Is Health Canada the Key to Cracking the Nut of Healthcare Reform?

Canada, Health System of

Youth and the National Children's Agenda

Academic Labor:The Canadian Context Vicky Smallman (bio) As I write this, 9,100 college faculty in Ontario are walking picket lines. Teaching staff, librarians and counselors in the province's college system (equivalent to two-year colleges in the United States) are represented by the Ontario Public Service Employees Union. After two decades of cuts to the post-secondary education system, academic staff have found themselves burdened with increasing class sizes, too few resources, and heavy workloads. Enrollment at Ontario colleges has increased by 52 percent since 1988–89, while numbers of full-time faculty have fallen by 22 percent. Faced with employers who refuse to acknowledge the connection between workload and educational quality, academic staff felt they had no alternative but to withdraw their labor. Universities and colleges across the country face many similar challenges: no significant improvements in funding despite improved fiscal situations for federal and provincial governments, the legacy of two decades of significant budget cuts, a looming infrastructure crisis, and a generation of faculty nearing retirement without a clear strategy for replacement and a system reliant on casual labor. Canada's post-secondary system differs considerably from its neighbors to the south in several ways. The Canadian system is almost exclusively public; it is both regulated and funded by provincial or territorial governments, although the institutions operate independently. The federal government provides funding through transfers to the provinces and territories as well as specialized programs to support research, such as granting councils, as well as student financial assistance. In the mid-nineties the federal government implemented a number of changes to its fiscal arrangements with the provinces, leading to drastic cuts to funding to health care, social services and education. Funding for post-secondary education was reduced from .56 percent of GDP in 1983–84 to .19 percent of GDP in 2004–05. 1 Provincial governments, many of which were also struggling with deficits, passed the cuts along to universities, many of which turned to students to help fill the gap through increased tuition and fees. In recent years, some provinces have begun to reinvest, while others are left with drastically underfunded institutions. Ontario and the Atlantic provinces have since 1990 implemented the most extreme austerity measures: since 1983–84, funding has dropped 32 percent in Ontario, 60 percent in Prince Edward Island and 36 percent in Nova Scotia. To make up for the shortfall, universities and colleges have looked to two sources: students and the corporate world. Tuition and other fees have risen dramatically—average undergraduate arts tuition has increased 135 percent since 1991–2. 2 Tuition for professional programs, deregulated in many provinces, is now beyond the reach of many. Student debt loads have also seen a considerable rise. As for corporate contributions, one look at a university or college campus is all one needs to see the creeping influence of the private sector on public education—cafeterias have become fast-food franchise outlets; soft drink companies negotiate exclusive deals [End Page 108] with institutions in exchange for project or infrastructure funding; classrooms, buildings and even programs bear the names of corporate sponsors. But there are more insidious effects on institutional management, working conditions and educational quality. The adoption of a corporate mindset by post-secondary institutions is reflected in the language used by administrators. What once were institutions that served the public interest are now being transformed into deliverers of "education services." Students are referred to as "clients" or "customers." Whether by necessity or design, university administrators have assumed the persona of the corporate manager or CEO, experimented with "Total Quality Management" techniques, embraced outsourcing and flirted with labor-replacing technology to help reduce costs. One particularly disturbing development involves the way the university views research. According to Neil Tudiver, "Where universities have traditionally operated from a professional model, the corporate university follows a business model: capitalizing on research as an investment, seeking profit from its ventures, and forming partnerships with corporations through equity financing and licensing." 3 The increase in corporate-sponsored research has led to some very prominent violations of academic freedom, the most notorious of which is the case of whistle-blowing medical researcher Dr. Nancy Olivieri. 4 Olivieri...

In most countries, population aging is becoming more evident now that the first members of the large babyboom cohort have reached 65 years of age. As an accelerating increase in the number of older persons and the proportion of the public aged 65 and older will now occur, planning for population aging has become ever more crucially important. A systematic review of Canadian provincial, territorial, and federal government documents was undertaken to search for the existence of population aging policies, and to determine the aims and other content of the most current policy documents. Documents were identified in all but two jurisdictions of Canada (two northern territories). Document developers, and the aims and content of the 14 reviewed documents varied considerably. Some similarities were identified, however, including some common stated purposes for these documents - to address current issues and challenges facing older people and to plan ahead for a preferred future with population aging.

