to better data collection, coordination, analysis and planning tools, we can expect inadequate planning to continue now and in the future.

Health workers represent a significant public investment. In 2019 this amounted to nearly eight per cent of GDP. More than 10 per cent of all employed Canadians work in health care. And yet, we know very little about our health workforce. We lack the most basic data and tools needed for planning. To plan for the future and build a responsive health care system, we need the ability to forecast how the workforce will change.

The federal government must assume a leadership role by collecting better and more complete data. Meanwhile, the provinces, territories and regions will benefit from a more strategic and holistic approach to health workforce planning.

Throughout this pandemic, nurses have shouldered the burden of a short-staffed and under-funded health care sector. It’s time to do right by health care workers and invest in a stronger health care system. Linda Silas is a nurse and President of the Canadian Federation of Nurses Unions, representing nearly 200,000 nurses and student nurses across the country.

Bryan Thomas and Vivek Krishnamurthy
QUOI Media

Some businesses may be apprehensive as most provinces and territories begin removing vaccination passport and mask mandates. But do Canadian privacy laws prohibit them from continuing to verify patrons’ vaccination status on their own initiative?

The law in this area is notoriously complex, but the short answer is that it continues to be legitimate for many businesses to require proof of vaccination from their customers — so long as they verify vaccination status without retaining that information.

Businesses may collect and retain personal information if they can specify a ‘legitimate purpose’ for doing so which a ‘reasonable person’ would deem appropriate under the circumstances. Businesses must disclose that ‘legitimate purpose’ to their customers at the time of collection and limit their use of customer data to that purpose.

The key question is whether businesses can specify a reasonable and legitimate purpose for continuing to check patrons’ vaccination status. That should be pretty easy to do – for now.

The available science suggests that double vaccination provides some protection against transmitting the Omicron variant, while three doses provide much more protection. Regardless of the number of doses, however, this immunizing effect wanes over time. Even so, there are some settings where it would be reasonable to continue requiring vaccination as an added protection against transmission. This may include crowded public venues such as gyms, restaurants and theatres, or businesses that cater to segments of the population that are particularly vulnerable to COVID-19.

Some might argue that the provinces’ decision to lift vaccine passport requirements — a decision ostensibly guided by public health experts — signals that these measures no longer serve any legitimate purpose. But this doesn’t necessarily follow. In deciding whether to lift or retain vaccine passport requirements, public health officials will look at the matter from a macro perspective, balancing risks and benefits across diverse settings.

Vaccine requirements continue to serve a legitimate purpose in at least some private sector settings – and some provincial leaders have already urged businesses to evaluate the merits of continuing to check vaccination status on their own initiative.

Down the road, however, businesses may face practical challenges in their efforts to reduce transmission through continued vaccine passport checks.

In many provinces, vaccine passports only confirm that someone has received two doses. Thankfully in Canada, most people who have received two doses have also received a third, so this offers some assurance of reduced transmission. But as the protective effects of three doses wane with the passage of time and the arrival of new variants, the practice of continuing to check for double vaccination will become increasingly a form of public health theatre — and arguably cease to serve a legitimate purpose.

Then there is the question of method. To our knowledge, no provincial government has indicated that they will continue to update vaccine passport technologies to keep pace with the evolving science. If governments simply abandon the technology, businesses will be left to their own devices in deciding what vaccinations are required for the purposes of preventing transmission on their premises, and to devise some reliable and efficient way to verify adequate vaccination.

Perhaps private companies will pick up the baton from government and develop smartphone apps that businesses can use to quickly and reliably confirm vaccination status. Nothing in Canadian privacy law precludes the possibility of private vaccine passports — provided users are consenting, the collection and retention of personal information is minimized, and the businesses checking these passports have a legitimate and clearly explained purpose.

Unfortunately, if Canada’s COVID-19 response has a recurring theme, it is the dynamic of being too slow to apply response measures and too quick to lift them. This pandemic is far from over and we can only hope that government has learned its lesson from past indecisiveness. Private businesses shouldn’t count on this, though, and should instead make their own careful assessment of whether to persist with protective measures like vaccine passports, now and in the future.

