Jane Philpott opens up about dealing with the opioid crisis - "I feel a significant burden of responsibility." - Health Leadership Conference
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JUNE 2017
MAGAZINE
Jane Philpott opens up
about dealing with the
opioid crisis
“I feel a significant burden of responsibility.”
THE HEALTHCARE ISSUE | HEALTH DISCORD | HOW SAFE ARE YOUR HEALTH RECORDS?
Dollars and Sense:
Achieving Mental Wealth by Investing Smarter
SCALE ACROSS THE LIFESPAN
50% 65+
People in Canada will experience
a mental health problem or
illness in any given year
About 50% of all mental health As many as 25% of emergency
problems and illnesses department visits are by people
have likely begun by 65+ with a mental health
the teenage years problem/illness
Canadians with mental illness $1,400
Canadians with type two diabetes
Canadians with heart disease Total cost to Canada’s economy
incurred by mental health
This is nearly twice the number problems and illnesses is nearly
of people in all age groups with $1,400 for every person The highest rate of mental health problems
heart disease or type 2 diabetes living in Canada and illnesses is among young adults ages 20 to 29
BRIDGING THE GAP COST SAVINGS
About 1.6 million Canadians
recently reported that their
need for mental health
care was only partially
met or not met at all
$ Research over 40 years showed
$ that $3 invested in one early
$
$ $ intervention program saved $4
$ in publicly funded services
$
LOW INVESTMENT month
Canada's mental health spending
represents only 7.2% of Canada's
total health spending compared
to 13% in England
Offering collaborative care to a Making psychotherapies
person on short-term disability more available can save $2
for a mental health problem in the long term for every $1
results in 16 fewer days spent today
on disability
To review the full report, Strengthening the Case for Investing in Canada’s Mental Health System:
Economic Considerations visit mentalhealthcommission.ca or email C4$@mentalhealthcommission.ca
Suite 1210, 350 Albert Street, Ottawa, ON K1R 1A4 • Tel: 613.683.3755 • Fax: 613.798.2989 @MHCC_ /theMHCC /1MHCC @theMHCC
info@mentalhealthcommission.ca • www.mentalhealthcommission.ca /Mental Health Commission of Canada
MAGAZINE
CONTENTS
JUNE 2017 | HEALTHCARE EDITION
4
Finally, out of
the shadows
Fixing a broken
Jane Philpott opens up about
1
system to cure
dealing with the opioid crisis
what ails First
Nations 11
Celina Caesar- How safe are
Chavannes:
7 16 18
Her battle with Health your health
depression Discord records?
CONTENTS
PUBLISHER/FOUNDER
James Baxter
EXECUTIVE EDITOR
Stephen Maher
DEPUTY EDITOR
Doug Beazley
Major investments needed in
fundamental research science if Canada
wants to get its game back 22 SENIOR EDITOR
Holly Lake
ALPHEUS GROUP
Danelia Bolivar
NEWS TEAM
Beatrice Britneff
Amanda Connolly
Janice Dickson
Kyle Duggan
Kelsey Johnson
James Munson
Scheer wants to punish universities
24
BJ Siekierski
that stifle ‘free speech’. Kirsten Smith
Is he serious?
IPOLITICS LIVE
Andrew Beattie
BUSINESS TEAM
John Butterfield
Sally Douglas
Callie Sanderson
Yamina Tsalamlal
Emily Francis
PHOTOGRAPHER
Matthew Usherwood
The Canada Infrastructure Bank -
a ‘boondoggle waiting to happen’? 26 GRAPHIC DESIGNER
Sarah West
CONTACT
Canada’s Canadians 201-17 York Street
untapped concerned about Ottawa, ON K1N 9J6
anti-corruption opioid overdoses Canada
blitz and hospital cyber Office: 613-789-2772
28 31
attacks
ipolitics.ca | info@ipolitics.ca
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for independent, up-to-the-minute
The Great Canadian Healthcare Debate coverage of Canadian politics and the
Issue Briefs Top 6 Motions business of government.
JANE PHILPOTT
OPENS UP ABOUT
DEALING WITH
THE OPIOID CRISIS
BY KYLE DUGGAN
“H
I feel a significant burden
of responsibility.
ealth Minister Jane Philpott is the lead
federal figure tackling Canada’s opioid
overdose crisis, which she says is the
biggest health crisis since the Spanish flu
epidemic in the early 20th century.
But even she doesn’t know how deep the problem
has become.
“It’s frustrating,” she told iPolitics in a series of
interviews.
“It’s the most serious public health issue that
we’re facing right now in the country, and it disturbs
me that as federal minister of health I can’t tell you,
for example, how many people right now use opioids
on a regular basis. I can’t tell you how many people
overdosed in the country last year. I can’t tell you
how many deaths there are. It’s frustrating.”
Philpott knows the rough numbers. At least 2,300
Canadians died last year from an opioid overdose,
which is most likely an underestimate because several
provinces haven’t reported numbers and some are
using 2015 data. She has acknowledged the death
toll is “higher than any infectious epidemic that this
country has seen in a century,” including at the peak
of the AIDS crisis.
Although she normally maintains a cool
demeanour when talking about health policy, Philpott
dropped that face a bit when talking to a crowd
of harm reduction advocates at a conference in
Montreal in May. There, she said Canada has “feeble”
public health laws that have suffered from a “decade
of regressive thinking,” She told those gathered she’s
troubled by the “appalling dearth of data and the
glacial pace at which we’re getting information.”
Jane Philpott. iPolitics/Matthew Usherwood.
IPOLITICS MAGAZINE JUNE 2017 1
JANE PHILPOTT OPENS UP ABOUT DEALING WITH THE OPIOID CRISIS
Those have been her top areas of concern “My experience as a clinician has been
and there has been movement - albeit slow - helpful to understand the context of the crisis
towards seeing accurate, timely national data. and be able to see this is something that affects
“We’re getting much closer to the point individuals because I’ve treated people on a
where we will have up-to-date details,” she said. one-by-one basis.”