Education in Canada is generally considered to be within the exclusive domain of the thirteen provincial and territorial governments. There are numerous statements or writings from politicians, textbook authors, federal and provincial governments, researchers, newspaper columnists, as well as education organizations that state unequivocally that education in Canada is the exclusive jurisdiction of the provinces and territories. Some statements indicate that the federal government has no constitutional role in education. Such misinformation and beliefs have had severe consequences for First Nations as Canadians absolve federal inaction in First Nations education because ‘education is a provincial responsibility’. However, education in Canada is the constitutional responsibility of both the federal and provincial/territorial governments. This article will examine the federal government’s constitutional responsibility in education, as well as the consequences of the misinformation.

OBSOLETE: Health System of Canada

Canada, Health System of

Canada needs a national strategy to fulfill its obligation to ensure universal access to necessary healthcare, including prescription drugs. A 2004 attempt at a national strategy for pharmaceutical policy failed because it lacked clear vision, logical planning and commitment from federal and provincial governments. The result of uncoordinated pharmaceutical policies in Canada has been more than a decade of poor system performance. In this essay, we present a framework for a renewed national strategy for pharmaceutical policy. Building on published research and international frameworks, we propose that pharmaceutical policies of federal, provincial and territorial governments be coordinated around a core health-focused goal. We strongly suggest policy actions be taken on four core objectives that are necessary to support the overarching health goal. If implemented, the proposed strategy would offer clear benefits to all Canadians who use medicines, federal and provincial governments and to the economy as a whole. We therefore argue that political leadership is now needed to articulate and implement such a plan on behalf of Canadians.

Jordan's principle: Editorial update

Australia's political engagement on health and climate change: the MJA-Lancet Countdown indicator and implications for the future.

With governments playing such massive roles in Canada’s economy and Canadians’ lives, we need transparency and accountability in fiscal policy as much as we need it anywhere. Over the past 15 years, Canadian governments have done much to improve their reporting, and stewardship, of public money. Yet major gaps remain, and the astonishing amounts by which revenue and spending have exceeded the amounts approved by legislators at budget time over the period show that failures of accountability have major real-world consequences. This latest edition of the C.D. Howe Institute’s annual report on the fiscal accountability of Canada’s federal, provincial and territorial governments assesses the quality of financial information these governments present, and looks at their success or failure in achieving their budgetary goals over the past 15 years. It measures the quality of financial reporting by a number of criteria. The key question is whether an intelligent and motivated non-expert – a citizen, taxpayer or legislator – could find valid consolidated numbers for revenue and spending in the budget each government presents at the beginning of the year, and in the financial statements released with its public accounts at the end of the year. The top presentation marks go to Alberta and Saskatchewan, with Ontario not far behind. British Columbia and New Brunswick also earn high marks for consistent and clear presentations, but auditor reservations push them out of the top tier. The federal government provides reliable numbers, but its budgets do not display them prominently, and the spending estimates members of parliament review are on an incompatible basis of accounting. As for success or failure in hitting budget targets, the dominant theme of the 15-year period is major overshoots of both spending and revenue. Cumulatively, Canada’s federal, provincial and territorial governments spent some $69 billion more than projected, with the Prairie provinces and the territories showing the biggest over-runs relative to the size of their budgets. Over the same period, revenues overshot budget projections by an even larger amount: $118 billion. More encouragingly, comparing the overshoots over the period shows some improvements: smaller misses generally, and less tendency for in-year revenue “surprises” to be accompanied by in-year spending “surprises.” Legislators and Canadians generally should insist on better financial information from governments, and use that information to hold governments to a higher standard when it comes to hitting their budget targets. Canada’s senior governments can improve their financial reporting and their adherence to targets, and legislators and voters should hold them accountable for doing so.

