Grassroots activism is the key to worker health and safety

In October 2016, the OPSEU Mental Health Division hosted a two-day conference in Toronto on “Violence in health care and mental health facilities.” Bob DeMatteo, a renowned health and safety activist and retired Senior Health and Safety Officer for OPSEU, gave the keynote speech. The full text of his remarks is below.

Activism, the law and health and safety change

It is a pleasure to be here with you to work through this whole question of activism and its relation to health and safety law and positive change in occupational health.  Thank you for inviting me.  I hope what I am about to say will be of some use in your deliberations.

But before addressing this whole question of activism, I thought it important to address the current state of occupational health, the current context of our political economy and the forces at work inhibiting our progress. It’s important to know what we are up against so that we can develop effective ways of overcoming these obstacles to positive change.

Canada has one of the worst health and safety records world-wide

  • 1,000 workers die annually from work related injury and disease – that’s five work-related deaths every working day. Ontario accounts for about 30 to 35 percent of these deaths.
  • And it is not getting better. Between 1993 and 2012, work-related deaths increased by over 29 per cent. Occupational disease claims increased by 172 per cent.
  • Of 29 OECD countries, Canada had the fifth-highest work-related fatality rate.
  • We know also that even these statistics underestimate the true extent of injury and disease on the job. Study after study confirms that companies are under-reporting lost time injuries. It’s been estimated that an additional 6,000 deaths due to toxic exposures occur annually but are not acknowledged or supported by authorities.

The more things change, the more they seem the same

The history of occupational health is strewn with too many tragedies resulting from employer negligence and government inaction.

  • In 1911, 146 young women perished in a factory fire at Triangle Shirtwaist Company on Manhattan’s Lower East Side where I grew up. Workers were trapped because the company had locked the doors to the stairwells and fire exits to prevent pilfering.
  • In 1990, 25 workers were killed in a fire at the Imperial Food Products plant in Hamlet, North Carolina where they produced chicken nuggets. Workers were trapped because the company locked the fire exits to prevent pilfering of chicken nuggets.
  • In 1992, 26 coal miners were killed in a coal dust explosion at the Westray Coal Mine in Pictou County, Nova Scotia. Months before the disaster, numerous violations of the OHSA and mine regulations were noted by government inspectors and workers, but nothing was done to enforce these violations that were identified as causes of the explosion. To add insult to injury, the company was presented with the J.T. Ryan annual safety award one week before the explosion.
  • On Christmas Eve in 2009, four immigrant workers [in Toronto] fell to their death when a defective stage scaffold collapsed. This accident was so disturbing that the [Ontario] government was forced to conduct an inquiry headed by Anthony Dean. This led to a series of weak recommendations that barely touched on the question of lax enforcement and worker empowerment.
  • All of these human tragedies were followed by the usual hand-wringing by politicians promising that such catastrophes would never happen again. These scenes are now commonplace, but as you can see the promises don’t amount to much.

Lax enforcement & weak worker rights

The common element in all of these tragedies and Canada’s abysmal health and safety record is the lack of adequate and effective enforcement and a very weak system of worker rights. In every instance, these tragedies involved violations of existing regulations that were not complied with and not enforced.  As well, those responsible barely got a slap on the wrist. The other element was the powerlessness of the workers. Let’s take a look at what is happening in Ontario’s enforcement system.

Ontario’s enforcement performance

Between 2007/08 and 2013/14, enforcement was down on every parameter, e.g., field visits, inspections, orders, prosecutions. Reflecting the growth in precarious employment and a stagnant economy, and job insecurity, work refusals were down by 35 per cent, and if compared to 2003 it was down by 65 per cent. It’s ironic that this major decline is taking place on the heels of the Christmas Eve disaster.

Well, you might ask, could this be an indication that things are getting better?  I don’t think so.  Fatalities are up and worker complaints to the ministry are up by 51 per cent.  Note also that these latest stats likely include the blitz in the health care sector that the [Ministry of Labour] has been publicizing about in 2015.

Failure to protect workers from exposure to toxic chemicals

The regulation of worker exposures to toxic chemicals is another area in which the government has failed to provide appropriate and effective protection. The government continues to adopt out-dated exposure standards primarily from the American Conference of Government Industrial Hygienists (ACGIH), a body that is not governmental at all and whose “experts” are essentially from industry. Despite several studies showing that these threshold limit values (TLVs) are not health based, our government continues to adopt these as our occupational exposure levels (OELs).  Indeed, Dutch regulators have just concluded that a large percentage of TLVs have little valid documentation to support their adoption as protective standards.

In addition, there are a whole class of chemicals that significantly disrupt the endocrine system at minute levels. These chemicals such as Bisphenol A can contribute to the development of breast cancer as well as cause serious reproductive and developmental problems in children. Despite these serious effects, this substance and many others in this class are treated as nuisance dusts.

What has been shown to work in preventing injury, illness and disease at work?

Enforcement:

What is troubling about Canada’s weak enforcement experience and the abysmal record in Ontario is that strong enforcement efforts by government have been shown from both experience and scientific study to be the major factor in reducing workplace injury and disease. Study after study shows that it is:  strong enforcement and thorough inspection; the existence and compliance with regulations and frequent visits by inspectors; high visibility and access to enforcement tools; and provision of sufficient spending and resources.

Worker resistance:

The other factor also supported by good scientific study has to do with the ability, capacity and willingness of workers to resist employers’ control over decisions that affect their health and safety and demands for higher productivity at the expense of their health. Much of this has to do with the balance of power in the workplace which also reflects the general class balance of power in our society.