“It may end up being that we’ll report Philpott says she misses her patients, who
quarterly – we’re still sorting out what can have given her a perspective that informs the
be done, but I’ve tasked my team to provide way she looks at the crisis.
epidemiologists, for instance, to provinces who “I see people who die of overdose as
are lacking capacity to get this information. individuals and I’ve had experience dealing with
Hopefully before long, we’ll be able to get a patients who have severe drug dependence.
much better picture of what’s going on.” I understand that what has gotten people into
circumstances of severe addiction is largely due
to events completely beyond their control. It’s
not a matter of having made that choice, it’s a
matter of having a tremendous amount of pain
in their lives. Often people have lived with abuse,
lived with a huge number of social challenges:
poverty and homelessness and joblessness. I
think it’s helped me to realize this is a health
problem. It’s not a crime. It’s not a problem of
being morally weak.”
She admits she feels “a significant burden of
A naloxone kit from Toronto Public Health. responsibility.”
THE CANADIAN PRESS/Frank Gunn
“I know there are lots of partners working
Philpott has often touted widening access to together on this, but I’m thankful that my
the opioid blocking drug naloxone as one of her background has provided me with some idea of
her biggest achievements while in office. Her how important it is, and some idea of what is
latest notch on that list is the Liberal’s legislative possible to do,” Philpott said.
response to the crisis, Bill C-37, which repeals the “This is obviously a tremendous crisis, but
Harper government’s Respect for Communities I’m pleased I can use the opportunities I’ve been
Act, and streamlines the process to apply for given to hopefully improve the lives of people
approval to set up a supervised injection site. and help save more lives.”
It’s a bill that the Tories fought because it
reduces consultative steps to apply for a site.
The NDP helped rush through the legislative
process, which Philpott characterizes as “much
better fuel for being able to support expanded
access to harm reduction.”
Among its immediate effects, she said, “we
anticipate that there may be more applications
coming.”
As a doctor, she’s seen both sides of the crisis
– at the micro level – up close and personal with
patients – and macro, watching the problem
unfold across the country - and looking at
large scale solutions that take much longer to
implement.
“It’s a different kind of work,” she said of the
change in roles. Jane Philpott. iPolitics/Matthew Usherwood.
2 IPOLITICS MAGAZINE JUNE 2017
JANE PHILPOTT OPENS UP ABOUT DEALING WITH THE OPIOID CRISIS
FURTHER Q & A WITH We’re also looking forward to being able
to announce new measures using research
HEALTH MINISTER JANE PHILPOTT as a way to evaluate, for example, different
Q: How significant is Bill C-37 – your Liberal
types of treatment models that would be
government’s response to the overdose crisis in
available. So we’ll have news on that in the
Canada – as an advance in harm reduction?
coming weeks. These are all ways the federal
A: It’s a very important step that we’ve
government can support the provinces and
moved this to the point of Royal Assent. It’s good
territories. The work we’re doing on trying
news. It provides us with much better fuel for
to expand different types of treatment that
being able to support expanded access to harm
would be available so the whole range of
reduction, particularly supervised consumption
therapies would be accessible to prescribers
sites. It’s just one of a huge range of measures
to treat people with opioid dependence. We’re
that we need to put in place in response to the
still active on a whole range of activities.
overdose crisis ... we have a new process, and
Q: How long will it take to fix the data
hopefully will be able to support communities
collection issues to the point where we know
much better.
how many people have died across Canada
Q: And do you think after [C-37] passes, are
from opioid overdoses, and the areas where
you expecting more applications from people …
communities who are holding out, waiting for the rate is growing fastest?
the bill to pass? A: We’re working on this. We have a
A: Well, the significance of the passage of special committee that’s been put together
Bill C-37 is of course it makes the application that includes medical officers of health and
process much less onerous. So I know that there public health leaders across the country,
are communities who are currently examining also working with StatsCan, the Canadian
their needs and trying to look at whether or not Institute for Health Information, coroners
they have adequate capacity for harm reduction and medical examiners. The goal is to get
techniques like this, so we anticipate that there timely data, accurate data and get it for every
may be more applications coming. region of the country. Some places like B.C.
Q What are the next steps on tackling are doing a fantastic job where we’re getting
opioids? reliable monthly updates on how many
A: There are a number of initiatives that people have died. We’re getting much closer
we’re working on – all in the classic pillars of to the point where we will have up to date
prevention treatment, harm reduction and law details.
enforcement. One of the things I announced (in Q: What does the opioid crisis tell us
May) was trying to get a better understanding of about our public health laws? Some might
what’s going on. You know, I’ve been frustrated think back to SARS and think it’s striking
by the lack of good data by not really knowing how policy makers still can’t respond very
how many people are overdosing, how many quickly to large public health crises.
people are dying, and to fully address the A: I think that there’s work to be done in
problem and get the resources we need, we terms our public health legislation. I think
should have a better understanding of what is it has reminded us that while obviously our
actually happening. public health agency plays an important role
One of the things that we’re doing, for – it was established at the time of SARS – we
example, is the Public Health Agency of Canada still do have challenges in terms of gathering
just launched an epidemiological study to assess data and in the context of an emergency like
all of the overdoses that took place last year to this, it’s problematic. So we will be certainly
look at where they’re happening, what sort of considering whether there’s work to be done
drugs are being used, who is being affected by in that regard.
this. That’s one step.
