QUARTERLY MAGAZINE JUNE 2018

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Streamlining Canada’s healthcare system for the 21st century 09

Could Pharmacare become the defining policy issue in 2019? 01

Debating decriminalization Treating drug use as a health issue 13

Ontario’s OHIP+ Canada’s new food labels leaving a A microcosm for a national plan 05 bitter taste with some stakeholders 15 CONTENTS

EDITOR & PUBLISHER James Baxter EDITORS Catharine Fulton Emily Kennedy Holly Lake Peter Robb WRITERS Janice Dickson Kyle Duggan Rachel Gilmore Kelsey Johnson Kathryn May Kady O’Malley Kirsten Smith Sarah Turnbull Marieke Walsh CONTRIBUTORS The Regulatory Black Hole of Russell Williams & John Muscedere Chris Simpson Sperm Donation 21 Jennifer Zwicker & Stephanie Dunn PHOTOGRAPHER Matthew Usherwood DIGITAL & DESIGN A national seniors Sarah West strategy needs to 27 BUSINESS TEAM Heather Bakken account for complexity John Butterfield Emily Emberson in the aging process Callie Sanderson Yamina Tsalamlal IPOLITICSINTEL Danelia B. Bolivar (Executive Editor) Marguerite Marlin (Deputy Editor) Kirby Bucciero How to solve Canada’s Irina Cristescu wait time problem 29 Felixe Denson James Gragg-Reilly Codie Mitchell Sarah Nixon Charlie Pinkerton Curtis Rafter Vincent Rocheleau Olivia da Silva Kevin Smith Who’s in charge here? The tangled web of 33 201-17 York Street Ottawa, ON K1N 5S7 Canada disability governance Office: 613-789-2772 and policy in Canada ipolitics.ca | [email protected] iPolitics is Canada’s top digital source for independent, up-to-the-minute coverage of Canadian politics and the business of government. Could Pharmacare become the defining policy issue in 2019? Get ready for the politics of pharmacare.

BY KYLE DUGGAN

JUNE 2018 IPOLITICS MAGAZINE 01 COULD PHARMACARE BECOME THE DEFINING POLICY ISSUE IN 2019?

he next federal election will be full of debate about Conservative insider Geoff Norquay agrees pharmacare is the idea of a national single-payer program that will going to be a “pretty big issue.” cover the drug costs of Canadians. T He noted the idea has been around for several election It could be the “defining” issue of the 2019 campaign. cycles but the recent endorsement from a House of At the very least it will be the ground for a battle royal Commons committee and the NDP trying to draw a “line in between the Liberals and the NDP for centre-left voters. the sand” on the political turf it had staked out suggest it will play largely in 2019. Although it’s not clear yet exactly what the Liberal government is cooking up for 2019, insiders are sure the “The Liberals are in mortal combat with the NDP for the issue is primed for political prominence. centre-left vote,” the principal at Earnscliffe said.

NDP insider Robin MacLachlan is ready. The House of Commons health committee recommended in April that the federal government should implement a “I think pharmacare could very well be the defining issue universal, single public-payer prescription drug coverage from the policy standpoint in the next election – at least program – days ahead of the Liberals adopting a in the battle for progressive voters that helped elected pharmacare policy at their annual convention in Halifax. Justin Trudeau’s liberals to a majority government,” the vice principal at Summa Strategies said. “This will be The partisan brawling over the issue this past year a battle between the Liberals and the NDP to position culminated shortly after budget day in late February, when, themselves as the party that can actually implement what as part of a concerted NDP question period onslaught, would be in my view the fulfillment of Tommy Douglas’s finance critic Peter Julian charged that the Liberal ‘medicare for all.’” government was “sabotaging” and “vandalizing” the NDP’s

C M A H E A L T H SUMMIT

02 IPOLITICS MAGAZINE JUNE 2018 COULD PHARMACARE BECOME THE DEFINING POLICY ISSUE IN 2019?

idea, not just stealing it – because the finance minister Pension Plan enhancements, In this case, the parties proposed a system that would be means tested (he has talked about CPP enhancements in the last election, and since said he’s open to hearing from experts what the best there were a lot of skeptics who didn’t think the federal approach would be). government could get the provinces on board.

But Liberal insider Rob Silver says no political party “owns” “This government has a record of actually having delivered a specific policy idea. on it,” he said.

“You own an idea in politics to the extent that voters UBC professor Steve Morgan, a health economist and associate your political party with that idea,” he said. prominent advocate for a national system, said that the stars might be aligned for the kind of major federal- “There is no reason in fact to believe that Mr. Jagmeet provincial agreement on pharmacare. Singh is synonymous as Mr. Pharmacare. They need to get over themselves and make a case to Canadians on But such a deal could have a narrow window of time, why they are in the best position to to implement it, and depending on what happens in provincial elections this it’s up to the Liberal Party – if they decide to proceed with year. (At time of publication, Ontario had not yet gone to pharmacare – to convince Canadians.” the polls).

Silver said while it could could a platform plank for the Based on the Parliamentary Budget Officer’s cost Liberals, elections never turn on just one issue. estimates, he said, a pharmacare sales pitch would be relatively easy for a party to campaign on. It would cost Shachi Kurl, executive director of the Angus Reid Institute, a total of about $19 billion a year. But the provinces said it’s probably too early to figure out if it’s a ballot box and territories already spend some $12.5 billion of that issue. Although past polling her firm has done suggested meaning the feds would only need to put up about $6 there’s strong support for a pharmacare program that billion. would provide relief from prescription costs. And he said it would be tough for the Liberals not to run “These are not issues that are going to hold necessarily on it after the party’s high-profile resolution calling for riding by riding. This is one of those overarching issues pharmacare passed in Halifax this spring. that does cut across political lines,” she said. MacLachlan said he “fully expects” the Liberals to run “Is there an advantage for either the NDP or the Liberals on pharmacare in 2019, but not promise it beforehand on that front when so many people support it, does it because “they want it to be the carrot that they hold out actually become a ballot issue or a ballot question? Hard there for progressive voters to vote for the Liberals rather to say. Sometimes these issues tend to not necessarily than the NDP.” turn the electorate when so many people are on one side of it. Party politics is one thing, the federal government is also examining policy options behind the scenes. “It’s a little like healthcare,” she said. “People say healthcare is at the top of their list of issues consistently, On budget day this year, former Ontario Health Minister but we have yet to see a federal election that’s decided on Dr. Eric Hoskins, a key figure in Ontario’s OHIP+ universal healthcare.” drug coverage for those under 25, was named head of the Advisory Council on the Implementation of National While the NDP and Liberals battle, the Conservatives, Pharmacare. Norquay said, are free to ask critical questions about costs to industry and the consequences of making complex That council is expected to report to the ministers of changes, noting the government’s propensity to botch health and finance by spring 2019. major projects like the beleaguered Phoenix pay system. One key question that’s surrounded Hoskins’ panel “The problem is that you cannot unscramble the eggs is whether it will have to start from scratch by asking that you crack,” he said. “The challenge is that moving to whether pharmacare is a good idea in the first place, and universal coverage with a single-payer (system) would be whether it should be universal single payer system. hugely complex.” Although there have been a few small signs to suggest To achieve universal coverage under a single-payer that it’s leaning in that direction. Some read into the system, the provinces and territories would need to name of the council which includes the key word be “significantly on-side with the federal government,” “implementation.” Norquay said, which means the new system would need A parliamentary petition sponsored by a Liberal MP also to be “as good as what they (the provinces) have now.” called for implementation of a universal pharmacare plan Although Silver said a good analogy might be the Canada “in this 42nd Parliament.”