For example, Grunberg’s study of unionized auto workers in Britain and France showed that strongly organized worker resistance on the shop floor resulted in lower accident rates, while the more compliant and accommodating unions had a rate of injury 40 times higher than the more resistive union. Grunberg concluded that the lower the intensity of labour, the lower the accident rates will be, and that workers rather than management tend to be the best guarantors of worker safety.

Similarly, a study by Dr. Peter Suschnigg of Laurentian University on the relationship between labour/management relations and lost time injury rates at three steel-making plants in Ontario showed that both labour intensity rate and lost time injury rate were significantly lower at the plant where labour relations were adversarial rather than compliant or accommodating.

What these studies show is that the more the balance of power is in favour of the employer, the greater the intensity of labour and the higher the risk of injury. It follows then, that work-related accidents and disease will vary with the ability of workers to circumscribe the power of the employer.

Both of these latter points I will return to as we look at the key parts of the activist agenda for positive change. But before we address the role of the activist and an activist agenda, I would like us to explore the general state of our political economy and the impact it is having on our well-being at work and our ability to make further progress in occupational health.

The Four Horsemen of the Economic Apocalypse

What I would like to turn to next is a look at the major changes in our political economy that have had a major impact on our ability to resist and on the ability of government to afford health  and safety protections for workers through their regulatory regimes.

Since the mid-1970s there has been a massive shift in economic wealth and power from the working class to the corporations, a.k.a. Capital. Part of this was initiated early during the [former Prime Minister Pierre] Trudeau years when his government introduced wage controls – there were no controls on prices) – as well as major changes to federal tax structure that significantly favoured corporations and had a tremendous impact on revenues and the creation of the fiscal crisis of the state.

Much of what we are experiencing can be traced to the “Four Horsemen” of the workplace: Downsizing; globalization; automation; and precarious employment.  This was manifested in the broader political economy through merger mania [and] lean and mean production methods. Employers have switched from their “take it, or leave it” to “take it , or we leave you” stance.

This has led many unions to make deep concessions for lower pay and benefits and working conditions, including two-tiered pay structures for new hires in order to save jobs – see Caterpillar, GM, Magna International. This also included a general retreat from resistance, particularly in the private sector.

In the public sector, the downward trend in health and safety can be traced to various structural adjustment programs similar to those imposed on third world countries by the [International Monetary Fund] and World Bank to appease the corporate sector’s demand for austerity programs including tax cuts, spending cuts, privatization and de-regulation, and contracting out to non-union, for-profit providers.

For public sector workers, we see a general deterioration of working conditions as a result of cuts in resources needed to do the work safely; staff shortages created by downsizing existing staff in all sectors; and the privatization and contracting out of services to non-unionized, for-profit providers. Public sector workers are also facing the societal fallout of these austerity programs – a client population, particularly in the mental health sector, that is growing more violent. People are growing more aberrant as a result of stress and frustration from economic and social insecurity. These public sector cuts amount to a massive cut to what is known as the social wage – that part of a society’s wealth set aside for the common good.

We now have a growing precarious work force characterized by job insecurity [and] low pay and benefits coupled with exhausting and dangerous work conditions.

These changes in our political economy have had a major impact on our ability to resist [and] created divisiveness and competition among unions, as well as among workers, on gender and racial grounds. This has led to a reluctance to “rock the boat” and made it more difficult to maintain solidarity.

We are witnessing the result of 25 years of corporate assault on labour in an effort to maximize profits and maintain control over production. Consequently we are witnessing a movement that is in a period of decline.

Where do we go from here?

Having said all this and painted a bleak picture, the question is:  How do we turn this around?

But it would be a mistake to believe that all is lost.  Up to this point, workers, unions and their activist and professional allies did come together as a movement and directly confront corporate power in an effort to make work safer and healthier. We made great strides throughout the 70s and early 80s in the peak of our activism. During this time we achieved major legislative reform that provided workers with the right to know, the right to participate, and the right to refuse.  We witnessed workers in constant motion, organizing and fighting for improved working conditions.

What can we learn from the past?

There are important lessons to be learned from our past achievements that are important for us to bear in mind as we rebuild a reinvigorated movement:

  • Organized labour has been the essential factor in most workplace improvements, from the industrial revolution to the present.
  • Working-class power depends on one basic ingredient – the active and committed participation of knowledgeable rank-and-file workers. Workers who are aware of the connection between their health and conditions of work. Workers who are aware of the state of their lives and its connection with the conditions under which they work.
  • Our power to bring about positive change was enhanced by our alliances with the larger health and safety community of activists and committed professionals. This included alliances with the environmental and women’s movements.
  • Public support for the cause of health and safety was an important factor in our ability to get governments to introduce stronger protections. Labour had tremendous public credibility on the issue of health and safety.
  • We resisted treating health and safety as a purely technical and scientific problem best left to the experts to solve. Rather we viewed health and safety as a political issue that required a grassroots, rank-and-file approach.

When it comes to challenging workplace harm, a hygienist might be useful to measure it or a doctor to provide a diagnosis, but only workers with collective power have a chance of doing something about it!

However, the “Four Horsemen” of the workplace have had a major impact on our ability to organize and resist and make further improvements in health and safety.  It would be a mistake to deny this and fail to learn what is necessary to overcome this setback. The real question for labour is how to overcome these obstacles and rebuild a new reinvigorated occupational health and safety movement in order to effectively confront the current political economy with its corporate domination.

An agenda for worker empowerment and action

To successfully reach workers (unionized and non-unionized) requires a grassroots, rank-and-file approach. This is in contrast to the current drift towards reliance on expert advice, training, and solutions, along with professional lobbying.