IPOLITICS MAGAZINE JUNE 2017 3
FINALLY
OUT OF THE SHADOWS
BY HOLLY LAKE
It’s been 11 years since the Senate where we started, which was
virtually zero, we’ve come a far way
released Out of the Shadows At Last - down the line. You can’t roll this
back any more than you can roll
a report that looked at transforming back the clock on cancer care. It is
mental health, mental illness and out of the shadows forever and that’s
a pretty significant and impressive
addiction services in Canada. accomplishment in a decade,” he
F
says.
ormer Sen. Michael Kirby Compare that to where things The now retired senator says
says the report’s name was are today and there’s no denying among the biggest indication of
no accident, but rather a society has come a huge distance. change was in the latest round
deliberate choice on the part “People are thinking about it. of health accord negotiations
of the Standing Senate Committee People are prepared to talk about it. between the federal and provincial
on Social Affairs, Science and And it’s not just the policy makers governments, with Ottawa’s
Technology. Committee members and doctors who understand this. insistence that billions be dedicated
wanted to make clear this was an I can’t go anywhere but someone to mental health.
issue that needed to be out of the starts talking to me about a friend of “That has never ever happened
shadows forever. theirs or a family member who has before. Not has it even not
Today, Kirby says it finally is. a mental illness. It’s become much happened before, it’s never even
“When our report came out, more a topic of conversation people been on the agenda before,” Kirby
mental health was not on anyone’s aren’t embarrassed to raise and says. “So you now have the federal
horizon. At all,” he says. “No that’s a wonderful change in public government and the provinces
government had thought about it attitude,” Kirby says. publicly acknowledging they are
seriously.” “It doesn’t mean the stigma has going to have a significant amount
entirely disappeared, but given of money into mental health. That’s
4 IPOLITICS MAGAZINE JUNE 2017
FINALLY, OUT OF THE SHADOWS
a phenomenal step forward, a sea Kirby agrees. He’s spoken to “If I were making a decision,
change.” many GPs over the years and says a the single most important change
Dr. Catherine Zahn, president quarter to a third of their patients to the system would be to get
and CEO of the Centre for Addiction are dealing with mental health psychotherapy for all children
and Mental Health in Toronto, problems. who need it,” Kirby says. “The way
says while past government’s “You can’t see that every day psychotherapy is delivered now is
have ranged in their willingness of the week and not come to the very much a two-tiered healthcare
to listen, there was less focus on conclusion that we better do system. The kids that get it are
making changes. For the first time, something,” he says. “We now have the families that can afford to pay
she’s seeing movement, something a minister who has experienced the the private money that it costs.
she called for in a speech to the problem first hand and I think that Otherwise, they’ll wait well over
Economic Club of Canada last fall. makes a big difference as to why she a year to see a child psychologist,
She warned Ottawa that without appears to care so much about the and by then the problem has
bold national leadership with the issue.” deteriorated.”
opportunity presenting itself to No one needs to convince Celina That’s already starting to
close a serious gap in the health Caesar-Chavannes of that. She’s happen in bits and pieces in some
care system, the country “would fail been open about her battle with jurisdictions, but he’s hoping
another generation of Canadians.” depression, even penning a piece this new money will make a big
“Personally, I’m pleased with the in The Huffington Post in the fall of difference to what’s already in place,
constructive approach the Trudeau 2016. and particularly in areas where
government and Health Minister “Jane was my GP before nothing’s in place.
Jane Philpott have been taking to she became an MP. She actually He says there’s also a very
advance the cause of mental health diagnosed me the first time and compelling economic argument for
and to improve mental health care we’ve had a great relationship,” doing that. As it stands, 70 per cent
and population health across the says the Liberal MP for Whitby. “I’m of adults who have mental health
proud to be able to advocate for this issues had the onset before the age
country,” she says.
with her. I’m very proud that this is of 24. Most problems start as mood
“I think the thing that was most
happening. It seems miraculous to disorders, anxiety and depression,
gratifying is that they stood firm
me that you can say one thing today but because people don’t get
on the health accord requiring
and within a little while, it gets put treated, issues escalate, with some
dedicated, earmarked funding that
on the government’s agenda. There progressing to addiction through
needed to go to mental health care.”
are people who have fought for this self medication.
She gives a lot of credit to
for a lifetime, so for me it’s brilliant. “If you were able to deal with
Philpott, who was a family doctor
It’s so critically important.” those problems when they first
prior to entering politics.
In outlining what was required of arose, when they are much more
Zahn says the minister has seen
a new multi-year health accord, the treatable, you would stop a huge
the inequities that exist when trying
minister of health’s mandate letter chunk of those people from going on
to care for people with mental illness
set out that in addition to a long term to have mental illness as an adult,”
as opposed to those with physical
funding agreement, it should also Kirby says. “You’d reduce the 70 per
illness every day in her practice.
“make high quality mental health cent phenomenally.”
“Those bring a sense of
services more available to Canadians Left untreated, many of these
grounding in reality to the issues
who need them.” children end up on the street when
you face,” she says. “Jane is a
Now the question becomes where they grow up and others end up in
fantastic example of someone who’s
the dedicated mental health funds jail: “That’s the most expensive way
credentials that are hard to parallel.
should go -- and on that issue, every to take care of any human being,” he
She’s highly educated, experienced,
province will of course differ. Some have says.
educated, intelligent, level headed, much more in the way of community- A good many psychotherapists
just an absolutely outstanding based services, while others have more have told him a child can make
leader and politician. She brings a youth services, so there’s no one agenda huge progress in eight therapy
lot to table.” that can be laid out. sessions. For parents with employee
IPOLITICS MAGAZINE JUNE 2017 5
FINALLY, OUT OF THE SHADOWS
assistance programs, that’s usually and get the help they need.” health minister in the last few years
covered. For those children whose Zahn doesn’t disagree. to drive home this priority. He hasn’t
parents don’t have coverage and “I think a rollout, if it has to be discussed it with Philpott yet, but
are unable to pay, it would cost the tiered, children and youth are a says he knows there’s strong support
government about $1,000 per child great place to start,” she says. “It’s in the federal health bureaucracy
to get treatment. your biggest opportunity.” for investing in psychotherapy for
“What I’m saying is that if you However, there are plenty of children.
can invest $1000 in a kid that needs others, including young adults, “There aren’t a lot of things in
help, you would get that money youth in transition and older adults health care that make good health
back 10 times over down the road in who are dealing with mental health sense and good financial sense. It’s
savings in your judicial system, your issues such as depression. generally too expensive. This isn’t,”
jail system, your hospital system,” “So my argument is more he says.“Even if you don’t want to
Kirby says. “It’s a ridiculously low along the lines of that this should believe in the humane aspect of this,
investment for the return.” be designated as a necessary and it makes such good public policy
Caesar-Chavannes says she just insured service overall,“ Zahn says, sense.”
wants to see young people to be able adding you have to be careful not to When asked if he expect to do
to access care. inadvertently disadvantage a group. another round of door knocking
“I don’t want anyone to have That said, she’s grateful for on the doors of provincial health
to go to the emergency room at 40, these first steps and wants to do ministers, Kirby pauses.
