Senate Standing Committee Research Articles

Walid Iqbal. Senator, Chairman of the Senate Standing Committee on Human Rights, Pakistan

Walid Iqbal. Senator, Chairman of the Senate Standing Committee on Human Rights, Pakistan

Extent and nature of poverty in Australia and the impact on rural health

The Senate Standing Committee on Community Affairs is conducting an Inquiry into the extent and nature of poverty in Australia.1 The National Rural Health Alliance (the Alliance) made a submission to this Inquiry in February 2023, with findings expected in October 2023.2 The Alliance believes that all Australians, wherever they live, should have access to comprehensive, accessible and high-quality health, disability and aged care, as well as other social assistance services. The Alliance does not consider that poor access to services, suffering ill health or premature death should be accepted outcomes of living in rural Australia. The Alliance highlights the multidirectional inter-relatedness of health, education and poverty and explores these concepts in further detail in its submission to the Senate Inquiry. Reducing poverty is good for health outcomes as well as social and economic outcomes. Investing in actions to address poverty, and other determinants of health, is an investment in human capital and is central to health and well-being in rural Australia, as are measures that ensure universal access to health care for those who experience inequity. Universal and structural social service approaches to reducing economic inequality are also essential to addressing poverty and health inequity. Due to the inter-relatedness of poverty and ill health, such approaches must work alongside co-designed and tailored solutions that are adaptable and flexible and build upon strengths and capabilities in local communities. This is especially critical in rural areas where there are thin or failed markets and services or support are lacking. Rural areas are not mini-metropolitan areas where a city solution can be ‘helicoptered in’ to solve a specific rural problem (no matter how well-intended). Tailored measures are likely to be more accepted and embraced by residents, especially if they are co-designed and inclusive of diversity within the community and when shared ownership can help drive the outcomes. The disparities also extend to research in rural Australia. Poverty is relative. It involves people experiencing deprivation and making difficult life decisions about necessities (for example, choosing to use limited finances to pay for meals or medications, but not both). The affordability of food, groceries, energy, housing, fuel or transport and other essentials (including medicines, out-of-pocket health costs) plays an important role in these decisions. Access to high-quality, affordable health care, regardless of where you live, is important to reducing poverty and improving the health, well-being and broader social and economic goals of rural communities. The Grattan Institute has noted that poorer people are not getting the GP services they need, with disadvantaged Australians facing barriers to care. Furthermore, there are even higher access barriers for allied health services. Compared with GP care, allied health services have higher average out-of-pocket charges and make up a bigger share of household spending on health.9 This is without considering barriers related to workforce shortages and long wait times in rural areas. The National Preventive Health Strategy 2021–2030† provides direction for preventive health action across the course of life. It also presents an opportunity to build sustainable systems, address increasing burden of disease and reduce health inequities, as well as improve preparedness for emerging health threats.10 Preventive health actions can build on strengths and mitigate risks. The focus on providing the best start in life and across the life course, and its potential to influence actions outside the health sector given the crossover in risks and protective factors, can provide a focus for community co-design. These principles align with the Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS) model proposed by the Alliance as a solution for providing primary care services in rural areas where the market is failing or has failed.‡ While the causes of poverty are complex, as are the multifaceted responses required, the Alliance argues that improving access to health care and supporting the healthcare workforce in rural Australia will lead to significant improvements in health and well-being and lower the rate of poverty experienced. This will, of course, advantage not only rural Australians but all who benefit from the food supply, exports and gross domestic product (GDP) supplied by the 30 per cent of the population who live outside metropolitan centres. Margaret Deerain: Writing – review and editing; writing – original draft.