We must shift our emphasis to developing the power of workers in their workplace and assume that workers are capable of understanding their situation and of acting on their own behalf.

The role of activists and professionals is to facilitate the empowerment of workers to act collectively to control their own destiny.

  • Avoid the information bubble
  • Don’t be the expert
  • Don’t be the lone ranger
  • Always promote collective action
  • Maximize worker participation
  • Educate, activate and legislate
  • Make it public – don’t hide abuse.

To this end, some activists and unions have developed useful techniques and methods to enhance worker participation and empowerment.  These include:

  • Popular education techniques that recognize the vast knowledge base that workers already have about their conditions of work and allow for the full and free participation of workers in a collective learning process – a process that builds upon workers’ existing expertise and experience.
  • Participatory Action Research (PAR) techniques in which workers conduct their own research with the full participation of the workers in the identification of their injuries and hazards and the development of priorities and agendas for action.
  • Body and hazard mapping are participatory actions research techniques that are useful in identify illness and hazards in the workplace, but because they directly involve the workers affected, they are powerful mobilizing tools to help organizing workers around their issues.

Such participatory techniques have been used in Canada and other jurisdictions with very positive results. The major problem is that up to this point, popular education and PAR have remained confined to a relatively small groups of workers.

The Canadian experience

In Canada [PAR] was successfully employed with gaming workers in Manitoba and asbestos workers in Ontario. In both instances, the employment of PAR involved the participation of workers in body mapping their injuries and illnesses, hazard mapping the work hazards in the workplace, [and] mapping their lives to see how work affected their lives outside of work. Finally, workers were then able to develop short-term and long-term priorities and an action agenda to address the problems. The achievements of these projects were chronicled by Drs. Margaret Keith and Jim Brophy. What is important to note in addition to the workers’ ability to effect change was the heightened level of membership participation and activism.

My wife Dale and I have been working with current and former General Electric (GE) employees in Peterborough to document their toxic exposures over the years in an effort to support their WCB claims for various cancers. The research is essentially participatory in nature – the workers do all the research digging and it is also allied with the local environmental activists. As a result, an occupational and environmental health coalition was formed to look at pollution inside and outside the GE complex.

What needs to be done to revitalize our movement and effectively challenge corporate power?

This calls for a variety of actions, ranging from actions to preserve and strengthen existing laws, regulatory apparatus and existing organizations, and a call for reforms to improve the status quo.

However, our central task is to increase workers’ influence and control at the workplace and in the broader political arena. To this end, we need to develop a practical agenda for action that addresses the current predicament and comes to grips with the constraints on bringing such an agenda to fruition.

Building a legal framework to enhance the influence of workers in the workplace

Over the last 30 years we have made significant legislative and regulatory gains in health and safety. The right to know, the right to participate, and the right to refuse dangerous work are major achievements. More recently we gained bilateral power to issue “stop work” directions in some jurisdictions such as Ontario, although this is rarely invoked. Unfortunately, these have turned out to be weak rights and frankly, not used enough. And at the same time, regulatory enforcement has been dismal.

We must begin to develop and demand legal provisions that enhance workers’ influence over health and safety decisions in the workplace.

There are jurisdictions outside Canada that have legal regimes that: provide for more powerful worker rights and tougher enforcement. For example, the Occupational Health and Safety Act for the State of Victoria in Australia provides worker health and safety representatives with a number of important rights and powers:

  • the power to conduct routine inspection “at any time” after having given reasonable notice, and carry out “immediate” inspections in the event of an accident or hazardous situation;
  • the power to issue “provisional improvement notices” that must be complied with after seven days, provided the notice hasn’t been cancelled or modified by an inspector on appeal;
  • the power to issue a unilateral stop work direction if the employer and the representative disagree over a safety issue;
  • the right to be consulted about any proposed changes to the workplace, plant or use of substances that may affect the health and safety of the workers;
  • the right to appropriate facilities and assistance to carry out his or her duties;
  • the power to obtain outside assistance from the union or other expert;
  • the power to require the employer to establish a joint health and safety committee.

In effect, we need to establish an Internal Enforcement System that is based on workers being accorded sufficient powers to act, rather than a system based on voluntary compliance and weak worker rights.

More effective enforcement

We need to insist upon an enforcement system that has teeth and is a real incentive to protect workers.  We need a severe and tough system of punishment and not persuasion.

A system based on the following enforcement principles would provide more protection for workers:

  • The cost of violation must be significantly greater than the cost of compliance (in some jurisdictions, fines are also tied to historical safety record and can escalate accordingly).
  • The enforcement system must be organized and resourced to ensure that the chance of getting caught violating the laws is great.
  • The inspectorate must be provided with more effective and immediate forms of sanctions that require mandatory application.
  • The government health and safety apparatus must include appropriate levels of technical and scientific capacity.

Making connections and building a movement

Our occupational health and safety agenda must take a broad approach that encompasses environmental, public health and general social issues within society. And we need allies in the society at large to have any chance of achieving our agenda.

We must go beyond the narrow and more technical orientation that contributes to the isolation of health and safety, and inhibits the development of alliances necessary to increase our strength and influence. This might include allying with community groups trying to deal with a specific environmental health problem. Or it might involve joining forces with health coalitions fighting to maintain our public health care system. In Brampton, Ontario, health care workers joined forces with patients and their families recently to expose the serious problems with P3 (public-private partnership) hospitals.