JUNE 2018 IPOLITICS MAGAZINE 03 COULD PHARMACARE BECOME THE DEFINING POLICY ISSUE IN 2019?

But Morgan said Hoskins’ appointment bodes well because he’s demonstrated in the past he can rally provinces around a given issue, at least with the country’s health ministers.

Various lobbyists are pushing for different styles of drug reform that would change the system – some against implementing a single-payer system and instead following what Morneau suggested a day after the budget: filling “gaps” in coverage and not “throw out the system that we currently have.”

There might be a relative lull on the issue until next spring, when Hoskins’ final report is expected to be made public. But with stakes high for the NDP and Liberals to Dr. Eric Hoskins. THE CANADIAN PRESS/Chris Young define themselves as best positioned to implement such a program, it should heat up again in no time. The government’s response to that petition, just recently tabled, said Hoskins’ work will “complement the study conducted by the House of Commons standing committee Disclosures: Silver left his consulting job at a lobbying firm on health” on the development of a national pharmacare in 2015 because he’s married to the Prime Minister’s chief program. of staff Katie Telford, although he still does TV punditry. That doesn’t mean that the government, or the Liberal Norquay and MacLachlan have both been registered to lobby party, have settled on anything yet. on pharmaceutical policy or pharmacare.

04 IPOLITICS MAGAZINE JUNE 2018 Ontario’s OHIP+ A microcosm for a national plan BY MARIEKE WALSH

JUNE 2018 IPOLITICS MAGAZINE 05 ONTARIO’S OHIP+A MICROCOSM FOR A NATIONAL PLAN

Amanda Sterczyk. iPolitics/Matthew Usherwood

or Amanda Sterczyk’s family it’s a matter of life and months it served more than 1.3 million people and paid death. more than four million claims. F“It’s a non-starter,” Sterczyk said from her home in The province estimates the program will cost $465 million Ottawa. “You’re not going to choose buying new shoes or in its first full year. For Emily’s family that’s $2,600 per year buying food over buying insulin to keep your kid alive.” that they no longer have to pay. Her 15-year-old daughter Emily was diagnosed with type It’s a small step toward universal pharmacare. The province 1 diabetes seven years ago. Neither Sterczyk nor her is covering the age group that eats up just a small share husband has a private health plan so each year her medical of total drug costs — between three and four per cent, bills run into the thousands of dollars to cover the test according to Carleton University associate professor Marc- strips, glucagon, and the insulin. André Gagnon. It’s why Sterczyk believes those costs should land on the The impact is “not huge but it changes the way we think government instead of individual families. about this issue,” Gagnon said. “We’re changing the paradigm.” “It’s not like you’re going to give someone a pace maker to keep them alive and then ask them to pay the bill on their York University professor emeritus Joel Lexchin calls OHIP+ way out of the hospital.” a “first step” but he said it falls short of ensuring the full benefits of universal pharmacare are realised. Ontario’s Liberal government took the first step to rectifying that inequity when it launched OHIP+ in January. “It only incorporates some of the aspects that pharmacare The pharmacare program makes drug coverage universal should incorporate,” he said. for every Ontarian under 25. In the program’s first four

06 IPOLITICS MAGAZINE JUNE 2018 ONTARIO’S OHIP+ A MICROCOSM FOR A NATIONAL PLAN

What’s missing, Lexchin said, is a more “rational” when they were expected. But the base Hoskins has approach to what’s offered on the drug formulary and the to work from are conflicting lines of thought from the cost savings that would come if it were a truly universal federal finance minister and the Liberal-dominated health system with a single payer. committee. The former has previously called for a system that simply fills the gaps in coverage while the latter is Gagnon argues that’s best done with national calling for a public system for everyone. pharmacare rather than provincial pharmacare because of the resources and “institutional capacity” needed to Gagnon says the need for a universal system becomes do evidenced based reviews of pharmaceuticals and clear when you compare Canada to other countries. implement a system of tenders. On a per capita basis, he said the United Kingdom pays “A good drug plan is not only about providing access it’s half what Canada does for drugs and gets way more also about making sure you get cost effectiveness and bang for its buck. In Canada, a lack of affordability means promoting a more rational use of medicine,” Gagnon said. one in 10 people won’t fill a prescription. In the United Kingdom, that number plummets to two in every 100 The problem right now, Gagnon said, is that there’s a people. “patchwork” of private and public programs trying to do that work. On virtually every measure Gagnon said, Canada’s “completely fragmented system” falls short. “We pay the But the former bureaucrat in charge of Ontario’s public most for generics and we have the most shortages,” he drug programs warns that a move to pharmacare won’t said. necessarily lead to a unified system. Helen Stevenson said that’s because private health insurance will still be used But Stevenson cautions against comparisons to other by employers to cover drugs that aren’t on the public countries. For example, she said in the United Kingdom fomulary. the people who manage the health care system are also responsible for managing the prescription drug budget. We’re “getting rid of a patchwork now and creating a new She said that creates a direct incentive to restrain costs patchwork,” she said. for the frontline doctors writing the prescriptions.

Now the founder and CEO of the Reformulary Group, Her point is that Canada has spent the last 60 years Stevenson manages a drug formulary that private benefit building a different system and unwinding it would be plans can purchase. “lengthy, disruptive and it will cost way more money than For pharamcists the change to OHIP+ hasn’t been glitch- they’re projecting.” free but the Ontario Pharmacists Association and most Instead she says governments should “target the problem other professional groups have applauded the move which is there are Canadians that don’t have coverage.” from Premier Kathleen Wynne. But even within the 25 and under age group, her decision to make the program But Lexchin said insurance companies have not shown universal is still controversial. “real interest” in doing the work needed to ensure a more rational formulary is offered. And he said that’s a key By deciding to cover every person under 25, the shortcoming of the current system. Conference Board of Canada found that Ontario is now paying for the drug bills of 2.1 million Ontarians Still he agrees the cost to taxpayers will be higher. previously covered by private plans. The same report “You’re going to spend more public money but its going to says Emily falls into the 1.2 million young Ontarians who be money that’s spent much more rationally,” he said. weren’t previously covered by a plan. At her kitchen table in Ottawa, Sterczyk said the issue That same debate is playing out nationally as the federal comes down to fairness. Where some families in Canada government considers Canada-wide pharmacare. are asked to pay for life-saving medical needs when In its surprise appointment of Eric Hoskins to chair the others aren’t. Advisory Council on the Implementation of Pharmacare, OHIP+ is “not perfect but it works for a lot of people and Ottawa turned Hill watchers’ attention to Queen’s Park. it’s a good first step,” she said. Until his federal appointment, Hoskins was the provincial health minister and the man in charge of OHIP+. More importantly, she said the cut-off of 25 years means her daughter can graduate and focus on paying tuition, Federal Health Minister Ginette Petitpas Taylor’s then finding a job. spokesperson Thierry Blair did not follow-up on repeated requests for an interview with Hoskins. The one question she won’t have to ask: “am I going to eat or am I getting my insulin this month?” The terms of reference for the council have not yet been released and no timeline was provided to iPolitics on

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08 IPOLITICS MAGAZINE JUNE 2018 Streamlining Canada’s healthcare system for the 21st century BY SARAH TURNBULL

JUNE 2018 IPOLITICS MAGAZINE 09 STREAMLINING CANADA’S HEALTHCARE SYSTEM FOR THE 21ST CENTURY

ragmented, overburdened, inefficient, costly. Welcome to one view of Canada’s healthcare system. FAcademics and researchers from around the world suggest many reasons for this. Some blame the single- payer system, others say varying patient demands and the demographic shift to an older society take the blame.