A Submission on the Public Health (Tobacco and Other Products) Bill 2023 (Cth) and Accompanying Regulations: Senate Standing Committee on Community Affairs - Legislation Committee

A Submission on the Public Health (Tobacco and Other Products) Bill 2023 (Cth) and Accompanying Regulations: Senate Standing Committee on Community Affairs - Legislation Committee

МЕЖДУНАРОДНАЯ НАУЧНАЯ КОНФЕРЕНЦИЯ «ИСЛАМСКАЯ РЕСПУБЛИКА ПАКИСТАН: ПРОБЛЕМЫ И ПЕРСПЕКТИВЫ РАЗВИТИЯ (К 75-ЛЕТИЮ НЕЗАВИСИМОСТИ)»

This article is a review of the International conference «The Islamic Republic of Pakistan: Problems and Prospects of Development (on the 75th Anniversary of Independence)». The event was held on September 26, 2022 at the Institute of Oriental Studies of the Russian Academy of Sciences in a mixed part-time format by using the Zoom platform. Speeches and reports of numerous International conference participants, presented by the Head and staff of the Pakistani and Russian diplomatic missions in Moscow and Islamabad respectively, members of a high-ranking delegation of Pakistani Senators, as well as of Heads, staff, senior and junior scholars of leading Russian and Pakistani analytical centers, institutes and various institutions, covered a wide range issues on Pakistan studies. Besides the official greetings and addresses by Honorable Guests of this International forum, the conference program also reflected relevant studies of domestic and Pakistani scholars on Pakistan national statehood building, its current inner political, socio-economic problems, the main directions of this country foreign policy at the global and regional level, including the possibilities of enhancing Pakistan-Russia relations on bilateral and multilateral cooperation with the geographically close states in the vector of Eurasian integration by means of major joint investment projects implementation. Much attention at the conference was paid to the necessity of the socio-cultural communication formation between the Russian and Pakistani peoples for the increase of their mutual understanding and convergence. A separate remarkable event was devoted to this issue within the framework of the International conference, which took place at the Eastern Cultural Center of the IOS RAS. It was connected with the presentation of the Three–volume «Encyclopedia of Muhammad Iqbal’ (in Urdu) and the solemn ceremony of its donation to the Institute of Oriental Studies of the Russian Academy of Sciences by the Honorary Speaker of the conference, Chairman of the of Pakistan Senate Standing Committee on Human Rights, Senator Walid Iqbal — grandson of the outstanding Pakistani poet and thinker, the ‘Spiritual Father of Pakistan» Allama Muhammad Iqbal.

The Canadian response to the COVID-19 pandemic.

The Canadian Psychiatric Association (CPA), the national voice of Canada's 4800 psychiatrists and 900 residents, appeared before the Canadian Senate Standing Committee on Social Affairs, Science and Technology by videoconference on June 3, 2020. The Senate committee is studying the federal government's response to the COVID-19 pandemic, and Dr. Georgina Zahirney, CPA president, appeared before the committee to recommend four priorities for Canada in addressing unmet mental health needs.

The Child Health Protection Act: advocacy must continue.

KEY POINTS In 2015, Canada’s prime minister mandated the federal minister of health to restrict commercial marketing of unhealthy food and beverages to children. In early 2016, the Standing Senate Committee on Social Affairs, Science and Technology recommended a ban on the advertising of food and

Dementia Care in Canada: Nursing Recommendations.

ABSTRACTThe prevention and management of dementia in Canada is at a crossroads. Despite the low diagnosis rates, the number of persons living with dementia continues to increase. Yet, Canada's health care policies have resulted in more people living with dementia living at home, and with most of their care being provided by family, friends, and significant others. This Policy Note provides an overview of a joint submission from the Canadian Gerontological Nursing Association (CGNA) and the Registered Nurses' Association of Ontario (RNAO) to the Standing Senate Committee on Social Affairs, Science, and Technology. This article outlines the background and recommendations in five key areas of dementia care in Canada: health system resources, education and training of health providers, housing, care partners, and the integration of health and social supports. Based on these five key areas, a number of health and social policy interventions are discussed.

Op-Ed: First Nations Elementary & Secondary School Education – A National Dilemma

During the past five years, First Nations elementary-secondary education has been the focus of some useful recommendations in two major reports: The Senate Standing Committee on Aboriginal Peoples in 2011, “Reforming FN Education: From Crisis to Hope,” and the 2012 Report of the National Panel on First Nations Elementary-Secondary Education. In response, the Harper government introduced Bill C-33 in 2014, the first-ever federal First Nations Education Act. Both reports identified much-needed reforms and despite vociferous opposition by most First Nations leaders the First Nations Education Act was a serious effort to accommodate some of them. But neither the reports nor the eventually torpedoed Bill C-33 zeroed in on the three key components that serve as the foundation of any education program: teachers, principals, and the curriculum. If these three elements remain untouched in the new Liberal government’s First Nations education policies, First Nations education outcomes will continue to be a national humiliation. This conceptual paper offers a critique of the provincial and federal governments’ approaches to remedying the dire condition of elementary and secondary school education for First Nations youth, with a focus on teachers, principals, and curriculum.

