Health Links attract huge audience at HealthAchieve

There was a kind of sliding sound and then a rattle as a woman fell to the floor during Tuesday afternoon’s session of the Ontario Hospital Association’s HealthAchieve. When someone asked if there was a doctor or nurse in the house, a variety of arms shot up. We could have probably added a few allied health professionals too should the distressed conference attendee also need a lab test or an x-ray.

If you are going to pass out, this was the place to be.

Each year the OHA features a number of well-attended “candy” sessions that do more to inspire than really inform, often involving high-profile individuals. This was not one of them.

In fact the five panelists joked about whom the big crowd had come out to see.

There is great curiosity about the province’s new Health Links. As one person told me, the session attendance is in inverse proportion to how much knowledge there is about the subject. Given the crowded standing-room only audience that was driving up the room temperature, many wanted to know more.

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Few anti-stigma campaigns based on evidence — Stuart

“Mental health is set aside as that other kind of health care we don’t want to talk about.” – Asante Haughton, one of three youth featured in the Ontario Shores produced film “Talk To Someone: You’re Not Alone.”

Queen’s University researcher Dr. Heather Stuart says the majority of anti-stigma campaigns are not evidence based and few are evaluated. In fact, her research suggests that we may even have to retrench and undo the damage some of these past campaigns have created.

That includes discussion of mental disorders as a brain disease. Her research shows that such descriptors actually increase social distance, not close it.

Speaking at the Ontario Hospital Association HealthAchieve on Monday, Stuart says protests over stigma can “backfire,” resulting in greater polarization of the issue. Stigma should be regarded as a “transgenerational problem.”

“You can’t sell social inclusion like you sell soap,” she told the packed conference room.

We’re all part of it, she says, including families and the mentally ill themselves who create a “self-stigma.” That includes self-blame.

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Robots replacing workers in health care

Casper the robot is in development to serve seniors with cognitive disabilities in the home.

Casper the robot is in development to serve seniors with cognitive disabilities in the home.

His or her name is Casper. Casper is really an “it.”

Casper is also the future we need to start talking about – one where humans get replaced by machines. It’s no longer a matter of science fiction. It’s now.

Casper is still a little way off from coming to market, but Humber River Regional Hospital is counting on other robots to do the heavy lifting when it comes to moving materials around their planned new hospital. CEO Dr. Rueben Devlin is championing the fact that these robots will save operational costs that can be applied to front line care. Those “costs” just happen to be jobs that people are presently doing and using to support their families.

Still in development, Casper is a project by a private company – CrossWing – intended to answer the question of how we will find and afford all the caregivers we need when seniors make up 25 per cent of the population.

This is no joke.

Casper is not meant to do the heavy lifting humans presently do in home care. It can’t give you a bath or help you get up in the morning. Casper is meant for adults with cognitive impairment who may be able to live at home a little longer with help.

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Frontenanc Community Mental Health a case study in empty promises

You would think these would be the best of times for community health care providers.

The Wynne government is freezing base hospital funding and telling Ontarians that they can instead have it all closer to home.  The policy is one of a burning platform in which hospitals are fiscally forced to divest services to community agencies or run up considerable debt.

On the surface it appears popular in theory. Patients see it as an opportunity to access care without paying those costly hospital parking fees or risking a super bug because of the hospital cleaners that got laid off.

It remains largely a theory because the money the government is saving on hospitals is not necessarily flowing to community agencies.

If you look at reallocation of health spending over the last three decades, hospitals in Canada have shrunk from 41.8 per cent of the health care pie in 1984 to 29.1 per cent in 2011. Where did the money go? Much of it went to rapidly rising pharmaceutical costs — not to home and community care. In 1984 drugs took up 6.1 per cent of health spending. By 2011 it was 13.6 per cent. Through much of the mid-decade spending on home and community care actually went down in Ontario relative to other health sectors. The McGuinty government never walked the talk.

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Social Determinants: Low income second leading cause of death in Canada

Dr. James Dunn makes it clear that wealth not only is a key determinant of a person’s health, but it is stratified so that each economic level outperforms the one before it. That means each layer in the economic pyramid has worse health outcomes than the one above it — not just between the bottom 10 per cent and the top 10 per cent.

Therefore when we look at a country’s mortality rate – and Canada’s is among the top – it doesn’t tell the whole story.

Dunn teaches at McMaster University in Hamilton and is very familiar with where people live in that city based on economic status.

Speaking this week at the Conference Board of Canada’s Summit on Health Care Sustainability, he says if some of the lower socioeconomic neighborhoods in that city were looked at as a country, the mortality rates would rank 155th in the world.

Put another way, if low income was considered a disease causing death, it would rank second in Canada to cancer.

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Social Determinants: Have we designed physical activity out of our cities?

CHEO's Dr. Mark Tremblay talks about child obesity during the Conference Board of Canada Summit on Health Care Sustainability.

CHEO’s Dr. Mark Tremblay talks about child obesity during the Conference Board of Canada Summit on Health Care Sustainability.