Whatever the cause, family physician Dr. Danielle Martin says it’s about time the country’s top government officials start looking at solutions.

Martin co-authored a report released in April suggesting one possible cure: a major realignment of eight national health organizations following a review by Health Canada.

The report says the pan-Canadian health organizations (PCHO) are responding to the healthcare needs of the past and the federal government should help revitalize them. All eight were established between 1988 and 2007 and since then, Martin said the government has taken a backseat role. The groups claim more than $300 million a year from the federal government.

“Each of them have made contributions. It’s not that they haven’t done good work, but if we’re really trying to take a forward-looking perspective on the health systems of the future of this country and if this is the money that the federal government is going to invest to try to build pan-Canadian infrastructure, what’s the best investment that they could make to really accelerate change?”

The groups under scrutiny are:

• Canadian Centre on Substance Use and Addiction Dr. Danielle Martin (CCSA) and grouping some of their functions under other local, • Canadian Agency for Drugs and Technologies in provincial, and national organizations. However, Martin Health (CADTH) was quick to note this ends the need to focus on these areas. • Canadian Institute for Health Information (CIHI) “The fear when we put this report out with the • Canadian Foundation for Healthcare Improvement recommendations that we had was that a superficial (CFHI) read might lead someone to the conclusion that we • Canada Health Infoway (Infoway) think mental health is dealt with and cancer is dealt with, and therefore we don’t need these organizations • Canadian Patient Safety Institute (CPSI) anymore,” said Martin. “That couldn’t be further from • Canadian Partnership Against Cancer (CPAC) the truth.”

• Mental Health Commission of Canada (MHCC) By the same token, she insists the report was not a cost- cutting exercise. The report specially recommends phasing out CCSA, CPAC, and MHCC, representing about $60 million a year, Instead, she said, it was geared at finding more modern

10 IPOLITICS MAGAZINE JUNE 2018 STREAMLINING CANADA’S HEALTHCARE SYSTEM FOR THE 21ST CENTURY

models of care for the top health issues of today. This This scenario calls for the creation of two major federal includes Indigenous health, Canada’s aging population, agencies. One would manage the Health Innovation the changing role of the federal government in health Fund — with a proposed annual budget of $1 billion — and the need for a national pharmacare strategy. with CFHI, CPSI, and Infoway under its mandate. The other would focus specifically on data accumulation CCSA, CPAC, and MHCC each told iPolitics they were and use, with funding from CIHI. The establishment of unable to comment before the health minister has a central data agency is laid out in scenarios two, three, officially responded to the report. and four. Louise Bradley, president and CEO of MHCC, said “The unleashing innovation scenario aims to create the “we’re very pleased that the PCHO review report, Fit for conditions under which targeted innovation could be Purpose, notes throughout the document that mental used in service of better health care,” the report says. health remains a priority. We will continue to focus our energy on the important projects laid out in our work The third option calls for a nation-wide network to plan, while striving to support the minister and Health foster collaboration and act as the middle man between Canada to articulate how we might best support the government and non-government actors. Its vision recommendations.” would be more broad and less focused on a specific disease or issue. Health Minister Ginette Petitpas Taylor said she was “looking forward to following up on the In this scenario, as well as four, the authors recommend recommendations that [the authors] made,” speaking in the introduction of the Canadian Drug Agency to a scrum with reporters after its release, and added the build a “coherent, comprehensive, and integrated” “status quo will not remain.” pharmaceutical strategy.

More specifically, she noted her team was “not looking Finally, equity. This is a theme that will likely score points at the work [the organizations] have done but how we with the Liberal government given their focus on gender can go forward and continue to do that work to meet equality and Indigenous reconciliation. the needs of Canadians.” “If equity is a focal goal of health care,” the report says , Her office did not respond to questions from iPolitics “the federal government has an important role to play in about where she is now in her review process or when reaching it.” Canadians can expect a decision with regards to which Here, Martin and her colleagues emphasize the need direction — if any— she’ll take. for increased collaboration and communication with the The report makes 10 recommendations and includes provinces and territories to ensure services are delivered four scenarios, each highlighting the value that consistently. The hope is to reduce care disparities from underpins it: efficiency, innovation, engagement, and one pocket of Canada to another including services equity. delivered outside hospital, such asq home care and mental health. The first scenario, as its core value of efficiency would suggest, seeks to recast existing resources to maximize Like two and three, there’s value placed on the maturing results. Of all the proposals, it stays closest to the of open data systems to be able to connect people with existing model, which is why the authors refer to it as their health records wherever they are. ‘Status-Quo-Plus.’ Martin said while she’s impartial with regards to which Here, they suggest streamlining the functions of CIHI, option should be further fleshed out, she hopes the Infoway and CADTH. The report also calls for the proposed scenarios provide inspiration about how development of a new national organization focused national organizations can play a key part in removing specifically on health quality. Healthy Quality Canada some of the problems weighing down the healthcare would act as the central platform for all of its existing system. provincial counterparts. “We’re agnostic,” said Martin. “We said if the minster Similar to the other scenarios,CCSA, CPAC, and MHCC likes some parts of one and some parts of three, feel are reimagined with CCSA being completely eliminated. free to do a mashup. You can treat it as a buffet but the point is you have to understand why — what is it you’re The second framework is more disruptive. It draws on trying to achieve.” the conclusions of the 2015 report out of the Advisory Panel on Healthcare Innovation, led by Dr. David Naylor. What she was most surprised by was the apparent divide between data and the technology that supports it.

JUNE 2018 IPOLITICS MAGAZINE 11 STREAMLINING CANADA’S HEALTHCARE SYSTEM FOR THE 21ST CENTURY

“It’s not a 21st century way of thinking about how we needs to be dragged into the 21st century, “medicare is use information to make systems better,” said Martin. the third rail of Canadian politics. Touch it and you die.” “You can’t have the data conversation, like the use Or as Martin puts it, “it’s sort of a national pastime to of information to drive decisions, separate from the complain about the ways that our healthcare system agenda around building IT infrastructure.” fails us.” Right now, an organization like CIHI functions separately Nevertheless, she insists that a federal dollar invested from Infoway, the Crown corporation which is working well is “a really, really helpful and useful dollar to the on developing digital solutions in healthcare such as the front line, even if the front line doesn’t necessarily see implementation of electronic health records. it.” It’s this exact issue that Martin says contributes to She said she’s hopeful this government can help the Canada’s current siloed approach to healthcare. It’s why provinces navigate what should be publicly funded, each scenario in the report incorporates plans for a while at the same time removing itself from the details comprehensive data system. of how care should be delivered. Federal involvement in healthcare — financial or “The question is: what is the necessary national otherwise — has long been a controversial issue. Some infrastructure that will allow each province and territory say the government’s reach should be more expansive to build those patient-centred systems of care in while others say an increased presence makes the their own jurisdiction,” said Martin. “No matter which situation at the provincial level more complex. direction the government chooses to pursue with these As former Globe and Mail columnist and long-time organizations, we need a shared mechanism for saying health reporter Jeffrey Simpson notes in his book on the basis of best available evidence, this is what we Chronic Condition, Why Canada’s health-care system should pay for.”