42-years-old, however old I was, and everything she can to keep the “I’m kind of relentless,’ he
not be able to get help. I want people momentum going. says with a laugh. “I’m going to do
to be able to get help early and have Kirby plans to do the same. He’s anything I can to get governments to
it be normal for young people to go already spoken to every provincial make that change.”
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6 IPOLITICS MAGAZINE
Better data. Better decisions.
Healthier Canadians.
JUNE 2017
© 2017 Canadian Institute for Health InformationCELINA CAESAR-CHAVANNES
HER BATTLE
WITH
DEPRESSION
BY HOLLY LAKE
Celina Caesar-Chavannes
Photo Canadian Press.
IPOLITICS MAGAZINE JUNE 2017 7CELINA CAESAR-CHAVANNES | HER BATTLE WITH DEPRESSION
There was a time when Abraham Lincoln to Winston Churchill.
And as time wears on, the assumption that
a politician would have admitting to mental illness is more than enough
to kill a political career is being abandoned —
gone to great lengths one story at a time.
Liberal MP Celina Caesar-Chavannes says
to hide a battle with there’s a power in telling such personal stories
mental illness. in public life. She penned a blog post last fall
about her struggle with depression.
“For yourself, you release the burden of
having to hide or be overwhelmed or be afraid
T
to cry in public or to express your feelings,”
here would have been too much of a she says. “That takes that away because people
stigma to bear — and no shortage of understand and know this is what you’re going
questions about their fitness to hold through.”
office. She was first diagnosed in mid-2015, but
And yet, people in politics (who are people, in the early months of 2016, her condition had
after all) face the same health crises as the taken hold in a different form. By then she was
average non-politician. Many successful leaders an MP in the new Trudeau government and a
have struggled with mental illness, from parliamentary secretary, and found the illness
overwhelming.
8 IPOLITICS MAGAZINE JUNE 2017CELINA CAESAR-CHAVANNES | HER BATTLE WITH DEPRESSION
“So overwhelming, in fact, that one day in “Taking five minutes to breathe is a lot
late February I abruptly left a meeting I was better than two days of being completely off
having with my caucus colleagues, had a brief your feet. That acknowledgement that it’s okay
stay in an Ottawa emergency room, then left on is important.”
a train, en route to Whitby,” she wrote. “I was Caesar-Chavannes says her colleagues on
spiraling out of control and I did not know what the Hill have been incredibly positive and
to do. I sat on the train thinking, ‘Will anybody supportive. Being honest about what she’s
help me? Does anybody see how much pain I dealing with, she says, has helped her learn to
am in?’ By the time I got home, I felt at a total be okay with not being okay. That’s led those
loss. Like my life was slipping away.” around her to share stories about friends
Depression made her a prisoner — unwilling and loved ones who’ve struggled with mental
to leave the house or even wash her hair. illness, as well as their own troubles.
“I wasn’t sad and crying all the time. It didn’t “It’s been amazing and I think it’s been
manifest that way.” liberating for a lot of people to say, ‘Look, we
With time, treatment and self-care, she won can talk about this like anything else and we
her life back. Still, it can be a steady struggle to don’t have to worry,’” she says. “We need to do
keep depression in its place; Caesar-Chavannes this.”
says some days are better than others. “When there are days that I just can’t … I
“If you’d talked to me a couple of hours ago, can say that. It also allows the people around
I was a mess. Now I’m a little better. But it’s day me to say, ‘How can we make this better?’ That
by day. There’s no, ‘This is a great day.’ It really makes a big difference when I’m not fighting
is a day-by-day experience. You take the good with people all the time but working with them
with the bad. You take what you get and try to to get through the day.”
muster through. Beyond caucus, Caesar-Chavannes often
“The more stressors there are in a day, they’ll speaks of her battle with depression at public
build up and to a point where I know it’s going events. That’s brought its own rewards.
to throw me off, so I can’t. I try to eliminate “At one, I was telling my story and what I
those stressors earlier so they don’t build up.” dealt with, when an older black lady came up
And yet, just a decade ago, she thrived on to me and said, ‘I had no idea that’s what I was
that kind of stress. going through. I was just sitting in front of my
“I was nimble. I was able to move around. window, day in and day out, watching the sun
Twenty things on my plate, that’s how I liked come up and go down,’” Caesar-Chavannes
it. It allowed me to press to try and get things says. “She wasn’t crying. She just didn’t realize
done. It gave me adrenaline. that could be depression.
“Now it’s debilitating. I can’t function in that “Hearing that story, for me, was telling.
space so I need to chuck things off the list and Because how many more people are suffering
not have too many things that are high stress and they don’t need to?”
items on the list.” For that reason, she’s more than content to
She says a sense of perspective has been one speak up for everyone suffering in silence —
of her best coping mechanisms. Two years ago, and that’s a form of therapy in itself.
opening her son’s backpack on the weekend “I’ve always been one to be honest as
and discovering his lunch containers hadn’t possible with my story,” she says. “I don’t think
been emptied would have led to a complete there’s any shame in that. And it’s unrealistic
meltdown. Now she’s able to step back and for me to try and live otherwise.”
separate the small matters from the great.
IPOLITICS MAGAZINE JUNE 2017 9OUR HEALTH CARE. Our Stories.
In sickness
and in health:
This is the story of Theresa H.
“I am a senior caring for an ill spouse. Fortunately I am blessed with good
health but my husband has many medical problems and needs help with
pretty well all his basic needs.
