4.7 Healthier people – healthier health care

Governments keep telling Canadians how they are going to “fix” the health care system. Yet many problems are actually getting worse, including longer wait-lists for diagnosis and surgery, over-crowded emergency rooms, and increasing shortages of family doctors.

The state of our health is getting worse, too. One in five Canadian children have asthma. Almost half of us face cancer at some time in our lives. There is an epidemic of obesity in adults and children. Close to one million Canadians have been diagnosed with Multiple Chemical Sensitivities. Skyrocketing pharmacare costs have now eclipsed all other health care expenditures. Throwing more money to the provinces, as the federal government has been doing in the last two governments, is not achieving concrete results. The 2004 First Ministers Health Accord committed $41 billion to health care system improvements, including $5.5 billion over 10 years to reduce wait times. Benchmarks were established in December 2005 in five key health care areas that have been prone to longer waiting times.

Experts tell us that spending more money does not necessarily produce better results. Economies of scale can be achieved through creating centralized wait lists, moving from a paper system to electronic technology to share information, addressing the staffing shortage and in some cases, the facility and equipment shortages. These steps can help in reducing wait times, but the truth is that Canada does not have enough doctors, nurses, radiologists and other health care providers. Short-sighted, government cut back on the training of doctors in the 1990s and failed to help fast-track the certification of foreign-trained doctors and nurses. Now Canada ranks among the lowest of 30 Organization for Economic Cooperation and Development (OECD) countries in the ratio of doctors and acute care beds per thousand people. In some parts of Canada, 60 % of people have no family doctor. It is a matter of training more doctors and ensuring better allocation of doctors − more family doctors, fewer specialists, and channeling more doctors into working in rural areas.

We have also focused on treating acute health problems after they arise, and failed to place sufficient priority on preventing illness in the first place. We have also failed to provide adequate services for mental health, especially for the young. Services to assist young people and others with addiction issues are also woefully inadequate.

Greens subscribe to the World Health Organization’s definition of health as “a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity.” Our present health care system addresses only one dimension – the treatment of disease and/or trauma by qualified professionals in publicly-funded medical facilities.

We believe we can solve health care problems, including excessive wait times for surgeries, within our public health care system, as is being done successfully in Alberta with that province’s hip and knee replacement program, and as is being done in many parts of Europe.

The Greens fully support the Canada Health Act (CHA) and all of its principles. We oppose any level of privatized, for-profit health care. The five criteria of the CHA guiding the provincial public health insurance plans, which we believe to be non-negotiable, are:

  1. Public Administration – The public health insurance plan must be managed in a public, not-for-profit fashion.
  2. Comprehensiveness – All residents must be covered for “medically necessary” health services.
  3. Universality – All residents must be covered by the public insurance plan on uniform terms and conditions.
  4. Portability – All residents must be covered by their public plan, wherever they are treated in Canada.
  5. Accessibility – All residents must have access to insured health care services on uniform terms and conditions without direct or indirect financial charges, or discrimination based on age, health status or financial circumstances.

The threat of a NAFTA challenge from the American for-profit health care industry cannot be over-estimated. Allowing for-profit health care would be the “thin end of the wedge” that jeopardizes our entire health system. Based on the rules for “national treatment,” if Canada allows increasing numbers of for-profit facilities, we run the risk of losing our entire universal single payer system in a NAFTA challenge. We cannot take that risk. Fixing our health care system means protecting the core elements of universal single-payer health care.

We need to ensure that every Canadian has a family doctor. We should embrace the vision of “Patient-Centered Primary Care” as developed by the College of Family Physicians of Canada. The health care team, centered on the patient, includes a large number of trained professionals. We can do more to make efficient use of nurse-practitioners, to ensure nurses are well supported with other workers performing cleaning and other essential services. We need more health care professionals and we need more beds to reduce the wait times. We also need adequate funding to ensure that the support staff of cleaners is not compromised. The spread of infection within hospitals has worsened as janitorial staff have been privatized with lower wages and cut back.

In order to keep health care spending from continuing to skyrocket we must find a way to control the cost of drugs. Currently, 20% of our health care budget is spent on pharmaceuticals – and this is the area of health care in which costs are rising most quickly.

Pharmaceutical use must be more rigorously assessed on an evidence-based approach. Used as directed, it is estimated that prescription drug use leads to 150,000 deaths every year in North America. Health Canada has not performed adequately in assessing risks. Canada still lacks any requirement for mandatory reporting of side-effects from prescribed drugs. Far too often, conflict of interest in the relationship between those who advice government agencies, and even physicians who accept trips and promotions from the pharmaceutical industry can influence decisions. There are two and a half drug sales representatives for every physician in Canada.

Getting a handle on the use of prescription drugs can both save lives and cut costs.