Foreseeably Unclear: The Meaning of the 'Reasonably Foreseeable' Criterion for Access to Medical Assistance in Dying in Canada

In April 2016, the federal government of Canada introduced draft legislation to regulate medical assistance in dying (MAiD). There was a swift and fierce response to various aspects of the Bill with some of the fiercest criticisms aimed at one of the criteria for eligibility found in the proposed text for s.241.2(2) of the Criminal Code: (2) A person has a grievous and irremediable medical condition only if they meet all of the following criteria:… (d) their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining. Some criticized the provision for being inconsistent with the Canadian Charter of Rights and Freedoms (drawing especially but not exclusively on the decision of the Supreme Court of Canada in Carter v. Canada). This criticism is now being litigated in the courts through Lamb v. Attorney General and Jean Truchon and Nicole Gladu v. Attorney General (Canada) and Attorney General (Quebec) and is not the focus of this paper. Others criticized the provision for containing a phrase that is unfamiliar and unclear: “reasonably foreseeable.” Despite attempts to remove s. 241.2(2) (at the hearings for both the House of Commons Standing Committee on Justice and Human Rights and the Standing Senate Committee of Legal and Constitutional Affairs, and in amendments passed by the Senate but rejected by the House of Commons), the provision remained in the version of the legislation that came into force on June 17, 2016. Not surprisingly, eighteen months on, there is confusion among health care providers, lawyers, and the public as to what the provision means. One court case tackled the issue head on but, for reasons discussed below, did not resolve all of the confusion. As a result of the ongoing confusion, there is reason to be concerned that under- or overinclusive interpretations of this eligibility criterion are adversely affecting access to MAiD. With critical interests at stake (e.g., access to MAiD and potential criminal liability), it is essential that the meaning of the provision be clarified. Furthermore, the meaning of “reasonably foreseeable” will no doubt be contested in the two Charter challenges to the federal MAiD legislation currently before the courts in British Columbia and Quebec. In order to determine whether s.241.2(2) violates the Charter, the courts will have to first determine what it means because whether the limits on access to MAiD violate the Charter depends on the scope of the limits. For these two reasons, and because MAiD providers and assessors and the public need guidance as they wait for an authoritative interpretation from the courts, it is worth bringing the principles of statutory interpretation to bear on the phrase “reasonably foreseeable.”

Letter to the Hon. Sen. Orrt (NYS Senate) Regarding Litigation Finance (Lawsuit Lending) (2018)

Following testimony to the New York State Senate's Standing Committee on Consumer Protection (available on SSRN and YouTube), Professor Steinitz was asked to elaborate on her recommendation for a statutory minimum recovery requirement to protect consumers of litigation financing. Enclosed is her response to this inquiry.

Alcohol and tax - time for real reform.

Online first 29/03/16 A intoxicated society? This 1977 report from the Senate Standing Committee on Social Welfare noted that alcohol “now constitutes a problem of epidemic proportions”. The Committee concluded that, given the extent of the problem, “any failure by governments or individuals to acknowledge that a major problem— and potential national disaster — is upon us would constitute gross irresponsibility”.