Policy patchwork hurts kids

Let's put a national child care strategy back on the agenda

Professional nursing services were introduced into many rural and remote areas of Canada following World War II, especially Western Canada. At the time, the goal of governments was to provide health care to the previously neglected residents of the region, especially Aboriginal peoples.1 In the prairie provinces of Alberta, Saskatchewan, and Manitoba, small clinics and nursing outposts were created by both provincial health authorities and the federal Indian Health Services. These two types of health care facilities existed side by side; but they served different people because under the British North America Act in Canada's Constitution, were a federal responsibility. Jurisdiction over Indians and their health care was further deepened by the existence of federally negotiated treaties in these regions, some of which contained terms relating to health care. Thus, provinces did assume any responsibility for Indians. Provincial nurses were deemed responsible for the nonstatus, nontreaty Indian, Metis, and non-Aboriginal population, whereas federal Indian Health Services nurses attended the treaty status Indian population.Although these legal boundaries established distinct spheres of responsibility, inevitably duplication of services and confusion as to who was an Indian led to disputes over who should provide health care to whom. In Manitoba, Saskatchewan, and Alberta, federal and provincial governments often found themselves in a tug-of-war over patients and who should pay their fees because each division of government sought to minimize its health and welfare obligations in these regions. Ultimately, this jurisdictional wrangling interfered with the way nurses carried out their duties and put both patient health and professional nursing standards at risk.The provincial place that is the focus of this article is Northern Saskatchewan- not the Saskatchewan of wheat fields and grain elevators that exists in popular imagination but a treed place, clothed in boreal forest, rock, water, muskeg . . . and firmly situated in the geography and ethos of the north.2 For the most part, Northern Saskatchewan was ignored by both provincial and federal governments with an attitude that can be described as benign neglect. But after World War II, the region's relative isolation changed dramatically because of resource extraction projects and the proliferation of government institutions that affected every aspect of life for residents in the region.3When Northern Saskatchewan was formalized as a region in 1944, living conditions for the people there-many of Aboriginal descent-were appalling. Hospitals and schools were lacking. There was little decent housing, communication and transportation systems were inadequate, and there were virtually no government-run social services. Indeed, northern residents inhabited a landscape of hardship. It is into this landscape that small outpost nursing stations, operated by a lone provincial public health nurse, were introduced. But the nurses quickly encountered jurisdictional obstacles that, at times, impeded their efforts to provide much-needed health care services.Although it is possible here to explore the complex historical relationships that evolved between the state and Aboriginal people, suffice it to say the results were spatial and social boundaries that effectively split the population and landscape into different jurisdictional realms. Consequently, nursing practices and jurisdictional divisions contrasted sharply in the northern landscape-nursing was inclusive; jurisdiction was divisive. But the two were intertwined and, as this article will illustrate, profoundly affected how the nurses carried out their work. Sadly, the divisions became more entrenched over time and continue to plague health care delivery in the region.This research draws from an archival collection documenting the experiences of nurses working in Northern Saskatchewan between 1944 and the mid-1950s to late 1950s. …

Sexually transmitted and blood-borne infections (STBBI)-which include HIV, hepatitis B and C, chlamydia, gonorrhea, syphilis and human papillomavirus-remain significant public health issues both nationally and globally. In 2018, a Pan-Canadian STBBI Framework for Action (the Framework) was released by federal, provincial and territorial governments to provide an overarching and comprehensive approach to addressing STBBI for all those involved. This includes all levels of government, First Nations, Inuit and Métis communities and leadership, frontline service providers, clinicians, public health practitioners, non-governmental organizations and researchers. The Framework includes strategic goals, guiding principles and pillars for action to address STBBI in Canada. In response, the Government of Canada released its own action plan in July 2019: Accelerating Our Response - Government of Canada Five-Year Action Plan on Sexually Transmitted and Blood-Borne Infections (the Action Plan). This document identifies seven priority areas for federal action on STBBI over the next five years: 1) moving toward truth and reconciliation with First Nations, Inuit and Métis Peoples; 2) stigma and discrimination; 3) community innovation-putting a priority on prevention; 4) reaching the undiagnosed-increasing access to STBBI testing; 5) providing prevention, treatment and care to populations that receive health services or coverage of health care benefits from the federal government; 6) leveraging existing knowledge and targeting future research; and 7) measuring impact-monitoring and reporting on trends and results. The Government of Canada is currently working with provincial and territorial governments, First Nations, Inuit and Métis partners, and other stakeholders to develop STBBI indicators and targets for the Canadian context that are appropriate, feasible and measurable against the shared strategic goals of the Framework and the Action Plan. In addition, the Government of Canada has also committed to reporting annually on its progress in implementing the priority areas laid out in the Action Plan.