Category Archives: Health System

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.

 

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.

Why are we risking Canada’s blood supply – again?

The tainted blood scandal was the worst public health disaster in Canadian history. In the 1980s and 1990s, more than 30,000 Canadians became infected with HIV and Hepatitis C. This was due to government and bureaucratic failure to protect the blood supply. Tainted blood killed thousands. People are still dying from it today.

In 1997, the Royal Commission of Inquiry headed by Justice Horace Krever issued 50 recommendations to keep Canada’s blood and blood products safe. Public safety, Krever said, depended on five principles:

  • Blood is a public resource
  • Donors should not be paid
  • Canada should be self-sufficient in blood
  • Access to blood and blood products should be free and universal
  • Safety of the blood supply system is paramount

Canadian Blood Services (CBS), a nonprofit organization, was formed as a result of the tainted blood scandal. The CBS’s sole mission is to manage blood and blood products for Canadians (outside of Quebec).  It is based on the recommendations of the Krever Inquiry.

But the federal government has violated Krever’s principles by granting a license to a for-profit company named Exapharma/Canadian Plasma Resources (CPR). It  wants to pay blood donors in Saskatchewan. Plasma extracted from this blood would be exported. The clinic opened for business today.

In 2014, Canadian Plasma Resources (CPR) tried to open three private blood-collection clinics in high-risk areas in Ontario.  After a public outcry, the provincial government shut down the clinics and passed legislation to ban private plasma collection. (Quebec already had similar legislation.)

“The proliferation of private blood clinics in Canada would compound a three-decade tragedy and shatter the efforts made by those brave Canadians who fought to make our blood system safer,” says activist Kat Lanteigne, author of Tainted, a play about the blood crisis.

The World Health Organization (WHO) wants all profit-motivated plasma donations to end by the year 2020. There is too much risk in paid-plasma programs. WHO makes its persuasive case for a purely voluntary system in Towards 100% Voluntary Blood Donation: a global framework for action.

It is well documented by the European Blood Alliance’s (EBA) report in 2013 and by WHO that paying blood donors endangers the safety of the blood supply. Paying for blood draws donors away from our voluntary system. Paying donors attracts higher risk donors. They often lie about their health status to get the money.

In Europe, as reported by the EBA, German blood brokers bussed in poor donors from Poland. The practice has recently been restricted because the blood and plasma show higher infection rates.

In the United States, the economic collapse of 2008 generated a boom in for-profit blood companies. In Flint, Michigan, 100,000 people have been exposed to lead poisoning and legionnaire’s disease via contaminated water. Yet the publicly traded Grifols Company has not closed its paid-plasma centre in the area. It won’t until the U.S. Food and Drug Administration shuts them down.

Canadian Blood Services (CBS) would never allow Flint residents to donate into a public supply.  Not only are they high-risk donors, but they have compromised health and should not be allowed to donate.

Canada is self-sufficient in fresh plasma. Fresh plasma is used in the treatment for cancer patients and burn victims. We can’t afford to have competition in any collection because we will lose donors to our voluntary system. And that could risk the lives of Canadians.

Health Canada must reverse its decision and ban for-profit blood collection.

The chief executive officer of CBS has assured the public that everyone is getting the blood they need. If a shortage were to occur, CBS has the ability to collect more.

Some suggest that blood testing has progressed to where tainted blood can easily be identified.  But the new Zika virus has proven once again how fragile our blood supply is.

Please add your name to the petition to demand the federal government ban private blood collection in Canada.

“Care as a relationship” is key to good long-term care: research

What are long-term care residences around the world doing right?  That’s the question an international research team travelled across North America and Europe to find out.

Led by Pat Armstrong and Donna Baines, researchers visited nursing homes in Canada, Germany, Norway, Sweden, the United Kingdom and the United States, looking for practices that make long-term care centres feel like home to their residents.

diablogue fotoTheir findings won’t surprise long-term care workers. Good long-term care means building strong care relationships between residents and their care providers. Strong staffing levels, good working conditions, secure jobs, proper levels of public funding, full-service kitchens with in-house food service staff, and sensible standards – not onerous bureaucratic one-size-fits-all rules – lead to excellent care for residents.