As part of my daily tasks, I monitor all his medications, which are constantly
changing. I manage all the finances and house doctor appointments and
anywhere else he has to go, with difficulty. Our combined income is under
$50,000 a year and we spend close to $10,000 on medications alone.
My question is: What will happen
to him if I get sick or hurt?
The government talks about keeping seniors in their own home as long
as possible but as far as I can see, offers no help.”
The time to act is now.
Ensure seniors get better access to care
Learn more: cma.ca/demandaplan
10 IPOLITICS MAGAZINE JUNE 2017FIXING A BROKEN
SYSTEM TO CURE WHAT
AILS FIRST NATIONS
BY HOLLY LAKE
Residents walk in the northern Labrador community of Natuashish, N.L
THE CANADIAN PRESS/Andrew Vaughan
IPOLITICS MAGAZINE JUNE 2017 11FIXING A BROKEN SYSTEM TO CURE WHAT AILS FIRST NATIONS
AFN National Chief Perry Bellegarde and Prime Minister Justin Trudeau. THE CANADIAN PRESS/Adrian Wyld.
First Nations say the Liberal government is at the table and
listening, but it’s still a long road ahead
T
he Liberals made a lot of promises to relationship, no question,” he says.
Canada’s First Nations during the 2015 “I can see a big difference between the
election campaign. former Conservative government and this Liberal
The party and Justin Trudeau courted government. My job is to make sure they live up
indigenous groups and committed to a rebuilding to their promises and commitments and that our
a relationship based on mutual respect. issues and priorities don’t fall off the table.
Fair to say, there was no shortage of talk. “That means holding the prime minister’s feet
But since taking office more than a year and a to the fire. He is listening and saying the right
half ago, have the Liberals also been walking the things, but the proof is when you see action. That’s
walk, particularly when it comes to health and what I have to keep pushing on.”
healthcare? There have been investments, which have
Assembly of First Nations Chief Perry things moving in the right direction, but there’s
Bellegarde says yes: The government, including plenty more that has to be done. At the top of
Minister of Indigenous and Northern Affairs the list is long-term, sustainable funding for
Carolyn Bennett, is very much at the table and things such as housing, water and education —
willing to listen. all critically important determinants of health.
“I believe we have a good cooperative Bellegarde says you can’t expect to address health
12 IPOLITICS MAGAZINE JUNE 2017FIXING A BROKEN SYSTEM TO CURE WHAT AILS FIRST NATIONS
fourth time last month for continuing to restrict
social and health services for indigenous kids in a
way that doesn’t comply with Jordan’s Principle,
which says indigenous children should receive
a level of services comparable those for other
Canadian children.
“Children deserve care, no matter where
they are. And it shouldn’t be caught up in
bureaucracies, federal or provincial,” Bellegarde
says. “They should just get the care and then it
should be sorted out later as adults.”
“They only have one chance. It’s only one
childhood they get to enjoy … supposedly enjoy.
You’ve got to make them as healthy as possible, so
they can be productive members of our society.
Like every child, they have dreams too. Our kids
want access to good quality homes, good quality
National Chief of the Assembly of First Nations Perry Bellegrade.
schools, good quality jobs.”
iPolitics/Matthew Usherwood The Trudeau government put $8.4 billion in
the budget two years ago for First Nations people,
and health care issues without ensuring people then last year added another $3.4 billion.
have these basic necessities of life. “Some would say that’s a lot of money,”
“I always come back to six versus 63rd,” he Bellegarde says. “Well, yes it is, on one hand — but
says. “According to the United Nations Human no it isn’t on the other. How do you close that six
Development Index, Canada is rated sixth in terms versus 63 gap?”
of quality of life. When you apply the same indices Certainly not with the longstanding — though
to our people, we’re 63rd. As national chief I’m not now lifted — two per cent funding cap on annual
going to rest until there’s no difference.”
He says the data don’t paint a good picture
of the overall health of his people. Their life
expectancy is five to seven years less than that of
other Canadians.
“Half of our kids live in poverty,” he says.
First Nations children and youth make up 48
per cent of those in foster care across the country,
despite comprising only 4.3 per cent of Canada’s
population. The suicide rate among First Nations
youth remains five to seven times the national
average.
There are 132 boil-water advisories in place
today and a vast number of families packed into
overcrowded houses filled with black mould.
Children on reserves are receiving a poorer
education than children elsewhere, and the
Canadian Human Rights Tribunal found the
government is discriminating against them by
providing them with less money for their welfare
services than is available elsewhere in Canada.
Ontario Regional Chief Isidore Day.
The Tribunal slammed the federal THE CANADIAN PRESS/Adrian Wyld.
government’s indigenous children’s services for a
IPOLITICS MAGAZINE JUNE 2017 13FIXING A BROKEN SYSTEM TO CURE WHAT AILS FIRST NATIONS
increases to First Nations budgets, which was in
place for 20 years. That’s not the path to health
equity. First imposed by the Liberals in 1996, the
cap limited annual increases to First Nations
budgets. It was only supposed to remain in place
for a few years, but stuck, leaving many services
and programs squeezed.
“Without a huge injection of capital in fiscal
resources, you’re just maintaining the status
quo and that is not acceptable,” he says. “We
need long-term sustainable investments. That’s
what it’s going to take.”
However, Ontario Regional Chief Isadore
Day, responsible for AFN’s national health
portfolio, says even when there is new money,
getting it out and working on the ground to
make the needed improvements to health
standards is a challenge. He says a shift within
the bureaucracy needs to happen, as the current
framework doesn’t work. It’s only created a
situation where things are in perpetual crisis,
and the best intentions often get snarled in the
system. Indigenous Affairs and Northern Development Minister Carolyn Bennett.