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Canadian12 IPOLITICS MAGAZINEbiotech. JUNE The 2018 science of amazing. More solutions at biotech.ca. Liberal MP Nathaniel Erskine-Smith. iPolitics/Matthew Usherwood DEBATING DECRIMINALIZATION Let’s treat drug use as a health issue, Toronto MP says

BY JANICE DICKSON

hile Prime Minister Justin Trudeau and Health Minister Ginette Petitpas Taylor may be a little more than reluctant to include the decriminalization of all drugs on the Liberal banner in 2019, Liberal WMP Nathanial Erskine–Smith still hopes that by next year, they will find a way to do it. “We’ve adopted this idea of treating drug use as a health issue at the grassroots membership this year… and my hope would be that we can find a way to run on some of these ideas in 2019 and then implement them thereafter,” Erskine-Smith said in an interview. The Toronto MP’s optimism comes on the heels of the Liberal convention in Halifax where delegates adopted a resolution that supported decriminalizing all illegal drugs.

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14 IPOLITICS MAGAZINE JUNE 2018 DEBATING DECRIMINALIZATION

“We know it works. It’s just a question of if ‘decriminalization’ is the wrong word to explain it. What’s the best way of explaining the concept to people? We want to treat patients as patients not as criminals. We want to treat drug use as a health issue not as a criminal justice matter,” said Erskine-Smith. That’s why he would be comfortable with the idea in the Liberal platform next year. “I personally would not worry about having that there because I think when you’re supported by the Canadian Mental Health Association … by drug policy medical health experts across the country and anyone who has studied this issue even a little bit quickly recognizes the Federal Health Minister Ginette Petitpas Taylor. iPolitics/Matthew Usherwood criminalization of low level possession is the No. 1 stigma for people who need to seek treatment.” “We don’t want to distract from the cannabis legalization Erskine-Smith was the first Liberal MP in Trudeau’s and regulation effort,” he said. “We don’t want to confuse caucus to champion the idea. In 2017 Erskine-Smith Canadians of the objectives of the two exercises.” wrote an article in VICE News where he advocated for the decriminalization of all drugs and quoted then-Health When it comes to legalizing marijuana, the government’s Minister Jane Philpott who had told the United Nations that goals include restricting access, controlling production Canada can’t “arrest our way out” of the drug problem. and distribution and, as Erskine-Smith puts it, “treat “I thought that logical progression would lead us to Canadians like responsible adults with a substance that’s treating this as a health issue and not a crime,” he said, less harmful than alcohol.” admitting he may have been on his own then. But he’s not Erskine–Smith is frustrated that many people confuse alone any more. decriminalization with legalization. So in the motion Erskine–Smith would like to see the government follow supported at the Liberal convention, Erskine–Smith Portugal. In 2001, Portugal decriminalized all drugs by actually omitted the word ‘decriminalization.’ eliminating criminal penalties for small possession and “They think it means no regulation, people don’t consumption of illicit drugs. necessarily understand what is intended by that word, The EU country expanded its treatment and harm so, in the resolution you’ll see us call for treating drug reduction services and has seen a significant increase in use as a health issue, you’ll see us call for expanding people seeking treatment, the number of people who have harm reduction treatment options and you’ll see us call overdosed decrease, and HIV transmission rates drop. for reclassifying low level possession as an administrative offence,” he said. In Portugal, if you’re found in possession of an illegal drug, you’re ordered to appear before a panel, which is There are a few components involved in the policy’s called a dissuasion commission, where you’ll be referred success – beyond convincing Trudeau and Petitpas Taylor. to treatment or will be ordered to pay a fine. The panel has representatives from the medical field, social work “Part of it depends on how you educate [people], part and law. of it depends on how you message but I worry that you then leave the word ‘decriminalize’ in the hands of the But right now grassroots Liberal members and the Liberal conservatives and then the conversation gets upended,” cabinet are still at odds over their view of Portugal’s policy. he said. In April, Petitpas Taylor said she “recognizes” there’s a lot But while Erskine–Smith acknowledges there are still of comparison between Portugal and Canada but that “we quite a few kinks to be worked out and colleagues to be have to develop the Canadian model here.” convinced, he says it’s great that support is finally coming “We have to deal with the realities on the ground. We from national caucus and grassroots members. have…many provinces and territories and we have to look at what can work for Canada,” Petitpas Taylor told “If I played any role in putting this on the agenda and reporters. on the map, in helping to advance a more progressive drug policy that will save lives down the road I’ve done Erskine-Smith said he doesn’t know what to make of the my job and I’m very happy to have done it, but it will be comment, but he does recognize that there’s a worry much more impactful and already has been much more that the conversation about decriminalizing drugs can impactful when it’s national caucus and our grassroots get confused with the government’s legislation to legalize membership and not just one member.” marijuana.

JUNE 2018 IPOLITICS MAGAZINE 15 Canada’s new food labels leaving a bitter taste with some stakeholders BY KELSEY JOHNSON

16 IPOLITICS MAGAZINE JUNE 2018 CANADA’S NEW FOOD LABELS LEAVING A BITTER TASTE WITH SOME STAKEHOLDERS

In 2016, Health Canada took aim hat is front-of-package labelling? at unhealthy eating. The proposed Front-of-package labelling is a label put on the front of pre- Healthy Eating strategy included Wpackaged foods. They can come in many different designs and contain a variety of nutritional information. a commitment to revamp the Canada Food Guide, change how Health Canada has said it wants to put mandatory front-of-package labelling on pre-packed foods that meet or surpass a certain level of saturated fat, food products could be marketed sugar or sodium. to children and improve the Four designs are being considered. A public consultation asking for input on nutritional quality of food. the design short list closed April 26. At the same time, the department Under Health Canada’s proposal, certain foods would be exempt, including foods where there is evidence of a protective effect on health (think fruits and said it would soon require front- vegetables without added sugar, sodium and fat, whole and two per cent milk of-package labelling, a move and most vegetable oils such as canola and olive oil.) Canada’s agriculture and food Why is the federal government doing this? industry says could cost them Officials are grappling with a growing public health crisis thanks to rising billions, lead to consumer obesity and chronic disease rates. Health Canada data shows two in five Canadians live with a chronic disease, including heart disease, high blood confusion and have adverse pressure and diabetes. The leading cause of this epidemic, health officials trade effects. iPolitics’ Agriculture say, is poor diet – including an overconsumption of sugar, sodium and fat. Reporter Kelsey Johnson digests Canadians’ burgeoning waistlines are also straining the public health care the file. system. Health Canada’s estimates that unhealthy eating costs the country $6.6 billion annually, including direct health care costs of $1.3 billion,

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JUNE 2018 IPOLITICS MAGAZINE 17