Driving down injuries and deaths on country roads

The National Road Safety Strategy 2011–2020 stipulates that by 2020, Australia should aim to achieve a 30% reduction in the number of serious injuries and deaths on our roads each year.1 People in rural and remote areas are significantly overrepresented in these numbers, meaning that road safety in the bush should be a particular focus for policymakers and researchers. The rate of serious road-related injury among those living outside major cities is nearly twice that of those living within them.2 Country people are also more than three times more likely to die as a result of a transport accident than their city cousins.3 The difference in outcomes for city and country people is particularly marked among young men; the death rate in transport-related accidents for young men aged 20–24 years living in the country is nearly four times higher than it is for those in the city.4 These startling statistics can be attributed to a combination of factors, such as vehicle and road characteristics, transport habits, perceptions of risk and law enforcement rates. In country areas, for example, road conditions are more varied. Compared with urban areas, there are more dirt roads, more hazardous roadsides and generally poorer road geometry. There is a greater likelihood of colliding with livestock and wildlife, and more heavy agriculture and mining vehicles on the road. People in rural and remote areas also tend to travel longer distances than city people, and this places them at higher risk of fatigue and accidents. They generally travel at higher speeds and, as a consequence, have a greater risk of serious injury or fatality in the event of a crash.5, 6 They also tend to travel in vehicles that are not as safe as those used by city people. The lower socio-economic status of people in rural and remote areas may mean that they own older vehicles (meaning fewer safety features), and may give vehicle maintenance a lower priority. The poorer condition of country roads also contributes to faster rates of deterioration of vehicles. Crashes in remote areas are also more likely to involve an unlicensed driver/rider. This in part reflects the lower levels of licence ownership.7 Research also shows that there is much that can be done to improve road safety in rural and remote areas. Improvements to the physical features of rural roads, such as removing roadside hazards and having clearer road markings, have been shown to reduce the frequency and severity of rural road crashes. Expanding public and community transport options can provide a safe alternative to drink driving, driving without a license and driving while fatigued, and prevent vehicle overcrowding – all factors that contribute to road accidents. Ensuring that education programs are tailored to the specific needs of rural and remote people, and delivered through channels by which they normally receive their messages, is another important way of reducing risk behaviours, particularly among young men. Investment in better roads also has the potential to have a direct impact on rural people's access to the health system, and therefore their health and well-being. With better roads, country people will be able to get to primary care and rehabilitation services more easily, and this may lead to better chronic disease prevention and management for people in the bush. With better roads, patient retrievals and patient transfers between facilities and the supply of essential medicines and equipment will all be quicker, and this may contribute to better health outcomes for acutely unwell people. Improving road infrastructure also has the potential to make it easier for health professionals to get to country areas – for example, locums and drive-in, drive-out workers – and therefore may help address the chronic workforce shortages in rural and remote Australia. The Senate Standing Committee on Rural and Regional Affairs and Transport is currently holding an inquiry into aspects of road safety in Australia. The National Rural Health Alliance will make a submission to the inquiry and closely monitor its implications for the people of rural and remote Australia.

Accelerating the Road to Change.

There is consensus that the Canadian health system needs to be reformed and that we are failing to achieve this objective (Romanow 2002; The Standing Senate Committee on Social Affairs Science and Technology 2002; Harvey et al. 2013; Lewis 2015). The authors provide a refreshing perspective on how this could be accomplished: a new model for conditional federal investment that is linked to quality, efficiency and outcomes; incentives for improvement that don't invoke dysfunctional competition; and a national system of outcome measurement. It is a well-reasoned and thoughtful set of solutions that could fit with the complex multi-jurisdictional character of Canadian healthcare. The key will be how to get there.

The Right Stuff? The Original Double Jay as Site for Youth Counterculture

The Right Stuff? The Original Double Jay as Site for Youth Counterculture

Submissions to Senate Standing Committee on Legal and Constitutional Affairs re Modifications to the Supreme Court Act