Reaching out to high risk and non- unionized workers

Bearing in mind that the majority of the workers are not unionized, reaching out to non-union workers is key to the success or failure of the health and safety movement.  Non-unionized workers have no power and they work under the worst conditions in dirty low-paying jobs with no job security. Many are people of colour, women, and immigrants trying to support large extended families. Many of these workers are the new “temporary” workforce created by privatization.

Reaching out internationally

Workers and unions around the world are struggling with the same forces that keep us weak and unable to fight for improvements in health and safety. We must join with other struggles, both to assist and learn. Globalization and the freedom of capital to move to areas where labour is cheaper and regulations and laws weaker is the major threat to worker well-being on all levels.

The final analysis

A healthy and safe workplace will not come about when the experts in their wisdom deem it appropriate. It will only come about when workers get sick and tired of being poisoned and maimed as a result of their work that real change will come about.

So what do we do next? Well, what is the first thing that turtles do?  They stick out their necks!

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The TPP will hurt health care

Canada’s health care system will suffer deep and irreversible damage if the Trans-Pacific Partnership (TPP) agreement is ratified in its current form.

The TPP is a free trade agreement negotiated between 12 Pacific Rim countries: Canada, Chile, Mexico, Peru, the United States, Japan, New Zealand, Australia, Brunei, Singapore, Vietnam and Malaysia.  Together, these countries represent 40 per cent of the world’s gross domestic product (GDP).

The deal was finalized in October 2015, and signed in February of 2016, without public consultation.  But public outcry against ratification of the deal – partly because of its potential to increase Canadian drug prices – has prompted the federal government to announce a study of the agreement and to solicit input from individuals and organizations.

Groups such as the Canadian Health Coalition and the Canadian Centre for Policy Alternatives (CCPA) have dissected the deal, and examined its potential impact on the affordability of drugs in this country.  The consensus is, drug costs will rise if the TPP is ratified.

Canadians already pay significantly more than other countries for their medicines.  The Organization for Economic Cooperation and Development (OECD) says Canadians pay the fourth-highest costs for pharmaceuticals – about US$713 a year, compared to the OECD average of US$515.

The TPP will only make things worse for all of us – especially for the roughly 25 per cent of Canadians who, according to a 2013 EKOS Research poll, already can’t afford their medications.

The TPP contains a provision that would allow pharmaceutical companies to extend the length of their patents to account for “regulatory delays” in the approval of drugs.  This allows the companies to retain a monopoly over the market and keep prices high. It also keeps generic drugs, which are much more affordable, out of the market for a longer period of time.  It’s estimated that these delays would cost Canadians an additional $636 million a year.

Also worrisome is the mechanism for Investor-State Dispute Settlement (ISDS) in the TPP.  It allows foreign investors, including pharmaceutical companies, to sue the government if they feel that a policy decision is in any way blocking their right to make a profit.  These cases are usually adjudicated by a tribunal of arbitrators who are appointed by both sides.  The tribunal does not have the power to overturn a government policy decision, but it can order the Canadian government to pay foreign investors huge sums of money.  That award can then be enforced through Canada’s court system.

When all is said and done, Canadian taxpayers will be left to foot the colossal bills.

Yet another major concern is that the investor protections granted by ISDS could eventually lock in privatization.  If, for example, Canada privatized an area of our health care system by opening it up to foreign investment, it would be very hard to bring those services back into the public health care system.  Those foreign investors would be able to use the ISDS mechanism to sue for compensation, making it too costly for governments to revert back to the public system.

The potentially huge costs associated with the ISDS process and extended patent terms afforded by the TPP would also make it too expensive for the government to consider expanding our public health care system.

Canadians and their governments could save billions if there was a national pharmacare strategy to complement our national medicare program.  It’s something Ontario’s Minister of Health and Long-Term Care, Dr. Eric Hoskins, acknowledges and supports.  Ratifying the TPP would effectively undermine any effort to make universal drug coverage possible because of the exorbitant drug costs governments would face under the deal.

Our publicly funded system has always been guided by the principle that health care should be universal and based on need, not one’s ability to pay.  Trade agreements, on the other hand, are motivated by corporate profit-making.  These conflicting values should not mix.  In fact, that was a key finding in the Royal Commission on the Future of Health Care in Canada headed by Roy Romanow in 2001.  It recommended that international trade deals “make explicit allowance for both maintaining and expanding publicly insured, financed and delivered health care.”  Yet there are five chapters in the TPP that relate specifically to medicines.

Furthermore, and perhaps most confounding, there is no evidence that the TPP will do wonders for the Canadian economy.  A study from the C.D. Howe Institute suggests that the impact of the TPP on the Canadian economy would be minimal at best.  It predicts there will be a mere 0.068 per cent growth in GDP by 2035 if we ratify the deal, and only a 0.026 per cent drop if we don’t.

So why would a country that has so little to gain even consider the TPP?  These are the important questions we need to be asking our government.

The good news is that the TPP is not a done deal. It needs to be ratified by at least six countries which represent at least 85 per cent of the GDP of the group of nations involved in the deal.

The Canadian government is interested in what we have to say and has already extended its public consultations twice.  The deadline for written submissions is now October 31, 2016.

If you care about the future of medicare, let the government know.  You can make a written submission on the TPP agreement to the House of Commons Standing Committee on International Trade and email it to: ciit-tpp-ptp@parl.gc.ca. For more information on how to provide a written submission click on the following link: Guide for Submitting Briefs to House of Commons Committees.

 

Confronting the problem of violence against health workers

It’s a dangerous time to be working in health care.

On any given day, health care workers are at risk of getting stabbed, choked, punched, bitten, spat on or verbally abused.

