NOVEMBER 14, 2018 HEALTHTHE HILL TIMES POLICY BRIEFING

SINGLE-PAYER BILL THAT COULD EXPAND PHARMACARE POOL OF ORGAN DONORS IS A CURE WORSE THAN - RECEIVES ALL PARTY SUPPORT, WHAT AILS THE SYSTEM, BUT RISKS FAILING TO PASS BEFORE ELECTION says policy analyst Sean Speer p. 24 pp. 18-19

WE’RE PUTTING MENTAL HEALTH INDIGENOUS PEOPLES AT THE FOREFRONT: LEFT BEHIND BY UNFAIR, parliamentary secretary p. 14 UNEQUAL HEALTH SERVICES: Sen. Boyer p. 22

WHY IS LET’S HAVE AN ADULT HEALTH CANADA THWARTING CONVERSATION PARLIAMENT’S WILL? ABOUT HOW TO IMPROVE Green Leader p. 26 CANADIAN HEALTH CARE: Tory health critic p. 17 14 WEDNESDAY, NOVEMBER 14, 2018 | THE HILL TIMES Health Policy Briefi ng We’re putting mental health at the forefront We started with an historic investment, Our government devoted but we didn’t stop there. Our government knows that marginal- needed resources to boost ized groups face unique challenges in all mental health services, aspects of their lives, especially when it comes to their mental health. launched targeted Indigenous peoples in particular have suffered from negligence, colonial barri- initiatives to help vulnerable ers, and systemic discrimination, leading to high rates of depression, problematic populations, is embracing substance use, and suicide. This is why our government is investing more than technology, and leading the $350-million annually in community-based charge globally. mental health and addictions programming on reserves and in the North. We’ve also made signifi cant investments in appropriate, effective, and accessible men- tal health programs for Black Canadians, recently launching a fund to support mental health initiatives in the Black community. As with all aspects of the health-care system, we must always be looking to the future, where technology presents exciting THANK YOU TO ALL opportunities for innovation and change. In a country as vast as ours, technology can make a major difference. Exciting ad- THE PARLIAMENTARIANS John Oliver vances in tele-psychiatry and tele-medicine Government funding are making mental health care more acces- sible and convenient. WHO PARTICIPATED IN A great example is the Hope for Well- any years ago, C.S. Lewis lamented ness Help Line, a culturally sensitive CHILDREN’S VISION Mthat it’s “easier to say ‘My tooth is hotline aimed at Indigenous communities aching’ than to say ‘My heart is broken.’” available 24 hours a day, seven days a MONTH Decades later, his remarks speak to a fun- week, totally free. The hotline has already ACTIVITIES damental truth about mental health: many answered more than 7,000 calls. still don’t think of it as health at all. While the anonymity of technology is As our government works to ensure often perceived negatively, here it might THROUGHOUT Canada’s health-care system remains a actually be positive. Mental health is still point of pride for years to come, we must stigmatized, and, for many, seeking help change the discourse surrounding mental is extremely diffi cult. By allowing young OCTOBER. health so it takes its rightful place in the Canadians to remain anonymous, services health-care conversation. will reach more people, especially those Led by a prime minister who has cou- who are scared, embarrassed, or simply rageously shared his own family’s experi- reluctant to reach out. ence with mental illness, our government Our government’s commitment to has taken bold action to bring mental mental health extends beyond Canada’s health to the forefront. borders. While typically not considered an What does issue of global this look like? health, in many First, we devoted ways mental ill- Uncorrected vision problems badly needed ness is the most resources to global of them improve and all—affecting can impair child development, expand mental every nation, health services. without excep- interfere with learning and lead Second, we are tion. launching tar- That’s why geted initiatives Health Minister to vision loss. Early detection and to help vulner- Ginette Petitpas From left, Conservative health critic , Canadian able populations. Taylor joined ambassador to the UN in Geneva Rosemary McCarney, Third, we are her colleagues treatment are critical. Canada’s chief public health offi cer Dr. Theresa Tam, and embracing tech- from the United Health Minister at the World Health nology. Fourth, Kingdom and Assembly in May, where the minister helped launch the we’re leading the Australia in May Alliance of Champions for Mental Health & Wellbeing. charge on the to found the Al- world stage. Photograph courtesy of Ginette Petitpas Taylor’s Twitter liance of Cham- Your commitment to eye health Our work pions for Mental started with ensuring our health-care Health and Wellbeing, a group of nations and vision care on behalf of system has what it needs to address mental driving global progress on mental health. health. For too long these services have She recently spoke at the fi rst-ever United been underfunded. No longer. Nations event dedicated to mental health Canadian children will help them Last year, our government made the and represented Canada at the inaugural largest ever investment in mental health in Global Ministerial Mental Health Summit. reach their highest potential. Canadian history. The 2017 budget pledged While we’re proud of these major strides, a groundbreaking $5-billion to mental there remains much to be done. We have only health and addiction services for provinces begun our work to make sure that Canadians’ and territories—new funding that is trans- mental health is treated with the same care forming how we approach mental health and compassion as our physical health. care. As we strive to transform our health- These funds are going where they’re care system, we will continue to promote needed most, including support for youth positive mental health, fi ght stigma, and and early interventions. Most importantly, ensure everyone gets the help they need. We this funding will provide mental health invite all Canadians to join us in this quest. support for half a million young Canadians John Oliver is a Liberal Member of who previously had no access. Further- Parliament who represents Oakville, Ont., more, we are now measuring the outcomes and is the parliamentary secretary to the of these investments to ensure they are health minister. having the greatest possible impact. The Hill Times THE HILL TIMES | WEDNESDAY, NOVEMBER 14, 2018 15 Policy Briefi ng Health Despite initial ‘disappointment’ over make-up of pharmacare advisory council, pharma industry content with consultations