Bryan Thomas is an Adjunct Professor, Faculty of Law at the University of Ottawa and member of the University of Ottawa Centre for Health Law, Policy & Ethics. Vivek Krishnamurthy is the Samuelson-Glushko Professor of Law at the University of Ottawa.

Stephen Huddart
QUOI Media

Last month, the Intergovernmental Panel on Climate Change (IPCC) released its latest report warning that the window for preventing climate chaos is closing rapidly. It defines climate change as a global challenge requiring regional-scale solutions.

Importantly, the report asserts that climate change is as much a social problem as a scientific one, concluding that “climate-resilient development” must focus on decarbonization, adaptation, biodiversity preservation and social equity.

So, what’s Canada doing to create these regional-scale solutions? Our community sector has a big role to play.

The sector’s 170,000 charities and non-profits include hospitals, universities, philanthropic foundations, chambers of commerce, professional associations, cultural organizations, co-operatives and social enterprises. With 2.5 million employees and almost $170 billion in annual revenues, it’s an under-recognized wellspring of innovation, social capital, shared values and community well-being.

Canada’s community sector can help shape a ‘transition economy’ by funding organizations that produce social and environmental outcomes in addition to profits, by participating in rapid testing to generate evidence-based policy innovation and by supporting comprehensive community-transition initiatives.

The federal government will shortly name the organizations who will act as intermediaries for Canada’s Social Finance Fund (SFF) — a $755-million fund for putting capital to work in the social sector — based on the successful UK-model, Big Society Capital. Using SFF as a matching fund, the intermediaries will attract new capital to make loans and investments in social-purpose organizations.

Quebec’s l’économie sociale shows what this kind of transition economy could look like. In a province with a GDP of $365 billion, 11,200 social economy organizations generate $48 billion in revenues. They work in areas ranging from the arts and agriculture, to retail, restaurants, manufacturing and IT — prioritizing the common good over private profits.

Also at issue is how social and economic systems can be adapted or replaced to produce better outcomes for people and the planet.

In their 2019 book Good Economics for Hard Times, Nobel Prize-winning economists Abhijit Banerjee and Esther Duflo advocate for policy innovation informed by experiments that test solutions to real problems. This is a principle behind social impact bonds (SIBs), where private investments enable community coalitions to test new approaches to complex challenges, with governments, foundations or corporations repaying investors based on results. When SIBs establish goals but not the precise steps for achieving them, they can be a useful form of social research and development.

The Deshkan Ziibi Conservation Impact Bond is a good example of a SIB focused on climate resilient development. This groundbreaking initiative works on biodiversity protection and investment in a reconciliation economy across a large swath of southwestern Ontario. Partners include Carolinian Canada Coalition, the Chippewas of the Thames First Nation, Thames Talbot Land Trust, VERGE Capital and Ivey Business School. 3M Corporation serves as the outcome buyer.

Social impact bonds have also been used to improve high school completion rates; reduce the number of Indigenous children placed in foster care; and stem the spread of chronic disease. Concerns that SIBs lead to privatization of public services have not been borne out.

With their capacity to both grant and invest for modest returns, philanthropic foundations are well-positioned to support SIBs in collaboration with governments and community partners.

At MaRS Centre for Impact Investing — a Canadian social impact bond developer — Jason Sukhram, director of impact measurement and management, says: “SIBs remain an under-utilized tool for public sector innovation. They can also empower social purpose organizations to measurably improve outcomes in areas where there’s room and urgency for progress.”

Finally, comprehensive, consultative collaboration among community stakeholders can serve as both a test bed and bedrock for a transition economy. This is the premise behind initiatives such as Second Muse’s Future Economy Labs, Low Carbon Cities Canada, Future Cities Canada, and the Tamarack Institute’s Community Climate Transitions program.

Tamarack Program Director Laura Schnurr recently wrote: “With jurisdiction over buildings, transportation, waste and land-use planning, municipalities have influence over approximately 50 percent of Canada’s emissions. They’re more nimble and closer to the ground than higher levels of government, enabling them to act quickly in a crisis and engage directly with residents. They’re also natural environments for piloting innovative climate solutions that can be scaled elsewhere.”

To meet Canada’s international climate commitments, we need regional solutions. Canada’s community sector can help us get there.

Stephen Huddart is a founding member of the Transition Innovation Group hosted by Community Foundations of Canada. He lives in Montreal.