THE CANADIAN PRESS/Adrian Wyld
“Ultimately this is about health
transformation,“ Day says. “The current
structure is colonial, top-down paternalism and Non-Insured Health Benefits (NIHB) Program,
until Health Canada starts to become dismantled, which provides coverage to registered First
and things shift over to First Nations, we’re going Nations and recognized Inuit for a specified
to see the same phenomenon where money that range of medically necessary items and services
should be coming to communities never really that are not covered by other plans and
reaches communities.” programs. Day says it’s become quite clear there
Bellegarde agrees. “The prime minister’s is something fundamentally wrong with the
vision and the cabinet’s vision is huge, but the program.
bureaucracy is slow to change.” “We can’t tinker with it and change things,
He says new and innovative methods are de-list and re-list things and work with a broken
needed to achieve results and ensure “these process. The process right now is functioning
precious resources have meaningful impact on with a dysfunction.”
the ground.” Bellegarde says the federal government
“That’s part of the challenge,” he says. transfers billions to the provinces for healthcare,
“Sometimes you have the same old way of doing education and social services — and the same
business. It’s not enough to get new resources should happen for First Nations governments.
for your department. How are they being Transfer the money directly to them, he says,
implemented? How are they showing results? If instead of filtering it through contribution
they’re not, what can we do differently to make agreements.
sure they are?” Day points to the BC First Nations Health
Over the last few years, the AFN and the Authority — the first province-wide health
First Nations and Inuit Health Branch of Health authority of its kind in Canada — as an example
Canada have been part of a joint review of the to follow. Established in 2013, it assumed the
14 IPOLITICS MAGAZINE JUNE 2017FIXING A BROKEN SYSTEM TO CURE WHAT AILS FIRST NATIONS
programs, services and responsibilities formerly key part of his role.
handled by Health Canada’s First Nations Inuit “This is a huge issue and I don’t think
Health Branch-Pacific Region. That sees the Canadians get it — but when they do, they do
authority handle the planning, management, get behind the issue. I need them to say these
service delivery and funding of health programs, are important things to do deal with.”
in partnership with First Nations communities There is no shortage of heartache in tackling
in the province. the work at hand. Bellegarde admits at times
“It’s a model that’s working. It’s seeing a it’s overwhelming, particularly on days when
much greater penetration of solutions and a there’s been another life lost in a fire, another
ground-up approach to looking at traditional suicide or another fentanyl overdose.
health systems, community-based health “But then as a leader you have to provide
prevention models,” Day says. “It represents the the hope that things are going to get better, that
shift that is needed.” there’s an alternative and a better way. That’s
Bellegarde says that shift will be some time what I keep trying to provide. And to get that
in arriving. In the meantime, he’ll continue to pride back into our communities,” he says.
go from department to department, making the “I’ve always said, we’re First Nations people
ministerial rounds ahead of each federal budget being treated like second class citizens living
to lobby and ensure investments are being made in Third World conditions. That’s just not
in First Nations’ priorities. acceptable in 2017. Our people deserve what
He also sees the education of Canadians on everyone else deserves — a happy life.”
the problems of First Nations social services as a
What does the world need in
medicine that it doesn’t have
today?
Let’s see what’s in the lab.
CNL has decades of experience in developing and producing
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IPOLITICS MAGAZINE JUNE 2017 15HEALTH DISCORD:
OTTAWA’S CHRONIC HEALTH POLICY AILMENT
BY KYLE DUGGAN WITH FILES FROM BEATRICE BRITNEFF
With inter-provincial health funding activity” and improvements –
but that the collective deals are a
deals finally inked, is Canadian “relatively small down payment on
a much bigger problem.”
healthcare on the mend? University of Toronto health
P
policy professor Dr. David Naylor
atrick Fafard, an associate said he thinks the federal-provincial
professor at the University of wrangling was handled “adroitly”
Ottawa and a member of the by Ottawa. The results were
school’s Centre for Health “pragmatic” and created “good
Law, Policy and Ethics, said the baseline” funding levels to start
good news is provincial coffers will provinces off on “rethinking how
incrementally get more cash to play we do business.”
with when it comes to setting up their “But at some point we have to
healthcare budgets. But he added that wake up and get on with serious
it would be a mistake to overestimate health reform in this country – or
the impact of the individual deals else our system will continue to lose
when looking at the budget crunches, ground,” he said.
given the health spending pressures “We still have a system that has
provinces find themselves contending Patrick Fafard. Photo: University of Ottawa. an architecture from the 1960s with
with in the face of issues like Canada’s a few 1990s elements grafted onto
“The effect of a federal cash
aging population. it. It’s going to be very hard for us
contribution, by the time it works its
to really unlock value in the system
way through the system, is modest,”
to deal with an aging population
he said.
and to appropriately accommodate
“There are just too many people
some of the new technologies unless
making too many decisions for
we change the way we organize and
you to look at cause and effect, but
fund care.”
where you might notice it is on
John Church, an associate
mental health, where provinces
professor in political science at
will be required to be reasonably
P.E.I. Premier Wade MacLauchlan with Yukon University of Alberta, said that so far,
Premier Sandy Silver (left), NWT Premier Bob transparent.”
McLeod (second from right) and provincial health
the year of hashing out agreements
In other words, if you’re in
and finance ministers. has been helpful to governments
THE CANADIAN PRESS/Adrian Wyld the mental health sector, Fafard
and the political optics of funding
said you can expect “incremental
16 IPOLITICS MAGAZINE JUNE 2017HEALTH DISCORD: OTTAWA’S CHRONIC HEALTH POLICY AILMENT
healthcare in Canada. That’s despite the other things we try to do in the as their new party leader. The
the fact the provinces walked away healthcare system will not make a Quebec MP had campaigned to end
from an offer of $11 billion over ten lot of difference.” health transfers to the provinces all
years in December while trying to Ake Blomqvist, an adjunct together. Bernier as leader likely
boost the Canada Health Transfer professor of economics at Carleton would have launched 2019 into
escalator. University and health policy an election focused on Canadian
He said while the results of the scholar at the C.D. Howe Institute, healthcare and federal revenue
final bilateral accords are good thinks the new accord is more like sharing in the loudest way possible.