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while obesity is estimated to cost the country $4.6 billion to Health Minister Ginette Petitpas Taylor, who took over the $7.1 billion annually. file in 2017, to promote public health by “introducing new restrictions on the commercial marketing of unhealthy food In a commentary on its website, the Heart and Stroke and beverages to children, similar to those now in place in Foundation said the labels would encourage Canadians to Quebec; bringing in tougher regulations to eliminate trans make better food choices while forcing manufacturers to fats and to reduce salt in processed foods, similar to those make current and new food products healthier. in the United States; and improving food labels to give more “Heart & Stroke would like to see a single standardized, information on added sugars and artificial dyes in processed mandatory front-of-pack labelling system that is prominently foods.” displayed on the package and does not compete with other However, the prime minister specified that both ministers nutrient messaging,” said the blog post, written by Heart & were to “work closely with the Minister of Agriculture and Stroke dietitian Carol Dombrow. Agri-Food to align these regulatory initiatives with food “The label should be easy to understand, consistently policy.” That policy was expected to be released this spring, located and supported by a strong education program to but has faced delays. help consumers get to know the new system. The ultimate It also said those initiatives should be “based on high- goal is to encourage Canadians to purchase more whole, quality scientific evidence and meaningful consultation with natural foods and prepare them at home.” Canadians” – a point Canada’s agriculture industry and some The policy is also supported by Diabetes Canada. It told the opposition MPs argue isn’t happening, particularly when it House of Commons Health Committee that the Healthy comes to Health Canada’s plans for the Canada Food Guide. Eating Strategy, including front-of-package labelling will “help Conservative agriculture critic John Barlow has repeatedly make the healthy choice the easy choice, and will slowly start asked the House of Commons agriculture committee to to change the food environment in our country.” study Health Canada’s proposed food guide and front-of- In his mandate letters to his health ministers, Prime Minister package labelling – a request that was denied. “We raised Justin Trudeau instructed Jane Philpott in 2015 and current this issue because it was clear the direction the new Canada

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18 IPOLITICS MAGAZINE JUNE 2018 CANADA’S NEW FOOD LABELS LEAVING A BITTER TASTE WITH SOME STAKEHOLDERS

Food Guide was based on ideological activism and bad science,” Barlow wrote in an 2018 letter to iPolitics. “In fact, it can be argued it is headed in a direction that is inaccurate and could be counterproductive encouraging Canadians to make unhealthy food choices.” Health Canada has repeatedly disputed those allegations, arguing the policies are based on science. Why is the agriculture industry upset? Several food and farm groups have said they’re concerned with the direction Health Canada is taking with the Healthy Eating strategy, notably around front-of-package labeling, with some opposing the labelling policy outright.

In their 2018 submission to Health Canada, the Canadian Minister of Agriculture and Agri-Food Lawrence MacAulay. iPolitics/Matthew Usherwood Federation of Agriculture said the policy “fails to reflect the best available science” and warned the labels, as they stand of a letter written following a meeting. In testimony to the now, have the “potential to confuse Canadians when trying to House of Common agriculture committee, Carla Ventin, a make healthy eating decisions.” vice president with Food and Consumer Products of Canada, alleged the department said the two sides had “arrived at an Dairy Farmers of Canada has said consumers should be agreement on criteria for front-of-pack labelling, which we directed to the nutrition facts table included on the back or had not. side of a food’s packaging rather than relying on a series warning labels on the front that could deter Canadians from “This was a clear misrepresentation of the record,” she told consuming dairy products entirely. “What assurances can MPs. “Health Canada’s criteria is so narrow that it would Health Canada give that this type of warning labelling will not actually exclude exploring labelling options adopted by our simply deter consumers from the products themselves?” the major trading partners. It’s important to get this right.” association’s president Pierre Lampron said in a February 2018 new release. Further, at least one Canadian farm group has opted out of the latest round of consultations because of how the “This approach runs the risk of alarming consumers, and questions were phrased. ultimately preventing them from learning more about the nutritional benefits of a food. This is completely contrary to In a written submission to Health Canada sent in April 2018, the stated intent of Health Canada.” the Canadian Federation of Agriculture said, in its view, “the consultation questionnaire is “structured in a fashion that Dairy Farmers of Canada has also said that the current does not allow respondents to comment on underlying proposal would see front of pack labels applied to foods like principles or provide unbiased input on all available options.” yogurt. However, most snack foods, like potato chips, would Participants are required to select a preferred option, even not be required to have a label on the front, it noted in its when they may not agree with any of them. May submission to Health Canada. How much will it cost? The agriculture industry is also upset by the way Health Canada has consulted around the Healthy Eating strategy. An analysis done by Health Canada in conjunction with At the time of the announcement, the department said it the Treasury Board of Canada estimates the policy would would not hold direct consultations with the food industry cost industry and Canadians $894.6 million. The policy’s on the revamped guide, arguing industry’s participating in benefits are estimated to be approximately $3.19 billion over developing the current food guide has undercut public trust. 10 years, which leaves a net benefit of about $2.36 billion Instead, industry would be able to submit online comments, over 10 years. a decision that followed a recommendation from the Senate Canada’s agriculture and food industries dispute those Social Affairs Committee. figures, arguing Health Canada’s costing is too narrow and Direct consultation with industry was held over front-of- does not take into account the whole supply chain. In its package labelling. However, the department ruffled more 2017 report, the Food Processing Round Table estimated than a few industry feathers in September 2017 because then-proposed labelling changes being put forward by Health

Canada’s new health labels. Health Canada

JUNE 2018 IPOLITICS MAGAZINE 19 CANADA’S NEW FOOD LABELS LEAVING A BITTER TASTE WITH SOME STAKEHOLDERS

Canada and the Canadian Food Inspection Agency would cost Agriculture and Agri-Food Canada Deputy Minister Chris the industry $1.8 billion. Forbes and Canada’s Chief Agriculture Negotiator Frédéric Seppey during the fourth round of NAFTA renegotiations in When would the labels come into effect? Ottawa. The regulations would take effect once they’ve been Stringent front-of-package labels have been in place in Chile published in Canada Gazette, Part II, the federal government’s since 2016, despite the policy being challenged at the World official newspaper. However, Health Canada has said the Trade Organization by 11 other countries, including the industry would have until December 2022 to transition in the United States. Mexico, Brazil, Peru, Uruguay, Argentina and new labelling rules. Colombia are also currently in the process of developing Are there trade implications? policies of their own. Canada’s policy has been drafted with the Chile model in mind. Yes, potentially. Canada, Mexico and the United States are renegotiating the North American Free Trade Agreement Meanwhile, at least one Canadian health official said a shift where regulatory alignment is key piece of the talks. The New in food production could lead to new markets for Canadian York Times has reported that American negotiators were product. trying to limit the three countries abilities to warn consumers Health Canada’s Christine Donoghue told attendees at the about the dangers of unhealthy foods. Canadian Agri-Food Policy conference in Ottawa May 10 that The policy was put forward in the form of an annex that was the agriculture perspective and health perspective around agreed to by the food industries in all three countries and the strategy are “not mutually exclusive.” has yet to be agreed upon. Canadian industry has repeatedly Canada, she said, could be at “the forefront” of developing argued whatever policy Canada develops must fall in line healthier foods that have “less sugar, less salt and less fat” with American regulatory requirements in order to avoid as demanded by consumers. “There are opportunities across potential delays. the world, because the world needs to be fed and Canada iPolitics has been told regulatory and competitiveness has the opportunity to be part of that market, but also part concerns were raised by industry during a stakeholders of a market that, if it adapts to that healthy dimension, that meeting with Agriculture Minister Lawrence MacAulay, more and more consumers are asking for.”