OPSEU’s head office is located about a brisk 15 minute walk from the Leslie subway station in Toronto. The building is located in a business park in which thousands of workers arrive each morning. Given the proximity to the subway station, you’d expect long lines of pedestrians to be making their way past the North York General Hospital and into the business park each day. The thing is, they don’t. It’s rare to see anybody on the sidewalk at all.

Half an hour a day of brisk walking would add tremendous health benefits to the people in the business park. Dr. Mike Evans has a wonderful animated talk in which he speaks about half an hour of exercise reducing dementia and Alzheimer’s, the risk of hip fractures, diabetes, depression and anxiety. If it were a drug we’d be all asking our doctor for it.

If you’ve ever done that walk from the subway, chances are you wouldn’t want to repeat the experience. Leslie is very wide at that point and thousands of cars go roaring by in the morning. There is nothing in human scale to relate to. The noisy underpass below the 401 is particularly inhospitable. Worst still, there is no crosswalk to give pedestrians the right of way against traffic zipping along into an Eastbound on-ramp to the 401. The walk is full of anxiety. When you get to the business park, the sidewalk ends on one side of the street, meaning you have to cross the road and back again to get to OPSEU.

Suzanne Nienaber says we are designing physical activity out of our lives by designing our cities this way. The Partnership Director of New York’s Center for Active Design, told this week’s Conference Board of Canada Summit on Health Care Sustainability that if you make enticing public realms, people will actually use them.

Nienaber is actively working to design physical activity back into people’s lives through good urban planning.

In a vertical city like New York – not unlike Toronto – it makes sense to encourage people to use the stairs. Two minutes of stair climbing has tremendous health value. So why aren’t we making stairs attractive places and urging people to use them with encouraging signs Nienaber calls a “stair prompt?” If you visit many of our buildings – such as the Ontario Federation of Labour tower, the stairwell is not easy to find, and you might have a problem accessing the floor you are looking for from the stairwell.

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How much longer can Ontario dance around nursing home staffing needs?

Ontario has been remarkably resistant to the idea of staffing standards in long-term care.

Staffing is a major determinant of quality in long-term care – something even the most casual observer should understand.

Such standards are not uncommon in other jurisdictions – many have based regulations on a comprehensive U.S. Department of Health and Human Services study that stated a daily minimum of 4.1 hours of total nursing time (including personal support workers) is required to avoid common quality of care problems such as bedsores, weight loss, and loss of bodily functions for long-term care residents. That was in 2002.

There is not general agreement on how nursing home staffing is measured in Ontario, making it difficult to directly compare existing data to this benchmark. However, experts suggest that Ontario is hovering somewhere below three hours of direct care per resident per day based on average acuity.

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Poking the beast – “P” word missing from reform talk

The problem with discussing health care sustainability is there is no definition of what that means. Data would suggest that our health care spending is not out of control – the so-called cost curve has already been bent. Past increases appear to have occurred in sync with economic growth, the exception being the economic crash of 2008. Clearly those who are worried about sustainability are not equating it with affordability.

Across Canada the average increase in provincial health care spending this year is 2 per cent – hardly a matter of excess especially when one considers aging and population growth.

While Canada has done better than just about every other country in the OECD in controlling health costs, it has often come at a difference kind of price given quality issues that persist.

This week the Conference Board of Canada is hosting a two-day conference in Toronto on health care sustainability. Next week the discussions will be sure to spill over into the Ontario Hospital Association’s annual get-together at HealthAchieve. We’ll be at both.

Earlier this year health policy analyst Steven Lewis and former Cancer Care Ontario CEO Dr. Terrence Sullivan issued a paper on how to keep the cost curve bent.

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Ontario PCs war on public sector continues with Bill 113

For a guy who has spent most of his career working in the public sector, Conservative MPP Toby Barrett certainly has it in for public sector workers.

Barrett introduced Bill 113 in the legislature to carve out a new bureaucracy within the Ministry of Finance. Its job would be to compare public and private sector wages. This Orwellian “comprehensive pay fairness division” is supposed to provide guidance to arbitrators in settling contracts with public sector workers.

Never mind that arbitration decisions already factor in wage comparators and that such a division may be both very expensive and totally redundant.

This is just the latest attack on workers by the Ontario Conservatives who appear eager to reduce the wages of everyone who relies on a paycheque in this province. The end game is not to pass this piece of legislation, but to drum up public antipathy to the public sector. In fact, the proposed legislation didn’t even survive the day before being voted down.

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CLC TV ads promote unions, fairness

When we talk openly about our unions, others listen.

Let’s face it, for all the warts, unions have done an incredible job in securing and maintaining many of the things we cherish today — from paid vacation to health benefits and pay equity.

Non-union workers tell us that they hear more bad things about unions than good. That’s a shame.

Maybe its time for us to share all the good things about our unions. If we didn’t believe in them, why are nearly one in three Canadian workers unionized? We have the power to change that image and tell a different story.

The Canadian Labour Congress has put out a feel-good television ad to bolster the image of labour in Canada. If you haven’t seen it yet, check it out in the space below.