supports the “intent” of the report The pharmacare and its recommendations, and said Dr. Eric Hoskins, left, is chairing the as the government moves forward advisory council that is looking into implementation with a plan it has to consider the a national pharmacare plan. The “full range of options.” council will submit its report to Health advisory council will The advisory council has Minister Ginette Petitpas Taylor, right, submit its fi nal report travelled to every province and and Finance Minister by territory to speak to a wide mix the spring of 2019. The Hill Times to the health and of interested parties and to look photograph by Andrew Meade into the right way forward for fi nance ministers by Canada’s national pharmacare plan, said council member Diana the spring of 2019. Whalen, a former deputy premier and fi nance minister in the Nova BY NEIL MOSS Scotia legislature. A “solid groundwork” has fter initial concern over not been laid with the pharmaceuti- Ahaving a direct representative cal industry as the council has on the advisory committee for the had a number of meetings with implementation of a national phar- pharmaceutical and pharmacist macare plan, industry stakeholders stakeholders, said Ms. Whalen, say they are pleased with their level adding that as things progress of involvement in the consultations. there may be an opportunity for When the advisory council was more discussions. formed last June, the Canadian “I do feel it’s been a general Pharmacists Association (CPhA) effort to include [voices from the said in a press release that it was pharmaceutical industry] in every “disappointed” that there were no one of the stakeholder meetings pharmacists on the council. across the country,” she said. But since that time, Joelle “We have a strong apprecia- Walker, public affairs director tion that pharmacists play a big at the CPhA said the group has role, and are very important as been “happy” to participate in the well,” Ms. Whalen added. council’s consultations and has had Jim Keon, president of the the pharmaceutical industry as the strong report.” pharmacare is to use it in a partisan “good representation” in roundtable Canadian Generic Pharmaceuti- market for its drugs should expand Ms. Whalen said the options way, and not implement pharma- meetings. The group also met with cal Association, said he feels that with every Canadian covered. for a plan are diverse, and said the care as a very essential develop- the council privately to speak about the advisory council has given his But Mr. Davies said, since patchwork system that has devel- ment in our health care system.” how the system currently works group the time to be heard. the committee’s report, he has oped in Canada has served some Mr. Keon said he didn’t expect from a pharmacist’s perspective. Mr. Keon said his associa- detected a “clear and consistent” “well,” and others, “not so well.” the plan to be implemented prior “We were disappointed that tion was not prescriptive on the opposition to universal coverage Finance Minister Bill Mor- to the election. the council didn’t recognize the structure of a national plan, but from the industry in its social neau (Toronto Centre, Ont.) told “What happens after really very front line expertise that instead focused feedback on how media postings. the Economic Club of Canada in depends on which government pharmacists can provide—it’s a plan can be affordable and February that a pharmacare plan comes back,” he said. “[The] earli- certainly a gap on the council as NDP MP Don won’t be universal and will cover est [time] before we got some real it exists,” Ms. Walker said in an Davies says Canadians that aren’t already movement on it will be sometime interview with The Hill Times. he will be covered by a drug plan, according in 2020.” “But… we’ve tried to provide our ‘pleasantly to media reports of his remarks. [email protected] best feedback throughout the surprised’ if Mr. Davies said a patchwork The Hill Times consultation process in the round the advisory system for Canada was not the tables, and meeting with the council recommended approach by council as well.” recommends health-care policy experts who ap- Asked if the voices of pharma- Advisory a universal peared before the Health Commit- cists are being appropriately heard, pharmacare tee. Those experts thought the best Ms. Walker said it is “hard to tell at Council on the plan. The way forward was a universal plan. this time,” but that the CPhA has Hill Times He said he would be “pleasant- provided its “best advice.” Implementation photograph ly surprised” if Dr. Hoskins came She said there is no indication by Andrew back with the recommendation yet where the council will go with of National Meade for a universal plan. But he said its report. he is “worried that they won’t,” The Liberals announced the Pharmacare because of the “silence of their creation of the council in the political masters” in support of a 2018 budget, with former Ontario members universal plan. health minister Eric Hoskins ap- accessible for all Canadians. He Council members are pointed as its chair in February. added he didn’t have a preference Timeline of advisory Dr. Eric Hoskins: chair of the council and The other six council members between a fi ll-in-the-gaps ap- ‘really aware’ of deadline former Ontario health minister were named in June. proach and a universal program. council report is Mia Homsy: vice-chair of the council and A 2015 Angus Reid Institute poll “Our straightforward message to submit report: Whalen director general of the Institut du Québec found that 23 per cent of Canadi- to the advisory council is to take Ms. Whalen said the council is partisan: Davies Dr. Nadine Caron: Canada’s fi rst female ans, or someone in their household, advantage of these savings [of ge- “really aware” of the spring 2019 The panel was structured, says Indigenous surgeon did not take prescribed medication neric drugs], recommend strong, deadline to get a report into the Mr. Davies, so it has to report Vincent Dumez: co-director of the Centre of because of the cost. pro-generic… policies, and that’s health and fi nance ministers. A within one year of the appoint- Excellence on Partnership with Patients and the In a report stemming from a going to really help with the long- March briefi ng note for Dr. Hoskins, ment of the last council member, Public (CEPPP) at the University of ’s study that began in 2016—and term sustainability of a national that was obtained under the Access which would land on the last Faculty of Medicine took two years to complete, hear- pharmacare program,” he said. to Information Act, has the group week of the parliamentary sitting Camille Orridge: senior fellow at the Welles- ing from nearly 100 witnesses— NDP MP (Vancou- submitting its fi nal report between near the end of June 2019. ley Institute and former CEO of the Toronto the House of Commons Health ver Kingsway, B.C.), his party’s March and mid-April 2019. “That means that Parliament Central Local Health Integration Network Committee recommended the health critic, said the pharma- “Time is short,” she said. “We’re will not even have a chance to Diana Whalen: former deputy premier and adoption of a universal pharma- ceutical industry’s testimony was at the point where we’re very examine or debate the panel’s Nova Scotia fi nance minister care program. “very measured,” neither opposing well aware that time is narrowing recommendations,” he told The John Wright: former Saskatchewan deputy In a response to the committee’s nor strongly endorsing a univer- and we have to work hard now Hill Times. “Instead that panel will minister of health and deputy minister of fi - report, Health Minister Ginette Pe- sal pharmacare plan during the to do the rest of the thinking, and report and then we’ll go right into nance and former president and CEO of the titpas Taylor (Moncton-Riverview- committee’s study. He added a the modelling, and the testing an election in September.” Canadian Institute for Health Information Dieppe, N.B.) said the government universal program could benefi t of ideas, so that we can have a “Clearly the Liberals’ interest in 2,,705. /6:70;(3::(-, FIGHTING CANCER.

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3,(95469,(;>>>)9<*,76>,9*640:6;67,: THE HILL TIMES | WEDNESDAY, NOVEMBER 14, 2018 17 Policy Briefi ng Health

So, where is the Liberal government’s plan to ensure universal and portable Let’s have an adult health care for Canadians? If it exists, I haven’t seen it. There are some basic ele- ments that need to be in it, such as actions to address the root causes of the many conversation about chronic diseases, like cancer, heart and stroke, diabetes, and respiratory disorders, that make up 74 per cent of Canadian how to improve deaths. This means working with the provinces, territories, and Indigenous people to ad- dress obesity and nutrition, reduce alcohol Canadian health care intake, drug addiction, and smoking. It means ensuring treatments and medi- The World Health Organization considers cations are available to all. It means fi gur- France to have the best health outcomes from In Cape Breton, N.S., the community is short ing out how to pay for additional palliative its universal system—yet its system consists 52 emergency physicians, a vascular surgeon, and home care, drugs for rare diseases, of 24 per cent privatized services, writes and many family doctors. If you cut an artery and new (and sometimes extremely expen- Conservative health critic Marilyn Gladu. in Cape Breton, you may lose a limb or die sive) life-saving procedures and devices. Photograph courtesy of Chris Sampson before you can be transferred to Halifax. Some of these elements are currently be- Wait times to get a family physician in ing tackled, although somewhat ineffectively. sidered to be in the top tier in terms of qual- our capital city of Ottawa can be in excess of Pharmacare, front-of-package labelling, plain ity health-care outcomes, has also largely fi ve years. In British Columbia, some doctors packaging for cigarettes, and the prohibition privatized services. The United Kingdom is choose to be emergency room physicians of the marketing of unhealthy foods are all taking similar measures in an effort to con- rather than open a family practice, because ideas intended to address these causes, but tinue to afford its health-care system. This Conservative MP Marilyn Gladu the remuneration without overhead helps they miss the mark in their current form. is not an endorsement of privatization, but Health costs them pay back their huge student-loan debt. The choices seem to be that either rather a call to have an adult conversation In Ontario, the violation of doctors’ rights of more tax revenue will need to be devoted about the potential of leveraging ideas that conscience through medical-assistance-in-dy- to health, services will decrease, or other have been successful elsewhere. t’s important to look to the future needs of ing policies is causing some doctors to move alternative and innovative ideas must be In summary, Canada needs a clearly Ithe health-care system and ensure that the to other provinces or retire. Finance Minister explored. The issue of privatization of laid-out strategy to address the silver plans of today meet the demands to come. Bill Morneau’s tax changes have also affected certain health services is a hot potato for tsunami and increasing costs of health Canada has an aging population. One in medical practices, again causing some physi- some Canadians, but if we look to other care. The plan will have to look at the other six citizens is a senior today, a fi gure that cians to shut down or cut services. universal health-care systems in the world universal health-care systems of the world within 10 years is predicted to be closer Our hospitals are log-jammed because that have better health outcomes than and leverage ideas that are working, to to one in four. An aging population means of the lack of long-term care facilities. In Canada does, we need to consider their produce better outcomes for Canadians. more chronic disease than acute, end-of- addition, there is not adequate home care approaches. As the shadow minister of health, I am life services on the rise, and a shortage of to allow seniors to remain in their homes. The World Health Organization consid- providing input to the government on what front-line health-care workers of all kinds Wait times are too long in many cases, and ers France to have the best health outcomes the plan should be, for the betterment of to meet the demand. patients who can’t afford their medications from its universal system—yet its system Canadian health care. The doctor shortage in Canada is a crisis. end up at emergency rooms with condi- consists of 24 per cent privatized services. Conservative Member of Parliament Mari- In many jurisdictions across the nation, tions more expensive to treat than those France also has incentivized reimburse- lyn Gladu represents -Lambton, Ont., whether you live in an urban or rural setting, who are able (i.e. can afford) to control ments to encourage people to choose the and is the offi cial opposition health critic. the shortage of family doctors is a problem. their illness with prescribed medicine. lower-cost treatment option. Sweden, con- The Hill Times Diabetes 360° A national strategy that could prevent millions of Canadians from being diagnosed with diabetes and save billions of dollars in health-care. We’re urging for government action to address the epidemic that risks the health of 1 in 3 Canadians. Join us. Visit diabetes.ca/strategy 18 WEDNESDAY, NOVEMBER 14, 2018 | THE HILL TIMES THE HILL TIMES | WEDNESDAY, NOVEMBER 14, 2018 19 Health Policy Briefi ng Policy Briefi ng Health