The Committee has been asked to consider sections 471 and 472 of Bill C-4, which modify the Supreme Court Act. It has been asked to consider them in the midst of an important controversy. In late September, 2013, Prime Minister Harper nominated the Honourable Justice Marc Nadon, then a member of the Federal Court of Appeal, to replace the retiring Morris J. Fish as a member of the Supreme Court of Canada. After Justice Nadon was sworn in, but before he could take an active part in proceedings before the Court, a challenge was launched to the legality of his nomination. Mr. Rocco Galati, a Toronto lawyer, contended amongst other things that Justice Nadon was not eligible for elevation to one of the three seats on the Court reserved for jurists from Quebec. Justice Nadon stepped aside pending the resolution of the challenge to his nomination. Subsequently, the federal government took two steps. It proposed modifications to the Supreme Court Act as part of Bill C-4. And it referred two questions to the Court for the decision: whether federal court judges can be appointed to the Court pursuant; and whether Parliament can enact declaratory provisions to end the ongoing uncertainty about the validity of Justice Nadon’s appointment and to confirm for the future that judges from the federal courts can be elevated to the Court.In my written submissions, I propose to address three issues: (1) Can a member of the Federal Court or Federal Court of Appeal be appointed to one of the three Quebec seats on the Supreme Court of Canada in accordance with the provisions of the Supreme Court Act? (2) Do the provisions of Bill C-4 alter the existing law? (3) Do the provisions of Bill C-4 require a constitutional amendment? A brief summary of my answers is as follows: (1) No: The most natural reading of the English and French versions of ss. 5 and 6 of the Supreme Court Act is that sitting or former judges and lawyers with 10 years’ experience are eligible for appointment (s. 5), but that in the case of the three seats on the Supreme Court of Canada reserved for Quebec there is an additional requirement that the appointee be a current judge or practitioner from the province (s. 6). A purposive approach underpins this conclusion. The most obvious inference is that the object of s. 6 is to ensure that the Quebec judges on the Court have current knowledge of Quebec’s Civil Code. This is confirmed by the legislative history leading to the adoption of s. 6 and its subsequent evolution. The purpose of ensuring familiarity with civil law underpinned the policy choice to list the Quebec courts and Quebec bar as the sole sources from which the Quebec seats on the Court could be filled.(2) Yes: Parliament may enact declaratory provisions to cure doubts or mistaken interpretations of existing law by declaring the law’s ‘true meaning’ not only for the future but also for the past. A court faced with the question will have to take the declaratory provisions into account and will likely conclude that the proposed ss. 5.1 and 6.1 serve to put the appointment of Justice Nadon beyond all doubt. Whether the deployment of Parliament’s powers in the judicial domain is desirable is a separate question. (3) Maybe: It remains to be seen what approach the Supreme Court of Canada will take to the interpretation of the amending formulas set out in Part V of the Constitution Act, 1982. There is scope for it to take an approach which would protect core provisions of the Supreme Court Act from unilateral amendment by Parliament. The Court may well conclude that a change to s. 6 of the Supreme Court Act constitutes a change to the “composition of the Supreme Court of Canada” and requires a constitutional amendment. There is accordingly a risk that s. 6.1, declaratory or not, is beyond the powers of Parliament because alterations to s. 6 of the Supreme Court Act can be accomplished only by a constitutional amendment. Equally, however, the Court may conclude that the Supreme Court Act can be amended by Parliament.

The Case for Improved Post-Market Surveillance of Pharmaceuticals

In Canada, as in other countries, drug approval is predominantly focused on assessing safety and efficacy at market-entry, based on pre-market clinical trials data. In this paper, we discuss how the fixation of the drug approval system on pre-market activities results in a host of serious issues including: 1) a lack of good evidence on drug safety when assessments are based solely on data produced in clinical trials; 2) a lack of comparative evidence on patient benefit between different drugs; 3) problems with lack of data about off-label prescription, which is directly associated with these two above problems; and 4) an inadequate reporting of adverse drug reactions (ADRs). In this memorandum, prepared for a presentation at an expert witness hearing of the Canadian Standing Senate Committee on Social Affairs, Science and Technology for its study of Prescription Pharmaceuticals in Canada, we argue that improving and expanding post-market surveillance is a critical to address these issues. In particular, we highlight that drug regulatory reforms should include a more explicit requirement for both comparative effectiveness studies and for post-market clinical research on the effects of drugs in real-world settings. Further, we advocate for improvements to the current ADR reporting system, as well as for improvements in the systems for collecting, storing and analyzing ADR data. Finally, the memorandum concludes with a brief discussion of Health Canada’s recent reform proposals to adopt a progressive licensing framework, which while offering important reforms such as the ability to compel drug manufacturers to conduct post-market studies, nonetheless fall short in certain respects.