The research by Armstrong and Baines resulted in a highly-readable, information-packed book called Promising Practices in Long-term Care: Ideas Worth Sharing (2015). A collection of short and moving vignettes from 13 long-term care homes is accompanied by solid statistics and eight recommendations for promoting care as a relationship. (Download it free here.)

Removing private profit leads to better care

The researchers found that non-profit nursing homes with adequate public funding were more likely to have better working conditions.  The links between good working conditions and strong care relationships with residents are obvious:

  • Adequate staffing levels ensure that staff have time to interact with residents;
  • Permanent, secure jobs with stable work schedules help residents get to know regular staff who care for them at predictable times;
  • Paid sick leave allows staff to rest when sick and avoid infecting residents at work;
  • Good wages, hours of work, benefits and pensions reduce staff turnover, which ensures continuity of care;
  • De-emphasizing excessive paperwork and charting allows staff more time to interact and socialize with residents;
  • Offering staff continuing education increases their ability to provide quality care for residents;
  • Having all services provided by in-house staff instead of contracting it out (e.g. food service, cleaning and laundry) results in better quality and more personalized care for residents.

These findings are in line with a recently-published study by the Journal of Post-Acute and Long-Term Care Medicine showing that for-profit nursing homes in Ontario have 16 per cent higher death rates and 33 per cent higher hospitalization rates than non-profit facilities.  For-profit homes also have higher rates of falls, incontinence, and use of restraints.

Focus on good food

The way to our hearts may not be solely through our stomachs, but good food makes a big difference to quality of care, Armstrong and Baines found.  Many of the promising practices in their book revolve around food.

Time and again, they found that long-term care residences where all meals are prepared, cooked and served onsite by their own staff provided much better meals, and better overall care for residents, than those who contract out food services.

When food is cooked onsite, residents can smell it cooking. It stimulates their appetites and makes them look forward to meals. Directly-employed food service staff get to know individual residents’ likes and dislikes. They interact with residents at meal and snack times, creating another continuous care relationship.

When food service is contracted out, strict meal times must be observed because contractors enter and leave at set times. But when in-house food service staff have food available all day long, or even 24 hours per day as it was in one residence in the book, there is no pressure for all residents to eat at exactly the same time.

This takes a lot of pressure off of other care staff as well. Care relationships are built through conversations and exchanges during and in between routine care tasks. In homes with flexible meal times, personal support workers don’t have to rush through care routines to get residents to the table by a set time.  That leaves time for relationship and trust-building.

In a care home in Germany, residents were even encouraged to help with the food preparation as they were able, with food service and personal care staff nearby to assist when needed.  This created a social atmosphere between residents and care staff, and fostered residents’ independence.  In a residence where food preparation and service is contracted out to private companies, this kind of interaction doesn’t have a chance to happen.

Time to care: Relationships over bureaucracy

Decreasing staffing levels lead to lower quality care, which then leads to bureaucratic rules requiring excessive documentation and the regulation of what should be common sense.

Personal support workers in Ontario often have to do well over an hour of routine charting every day – time they could spend assisting and interacting with residents.  In contrast to this, one Manitoba nursing home visited by the research team “charts by exception” – in other words, they only document occurrences that are out of the ordinary or things they specifically need to track.  This gives them time to build care relationships with residents.

In the nursing homes visited in Germany and Sweden, there was a greater focus on putting “more life into days than extending the days of life.”  A certain level of risk is accepted in exchange for quality of life.  Residents engage in activities that encourage independence, like food preparation using knives, or walking about instead of being pushed in wheelchairs. Residents with dementia who wander are watched and redirected by staff instead of being restrained or locked in. Staff have time to sit and talk with residents, meeting their socialization needs, not just their personal care needs.

But these practices require a high ratio of staff to residents.  The German nursing home above had staff to resident ratios as high as 1:3. In Ontario, there are no regulations for minimum staffing levels to ensure that other regulations are met, such as the provision of toileting assistance, repositioning, and other types of assistance.  Some Ontario PSWs are responsible for up to 42 residents at a time.

Good care also requires more staff time per resident. On average, residents in long-term care homes in Ontario currently receive the following:

This is well below the four hours of direct care per day that the Ontario Association of Non-Profit Homes and Services for Seniors recommends.