It specifi cally recommended that the by encouraging others to donate their Mr. Casey called the bill “a simple way feds provide sustained funding to the Ca- organs,” he said. of increasing organ donations in Canada.” nadian Blood Services, establish a work- [email protected] “If it results in a handful of new suc- ing group with provincial and territorial The Hill Times Bill that could expand pool cessful donations, it will be worth it,” he ministers to review best practices in said. organ donation legislation Canada-wide, Currently, there are about 4,600 Cana- and study Spain’s model of presumed Deceased donor dians on a wait list for a life-saving organ consent. of organ donors receives transplant. In 2016, 260 Canadians died MPs also suggested that Ottawa cre- while waiting for a transplant. rate, by province: ate more opportunities for Canadians to While Canada saw a recent uptick in or- register as donors, and to invest in national gan donations from deceased individuals— British Columbia: 20.3 per one million people public education and awareness campaigns increasing to a rate of almost 21 donors per : 16.1 per one million people all-party support, but risks to promote conversations among family million people in 2016, up 42 per cent since Saskatchewan: 12.2 per one million people members regarding organ donation. 2007—Canada still lags behind the United Manitoba: 12.1 per one million people Mr. Webber said one in fi ve Canadian States, United Kingdom, and Spain. Ontario: 25.2 per one million people families are saying “no” against the wishes In Spain, where residents can opt out Quebec: 20.4 per one million people failing to pass before election of a loved one who consents to donating an Nova Scotia: 18.2 per one million people of organ donation as opposed to signing organ, something he said was “shocking.” up, the rate is 43.4 donors per one million New Brunswick: 17.2 per one million people While he understands that it can be a people. Newfoundland and Labrador: 13.2 per one million Conservative MP , second from right, is pictured at a House Health Committee prior to a lot of ask for a family, particularly when Bill C-316, An Act to amend the Canada reading until early this month, when 272 However, between 2007 to 2016, living people The bill is sponsored meeting in October 2016. He is the sponsor of a private member’s bill that would offer Canadians the their loved one is dying, he hopes more Revenue Agency Act (organ donors), would MPs voted in support of it being referred organ donation rates in Canada had de- Canada: 20.9 per one million people option to register as an organ donor on their annual tax return forms. The Hill Times photograph by Sam Garcia Canadian households will talk about organ allow Canadians the option to check off to the House Health Committee for study. creased 11 per cent. by Conservative MP donation earlier on, instead of when a whether they would like to become organ It will then have to clear the Senate before Organ donation policy falls under pro- loved one is dead or near death. Len Webber, who has donors on their annual tax return forms. Parliament is dissolved, giving it roughly vincial jurisdiction on health care delivery, the bill, with the Liberal government saying Organ donation Continued from page 18 Ms. Gavsie said two ways the federal Their information, provided they give con- between now and June 2019 to pass. and each province has its own donor list it could infringe on provincial powers. government can support organ donation is championed the cause sent, would then be passed onto provincial Mr. Webber, a member of the commit- and institutions that administer donations. Canada, with 25.2 donations per one mil- Mr. Webber said given that hurdle, it through providing more ways for Canadi- in Canada, by the organ donor rolls. tee, said each of its members support the Since organs only have fi nite time to be lion people. made sense to propose offering Canadians ans to sign up as donors, such as on pass- of organ donation and On Nov. 7, the bill passed its fi rst major test bill and “are passionate as well getting this out of a body and transplanted, the odds of Ontario has a mandatory referral sys- another option to sign up as organ donors. port forms, and a nationally co-ordinated numbers in 2016: and received unanimous support in the House bill further on in the process.” He said one someone receives a lifesaving organ can tem requiring hospitals to refer a potential “What better way than to tap into al- transplantation in his time awareness campaign that can raise greater of Commons, moving it from second reading Senator has already signalled interest in depend on geography. donor to the network to see if there is a most every Canadian through their taxes, awareness that organ donation does indeed to study by the House Health Committee. sponsoring the bill in the Upper Chamber. Deceased organ donation rates in On- medically suitable match for transplant and their tax forms,” he said. “I hope even- 20.9—Canada’s deceased donation rate per one million in national and provincial saves lives. However, with less than a year left “I am certainly going to be working tario, British Columbia, and Quebec were and whether or not the person has regis- tually that all federal and provincial forms people “We are not embracing all of the op- legislatures. before the next federal election has to be with the passion I’ve had now to ensure above 20 per one million people in 2016, tered consent. Ms. Gavsie also said hospi- will ask the same questions.” 22—the per one million people donation goal set by Canada portunities that are available across the held, and rumblings of an early election that this bill does make it through every but lower than that in Prairie provinces. tals across the province also have trained Blood Services and other organizations in 2011 country,” she said. being called in 2019, the bill’s sponsor said process,” he said, adding that he’s lobbied Ronnie Gavsie, president and CEO of co-ordinators to help families and potential 4,492—the number of people on the donor waitlist BY JOLSON LIM Health Committee recommends Mr. Webber, who advanced a provincial he’s worried that it may not move through his peers over the last two years to support Trillium Gift of Life Network, the Ontario donors, while Ontario has a province-wide 260—the number of Canadians that died while waiting for private members’ bill on organ donation in Parliament fast enough before the current it. “It’s a no-brainer. I believe it will be a agency responsible for the province’s resource centre to act as a main hub. stronger federal role in donations an organ donation 2013, when he was an Alberta MLA, said Conservative private member’s bill slate of bills are wiped off the table. lifesaving change to the act.” organ donation system, said the provincial “These are the kinds of initiatives that The same House committee that will exam- 2,903—the number of transplant procedures conducted in his passion for the issue was spurred be- that would offer Canadians another “I am concerned about the possibility… Health Committee chair and Liberal MP government has provided strong support other provinces are starting to take up,” she ine Mr. Webber’s idea also studied the overall Canada A cause his late wife, Heather, was saddened way to sign up to become organ donors has of an early election,” said Conservative MP Bill Casey (Cumberland-Colchester, N.S.) since the network’s founding in 2002, said, “some to a greater degree than others issue of organ donation and transplantation 758—the number of deceased organ donors she was unable to donate her organs due to received the support of all federal par- Len Webber ( Confederation, Alta.). said that given the time left in the current resulting in a more-fl exible system for but these appear to be the keys to success.” this year, releasing its report in September. 544—the number of living organ donors a cancer that spread through her body. She ties, although its sponsor is worried that “If that’s the case it could just bring this Parliament, Mr. Webber’s bill “has priority.” donation and transplantation. The province In 2016, Conservative MP The multi-party committee said the died in 2010. it may not become law before Parliament bill tumbling down.” “We’re going to fi nd a way to expedite has the highest deceased donation rate in ( Manning, Alta.) tabled a bill that federal government has a “leadership role —Canadian Blood Services’ Organ Donation and “I thought I would do anything I can to is dissolved ahead of next year’s federal The bill was fi rst tabled by Mr. Webber it as quickly as we can,” he said. “That’s the would have created a national registry for or- to play” in strengthening Canada’s organ Transplantation in Canada 2016 System Progress honour her wishes through other people, election. in October 2016 but sat awaiting second feeling of all members.” Continued on page 19 gan donors. However, the Liberals defeated donation and transplantation system. Report Update