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20 IPOLITICS MAGAZINE JUNE 2018 The Regulatory Black Hole of Sperm Donation

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1804_GA_ASI_iPolitics_(May).indd 1 4/26/2018 9:48:35 AM THE REGULATORY BLACK HOLE OF SPERM DONATION

ebecca Dixon never looked like her parents. Maybe her mother, once, when she was young, but Rthere’s no trace of her father in her wide brown eyes and matching chestnut hair. She never had a relative who looked like her. Kids at school would ask her if she was adopted. One day, after discovering she was the first child in her family with celiac disease, a genetic condition, she did some digging and her questions were answered. Her dad was not her biological father. In fact, Dixon discovered she is one of the “Barwin Babies” and part of a fertility scandal that has 150 people involved in a class action lawsuit against Ottawa fertility doctor Norman Barwin. The complainants allege Barwin inseminated prospective mothers with either his own sperm or the wrong sperm over the course of his decades-long career in reproductive health. The allegations in this lawsuit have not been tested in court. Barwin is not talking to the media. For months after the revelation Dixon said she “felt very dissociated with my face and my body because I didn’t know whose features I actually had.” She said she started to feel “a little bit crazy.” She would walk down the street looking at people, wondering if they shared any of her features. “For donor conceived people, the donors have usually … donated under conditions of anonymity and they don’t necessarily want to be found or want to be identified,” she said. Dixon’s mystery was ultimately solved when she learned, following genetic testing, that Barwin was her biological father. She has since learned that she has 10 siblings. That’s not where Barwin’s footprint ends. “In addition to me and my 10 siblings, we have more than 40 other children who … didn’t end up with the intended donor, or father, and they now don’t know who their biological father is,” Dixon said. For those individuals, things such as family medical history remain out of reach. The Barwin Babies saga has exposed deficiencies in Canada’s assisted reproduction laws. Among those issues is the fact that donor-conceived children don’t have the same rights as adopted children, who on their 18th birthday may learn about their birth parents — and their medical history. Assisted reproduction laws are also long overdue for a rewrite and, in their current form are actually deterring Canadian sperm donors and leading fertility clinics to import foreign and potentially under-regulated sperm.

Rebecca Dixon. iPolitics/Matthew Usherwood

JUNE 2018 IPOLITICS MAGAZINE 23 THE REGULATORY BLACK HOLE OF SPERM DONATION

In Canada, the law that governs sperm donation is the you don’t actually know that much about the quality of Assisted Human Reproduction Act. The Supreme Court records that are being kept,” she says. ruled in 2010 that much of the act was unconstitutional and struck down parts that fell under provincial jurisdiction. The She warned this unreliable supply could contribute to government hasn’t otherwise touched the legislation since doctors behaving like Barwin. it was crafted 14 years ago. Carol Gottberg, another claimant in the class action who This is a problem, according to University of Manitoba law had two children conceived at Barwin’s clinic, says the law professor Karen Busby. needs to change. One of the unforeseen consequences of the way our laws As a result of Barwin using the wrong sperm and not are currently crafted, Busby says, is that there are almost keeping quality records on the donors, her children are no sperm donors in Canada. enduring what she described as the “mental anguish” of not knowing who their father is. “Sperm donation wasn’t a problem when you could pay for sperm to be donated, but once it was made a criminal “Fertility clinics protect the rights of the donors. The kids offence to pay someone for sperm then the amount of have no rights and did not have any say as adults made sperm donation dropped drastically,” Busby says. life decisions for them taking away their rights,” she said. She says most individuals seeking donors are forced to look “Kids have should have the basic human right to know overseas, which takes some of the control away from both who their parents are for their mental and physical health Canada and the prospective parent. and for their own protection so they do not marry close family members.” “When you send some of your needs offshore, you lose the ability to control the conditions under which those needs Canada’s Health Minister, Ginette Petitpas Taylor, has said are met. You don’t actually know that much about testing, the government has plans to look into the issue. you don’t actually know that much about sperm quality,

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24 IPOLITICS MAGAZINE JUNE 2018

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“We intend to bring into force the dormant sections of world. So the sperm banks might be in the U.S., but this the Assisted Human Reproduction Act by developing the is not a U.S. problem because Canada has so few sperm necessary supporting regulations,” a spokesperson for donors [as a result of not] paying them,” Kramer says. Petitpas Taylor says. When it comes to the Wild West world of assisted human “These regulations will be aimed at reducing the risks to reproduction, Kramer says the Barwin babies story is “just human health and safety arising from the use of donor another story.” sperm and ova; regulating reimbursement of expenses incurred by donors and surrogates; and designating “It wasn’t the first time. It was like oh, here’s one that went inspectors for the purpose of administering and enforcing public, but it’s not shocking to us. We hear about these the regulations under the Act.” stories all the time.” However, despite the government’s verbal commitment, In 2017, Indianapolis doctor Donald Cline was given just any concrete action has yet to materialize. a one-year suspended sentence for injecting unwitting patients with his own sperm. His lenient sentence is the The federal government has a full plate just trying to result of lax Indiana laws that don’t specifically ban fertility craft the right kinds of laws to regulate the specialized doctors from using their own sperm. profession without killing it entirely, Busby says. In an interview with CBC’s All In A Day, Carissima Mathen, “Most people who are involved in reproductive medicine vice-dean of the University of Ottawa’s law school, said operate in a highly ethical way … so we have to have a Barwin might avoid criminal charges for the same reason. system that’s facilitative as much as a system is designed to get at the bad guys. But if all we are trying to do is get at “This could fall into a grey area where this is behaviour the bad guys, then it makes it really difficult for the good that everyone would find repellant and abhorrent, if the guys to do their job.” allegations are true, but it may not squarely fit inside the definition of offences within the Criminal Code,” she said. With the way the law is crafted, that job can only be done with the help of American sperm. “You have a number of offences that seem close, but maybe not close enough.” While stringent American sperm screening processes should still help mitigate the risks of its use, the director of Busby agreed. the U.S.-based Donor Sibling Registry, Wendy Kramer, had “I can’t believe for a minute that he couldn’t be charged few words of reassurance. with some kind of fraud related offence or deception Kramer, who helped some of the Barwin Babies find one related offence, but I don’t what that offence would be. another, explained that in the U.S., there is “no oversight” There’s nothing specific,” she says. of sperm banks that ship to Canada. In the meantime, real people like Dixon are living with the “Nobody’s watching and the sperm banks, for decades, repercussions of the industry’s loose regulations. In the lied … and they continue to lie. They claim that they have face of an unimaginable situation, however, Dixon is taking accurate records, and they claim they limit the number of the discovery of her new paternity – and 10 new siblings – births, and they claim that they update and share medical in stride. information, I mean they just make all these claims on their “I was raised as an only child … It’s incredible. I mean, it’s websites and on the phone and it’s all — it’s marketing,” not something that most people can ever experience, a she says. sudden burst of people into your life,” she said. Kramer’s organization has submitted a petition to the FDA “I had never had anybody who looked like me before…I in an effort to shed light on the Wild West-style regulation come out of every meeting with my siblings just feeling very of big-money American sperm banks. The petition, which warm and happy and full of love for them. And I’m thankful she says the FDA has yet to confirm it has even read, details to have the opportunity, a lot of them are people who I complaints from multiple parents. don’t think I would have necessarily come across outside of One woman claims she specifically asked her donor to this situation.” be screened for cystic fibrosis, as she was a carrier of the Dixon had a message for any donor-conceived people like her. disease and wanted to ensure her children weren’t born with it. When a doctor told her that her donor conceived “I always want to recognize that everyone’s going to have a child was displaying symptoms of cystic fibrosis, she said different reaction to this, and that no one should be forced the sperm bank was “unable to produce any proof that they to feel they have to make the same decisions that I have screened for cystic fibrosis.” made and that my family has made. But I think now is the opportunity for people to find information and to seek the She said these kinds of problems leak over into Canada. form of justice that is available to us.” “The U.S. sperm banks ship to 50, 60 countries around the