According to information obtained by the Toronto Star, the number of reports of violence on hospital staff in the University Health Network (which includes Toronto Western, Toronto General, Toronto Rehab and Princess Margaret Hospital) nearly doubled between 2012 and 2014.

Hospital administrators attribute the rise to changes in standards for reporting incidents – something unions that represent health care workers have been fighting hard to improve.  But worker advocates say continuing cuts to our health care system, and the ensuing cuts to hospital staff, are also a factor.  When there is less staff, the staff that remain become more vulnerable to assault because they might have to work alone and because they have to manage more patients.

Nine consecutive years of hospital funding cuts by Ontario’s Liberal government have only added to the already precarious situation health care workers face on the job.

In April of this year, an article in the New England Journal of Medicine drew attention to the problem of violence against health care workers in the United States.  It found that incidents are under-reported and largely ignored.   The authors reviewed previous studies on workplace violence and discovered that in one study in particular, 46 per cent of nurses surveyed had reported workplace violence in their last five shifts – almost half.  If this were happening in any other profession, it wouldn’t be tolerated.

All health care workers in all health care settings are at risk of becoming victims of violence, but due to the unpredictability of their patients, those most at risk are mental health care workers.

One recent study from the University of Melbourne concluded that mental health nursing is the most dangerous profession in the Australian state of Victoria.  The study found that mental health nurses were more likely to be assaulted than police officers.

It doesn’t take too much digging to see parallels here at home.

The examples are too numerous to list, but here is a sample:

In December of 2014, a nurse at the Centre for Addiction and Mental Health (CAMH) in Toronto was severely beaten and suffered a serious head injury.   A similar beating had occurred at the hospital the year before.

Royal Ottawa Health Care Group faced five charges under the Occupational Health and Safety Act relating to the stabbing of a nurse in October 2014 at its Brockville Mental Health Centre division.  The nurse was stabbed repeatedly in the throat with a pen, by a patient in the forensic treatment unit.  Health care workers in that unit provide care for patients who are found unfit to stand trial or not criminally responsible by the courts, or who are undergoing psychiatric assessments ordered by the court.

And just earlier this year, there was a serious violent incident in the forensic unit at Waypoint Centre for Mental Health Care.  A worker was stabbed in the back by a patient who had obtained a screwdriver from a job training program within the hospital.  Three other workers were also injured in the same attack. The next day, three more workers were hurt in another attack.  And just one month later, there was another violent incident that resulted in injuries to three other workers.

Workers at Waypoint see this disturbing pattern.  Many of them fear they might be next.

“These people need a safe environment, and they’re not getting it from management,” says OPSEU President, Warren (Smokey) Thomas.  “We want the government to step in now and do something to prevent further attacks, before someone gets killed.  Having worked in the mental health care field myself, this is a cause I’m whole-heartedly committed to.”

The OPSEU local representing this group of workers has launched a campaign to raise awareness about safety concerns at Waypoint.

Their worries can be summed up in a phrase that is echoed daily in the halls of the forensic unit.  “Stay safe, be safe,” is what caregivers at Waypoint say to each other at the beginning of their shifts.  This serves as a reminder to everyone to be vigilant.  They must always be on guard; they must always be assessing their surroundings – all while providing care to patients who have committed serious crimes.

“We at Waypoint face unpredictable patients all the time,” says OPSEU Local 329 President Pete Sheehan.  “Staff are getting assaulted, verbally abused or threatened with violence on a daily basis.   That can wear on you. And it affects your life outside of work.  I see people who develop substance abuse issues and mental health issues because of the things they experience on the job.”

Workers at Waypoint say they know their jobs are inherently dangerous.  But there are things their employer isn’t doing that could make them feel safer.  Through the campaign, workers at Waypoint are hoping to secure the following safety provisions:

  • a commitment from management to fix structural problems with the public-private partnership building, which workers say are contributing to the incidents of workplace violence;
  • that management hire security professionals on the wards to intervene preventatively and act in situations involving workplace violence;
  • the installation of more walk-through metal detectors; and
  • the implementation of safe staffing levels that would prevent scenarios where an employee has to work alone.

Dedicated security staff could also help reduce violence in regular hospitals.  One example of a facility that currently employs security staff is Michael Garron Hospital – formerly the Toronto East General Hospital.  When one staff member who commuted a long distance was asked why she continues to work at the hospital, she replied by saying it was because she felt safe.

There is no question the government needs to do more to protect health care workers from workplace violence.  Mandatory safety protocols are a good start.  After all, these are the people who are there for us when we get sick.  If we don’t take care of them, how can we expect them to take care of us?

Check out opseu.org/staysafe for more information on how you can get involved.

 

All health care workers matter

Nursing week is an annual opportunity to honour the dedication of nurses and acknowledge their contribution to the health care profession.  But this year, the otherwise celebratory tone of the event started on a sour note.

On May 9, 2016 the Registered Nurses’ Association of Ontario (RNAO) came out with a position paper about “reclaiming the role of the RN.” Essentially, the RNAO called for eliminating registered practical nurses (RPNs) in acute care settings.

In Mind the safety gap in health system transformation:  Reclaiming the role of the RN, the RNAO argues for an “interprofessional health human resources plan” for Ontario.  The association says their proposals would result in improved patient safety and health outcomes.

The report lays out eight recommendations.  Among them, the RNAO calls on the Ministry of Health and Long-Term Care to “legislate an all-RN workforce in acute care effective within two years for tertiary, quaternary and cancer centres… and within five years for large community hospitals.”  It also calls for all first home health care visits to be completed by an RN, and for minimum RN staffing standards in long-term care homes.