for home care and mental health a symptom of Canadian federalism It’s a debate Blomqvist would have
funding, problems will remain than a cure – only enabling federal welcomed.
for some time with coordinating politicians to claim federal support Andrew Scheer’s surprise win
and integrating services outside of for mental health and home care - a vote of confidence on where
funding. the party currently stands on most
“This is just the latest things - for the moment indicates
manifestation of what I consider the Conservatives will carry on the
our somewhat dysfunctional Harper government’s torch when it
system of divided jurisdiction over comes to healthcare funding policy.
health policy between the two It’s too early to tell how exactly
levels of government,” he said. Trudeau’s accord will stack up
“I frankly don’t think that the against Paul Martin’s 2004 accord
incremental impact of the emphasis – which was notable for falling far
from the federal government on short of its goals and leading Canada
mental health and home care to spend a good deal of money
is going to lead to a significant on doctors and nurses without
change relative to what would have alleviating systemic pressures.
happened, even if responsibility A key question is whether
for healthcare financing had been Trudeau’s Liberals, which purport
completely provincial.” a ‘deliverology’ mantra across
John Church. Photo: University of Alberta.
All of that said, Canada, seems the government, can translate its
to have just narrowly avoided performance management goals
hospitals and institutional settings. heading down a nation-wide debate across broad intergovernmental
“Provinces and territories are on completely rethinking health agreements where Ottawa will
still facing the same issues they were funding allocations. actually rely on the provinces for
a decade ago: increasing healthcare At the end of May, the the ‘delivery’ part.
costs and decreasing revenue Conservatives veered incredibly Time will tell.
sources. That hasn’t changed,” close to electing Maxime Bernier Canada’s premiers will meet
Church said. “It doesn’t matter at the Council of the Federation
what the federal government does, in early August, and Fafard said it
those two dynamics are not going should then become clear whether
away.” Ottawa has an agenda for more
Unfortunately, he doesn’t intergovernmental activity on
think there is any magic bullet for the health file – and whether the
healthcare. current government will decide
“One of the key ways to fix the between now and the next election
system is to get good integrated if it has finished its job in healthcare
comprehensive primary care and and is now on to other things.
have good access to that. As long as
we do not have that in place, a lot of Ake Blomqvist
IPOLITICS MAGAZINE JUNE 2017 17HOW SAFE ARE YOUR
HEALTH RECORDS?
BY ANN MACAULAY
It turns out they can be a “I think part of that is because the security
tends to be so weak in hospitals and healthcare
hacker’s dream come true settings,” says former Ontario privacy
commissioner Ann Cavoukian, who is now the
C
executive director of Ryerson University’s Privacy
yber criminals are increasingly targeting
and Big Data Institute.
healthcare records as a relatively easy way
This weakness means that unauthorized
to make money. Since personal healthcare
programs can easily be downloaded to a hospital’s
information is extremely sensitive,
criminals using malware and ransomware have
realized just how vulnerable and lucrative it can be.
Chock full of valuable information, including
names, birth dates, medical histories, health card
numbers and home addresses, healthcare data
can be sold on the black market for a premium.
And as individuals, criminal organizations
and state-sponsored hackers develop more
sophisticated methods of attack, those records
have become more exposed to risk. A 2016 study
by the Brookings Institution in Washington, D.C.
found that nearly a quarter of all data breaches
occur in the healthcare industry.
Unfortunately, online records are particularly
Ontario’s Privacy Commissioner Ann Cavoukian.
vulnerable to attack. THE CANADIAN PRESS/Colin Perkel
18 IPOLITICS MAGAZINE JUNE 2017computer system, creating an environment that
makes it easier for hackers to make phishing
attempts, she says.
Ensuring that healthcare practitioners have
widespread access to records opens the potential
for unauthorized parties to also gain access to it.
“The ease with which that can be perpetrated
increases when there’s little control on what
is introduced to the systems and the network,”
Cavoukian adds.
Data protection firm Bitglass published its
2017 Healthcare Data Breach Report in May,
which revealed that 2016 was a bad year for data
breaches in the American healthcare industry.
“Records of approximately 16.6 million
Americans were exposed as a result of hacks, lost
or stolen devices, unauthorized disclosure and
more,” according to the firm, which noted the five
largest breaches resulted from hacking and IT
Joan Roch. Photo: Canada Health Infoway.
incidents.
“[T]o put it in perspective, 80 percent of leaked computers in a ransomware attack that struck
records in 2016 were the result of hacking.” countries around the world. Software dubbed
Just last month, hackers employed malicious “WannaCry” exploited a Microsoft Windows
software to target hundreds of thousands of vulnerability, allowing hackers to take control
IPOLITICS MAGAZINE JUNE 2017 19HOW SAFE ARE YOUR HEALTH RECORDS?
of computers, encrypt their contents and make digital health solutions across Canada.
them inaccessible. Computer users found a The organization’s chief privacy strategist,
pop-up message demanding a ransom of $300 Joan Roch, says that “two big reasons that hackers
in Bitcoin in order for them to access their target healthcare records are because they can be
computers again. used for identity theft and health system fraud.
The WannaCry cyberattack hit the U.K.’s There’s a lot of value associated with the records
National Health Service (NHS) especially hard, so [hackers are] going to focus their efforts on
locking staff members out of their computers things that will bring them value.”
and making patient records, appointment She’s heard anecdotally of situations
schedules, phones and emails inaccessible. involving health fraud in which “people in the
The fallout included cancelled surgeries and United States get ahold of your health number,
appointments and the diversion of ambulances, come up to Canada and get services under your
putting patients’ lives at risk. health card number.”
Canada was largely spared the worst of
the attack, but it did affect Lakeridge Health in
Oshawa, Ont. to a minor extent. The virus was
found in Lakeridge’s system, but fortunately
anti-virus software caught it before it could
affect medical records. Lakeridge released a
statement the day after the attack, saying that it
had caused “unexpected computer downtime at
our hospitals.”