JUNE 2018 IPOLITICS MAGAZINE 25 PDF/X-1a:2003

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BY RUSSELL WILLIAMS AND JOHN MUSCEDERE

anadians 65 years and older now outnumber children The most rapidly increasing segment of the population is 14 years and under, which means our needs as a individuals over 80 years old and over 50 per cent of those society are changing. We are succeeding in shifting over the age of 80 are frail. Cthe aging curve through preventive interventions and better public health — that’s good news. A large, growing proportion of our health and social care spending is, and will increasingly be, focused on older But the changing demographic is causing strains in our Canadians living with frailty. From a societal perspective, health and social care supports. How can Canada rise to frailty also places large burdens on family, friends and the challenge? caregivers, including financial, social and productivity costs. There are many calls for a national strategy for seniors, or Everyone is impacted by frailty. for homecare, palliative care, dementia and pharmacare strategies, which will directly impact care for seniors. Yet frailty is poorly understood, pervasively under- However, any strategy targeting seniors cannot be recognized and under-appreciated by health care based solely on age — but should be based on risk and professionals and the public. Not enough health care vulnerability — or what is known as “frailty.” professionals have expertise in caring for older adults that live with frailty and we do not have sufficient evidence to Taking frailty into account may both improve and help save guide the care of older adults living with frailty. our fractured health system. So what would transformed health and social care systems Frailty can occur at any age and describes individuals who look like if frailty were considered? are in precarious health, have significant multiple health impairments and are at higher risk of dying. The hallmark First, all older adults coming into contact with the of frailty is that minor illnesses like infections or minor healthcare system would be proactively screened for the injuries, which would minimally affect non-frail individuals, presence of frailty or risk factors for its development. By may trigger rapid and dramatic deterioration in health. using readily available, easy to use tools to identify frailty, proactive models of care and interventions could be put in Getting older doesn’t necessarily mean you are frail. It place to prevent or delay its development or progression. does mean that as you age you are more likely to become Care planning would also start early rather than waiting for frail. Frailty is a more precise, and evidence-based, a crisis. determinant of health outcomes and health care utilization than age alone. Next, older adults living with frailty and their family, friends and caregivers would be involved at every stage of system

JUNE 2018 IPOLITICS MAGAZINE 27 A NATIONAL SENIORS STRATEGY NEEDS TO ACCOUNT FOR COMPLEXITY IN THE AGING PROCESS

change. When citizens are engaged in decision making, it approaches to residential care needs would help seniors improves the patient experience, contributes to more cost- remain in the community as long and as independently as effective services and enhances the overall quality of our possible, including those who live with frailty. health and social care systems. Caregivers would be supported to ease the economic and The Canadian Frailty Network undertook a study aimed at other burdens of home care. Support for caregivers of identifying priority areas based on input from Canadians older adults has been shown to reduce institutionalization, affected by older adults living with frailty. The two top hospitalization and readmission. priorities identified dealt with 1) better organization of health and social care systems to provide integrated Evidence says transforming our health and social care and coordinated care, and 2) tailoring care, services systems to include frailty would produce both health and treatments to meet the needs of older adults who and economic benefits. Such benefits would be real and are isolated or without family and caregiver support or significant for older Canadians, their families and for those advocates. on the front lines delivering care. Training and certification qualifications for caregivers and This article was first published on EvidenceNetwork.ca. healthcare professionals would include frailty recognition Russell Williams and assessment. Canada is a leader in frailty measurement, Chair of the Board of Directors of the Canadian Frailty with Canadian researchers developing some of the most Network, Vice President, Government Relations and Public commonly-used tools, such as the Clinical Frailty Scale and Policy at Diabetes Canada and an expert advisor with the Edmonton Frailty Scale. Unfortunately, Canada has EvidenceNetwork.ca. been comparatively slow to adopt its own innovations, lagging behind other nations. Dr. John Muscedere Rehabilitative and social supports to improve care and Scientific Director and CEO of the Canadian Frailty Network. quality of life would include non-medical interventions to He’s also an expert advisor with EvidenceNetwork.ca, Professor address things like nutrition, exercise and mobility, advance of Critical Care Medicine at Queen’s University and an care planning, oral care and social isolation. And innovative intensivist at Kingston General Hospital.

28 IPOLITICS MAGAZINE JUNE 2018 How to solve Canada’s wait time problem

BY CHRIS SIMPSON

JUNE 2018 IPOLITICS MAGAZINE 29 HOW TO SOLVE CANADA’S WAIT TIME PROBLEM

anadians are fed up with long wait times for health- care services. CA new analysis from the Canadian Institute for Health Information (CIHI) shows wait times for hip and knee replacements and also cataract surgeries have increased across Canada since 2015. But we love our health care system. In particular, we take pride in the principle that care should be provided on the basis of need, rather than ability to pay. Our system and its virtues have become part of our collective identity. We even named Tommy Douglas, the architect of medicare, “The Greatest Canadian of all time.” Are long wait times simply the price we must pay in order to uphold our Canadian values of equity and fairness? As a doctor of medicine and professor who has spent a career in health policy and advocacy, I disagree. Our health system — designed in the 1960s — is in dire need of an overhaul. Canadians and their health needs have changed, but the system hasn’t changed with them. Wait times are not the core problem. They are a symptom of the problem.

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30 IPOLITICS MAGAZINE JUNE 2018

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A nation of perpetual pilot projects And no wonder. Because the problem is not a lack of investment. Canada has the fifth most expensive health- It can be difficult to challenge the status quo, particularly care system in the world. In 2017, we spent around 11.5 when the health system has become so iconic. per cent of our GDP on health care. Critics argue, however, that our “system” is not really a system at all — our public investment is largely confined Spending more is not the solution. Spending smarter is. to doctors and hospitals while home and community care, The underlying problem is the system itself (or, rather, drugs, rehabilitation, long term care, dentistry and many the lack of a system). The hodgepodge of bureaucracies, other important health services are paid for from a mixed budgets, facilities and providers that collectively carry bag of public, private and out-of-pocket sources. out the business of health care in this country are more Our federated model has created provincial and territorial disconnected than ever before. silos, and our attempts at integration and reform have At the same time, patients’ health-care experiences largely fallen flat. Monique Bégin famously said that we are a country of perpetual pilot projects, lamenting our inability to are changing. No longer is the health-care landscape scale-up and spread new ways of doing things. dominated by acute illness — where you get sick, you get treated and then you get better. The highly respected Commonwealth Fund has consistently ranked our system either ninth or 10th out of 11 peer Increasingly, the landscape is dominated by chronic countries for many years now. disease. In fact, most patients with chronic disease actually have multiple chronic diseases. On one issue in particular — wait times — we rank dead last. How to fix the system The ‘wait time problem’ Our system is not designed to provide optimal care for Nearly every Canadian family has a wait-time story. We wait these patients and, as a result, everything slows down. in emergency departments. We wait to see family physicians. Patients with complex needs who are not really acutely ill We wait for tests, procedures and surgeries. We wait to wind up in emergency departments and hospitals. see specialists. We even wait to get out of hospital — an increasing number of Canadian seniors find themselves Emergency departments and hospitals, in turn, experience in acute care hospital beds not because they are sick, but overcrowding and can’t do what they are designed to do. because they cannot live independently and have nowhere Surgeries and procedures get cancelled, wait times increase else to go. and everyone gets delayed care. A ‘national seniors’ strategy’ could help fix the system to Fixing the system is the only way we will ever get wait times reduce wait times. to come down. History has shown that spending more Successive provincial, territorial and federal governments money doing the same things over and over does not work. have all acknowledged and addressed the wait-time A great place to start would be to develop and implement problem. In 2004, Prime Minister Paul Martin announced a 10-year health accord with the provinces, touting it as the fix a national seniors’ strategy. Such a strategy would for a generation. acknowledge that the new health-care landscape is one of multiple chronic diseases driven by our aging The Wait Time Alliance (WTA), a national federation of population. It would work to develop a properly integrated, medical specialty societies and the Canadian Medical transdisciplinary model of care in the community. Association, developed a list of evidence-based wait-time benchmarks for nearly 1,000 health services so that progress Doing so would free up hospitals to do what they are could be measured. supposed to be doing — looking after acutely ill people and performing procedures and surgeries. Budgets that A total of $41.3 billion was spent by the federal government align with patient trajectories, wherever they are in the over 10 years, including $5.5 billion to specifically address system, rather than with institutions or programs, will allow wait times in five key areas: Cancer, cardiac, sight smarter, more efficient spending. restoration, medical imaging (CT and MRIs) and joint replacement. And building in incentives for better patient outcomes, Some provinces, notably Ontario, saw improvement. Annual shorter waits and enhanced satisfaction will help realign report cards from the WTA and Canadian Institutes for our primary accountability — to the patients we serve Health Information (CIHI) showed modest improvements rather than to the institutions where we work. across the country. This article was first published on theConversation.com/ca. A landscape of chronic disease Chris Simpson But now were are seeing slippage. Performance on wait Acting Dean, Faculty of Health Sciences, Queen’s University, times is holding steady at best. It’s increasingly clear that all Queen’s University, Ontario this money bought us time, but did not fix the problem.