The RNAO argues that cuts in health care have resulted in a nursing mix that favours RPNs over RNs. It says hospitals are replacing RNs with RPNs because they can pay them less, but are not taking into account the better patient outcomes that registered nurses afford.

There is no conclusive evidence that proves that a hospital that only employs RNs will have better health outcomes for patients.  There is a vital role for both RNs and RPNs in delivering a high standard of care.

RPNs must complete a focused two and a half year study of nursing and are governed by the College of Nurses of Ontario (CNO).  The Registered Practical Nurses Association of Ontario (RPNAO) says,  “RPNs work anywhere that health care is provided: in hospitals, homes for the aged, nursing homes, retirement homes, public health units, community nursing agencies, clinics, private practice, industry, schools, child care centres, and children’s camps.”  Some of them go on to complete post-graduate studies to practice in specialized areas such as gerontology, obstetrics, surgery and mental health.

The Canadian Institute for Health Information lists RPNs as being among 30 allied health professionals considered to be the greatest assets of our health care system.  They are on the same list as doctors, registered nurses, social workers, occupational therapists and psychologists.  These professionals all work together in a team that varies according to the needs of individual patients.

Patient care is multi-faceted and dependent on the contributions of many workers who also provide indirect care.  These “hidden” health care workers include filing clerks, records managers, receptionists, cooks, cleaners, maintenance staff and security personnel. Sadly, their work is often only recognized when it does not get done.

According to a paper published by Women and Health Care Reform called Hidden Health Care Work and Women, “to plan for and deliver good quality health care, we need to consider the whole health care workforce, not just a part of it.”

Let’s put this in perspective.  A doctor can diagnose and set a course for treatment when a patient is admitted into the hospital.  But that’s just one part of the patient’s health care journey.  Before the doctor came to the diagnosis, a medical lab technologist was probably involved.  While the patient is in the hospital, a nurse will monitor his/her condition; the records manager will ensure the patient’s history is up to date; the cook will prepare healthy food while taking into account dietary restrictions; the cleaner will follow protocols to minimize the spread of infection; the social worker will visit to talk about how the patient is coping; and the occupational therapist will try to make it easier for the patient to get around, once they are feeling better.

Health care cuts in Ontario have placed a huge burden on hospitals to do more with less and as a result, there are fewer people doing more work. RNs, RPNs and other health professionals need to band together to convince the government that this is unacceptable.  The Ministry of Health and Long-Term Care has clearly indicated its intention to put patients first. But in order to do that, we need more funding to ensure adequate staffing and the full range of health care professionals who can work together to offer the best care possible.

Health care is a team effort.  Every member of that team has the potential to influence patient outcomes.  Instead of arguing that one health care professional is better than the other, we should be acknowledging the value of all health care workers.

 

CBS CEO backpedals on paying Canadians for their plasma

The Chief Executive Officer of Canadian Blood Services is doing some damage control by backtracking on the agency’s position on plasma collection.

In an internal blog post last week, Dr. Graham Sher told employees at CBS that he’d like to set the record straight. Sher stirred up controversy recently with his comments on the issue of paying people for their plasma.

CBC reporter Kelly Crowe revealed Sher would not rule out a pay-for-plasma model, if CBS was not able to increase plasma collection in Canada with unpaid donors.  The fact that Sher would even consider such a scenario is unacceptable, and OPSEU has called on him to resign.

Sher’s blog post tries to convince workers he was merely responding to a hypothetical situation, with a hypothetical answer. He tells them, “it has never been our practice, and it is not our plan to pay donors.”

Notice he doesn’t say it will “never” be his plan to pay donors.

In the blog, Sher talks about CBS’s goal of becoming less reliant on plasma-derived pharmaceutical products from the U.S.  These are drugs that are used to treat conditions like immune disorders and Alzheimer’s. He says Canada currently collects 200,000 litres of plasma per year, and that we will need to collect at least double that amount in order to achieve some level of self-sufficiency.

Right now, there is no concrete plan on how CBS will do that.  But Sher says “it may mean building a stand-alone plasma system with a dedicated and specialized staff, recruiting plasma donors in densely populated locations where it makes the most sense to do so, and investing in new infrastructure to support plasma collections.”

That sounds like the kind of system that would be easy enough to convert to a pay-for-plasma model, if at some point CBS says it’s not getting enough voluntary donations to meet its plasma targets.

And how is it that we are all of a sudden in such dire straits, when just four years ago we were overflowing in plasma?  In fact, an abundance of plasma was the justification used for shutting down a Thunder Bay collection centre that produced 10,000 litres a year. The closure of that clinic put 25 people out of work.

This is what the Chief Operating Officer at the time, Ian Mumford, had to say:

“Over the past few years, there has been a consistent downward trend in the demand for plasma and based on our current projections we will need to collect approximately 10,000 fewer units next year.”

Was CBS simply the victim of flawed projections and lack of foresight?  Or is something else going on?

Currently in Canada, there is no licensed processor to convert plasma into various drug therapies.  Our plasma is exported to the United States where it undergoes what is called “fractionation.”  It is then imported back into the country in the form of pharmaceuticals to meet the needs of Canadian patients.

But that could soon change.

Sher says two private companies are about to enter the fractionation business.  Ian Mumford, who left his job as the second-in-command at CBS seven months ago, is now a director of one of them.

In the 1980s and 1990s more than 30,000 Canadians were infected with HIV and Hepatitis C through tainted blood and blood products.  At the time, the Red Cross had been operating Canada’s blood program.  An inquiry was launched to examine what became known as our country’s worst ever public health disaster.  The inquiry was led by Justice Horace Krever and set out 50 recommendations to keep Canada’s blood supply and blood products safe.   The recommendations included:  that blood is a public resource, donors should not be paid, and no part of the national blood operator’s duties should be contracted out.