The statement added: “Our antivirus systems
apparently disabled the virus, which was not
able to seriously impact our network. No health
information was compromised and we did not
lose any data. Most importantly, patient care was
unaffected. It continues to be business as usual
at our hospitals.”
This wasn’t the first time ransomware has
threatened a hospital’s computer system. Several
facilities were targeted in 2016, including Norfolk Mary Jane Dykeman
Photo by Patrick Fordham.
General Hospital in Simcoe, Ont., which became
host to TeslaCrypt, spreading malware to visitors For all of these reasons, those in healthcare
of its site. settings have protecting data “very high on their
The Ottawa Hospital was also subjected to a watch list. And their awareness and concern has
cyberattack last year in which four of its 9,800 been increasing over the past few years.”
computers faced a hacker attack after someone Despite the apparent ease with which cyber
at the hospital activated it by clicking on a link. criminals can break into computer systems,
Perhaps the most successful breach as of Roch believes the benefits of electronic records
late also happened in 2016, when a hacker took far outweigh using paper records.
over Hollywood Presbyterian Medical Center’s “The value of electronic systems to the
computer systems and received a $17,000 Canadian public can’t be understated. It provides
ransom in Bitcoin. greater access to the health information, speed
of service for the individual, and you start to see
IDENTITY THEFT AND FRAUD changes in approaches to care, which are very
Established in 2001, Canada Health
important.”
Infoway works with partners to accelerate the
While some people believe there’d be fewer
development, adoption and effective use of
20 IPOLITICS MAGAZINE JUNE 2017HOW SAFE ARE YOUR HEALTH RECORDS?
breaches if the shift to electronic records hadn’t the vest,” Dykeman says.
happened, it’s really hard to say. With paper “And once it is out there, it can have an
records, “we wouldn’t know about someone impact on housing, on relationships and on
who’s breaching your information and we do employment. It’s very difficult to pull it back
know that that occurs.” when that happens.”
Roch points to the fact that in the past, people As an example, she points to someone’s
would steal celebrities’ healthcare records mental health information being exposed to a
directly from doctors’ offices and sell those to potential employer.
tabloid newspapers. But now there’s an electronic “As much as we’ve made a lot of progress,
fingerprint when someone accesses information. certain information in the hands of some
Whenever anyone touches a healthcare record, employers may all of a sudden lead to
“there’s a notation in the system that that record discrimination.”
was touched.”
HUMAN ERROR
ALTERING DATA? The ease with which someone can
Yet another issue that could arise from having accidentally make a far-reaching breach is very
healthcare information stolen is that hackers real, says Dykeman. She advises her healthcare
could potentially alter the data. clients to tell staff not to talk about private issues
Although Cavoukian hasn’t heard of it in public places, such as elevators, and to make
happening, a prankster or someone wanting sure they use the screensaver function to avoid
to target a specific individual could potentially prying eyes.
cause a great deal of harm. “These days, anything Email has made sending information
is possible,” she says. extremely easy, but that also makes it easy to
Inaccurate health data that appears to be make a mistake, such as inadvertently sending
accurate in a person’s files could impact the an attachment with sensitive information.
delivery of their health services. If that were “With the stroke of a hand you could write in
to happen, “that to me would be the worst ‘info@’, thinking you’re trying to reach your own
consequence.” help desk and end up sending it to another help
Cavoukian says it’s incredibly important that desk at a bank.”
a person’s healthcare data remain totally accurate One of the challenges with ransomware is
and untainted, since any changes -- particularly the fact that it is spread by someone clicking on
when healthcare providers aren’t aware of the a link from an unknown source. Quite often, that
fact it’s been compromised -- could “wreak havoc link is in an email that looks as if it’s coming from
in terms of their treatment and care” and have someone who is known to the recipient.
significant ramifications for a person’s health Dykeman reminds her own staff not to click
and well being. on suspicious links. Unfortunately, statistics show
that even among those who’ve had training, a
WAKE-UP CALL good many people will still click on something
The WannaCry cyberattack should serve as
that looks interesting.
both “a cautionary tale and a wake-up call,” says
Cavoukian says the main message people
Mary Jane Dykeman, a lawyer with DDO Health
should take away from the WannaCry attack
Law in Toronto.
was that everyone has to get really serious about
She advises healthcare clients on a broad
security. A strong base of security is needed for
range of health law matters and in the wake of
privacy to exist.
the attack, says she has no doubt people will be
“Try to secure the data as much as possible,
emboldened to do it again.
not just in terms of the perimeter, having a moat
Healthcare is certainly not the only area
around your operations, but also from insiders,” she
where there have been breaches, “but people do
says. “You’ve got to take a Fort Knox position.”
hold their healthcare information very close to
IPOLITICS MAGAZINE JUNE 2017 21MAJOR
A
report that reviewed the state of
fundamental science research in
INVESTMENTS
Canada and called for major renewed
investments in the field came too late for
the 2017 federal budget – but the chair of the blue-
NEEDED IN
ribbon panel that wrote it says there’s still a lot the
Liberal government can do before the next budget
to begin rectifying the many problems plaguing
FUNDAMENTAL
Canadian researchers.
The panel’s report, Canada’s Fundamental
RESEARCH
Science Review, is often referred to as the “Naylor
report” after chair Dr. David Naylor. Released in
April, it made a plea for a $1.3 billion boost in federal
SCIENCE
funding for science programs over four years. It
also provided numerous recommendations for
how to overhaul what the nine-member advisory
IF CANADA
panel concluded was a “weakly coordinated and
inconsistently evaluated” research system that
lacks “consistent oversight.”
WANTS TO GET Naylor, a Canadian physician, researcher and
former president of the University of Toronto,
ITS GAME BACK
said he hopes to see the federal government begin
that overhaul this year and start laying down the
structural groundwork for “major” investments in
BY BEATRICE BRITNEFF Photo: Immunology and Microbiology PHD student Feras Al-Ghazawi.
THE CANADIAN PRESS/Sean Kilpatrick.
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