According to Armstrong and Baines, high quality long-term care could be the norm instead of the exception in Canada, if we had the desire and political will to make it happen. It will require a culture shift – a move from thinking of care for seniors in terms of a business model, to thinking about what long-term care residents need in order to live fulfilling, dignified lives.

Relationship-building cannot be legislated.  But we can create the conditions under which care relationships can thrive by setting minimum staff ratios and care hours per resident, creating better working conditions for staff, committing to strong public funding and removing the profit motive from long-term care.

Press conference aborted after doc asks question about cuts to refugee health plan

University Health Network CEO Bob Bells tried to apologize after a doctor and a medical student interrupted a press conference by Federal Natural Resources Minister Joe Oliver at the Toronto General Hospital yesterday.

Is this really Dr. Bell’s role?

The doctors vow to “interrupt” the Harper government over their cuts to the Interim Federal Health plan for refugees to Canada due to take place June 30.

The cuts remove so-called supplemental health services from newly arrived refugees, the Harper government stating that these are not services normally covered for most Canadians. This is not entirely true.

In fact, similiar health services are normally made available to Canadians on social assistance. Most refugees arrive in Canada without money for dentistry, drugs and other non-insured services.

As Dr. Chris Keefer states in the video, these are similiar to services available to Ontario Works recipients.

CBC’s clip of the aborted news conference is below:

 

Read about the open letter sent by AMMI Canada regarding the Harper cuts.

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Frail and elderly asked to pay more in Ontario

Frail and elderly residents in Ontario’s nursing homes may be paying in more ways than one for the province’s budget shortfall.

While Health Minister Deb Matthews is holding the line on increases to long-term care funding to 2.8 per cent (only 1 per cent dedicated to direct care), she is asking residents to kick in a lot more than that.

On May 30th the Ministry issued a bulletin to say the basic co-payment rate is increasing by $1.81 per day. That amounts to a 3.4 per cent increase.

The premium rate is also increasing from an additional $8 a day to $9 a day for semi-private (8.8 per cent) and from $18 to $19.75 a day for private (9.1 per cent).

Depending on the accommodation level, that could mean a hike of between $54 and $106 per month.

This comes at a time when Deb Matthews is also holding the line on the Ministry’s complement of inspectors, who say they are so short-staffed that homes will be waiting as long as five years for a detailed inspection.

While business is being told to wait for another cut in their taxes, frail and elderly residents are being asked to pay more for their care.

A reminder of what we’re fighting for

OPSEU represents about 36,000 health care professionals and support staff who work in settings ranging from community mental health to large urban hospitals.

When it comes to this BLOG, we don’t hide our perspective as workers.

We hope that those who read our BLOG do so with the understanding that the stories we write about and the positions we advocate are with the intent of building a better public health system.

We are aware that not everyone shares that goal. Since Medicare was founded, there have always been those who would undermine it, and sometimes it makes for odd bedfellows in the opinion pages.

Sometimes we need to ask ourselves, are we building on Tommy Douglas’ legacy, or are we tearing it down by only pointing out the system’s weaknesses?

It was therefore refreshing to see a letter this week in the Windsor Star by health reporter Veronique Mandal that points out what we hear too seldom – for most of us, the health system still works.

“As a health reporter, I have written hundreds of stories about Canada’s health system – some were laudatory, many showed its shortcomings and failures,” she writes.

The public letter goes on to thank the “doctors, nurses, admitting and technical staff” at Windsor’s Hotel Dieu Grace Hospital who saved her life April 20. Mandal doesn’t specify what her medical emergency was.

Mandal says that “being rescued from the brink of death is a profoundly life-changing experience.”

At Diablogue we often write about hospitals being overcrowded, cuts to cleaning and its impact on infection control, unhealthy and inedible rethermalized food, poor performance scorecards and the perils of privatization. At the end of the day, however, most hospitals still score above 90 per cent in patient satisfaction surveys and Canadians are still embracing our public Medicare system.

For all the problems, we’re obviously still doing some things right.

This does not mean that everyone is getting the care they need, or as the province likes to rhyme off, we’re not finding the right care in the right place at the right time. Not yet.

Letters like Mandal’s do remind us what we are fighting for.

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