If Canada wants to be truly self-sufficient in plasma products, CBS should be trying to find a way to process the plasma it collects in-house.  That way, we could have real confidence that the head of the agency is serving the public, and not profit-driven businesses.  We would know that the plasma we are collecting is coming from healthy unpaid donors, that it is processed under the highest standards, and that the pharmaceuticals produced will be used to treat Canadians.

Dr. Sher needs to be reminded of the real reason he has a job.  Canadian Blood Services was established as a result of the Krever inquiry.  Sher should be following Krever’s recommendations to the letter, not making a mockery of them.

Click here to see Sher’s full internal blog.

An ounce of prevention: Fighting poverty improves health

Imagine two children, born on the same day, at the same hospital, to different parents.  One family is rich, the other is poor.  Experts say one of those kids will grow up to be healthier than the other.

Which one do you think it is?

We all know that we could be healthier if we ate better food, quit smoking and exercised more.  But there’s another idea that’s perhaps just as important or even more important in influencing our health.  Doctors, health advocates and researchers have been saying for some time now that social and economic factors have a huge impact on health outcomes.

Experts have identified a number of social factors that influence health. What is your income? What kind of house do you live in? Where do you work? What is your education? Do you have access to healthy food and recreation programs? All of these factors affect not only your physical, but also your mental, health.

There is overwhelming evidence that shows people with lower incomes die earlier and have higher rates of chronic diseases or conditions. In 2013, the Canadian Medical Association (CMA) held a series of town-hall meetings on the issue of what makes us sick. Their conclusion was simple: poverty kills.  In the report that followed, CMA President Dr. Anna Reid had this to say about the importance of the social determinants of health:   “If a patient comes to a doctor with asthma, we can prescribe medication.  But if that patient goes back to a home where there’s mould inside the walls and the air is unhealthy, all the medication in the world won’t make that person better.  If a patient has diabetes, we can prescribe medication, and the physician or another health care provider can explain to that person the importance of a healthy diet. But if that patient can’t afford fresh fruits or vegetables, or if there isn’t a proper supermarket in the community where these foods can even be found, that diabetes is going to be much more of a challenge.”

A new report by Health Quality Ontario also found that the poorer people are, the more likely they are to suffer from multiple chronic conditions and to be overdue for screening tests.  The report shows half of the people living in the poorest urban neighbourhoods in Ontario are overdue for colorectal cancer screening, compared to just over one-third of the people in the richest urban neighbourhoods.

The stress of being poor also has mental health repercussions. The recent spate of suicide attempts in Attawapiskat highlights the need to pay closer attention to the social determinants of mental health, as well.  Attawapiskat First Nation community leaders declared a state of emergency after 11 people tried to take their own lives in one day earlier this month.   In the past seven months, more than 100 of the 2000 people that live in the remote northern Ontario community have attempted suicide. The youngest was 11.  The oldest was 71.

The regional chief has blamed the crisis on the social determinants of First Nation health.  Ontario Regional Chief Isadore Day says the Indian Act created third-world social conditions that have led to health and suicide emergencies.  Chief Day says there “must be a combined and coordinated effort from all levels on all aspects of First Nation health in order to repair this broken system.” Day also says:  “The cycle of poverty, poor health, suicides, violence will continue for another generation if determinants of health are not addressed immediately.”

The Chiefs of Ontario have presented the federal government with a framework on how to fix this broken system.  Their recommendations include implementing mental health and addiction services.  They’re also calling for a plan to eliminate poverty through investments in housing, healthy affordable food, infrastructure, and education and training.

Federal health minister Jane Philpott doesn’t think there is a need for a national suicide prevention strategy, but she does believe in the importance of the social determinants of health.  At a conference in Ottawa in early April, Philpott said “when people have access to high quality of education, when they have access to jobs, when they have money in their pockets, when they have hope – that’s when we are going to be able to make progress.”

The Ontario government has shown some interest in addressing the correlation between income disparities and health disparities.

In 2008, the province rolled out a plan to reduce poverty.  The strategy yielded some progress early on.  The poverty rate dropped to 15.1 per cent in 2011, but by 2013 it was back up to 15.6 per cent – almost as high as it was initially in 2008.  In 2014, the province committed to a new five-year poverty reduction strategy.  In 2015, it also made a commitment to end homelessness in Ontario within 10 years.

Earlier this year, the Ontario budget pledged free tuition for students from low-income families.  The government said it was combining existing programs to create an Ontario Student Grant.  Starting in September 2017, the grant will pay for “average” college or university tuition for students from families earning incomes of $50,000 or less.   The Canadian Federation of Students has welcomed the idea.  But there has been some criticism on how the system will work.  Students will still be on the hook for possible travel and living expenses.  In addition, those who want to pursue programs with higher-than- average tuition fees, such as engineering, will have to apply to another program to cover the extra cost.

While these may be steps in the right direction, we could do so much better.  Every action our government takes now to tackle inequality could make a real difference in the health of generations to come.

We need to keep advocating for public policies that do more to address inequities.  And we need to make sure governments follow through on their promises.  Single mothers are among those that persistently struggle to get by on low incomes.  Pushing the government to eliminate the gender wage gap and implement a higher minimum wage could help pull many families out of poverty.

We have a responsibility to take action now, so that one day it can be the birthright of all children to enjoy a long and healthy life.

Bloodwatch.org calls out minister over for-profit paid-donor plasma clinics

A lobby group fighting to ban paid-donor blood clinics is accusing the federal government of misleading the public.