THE EDGE IS HERE UVic launches the world’s first Indigenous law degree

Feminist, artist, grandmother and embracer of disruption, Dr. Val Napoleon is one of the most influential legal scholars in Canada. She is changing legal education and the lawscape of Canada as co-founder of the Indigenous Law Degree Program.

uvic.ca/worldsfirstworldsfirst In the Kokum Raven Series, Val Napoleon represents Indigenous law with trickster-grandma Ravens who create spaces for conversations and questions. 20 WEDNESDAY, NOVEMBER 14, 2018 | THE HILL TIMES Health Policy Briefi ng

spend fewer than 10 seconds selecting an but powerful words “Health Canada/Santé Of course not, in the same item. That’s certainly not enough time to Canada” should also be on the label to Does this review current Canadian nutrition labels, convey the alert symbol has legitimacy and way nutrition labelling on which are on the back or side of packages authority. the back of food packages and contain detailed information that’s This is an excellent step forward and headline often too complex for many consumers to will make Canada the fi rst G7 country to doesn’t communicate what understand. mandate such labels, if the current plan But nutrition labelling is about to proposed by Health Canada is approved we need to know before change in Canada and that’s good news, and implemented. say what both for our health and for informed con- Why did Health Canada choose this buying food. sumer decision-making. option? Health Canada is currently developing Research, including work awarded the you need new “high in” nutrition alert labels for the Nobel Prize, has consistently demonstrated front of food packaging. This is consistent that consumers do not spend a great deal with best practices and evidence on how of time and effort in purchasing situations, to provide consumers with quick and easy especially when it comes to repetitive deci- to decide information about the levels of saturated sions, which is the case when buying food. fats, sugars and/or sodium in food and Current nutrition facts, unfortunately, do drink products. not suffi ciently infl uence shoppers’ choices whether How does it work? towards healthier products. When a product has more than a speci- Why is this the case? Because food and fi ed level of certain nutrients, it must have drink nutrition labels are frequently dif- Fabio Gomes a prominent black label on the front of the fi cult to fi nd, hard to read and obscured by package that says simply, depending on the competing claims on the packaging. to read the Nutrition nutrient in question: “high in sugar,” “high There are often prominent but mislead- in fat,” or “high in sodium.” There are no ing claims by manufacturers on the front of upermarkets are crowded with around numbers or symbols that require further the packages that may be at odds with the article? S40,000 products, yet most shoppers interpretation. Importantly, the simple nutrition label on the back. Images of natu- ral foods, such as fresh fruits and cartoon characters, as well as colorful designs, can also distort consumer perceptions about certain foods. A good nutrition label needs to cut through the hype. The key to an effective front-of-package labelling system is that it must be both simple and interpretive. Simple means that it shouldn’t require any nutritional knowl- edge to be understood. Interpretive means that information should be given in the form of guidance to the consumer, rather than simply providing numbers. Consumers invest little time in making a purchasing decision, so the system has to also facilitate quick recognition and processing of the information. Various other promising front-of-pack- age labelling systems have been devel- oped to help consumers make better food choices. Some involve traffi c lights—green, yellow and red to indicate low, moderate or high levels of nutrients. Others use num- bers and percentages to depict the level of nutrients and some use stars—the more stars, the healthier the food. But research has generally found that these systems are not as effective at help- ing consumers steer away from foods that are “high in” sodium, sugar, or saturated fat. And these ingredients are linked to the diseases that are the major causes of death and loss of years of healthy life in Canada, such as cardiovascular diseases, cancer, and diabetes. Health Canada was also able to rely on international experience when making their decision. The “high in” labelling ap- proach is already being used in Chile—and approved for use in Peru and Uruguay. Evaluation of the fi rst year of use in Chile shows that 93 per cent of Chileans reported they understand the labels and 92 per cent found it infl uenced their purchas- ing decisions. Manufacturers may also be improving the nutritional content of their product to avoid the negative labels. Food manufacturers in Chile reformulated 18 per cent of their products prior to the implementation of the labelling system in order to avoid having the label on their products. Canada and many other countries face an epidemic of obesity and diet-related chronic diseases with serious and expen- sive health consequences for individu- als and societies. Front of pack “high in” nutrition labels will help consumers make healthier and more informed food choices. Dr. Fabio da Silva Gomes is an adviser in nutrition and physical activity with the Pan American Health Organization/World Health Organization and a contributor with EvidenceNetwork.ca based at the University of Winnipeg. The Hill Times THE HILL TIMES | WEDNESDAY, NOVEMBER 14, 2018 21 Policy Briefi ng Health Inequality in system no reason to criminalize paying for