JUNE 2018 IPOLITICS MAGAZINE 31 Don’t Cut Us Out, Cut Us Up!

Canada’s Food Guide revision includes a recommendation to seek protein primarily from plant-based sources.

Chicken Farmers of Canada supports an increase in plant-based proteins in Canadians’ diets, and these pair very well with Canadian chicken – but they shouldn’t replace it altogether.

22 g 5 g 28 g 8 g 10 g protein per protein per protein per protein per protein per 100g grilled 100g cooked 100g lean 50g cooked 115g raw, salmon quinoa chicken lentils firm tofu

Protein quality is not created equal among foods. Here’s what The quantity of protein required for optimal health is significant. Health Canada’s own data indicates that there is no plant-based you need to source that qualifies as an “Excellent Source of Protein”. know Aim for a minimum of 20g protein per meal* * Am J Clin Nutr (2015)

Evidence suggests that protein is used less efficiently with aging, which may translate to higher protein requirements. Current protein recommendations appear to be under-estimated by about 30% for adults and elderly and women and 70% for children1.

Contact your MP to make sure chicken stays an important part of Canada’s Food Guide!

1. Journal Acad Nutr Diet. 2016; 116: 1970-1980.

chicken.ca | chickenfarmers.ca 32 IPOLITICS MAGAZINE JUNE 2018

ipolitics ad - May 2018.indd 1 2018-04-30 2:28 PM WHO’SMinister of Revenue Diane Lebouthillier. THE CANADIAN IN PRESS/Fred Chartrand CHARGE HERE?

BY JENNIFER ZWICKER AND STEPHANIE DUNN

Affairs, Science and Technology to defend their highly- The tangled web of criticized supervision of the DTC – a program that currently fails to reach most Canadians with qualifying disabilities, with take-up estimated to be only around 40 per cent of disability governance eligible working-aged adults. Over the course of the hearings, disability advocates and and policy in Canada Senators reiterated a broad range of concerns including poorly-defined and interpreted eligibility criteria, a complex t a recent Senate committee hearing on the Disability application process, opaque appeals channels and the Tax Credit (DTC) and the Registered Disability Savings absence of adequate data to monitor the program. Plan (RDSP), the father of a child with autism made a While some of these issues can be addressed with more Aheart-felt plea and a chilling statement: “We are impacted effective administration – for example, the CRA has yet by the inability to secure our son’s future. We are his sole social to enforce the bill limiting third-party fees despite the bill circle, we are his financial backers, we are his transportation – being introduced four years ago – others are beyond the we are his life. My fears keep me awake at night. scope of the CRA. If we don’t have something in place – a plan, a program, a Yet it is unclear which ministry is willing to address them. support network – what will happen to my son when I’m gone? At the heart of this issue is the fragmentation of the Institutionalized, neglected, or worse, homeless, with no love or governance of disability policy in Canada, leaving no single supports – I need peace of mind and he needs a future.” ministry with appropriate authority, decision-making ability and, importantly, accountability. Who do you think this father should turn to in Canada to raise these important issues? The CRA is responsible for administering federal disability tax measures including the DTC and aspects of the RDSP. The Minister of Revenue, Diane Lebouthillier and the Finance has purview over the legislation underlying these Canada Revenue Agency (CRA)? Probably not your first tax measures (including the eligibility criteria for the guess. Yet through their administration of the DTC our DTC) via the Income Tax Act. The Minister for Sports and national tax agency is the unlikely gatekeeper of a number Persons with Disability is responsible for administrating of important disability supports in Canada. the grants and bonds associated with RDSPs (for which the In February, Minister Lebouthillier and CRA representatives DTC is a prerequisite), in addition to its mandate around appeared before the Standing Senate Committee on Social accessibility and overseeing the Office for Disability Issues.

JUNE 2018 IPOLITICS MAGAZINE 33 WHO’S IN CHARGE HERE?

This fractured governance and limited accountability bodes to address concerns around barriers to accessing the DTC, poorly for Canadians with severe disabilities, a group that and engagement in meaningful collaboration with other faces high levels of unmet needs and significant barriers ministries. to accessing education, employment and achieving equal participation in society. How Canada governs disability policy says a lot about who we are as a nation and what we value. Our current federal What needs to change? system suggests that we consider disability somewhat as an afterthought, scattered around and tacked on to If we are serious about wanting to improve outcomes for other programs. But if we value a society that encourages individuals with disabilities – and the federal government equality and full participation for people with disabilities should make this a priority – accountability in governance – as we have agreed to when ratifying the United Nations of disability policy in Canada is needed. Convention on the Rights of Persons with Disabilities – we A strong and empowered ministry that is directly need to do much better. responsible and accountable for the broad portfolio of This article was first published on EvidenceNetwork.ca. disability policy, including both supports and rights-based legislation, is essential. This includes shifting the important Dr. Jennifer Zwicker task of disability assessment out of the CRA’s purview An expert advisor with EvidenceNetwork.ca, a Director of Health (and the Income Tax Act) and into a department under the Policy at The School of Public Policy and Assistant Professor in disability ministry’s authority. the Department of Kinesiology at the University of Calgary.

In the short term though, the CRA will continue to Stephanie Dunn administrate key disability supports. To do this effectively A Research Associate in the Health Policy division at The School they need to recognize that they are currently, de facto, of Public Policy at the University of Calgary and an expert one of the most powerful institutions involved in federal advisor with EvidenceNetwork.ca. disability policy as the decision-maker for access to life- changing disability supports. This will involve both the will

34 IPOLITICS MAGAZINE JUNE 2018 iPoliticsAd_May2018.pdf 1 5/4/2018 12:21:00 PM

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