Bloodwatch.org is taking on the Health Minister Jane Philpott, for allowing a private clinic to open in Saskatoon and pay people for their plasma.

In a scathing letter to the minister, Bloodwatch.org co-founder Kat Lanteigne calls for public consultations on paid-donor clinics and picks apart the arguments that Philpott has provided for putting our blood supply at risk – again.

Haven’t we learned from our past mistakes?  Back in the 1990s, a Royal Commission into the blood system, led by Justice Horace Krever, laid bare the mistakes that infected 30,000 Canadians with AIDS and Hepatitis C. We shouldn’t repeat those mistakes.

By allowing Canadian Plasma Resources/Exa-Pharma to open a clinic in Saskatoon, Canadian Blood Services is ignoring key recommendations in Krever’s report.  CBS is supposed to be guided by the principles that blood is a public resource, donors should not be paid, and the safety of the blood supply system is paramount.

Yet our federal Minister of Health is supporting private for-profit plasma clinics!

Read the full open letter from Bloodwatch.org to the minister below:

Dear Minister Philpott, (an open letter)

It is inappropriate to use the office of the Federal Government to spread information that is fundamentally untrue about Canada’s tainted blood tragedy.

There will be no historical revisionism on Canada’s tragic blood story. You are making a mockery out of this situation and it is a great disappointment to our country and to the brave Canadians who fought for the safe blood system we have today.

Your office and your staff need to be reminded that safe blood products were available at the height of the tainted blood crisis but every single vial of tainted blood was distributed across Canada anyway. Every. Single. One. The last 98 vials were sent to Sick Kids Hospital in Toronto and infected young children who were there for care with AIDS. The Red Cross distributed bad blood knowing it was tainted. Health Canada never issued a recall on those tainted blood products and it took years for our government to issue proper trace back calls.

The viral inactivation process existed for over ten years when Justice Krever made his recommendations in 1997 and Canada had access to safe blood products throughout that period. Your argument that no one has been killed in 20 years by a deadly virus through a blood product so it is okay to deregulate and privatize plasma collection is an inscrutable defense. We don’t need another tainted blood crisis to understand the importance of protecting our Canadian voluntary blood system.

Your office continues to reference a small company in Winnipeg that makes a very rare medication to help prevent women from having stillbirths as a reason to allow private paid plasma in Canada. This facility has been in Canada for over forty years and was cited in Krever’s Report as a “rare circumstance”. It was not meant to be used as a precedent for Canadian Blood Services to abdicate their responsibilities of blood and plasma collection.

It is a fact that Germany has experienced difficulties in retaining voluntary donors due to the competitive model of private plasma centers. It is also true that the poorest and most vulnerable population in America are selling their plasma because they do not have enough money for basic needs. Just because we now have to buy blood products from the US made from their model does not mean we need to mirror it in Canada. We should be making progress to do better.

The VISA card that is given out to people from Canadian Plasma Resources can in fact be used by other people other than the recipient. Splitting hairs between twenty-five dollars cash and a twenty-five dollar VISA card as being a “non-cash incentive” is a ludicrous argument and beneath the intelligence of anyone in Canada. The WHO does not endorse paid-plasma. Quoting a representative from CPR whose lobby you are supporting in your letter is utterly shameful. Their private aspirations should never circumvent publicly accessed facts.

I work alongside the top blood lawyers in the country who were instrumental throughout the Krever Inquiry. I can assure you that one of the center points of study was plasma based products and how they are made as FACTOR 8 was the plasma based medication that wiped out almost an entire generation of hemophiliacs in our country and infected many of their partners with HIV and hepatitis C. Who on earth is advising you on this file? Really?

You are putting our public blood system at risk without consulting the people in Canada who have a great understanding of the blood issue. Your government has had no public consultations on this issue and you have outright refused to meet with tainted blood survivors and public health organizations who have a different point of view – one that is geared to benefit the Canadian public and protect the integrity of our blood system.

Dr. Sher from Canadian Blood Services testified in support of the legislation in Ontario and he spoke at a town hall that I hosted and stated he did not want private plasma clinics to do business here. If his position has changed and he is promoting privatization then he should be asked to step down. It is not within his mandate as the CEO of our public blood system to promote private blood collection and the Canadian public does not pay him almost three-quarters of a million dollars to abuse his position.

Canadian Blood Services was born out of our blood tragedy and to contravene Krever’s fundamental recommendations is outright scandalous.

A private blood broker does not help Canadians become less reliant on foreign plasma products, all it does is fracture our public blood system. It is the responsibility of Canadian Blood Services to collect plasma and blood on behalf of the Canadian public regardless of what its intended use is. That is part of our social contract and CBS has a vested interested in the health of Canadian blood donors whereas a private company has a vested interest in their profit margins.

The push by the private pharmaceutical industry to take over plasma collection should not supersede the demands of the public. There is no benefit to the Canadian people to have private blood brokers and paid plasma clinics proliferate in our country. It will not bring the cost of these drugs down and it does not assist us to become more self-sufficient – only Canadian Blood Services can do that.

We are Canadians, Minister Philpott, we sing our own national anthem and write our own health policies in this country. We have no bound duty to adopt American blood policies so that pharmaceutical companies can carpetbag off of Canadian blood.

You have absolutely no public support for your egregious decisions to privatize plasma collection in Canada. Private paid plasma clinics must be stopped now in order to protect the integrity of the Canadian blood system.

Our advocacy will not abate.
Sincerely,
Kat Lanteigne
Co-Founder of BloodWatch.org
All Blood Is A Public Resource