NDP MP Don Davies, left, questions if the for-profi t sale of bodily fl uids is the right path for fertility services, says Canada. Conservative MP Marilyn Gladu, middle, says Conservative MPs will likely have a ‘free vote’ on Liberal MP ’s, right, private member’s bill on the topic. The Hill Times fi le photograph, by Andrew Meade, and by Sam Garcia Grit MP Housefather gets the great majority of donations from Mr. Housefather said his bill has the the United States, and it doesn’t have the support of the Liberal women’s caucus, same rigorous screening as Canada does. many Liberal and Conservative MPs, and rogacy or fertility services, it wouldn’t nec- Ms. Gladu’s NDP counterpart, MP Don Green Leader Elizabeth May. (Saanich- In surrogacy and fertility essarily be obtainable for working-class Davies (Vancouver Kingsway, B.C.), said Gulf Islands, B.C.) services, there’s always an Canadians, as even with payments there generally the NDP sides with those who won’t be a fl ock of people coming forward think organs, tissues, and bodily fl uids New regulations for donor, exchange of money—just not to be surrogates, and fertility services still should not be commodifi ed or subject to require an expensive drug regimen. for-profi t sale. However, he said he hasn’t surrogate reimbursement to the surrogates and donors, Prof. Snow said he is, “broadly speak- studied the bill, as it has yet to be referred On Oct. 26, Health Minister Ginette ing,” in favour of Mr. Housefather bill, to the Health Committee. Petitpas Taylor (Moncton-Riverview- says expert Dave Snow. C-404, since in surrogacy and fertility Mr. Davies said he would be open to Dieppe, N.B.) announced new regulations services there is already an exchange of looking at the evidence, but he said Cana- that would allow for the reimbursement for BY NEIL MOSS money, but the only person not seeing a da’s approach to not commodifying organs, some expenses that donors or surrogates payment is the person donating eggs or tissues, and bodily fl uids has served it well. may have, including medical and work- he ability to pay surrogates as well as sperm, or the surrogate. “I’m not sure opening up the sale of hu- related costs. Tsperm and egg donors for their services He said the current system is a “far more man fl uids to private for-profi t sales is the But for Mr. Housefather, the new regula- will largely benefi t wealthy and middle class exploitive arrangement” than one where the way to go,” Mr. Davies said. tions are insuffi cient. people seeking to be parents, and not those of surrogates or donors get paid for their labour. Mr. Davies said the NDP remains op- He said it is good to have clarity on less fi nancial means, but that’s no reason not posed to for-profi t health care, and services what can be reimbursed, but it is trying to to move forward with decriminalizing pay- Tories likely to have ‘free vote’ shouldn’t be subject “to the size of some- resolve the wrong issue. ments to surrogate mothers and donors, says on bill, says Marilyn Gladu one’s bank account.” Just knowing what expenses are cov- the author of a bill seeking to do just that. “One thing we all share—and I share ered doesn’t solve the problem that you Liberal MP Anthony Housefather (Mount Mr. Housefather’s bill still has to go with Mr. Housefather—is we’d like to make can’t pay people beyond their expenses, Royal, Que.) introduced in May a private through the shadow cabinet and Conserva- sure that Canadians who would like to and everyone’s expenses are different, Mr. member’s bill that seeks to change the Assist- tive leadership for discussion, but Conserva- have children and can’t have children have Housefather said. ed Human Reproduction Act, which currently tive MP Marilyn Gladu (Sarnia-Lambton, access to the best technology we have, and “We would be far better off to recognize criminalizes payments to surrogates and fer- Ont.), her party’s health critic, said because it a system that can assist as many people as that it shouldn’t be a criminal act to pay tility donors, with a punishment of between is a private member’s bill and involves “con- possible,” Mr. Davies said. “Whether that someone for their sperm or their eggs, or four to 10 years imprisonment, and a possible science issues,” she thinks the Conservative extends to paying people for surrogacy for be a surrogate,” he added, “and allow prov- fi ne of between $250,000 and $500,000. The caucus would have a “free vote.” the present system, I think the case has to inces to regulate and take it out of [juris- bill would make it legal for those over the age Ms. Gladu said there is a problem with made by Mr. Housefather… because it’s diction of] the criminal [system].” of 18 to be paid for their sperm or ova dona- the level of screening of the egg and sperm certainly inconsistent with the approach [email protected] tions, and for those over the age of 21 to be supplies for Canada, as Canada currently we’ve taken up to now.” The Hill Times paid as surrogate mothers. “You need money to have a baby,” Mr. Housefather said in interview. “Just be- cause only some people can use it, nobody should be allowed to use it?” He added that the current regime means the country has few domestic donors, lead-    ing to Canada importing the majority of the supply of eggs and sperm, which drives "%*( ** up the price more than if Canadians were paid to donate eggs and sperm. This would ultimately lead to greater availability for   working-class Canadians, he said. “The main thing we should all agree       with is people shouldn’t fear going to jail because [they] make a mistake in the way      P DUT they offer to pay a surrogate,” he said. Currently, there is a two-tier surrogacy   T DUD system where those who use surrogates belong to higher economic backgrounds,   # D said Dave Snow, a University of Guelph po-  litical science assistant professor who spe-     cializes in the intersection of politics, law, and assisted reproduction. The decriminal-      ization of payments won’t alter the system where surrogacy is already monopolized by the rich. “Poor people are not commissioning surrogates, and having children through surrogates,” Prof. Snow said. Even when surrogates aren’t being paid, having a child through surrogacy requires “lots and lots of money,” he added. Liberal MP (Davenport, Ont.), who fl anked Mr. Housefather at a press conference in support of his bill in May, said regulating costs could be an option for the    * !#*              ) W        government to make sure fertility services are                T          º/URºA   available to those who want to start a family. Prof. Snow said it is “unlikely” for               ºFROMººLEVEL   ºANDºWEºAREºWELLºONºOURºWAYºTOºTHISºGOAL the government to fund the services, as &ORºMOREºINFORMATIONºVISITºBALANCECALORIESCA&ORº&ORMOREºMOREºINFORMATIONºINFORMATIONºVISITºVISITºBALANCECALORIESºBALANCECALORIESCA CA there are more pressing needs to fund in    *   *        Canada’s health-care system. '! *'! *                   * $$  & * $$  &        ) )    *   * Even if the government subsidized sur-              !LL INFORMATION!LL!LLºINFORMATIONºREFERENCEDºISºDERIVEDºFROMº#ONFERENCEº"OARDºOFº INFORMATION REFERENCED REFERENCED IS DERIVED IS DERIVED FROM FROM #ONFERENCE #ONFERENCE "OARD "OARD OF #ANADA OF#ANADAºREPORTSºONºTHEº"ALANCEº#ALORIESº)NITIATIVE #ANADA REPORTS REPORTS ON THE ON "ALANCE THE "ALANCE #ALORIES #ALORIES )NITIATIVE )NITIATIVE 22 WEDNESDAY, NOVEMBER 14, 2018 | THE HILL TIMES Health Policy Briefi ng