Regulating Off-Label Prescribing: The Good, the Bad and the Uncertain

Off-label prescribing is a double-edged sword that offers both benefits and risks depending on a range of different factors such as whether the off-label use is new or well-established; the strength of the evidence supporting the off-label use; the urgency of the patient’s situation; and the availability of alternative treatment options. In this memorandum, prepared for a expert witness hearing of the Canadian Standing Senate Committee on Social Affairs, Science and Technology for its study of Prescription Pharmaceuticals in Canada, we discuss the rationale for permitting off-label prescribing and the problems associated with the practice in the Canadian context. We argue that reform efforts should focus on improving the monitoring of off-label use of drug products and in promoting an expanded post-market research agenda for off-label prescribing. In particular, better and more systematic adverse event reporting is essential for a proper assessment of the risks and benefits of medication use. Improving our knowledge of patient outcomes from off-label prescribing in real-world settings may support new beneficial uses of drug products, but will also help to prevent harmful off-label use. Supporting prescribers with access to timely and accurate information on off-label use of drugs will also help to ensure that off-label prescribing decisions are not made off-the-cuff.

Egregious Inaction: Five Years after 'Of Life and Death'

In November 1999, the Standing Senate Committee on Social Affairs, Science and Technology was authorized to examine and report upon developments since the release of Of Life and Death, the final report of the Special Senate Committee on Euthanasia and Assisted Suicide. A subcommittee to update Of Life and Death was therefore established. On February 14, 2000, I participated in the first panel of witnesses before this subcommittee. In light of the subcommittee's mandate, I set myself the following two tasks: first, to update the legal status sections of Of Life and Death by reporting on any changes to the legal status and any significant legal events/developments for each of the categories of assisted death: and second, to report on the status of the unanimous and majority legal recommendations made in of Life and Death. The following report captures the testimony I provided to the Senate Subcommittee. It is divided into five sections: pain control and sedation practices, the withholding and withdrawal of life-sustaining treatment, advance directives, assisted suicide, and euthanasia. Each of these five sections is divided into three subsections: changes in legal status, significant legal events/developments, and the status of the original Senate Committee recommendations.

Effective literacy instruction for all students: A time for change

Australia’s 2016 Senate report is highly critical of current Australian government support for children with disabilities, including children with reading and literacy difficulties, and children with language weakness and communication difficulties (Senate Standing Committee on Education and Employment, 2016). It reveals serious inadequacies of current instructional supports, inappropriate lack of transparency by education systems, and a major need to improve instruction and increasing government transparency. This paper explores the Senate report in the context of children’s rights and Australian legal requirements for supporting children with literacy learning difficulties. It discusses the complexities facing Australia and other Anglophone nations endeavouring to provide effective instruction for at-risk and struggling readers.

Submission 35: Senate Inquiry into the Renewable Energy (Electricity) Amendment Bill 2010 [Provisions]; Renewable Energy (Electricity) (Charge) Amendment Bill 2010[Provisions]; Renewable Energy (Electricity) (Small-Scale Technology Shortfall Charge) Bill 2010 [Provisions

This submission is in response to a request by The Senate Standing Committee on Environment, Communications and the Arts for submissions on a review into the Renewable Energy (Electricity) Amendment Bill 2010 [Provisions]; Renewable Energy (Electricity Charge) Amendment Bill 2010[Provisions]. It focuses on a three-fold approach to combating reliance on fossil fuelled energy production and its associated hazards has been considered and partially implemented by the Australian Governments with mixed successes: The first approach is to encourage consumers to reduce consumption of energy through better energy use practices and more efficient appliances. This carried out by the encouragement of the use of fuel efficient motor vehicles, energy efficient electrical appliances, architectural designs and insulation of existing buildings (passive solar); The second approach is to encourage the production of non-polluting energy systems and renewable energy sources to supplement, or replace where possible, polluting fossil fuelled energy systems (active solar); and The third approach is to impose a penalty on high energy consumers using large sources of fossil fuels. This approach is often referred to as a ‘carbon tax’ or ‘carbon trading.’ The focus of this submission is on the second approach, its related and proposed legislation. However the third approach has consequences for the second.