instance). As a consequence, children in need of assistive devices or accommodations for Indigenous peoples left behind by learning challenges are unable to receive the help they urgently require. In aggregate, First Nations children are being left behind by a unfair, unequal health services system that appears apathetic to the changes necessary to meet the standard of universal ac- cess and coverage promised to all Canadians. and compensable fi duciary obligation based and prove they have been adhering to their Recent actions by the federal government on constitutional and statutory rights. This treatment before the program will insure have given rise to the prospect of Indigenous fi duciary relationship extends to situations a CPAP purchase. Conversely, individuals communities reclaiming some degree of au- where Canada has discretionary control covered through Saskatchewan Health are tonomy and control over the design of their over Indigenous health care. Thus, Canadian loaned these machines at a discounted cost health programs. On Sept. 6, Indigenous Ser- health-care policy should refl ect these obli- and can take the machine home without vices Minister Jane Philpott announced that gations rather than outdated colonial theory. having to prove they can care for it. This Canada would commit $68-million over three The guardian-and-ward theory continues policy is indicative of the outdated and years to improve health services in Indige- to permeate Canadian health policy. This humiliating guardian-and-ward beliefs. nous communities. While this is a welcomed perspective underpins beliefs and attitudes of In northern Ontario, First Nations children Independent Senator Yvonne Boyer start towards restoring the decision-making some health-care providers and fi nds particu- in remote communities cannot access the capacity of Indigenous communities, more Indigenous services lar expression in the differing standards that health-care providers they require to obtain action is required to rectify the underpinning First Nations and Inuit peoples must satisfy specialized assessments, order medical thera- causes of inequities that Indigenous people when submitting claims for extended health pies, and be recommended treatments for cer- continue to experience. anada’s health-care system is a source benefi ts under the Non-Insured Health Ben- tain conditions and ailments. The NIHB travel Ontario Senator Yvonne Boyer is a Cof national pride. This conviction is efi ts (NIHB) program. When claimants qualify policy often does not cover the cost for health- member of the Independent Senators challenged, however, when one consid- for benefi ts under a private plan or a public care professionals to travel to these communi- Group. She is a member of the Métis ers the growing body of research that has program, the “payer of last resort” policy ties. NIHB adjudicators have interpreted this Nation of Ontario and has a background identifi ed an unequal and unfair applica- requires them to submit their claims to those policy as applying strictly to providers who in nursing. She came to the Senate from tion of health policy. programs fi rst before sending them to NIHB. bill the Ontario Health Insurance Plan directly the University of Ottawa, where she was There are signifi cant discrepancies in NIHB claims made for medically (in other words, doctors) and not to those who the associate director for the Centre for the way health-care services are delivered necessary devices and services regularly are publicly funded through provincial bodies Health Law, Policy, and Ethics. to and accessed by First Nations, Métis, require the claimant to demonstrate they (occupational and/or physical therapists, for The Hill Times and Inuit as compared to the non-Indig- are capable of caring for the device and enous population. These differences are adhering to the prescribed treatment for a rooted in the evolution of colonialism. set period of time where it is not required Since Confederation, the Canadian under provincial programs. government has regulated most aspects of For example, in Saskatchewan, patients Indigenous lives. In doing so, it has in- diagnosed with obstructive sleep apnea are Canadians deserve grained what the law has characterized as a treated using continuous positive airway guardian-ward relationship, where the state pressure (CPAP) machines. The machine assumes a paternalistic role in making deci- is a take-home device that requires the sions concerning the health and well-being patient to wear a mask while sleeping. It better health care. of Indigenous peoples. It was not until 1984 delivers constant pressure fl ow to ensure that the Supreme Court of Canada redefi ned the person’s airway is maintained. the Indigenous-Crown relationship, describ- Individuals covered by NIHB must com- ing it as one involving a legally enforceable plete a three-month CPAP rental period Patient’s Medical Home can get us there

Independent Senator Mohamed-Iqbal Ravalia The model embraces health information HEALTH technology, which includes electronic re- Family medicine cords to store and share information across points of care, allowing health profession- became a family doctor because providing als to communicate effi ciently. Icomprehensive, compassionate care gave me Evidence shows that PMH models of family meaning. In the small community I served in practice lead to better care, better outcomes, Twillingate, N.L., I have watched infants I cared lower health-care costs, and increased satis- for grow up and I’ve watched people reach the faction for providers and patients. When the end of their lives. I am a part of this commu- model works well, it is associated with reduced prescription opioids cannabis nutrition nity and the relationships I’ve developed are reliance on emergency rooms, better adher- drugs central to what it is to be a family doctor. ence to treatment plans, better access to after- I know that my patients also value these hours care, and improved patient follow-up. relationships. They know I see them as a Recognizing the variability of health-care person and not just as a collection of ail- delivery across Canada, the PMH is not based mental digital ments to treat. I am able to offer treatment on mandatory criteria; rather it is a set of pil- Indigenous plans or advise healthier lifestyles based lars that supports the need to be responsive to health health health on what I know about my patients’ socio- communities. The further a practice is aligned economic situation and their family envi- with the PMH vision, the better it can deliver ronment—right down to knowing whether on the full potential of the model. they are likely to follow my advice. To realize the vision of better care and Family medicine is rewarding and better outcomes for all, the PMH needs seniors organ/tissue complex, more so now than ever before. support from provinces, territories, the fed- donation However, it is becoming more challenging eral government, decision-makers, health- to address this complexity using traditional care providers, and the public, who will practice organization. ultimately benefi t from the model’s results. For example, a patient who is dealing With government support and joint with a chronic condition while managing a participation from the health professionals series of medications and coping with fam- who make it possible, the PMH can deliver ily issues needs support from a commu- care that is accessible and responsive to We declutter your workspace by nity-based team of health professionals Canadians’ needs. The progress made in to effectively take care of their health. To the past seven years is impressive, but providing you a single daily report on address this complexity, improve service, more work is before us. and meet the evolving needs of patients, What I have valued most as a family provinces are experimenting with a variety doctor in Twillingate has been working what has happened federally in health. of primary care models. with a good team with the common goal The College of Family Physicians of Can- of improving people’s lives through better ada launched its vision of the future of family access to person-centred care. And we do it at a price you can afford. practice in 2011. It’s called the Patient’s Medi- The Patient’s Medical Home vision can cal Home (PMH) and the model has caught make this achievable and accessible for the attention of provincial decision-makers everyone in Canada. and health-care providers across Canada. Senator Mohamed-Iqbal Ravalia is a for- Start a free trial today PMH is best described as a family prac- mer family physician. He is a member of the HillTimesresearch.ca • 613-232-5952 ext 264 • [email protected] tice serving as a central hub for providing Independent Senators Group and represents care that is responsive to the needs of indi- Newfoundland and Labrador in the Senate. vidual patients and their communities. The Hill Times Canadians want a label on it Make it simple. Make it right. Make some reasonable exceptions.

The federal government is proposing visible, easy to understand front-of-package nutrition labels to help Canadians make healthier choices.

These alert labels will provide busy shoppers the quick direction they need that the nutrition facts table doesn’t provide. They are based on the best scientific evidence and supported by 87% of Canadians.

Heart & Stroke supports this approach and urges government to consider some exemptions for dairy products that are high in important nutrients.

™ The heart and / Icon on its own and the heart and / Icon followed by another icon or words are trademarks of the Heart and Stroke Foundation of Canada. 24 WEDNESDAY, NOVEMBER 14, 2018 | THE HILL TIMES Health Policy Briefi ng

generosity is too limited. But it can form Single-payer pharmacare is a cure the basis of much greater federal support for the purchase of private health insur- ance and catastrophic drug spending. It should be reconfi gured and redesigned worse than what ails the system as a new, refundable tax credit that signifi cantly defrays the cost of health- related expenditures, including insurance But a single-payer pharmacare scheme premiums. A federal intrusion that is a cure that’s worse than what ails the Suppose you set the value of the credit system. It would disrupt coverage for the at $5,000 per family or $2,500 per indi- disrupts coverage for three- 77 per cent of the population generally sat- vidual for purchasing insurance. There quarters of the population, isfi ed with the status quo. It would impose would be room to adjust these amounts signifi cant new costs on the federal gov- based on income or health status. This requires tax hikes and ernment. It would almost certainly involve would provide substantial public support poorer drug access and less clinician and for individuals and families to purchase spending cuts, and leads patient choice. And it would thrust Ottawa different forms of private insurance rang- into provincial jurisdiction with no compe- ing from basic plans to more enhanced to less drug access hardly Sean Speer tency or expertise. benefi ts. It would leverage the best A federal intrusion that disrupts cover- seems like a political Drug coverage features of the current model and eschew age for three-quarters of the population, the worst parts of government-run phar- winner. But neither is requires tax hikes and spending cuts, and macare. those who need greater public support leads to less drug access hardly seems like The impending pharmacare debate is silence on the other side of without harming those who are well a political winner. But neither is silence on shaping up to have parallels to the child- served by the current mix of public and the other side of the debate. Ignoring the care debate in the 2006 federal election the debate. private insurance. real challenges facing a small yet growing campaign. That debate was similarly We don’t know precisely where the share of the population is a recipe for end- focused on a choice between a one-size- s we approach the 2019 federal elec- government will ultimately land on the fi le. ing up with a deeply fl awed pharmacare fi ts-all, government-centric option and Ation campaign, we seem to be moving But we have some signs. Its members on policy. a more targeted and fl exible model that towards to a major policy confl ict between the House of Commons Health Committee What would a better policy alternative empowered individuals and families. The political parties on pharmacare and the have strongly endorsed a pan-Canadian, entail? latter won out in that instance and has federal role. single-payer scheme. Eric Hoskins, the It would start by recognizing that the since reshaped the federal role in child- The debate will hinge on whether we chair of the government’s advisory panel current mix of public and private cover- care policy. should pursue targeted or sweeping re- currently studying the issue, has spoken age generally serves most Canadians well. A sensible alternative to national forms, whether we prioritize clinician and positively of the “the vision of national The goal then should be to build on what’s pharmacare can have the same policy and patient choice or cost control, and whether pharmacare.” currently working and fi ll gaps where they political effect. But it will require a com- we wish to see a more or less expansive This impulse isn’t wholly unjustifi ed. exist. bination of confi dence and ideas, just as it role for Ottawa in health care. There’s a small yet vulnerable share of the The two areas where there seems to did then. This debate will only unfold, however, population without private or public drug be a problem are: (1) the cohort without Sean Speer is a Munk senior fellow if both sides present credible plans. It coverage. There are also some who lack any insurance, and (2) the cohort without at the Macdonald-Laurier Institute. He won’t be enough for pharmacare critics catastrophic coverage for high-cost drugs. catastrophic coverage. These are the two previously served in different roles for the to merely critique the fl aws of national And out-of-pocket spending, which tends groups that Ottawa ought to target. federal government including as senior pharmacare. That’s the easy part. It will to be regressive, has been rising across the The Medical Expense Tax Credit is economic adviser to former Conservative behoove opponents to develop and put country. These are legitimate public con- presently too small to make much of a prime minister . forward a better alternative that targets cerns that require a policy response. difference. It’s non-refundable and the The Hill Times

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The forces in opposition to change are Two ways forward for extremely formidable, including private insurers and pharmaceutical companies. There will be repeated calls that the status quo is not that bad and only minor changes national pharmacare are required. We should learn from the experience of the United States health-care system, Under the fi rst option, the provinces that the “fi ll-the-gaps” approach is mere The ‘fi ll-the-gaps’ approach would agree to delegate the power to code for more of the same: high prices administer drug insurance plans to a and problems with access. It is imperative is mere code for more of federally funded agency. This process was that the federal government makes a fi rm used to establish Canadian Blood Services commitment to leading the country toward the same: high prices and in the 1990s. Through public tendering universal pharmacare. In negotiations with problems with access. and bulk purchasing, the CBS has been the provinces and territories, Ottawa’s bot- able to achieve dramatic cost savings for tom line must be ensuring the overarching certain pharmaceuticals on behalf of the Dr. Eric Hoskins, chair of the Advisory Council on principles of universality and accountable provinces. Its success shows that inter- the Implementation of National Pharmacare, speaks decision-making. governmental collaboration to implement to reporters to announce the remaining members of Colleen M. Flood, Bryan Thomas, and universal delivery of health-care products the council on June 20 in the House foyer. They are Patrick Fafard are professors of health can be achieved where suffi cient political set to release their fi nal report in spring 2019. The policy and law at the University of Ot- will exists. Hill Times photograph by Andrew Meade tawa Centre for Health Law, Policy & As a second option, the federal govern- Ethics. Asad Ali Moten is a freelance legal ment could adopt legislation similar to the universal coverage for a basket of essential researcher in Toronto. They are authors Canada Health Act and provide annual drugs, with no copayments or deductibles; of Universal Pharmacare and Federalism: transfers for pharmacare to the provinces and (2) decisions over what to include in Policy Options for Canada, published by Patrick Fafard, Colleen M. Flood, Asad Ali and territories. The funding would be con- the basket to be made by an arm’s-length the Institute for Research on Public Policy. Moten & Bryan Thomas tingent on compliance with two criteria: (1) body (or bodies). The Hill Times

Drug coverage

he case for universal pharmacare is Tcompelling and clear-cut. But as the fed- erally appointed advisory group led by for- mer Ontario health minister Eric Hoskins prepares the blueprint for a national plan, Ottawa must brace itself for negotiations with the provinces and territories. Canada is the only OECD country with universal health insurance that does not include prescription pharmaceuticals. One in fi ve Canadians reports that they or someone in their household are not taking their medicine as prescribed, owing to concerns about costs. Although provinces provide coverage for some groups, includ- ing the poor and elderly, up to 20 per cent of Canadians have no drug insurance at all. Our limited access also doesn’t save us money: Canada has among the highest per capita drug expenditures in the OECD. This patchwork mix of public and private drug programs leads to access gaps and high costs that threaten the health, and the very lives, of thousands of Canadians annually. But it doesn’t have to be that way. Ot- tawa and the provinces and territories have the chance to change lives with a robust, Canada-wide pharmacare program. A clear set of objectives is essential for a successful outcome of negotiations between Ottawa and the provinces and Healing what territories. To be sure, there are many chal- lenges. We need look no further than the bitter federal-provincial talks over health funding to recognize the delicate nature of such negotiations. V Complicating matters even more, gov- can’t be healed. ernments have overlapping, and at times confusing, jurisdiction over health care un- der Canada’s constitution. As the Supreme Court has clearly and repeatedly indicated, which level of government has primary jurisdiction depends on the particular issue yet at hand. Currently, the federal government exer- cises some of its constitutionally mandated powers to shape and direct pharmaceutical policy—playing a larger role in this domain than with respect to other parts of health care. This includes the regulation of patents and safety and effi cacy of medicines. It Canadians need innovative medicines. also funds prescription drug benefi ts for specifi c populations, such as prisoners, Medicines that don’t yet exist. Let’s build a members of the Armed Forces and the RCMP, and veterans. system that ensures we never stop innovating. Arguably, this provides a foundation for Ottawa to take a far stronger leader- ship role in the establishment of universal Learn more at innovateforlife.ca pharmacare than it has to date. In our recent study for the Institute for Research on Public Policy, we outline two constitu- tionally viable policy options for a national pharmacare framework. 26 WEDNESDAY, NOVEMBER 14, 2018 | THE HILL TIMES Health Policy Briefi ng

but the marketing minimized the ordered the data released for risk of addiction. It was true that several reasons, including contra- Why is Health Canada OxyContin is 1.5 to two times dicting the purpose of Vanessa’s more potent in relieving pain Law—to improve clinical-trial than morphine. It was completely transparency—and for failing thwarting Parliament’s will? untrue to claim that it was less ad- ‘to assess the effects of its deci- dictive than other painkillers. sion on Mr. Doshi’s freedom of But four years after Vanessa’s expression,’ as guaranteed in the In the 41st Parliament, when data to independent researchers. Law received royal assent, not a Canadian Charter of Rights and In the fi ght to was health Even after the Thalidomide disas- single regulation associated with Freedoms. minister, the crusading MP from ter of the 1950s and ‘60s, Health it has been put in place. Worse, “Health Canada breached the implement Vanessa’s Oakville at the time, Terence Canada had only the powers to draft regulations undermine the Charter. Yet the offending policy Young, accomplished the near ask the drug companies for a act’s purpose. Already, the guid- is still posted on its website three Law, it comes down impossible: the Canadian govern- voluntary recall. It also opened up ance document, created by Health months later.” to Big Pharma vs. the ment took on Big Pharma. Young the secretive culture of protect- Canada to implement the law, So what was going on as Par- would never have been a thorn ing data that could hurt a drug protects Big Pharma and under- liamentarians passed Vanessa’s health of Canadians. in the side of multinational drug company’s profi ts. Vanessa’s Law mines the health of Canadians. Law? Were people deep in the bu- companies if his daughter, Vanes- reaucracy at Health Canada qui- sa, hadn’t died in 2000 at the age Former MP Terence etly reassuring Big Pharma? Were of 15 after suffering complica- Young’s daughter they whispering: “Parliament may tions while taking the prescribed Vanessa died in think it can expose your secrets drug Prepulsid for minor indiges- 2000 at the age of to protect the health of Canadi- tion issues. 15 after suffering ans, but we’ll strangle their naïve She collapsed at the foot of the complications while zeal in implementation”? stairs at home, in front of her fa- taking the prescribed Why do we enter trade agree- ther, and died. In 2001, a coroner’s drug Prepulsid for ment after trade agreement inquest found that Prepulsid was minor indigestion expanding the profi t margins of a contributing factor in her death. issues. The drug has big-name pharmaceutical fi rms? Green Party Leader Elizabeth May No law required her doctor since been taken off Why do we allow drug com- the market. The Hill Legislation to know or the drug company to panies to enjoy obscene profi t communicate to her mom and dad Times photograph by margins that increase the strain that eight children had died dur- Cynthia Münster on our health-care system? he problem of regulators becom- ing clinical trials for Prepulsid 10 And what the hell is going on Ting captives of the regulated is years before and the FDA could requires the companies to publish This was all revealed in detail in thwarting the will of Parlia- not new. It’s the idea that a regula- not rule out that the drug played a results from drug trials. It was by Young, now a former MP and ment by blocking Vanessa’s Law? tor is basically an instrument of role in some of those deaths. with a non-partisan spirit and a chair of Drug Safety Canada, Health Canada needs to be the industry it’s meant to regulate. The tragedy that hit the Young sense of triumph that our House in a recent article he wrote for shaken by its ankles until the Former Alberta Liberal leader family was not that unusual. Used and Senate passed Vanessa’s Law. iPolitics. answers come tumbling down. I’ll Kevin Taft wrote about it in his book as directed, it is estimated that Since then, we are more aware Young chronicles the obstacles bet anything that this intransi- Oil’s Deep State. I see it all around prescription drug use leads to of how Big Pharma has contrib- put in place by Health Canada. gence is not being directed from us—in the National Energy Board about 150,000 deaths every year uted to one of Canada’s current In order to access data, Health the minister’s offi ce. This is a approach to pipelines, for instance in North America. health emergencies. Canada has a Canada requires researchers to captive regulator working for Big (though it says its decisions are In 2014, the Protecting Ca- particularly high rate of opioid ad- sign confi dentiality agreements. Pharma. based on evidence and not any pre- nadians from Unsafe Drugs Act diction, as the population with the A Maryland researcher, Peter Elizabeth May is the leader of determination), and in Nav Canada (Vanessa’s Law) received royal second-highest rate of prescrip- Doshi, challenged the rejection of the and describing airlines as its clients. assent. Under Vanessa’s Law, the tion opioid use in the world. In the his application. the Member of Parliament or But something rotten is going health minister may require drug 1990s, the drug OxyContin was “On July 9, Justice Sébastien Saanich-Gulf Islands, B.C. on in Health Canada. companies to release clinical trial marketed as a great pain reliever, Grammond of the Federal Court... The Hill Times

Western way of providing health care. The current We need a holistic system, by and large, dictates that the health- care professional approach to health care should simply treat the individu- al illness, or body I mimicked these important prevention. This encounter be- part in question, The patient needs to life skills in my own play. Through came the catalyst of my personal and move on to this, I saw the need to provide loss of voice and loss of respon- the next patient. be heard, not simply food and keep warm, as well as to sibility, to be steadily replaced by However, it is this narrow approach work hard and nurture family and increased anxiety. The current system, by and large, dictates that the seen. that has contin- community. These issues were not Over the next many years, I health-care professional should simply treat the ued to result in a separate, but rather interwoven in blindly accepted that the institu- individual illness, or body part in question, and greater defi ciency such a way that allowed genera- tions in which I found myself knew move on to the next patient, writes Sen. Mary Jane in health status, tions of Indigenous peoples to not what was best and should not be McCallum. Photograph courtesy of Conor Lawless simply survive, but thrive off the questioned. During this time I especially for land. Through this, I got my fi rst gradually abandoned my narrative those who are housing, and employment. With- glimpse of holistic health care. of self-purpose and self-worth, and already marginalized in society. out access to these basic neces- In 1956, at the age of four, I accepted the new story given to me Health care cannot fully suc- sities for survival, how can we visited the nursing station on my in which I was expected to be silent ceed in this silo-driven approach. expect them to spend resources reserve because of a sty on my and subservient. After years as a health-care on more advanced health care? eyelid. As I started to tell this to This included my 11 years as provider myself, I relearned that We, as a country, need to re- Independent Senator Mary Jane the nurse, in a very loud voice, a student of residential school, I was responsible for my patients evaluate our health policies. We McCallum she said: “Don’t tell me what’s which I left as a vulnerable young when they entered the door- need to re-evaluate our methods of way of my clinic and I needed Indigenous services wrong with you. I’ll tell you woman without any tangible life health education. And we need to what’s wrong with you.” skills or critical thinking skills. to honour the commitment. The ensure that, through these structural I was silenced. I was afraid. In its own way, this also included patient needs to be heard, not improvements, the patient is heard ooking back, I now realize that This was my fi rst, but unfortu- my time as a student of health simply seen. It is by learning their and upheld in a way that will result LI learned many fundamental nately not last, experience with professions, whose rigid view of situation and circumstance that in truly preventative health care. lessons of good health care at a lateral violence and shame from health care put a premium on the we can better achieve a more Manitoba Senator Mary Jane very young age. The traditional a health professional. It marked voice of the health-care provider targeted course of action for more McCallum is a member of the life skills my people demonstrated the start of my loss of power and while often working to stifl e the effective, and holistic, treatment. Independent Senators Group, while living off the land taught spirit. I was taught that others voice of the patient. This was my During my time as a dentist, a First Nations woman of Cree that responsibility and resilience had to take care of me because I fi rst experience of the economy I have had patients come back heritage, holds a doctor of dental through social capital (we-chi- was unable to take care of myself. of illness, whether it be mental, every two years to have fi llings medicine, and has provided dental e-twin) were instrumental to the It was with this entrenched belief physical, psychological, or social. replaced. These individuals, often care to First Nations communi- concept of preventing sickness, that I was incapable of self-care I regret that it took many years Indigenous, frequently do not ties across Manitoba. starvation, and other ailments. that I slowly lost the concept of for me to decolonize from the have the basic securities of food, The Hill Times