The best way to accomplish both life-saving and cost-cutting goals is through a universal pharmacare program, a bulk drug purchasing agency, and make new drug patent protection times shorter. This national agency would follow the principles of the gold-standard for evidence based assessment of the risks and benefits of pharmaceuticals – the Therapeutics Initiative at University of British Columbia. It is critical that no conflict of interest corrupt the drug assessment process. Drugs showing a greater harmful than beneficial effect will not be part of a national Pharnacare programme. The Therapeutic Initiative approach identified Vioxx as such a drug, when Health Canada missed the risks. It is estimated that the TI assessment, and the willingness of the British Columbia Health Department to accept that advice, saved 500 lives in BC. Advice to physicians from TI saved the provincial health care system approximately $700 million/year. These kinds of savings – in lives and health care costs – must be pursued across Canada.

By bulk buying prescription drugs, based on a strong evidence-based assessment, costs will come down for the provincial delivery of health care.

As well, we used to have a successful generic drug market in Canada, but changes to the patent laws have almost wiped it out. As patents for a number of commonly prescribed drugs are set to expire in the near future, this presents a great opportunity for the government to step in and provide less expensive generic drugs. The Green Party accepts the principle advocated by the Canadian Diabetes Association that no Canadian should spend more than 3% of his or her total after tax earnings on necessary prescribed medications and other treatments.

Greens understand that health is about more than “health care.” We are in the midst of a cancer epidemic, and no one is willing to speak of it out loud. Hundreds of chemicals used in our everyday life carry risks of increased cancer, infertility, learning disabilities and other intellectual impairment, and damage to the immune system. There are less-toxic substitutes for these products, but industry lobbies to maintain their registration and legal use drown out the voices of concerned health professionals and families concerned about health.

As noted above in the toxics section, the Green Party of Canada will act to remove from use those chemicals known to have a significant risk of human cancer, immunosuppression, endocrine disruption, neurotoxicity and/or mutagenicity. The substances will be regulated within CEPA to restrict use and registration with the goal of reducing and/or eliminating exposure to vulnerable groups within society (pregnant women, the unborn, children, the sick, the poor and the elderly). In addition, emissions of these substances will be subject to a Toxic Tax, offset by reductions elsewhere in the tax system.

We will clean-up toxic waste sites over a multi-year period, with a priority on those communities most at risk. The Green Party of Canada will not rely on “risk management.” A Green government will operate to reduce and manage hazard, not delaying action based on discredited modeling designed to protect chemicals, not people.

Green Party MPs will:

  • Eliminate Two-Tier Health care
    • Identify and measure the extent of two-tier health care in Canada and strive for the elimination of two-tier health care as quickly as economically possible.
    • Extend the national Health Accord.
    • Use the full force of federal spending power under the Canada Health Act to oppose any steps that open the way to further two-tier health care in Canada.
  • Improve Our Existing Acute Care System
    • Address the cost crisis that produces long waitlists by providing more money to hire staff to open currently closed beds, fully utilize existing operating rooms in hospitals and purchase new diagnostic equipment.
    • Provide funds immediately to begin training more doctors and nurses.
    • Work with the Canadian Medical Association (CMA) to immediately establish qualification standards and on-the-job mentorship programs to fast-track certification of foreign trained health care professionals.
    • Provide student loan forgiveness incentives for graduating doctors, nurses, paramedics and other health care professionals who agree to staff rural facilities and family practice clinics where recruitment is currently a problem.
    • Provide funds to expand provincial health insurance to cover proven alternative therapies that are less expensive and invasive such as chiropractic, massage, acupuncture.
    • Improve access to midwifery services across Canada.
    • Focus resources on recovery beds to move patients to community-centreed, lower cost recovery and post-op beds, relying on a decreased patient to nurse ratio, freeing up beds for those needing surgeries.
  • Improve Our EXISTING Chronic Care System
    • Enshrine a policy that seniors’ care must be provided in the communities where they or their families live.
    • Expand home support and home care programs and assisted-living services to support people with chronic care needs, including the many seniors who wish to stay in their own homes and communities.
    • Transfer funds to provinces to build and open more long-term care beds.
    • Educate Canadians about end-of-life issues; increase funding for palliative care hospices in hospitals and our communities; enact “living-will” legislation that guarantees people the right to limit or refuse medical intervention and treatment so people can make the choice of dying with dignity (see Section 4.4 Seniors).
  • Reduce the Costs of Pharmacare
    • Advocate for immediate action on the 2004 Standing Committee on Health recommendation that Health Canada enforce the current prohibition of all industry-sponsored advertisements on prescription drugs to the public to help reduce the demand for unnecessary proscription drugs.
    • Initiate a public inquiry into the rising costs and over-prescription of drugs.
    • Require reporting of side-effects requiring a doctor visit or hospitalization due to prescribed drug use.
    • Establish, in cooperation with the provinces, a new crown corporation to bulk purchase and dispense prescription drugs, based on a rigorous evidence-based model, and to study the feasibility of establishing a national pharmacare program that ensures that effective pharmaceuticals are available to all Canadians who need them.
  • Solve the Medical Isotope Crisis
    The use of medical isotopes in the diagnosis of cancer helps patients receive the treatment they need more quickly than with the use of other diagnostic tools. Medical isotopes are also used, to a lesser degree, to treat cancer. Canada has, in the past, been responsible for producing 1/3rd of the world’s medical isotopes, using the research reactor at Chalk River. The Chalk River nuclear reactor now is 52 years old and has been shut down on numerous occasions since 2007, due to leaks of radioactive water. It resumed operations in the summer of 2010, but is scheduled permanently shut down in 2016. The Green Party remains opposed to the use of nuclear reactors; however we also recognize the benefits that medical isotopes provide to cancer patients.
    The Chalk River facility uses highly-enriched weapons-grade uranium to generate medical isotopes. For years, Canada has imported approximately 20 kg of bomb-grade uranium from the U.S. annually, to make isotopes; 97% of it remains unused. These leftovers, which are now in quantities large enough to create several Hiroshima-sized bombs, are stored at commercial sites. The risk of terrorist activity in order to obtain this radioactive material for the proliferation of nuclear weapons is significant.
    International research has demonstrated that isotopes can be produced without a nuclear reactor/reaction. Both particle accelerators and cyclotrons successfully produce medical isotopes; however further assessment is required in order to determine their economic feasibility. Greens will support funding research into these revolutionary alternative technologies, the primary goal of which will be to ensure that Canadians have access to a safe and effective source of medical isotopes.
  • Achieve Better Health through Prevention
    • Remove from use those chemicals known to pose a significant risk to human health. (See Part 3: Preserving and Restoring the Environment.)
    • Ban all advertisements for tobacco products, and once legalized ensure no advertising is permitted for marijuana products.
    • Increase funding to tobacco awareness programs and marijuana-use prevention programs and set a goal for a smoke-free Canada.
    • Increase taxes on products known to be deleterious or potentially deleterious to peoples’ health (see Section 1.15 Agriculture and Food).
    • Move to extend medically required and preventive dental care to the current list of treatments covered by Medicare. Due to costs of this measure, this is a multi-year goal.
    • Provide more information to Canadians about healthy food choices and lifestyles.
    • Commission Health Canada to do a nationwide body burden study identifying the presence of carcinogens, neurotoxins, hormone disruptors, and the toxicity levels of Canadians.
    • Ensure clean drinking water for all Canadian communities by 2012.
    • Prohibit by law human reproductive cloning and require a Health Canada license for any organization or institution that performs genetic manipulation for commercial or scientific purposes.
  • Promote Fitness, Sport and Active Living
    • Promote a broad-based national program of active living as a prescription for better health and lower health care costs, to be delivered in partnership with provincial, municipal and non-governmental bodies to achieve the goal agreed to by all ministers responsible for physical activity across Canada of increasing physical activity by 10% over the next five years.
    • Introduce a national standard of daily, quality participation in physical activity in schools, colleges and universities to combat the epidemic of youth obesity.
    • Make a strategic investment through Health Canada of $500 million over five years to aggressively address inactivity and obesity.
    • Re-introduce a national school-based fitness-testing program.
    • Promote the “Walking School Bus,” as developed by the Toronto Atmospheric Fund, in which adult volunteers supervise neighbourhood children walking to school, thereby reducing pollution, improving fitness, and promoting community street safety.
    • Endorse and promote the Olympic Movement’s Agenda 21 for Sport, which advocates sport and recreation management practices that are sustainable, and encourages sustainable practices at all sports events and facilities.
    • Support the development of high-performance athletes both by encouraging broad-based participation in sport, and by contributing to the provision of essential facilities, coaching and medical support for high-performance athletes, as outlined in the 2003 Canadian Sport Policy.
    • Structure the spending for sports to ensure there is a practical progression of long-term financial support for sport at all levels in the sports continuum.
    • Establish a Canadian Sports Spending Accountability Act, to ensure the effective long-term use of tax dollars provided to high performance sports programs.
  • Recognize Environmental Sensitivities as a Health care Issue
    • Implement legislation that will result in increased public health protection, by reducing the quantities and variety of toxic chemicals in products, buildings, landscapes and foods, as Canadians move to using only least-toxic strategies, products and materials.
    • Promote the inclusion of environmental sensitivities in the International Statistical Classification of Diseases and Related Health Problems (ICD) that is published by the World Health Organization.
    • Earmark funding to provinces to include environmental sensitivities/multiple chemical sensitivities (MCS) in provincial health care billing codes.
    • Work with provincial and territorial governments to ensure workplace accommodations, medical accessibility and treatments, access to buildings and other public areas, social support systems, and adequate monetary assistance for people with environmental sensitivities.
  • Promote a Comprehensive Approach to Mental Health
    • Increase transfer funding for non-institutionalized mental health patients including children and youth to provide adequate community-based support and outpatient and inpatient care by mental health practitioners, including in rural Canada where lack of facilities and trained professionals is acute.
    • Support a public health initiative to reduce the use of psychoactive drugs through better rehabilitation and prevention programs, especially for children.
    • Provide increased funding for a robust comprehensive mental health strategy for all Canadians in need.
    • Require greater involvement of people dealing with personal mental health problems in research planning, policy development, program evaluation, and other decisions that affect their lives and communities.
  • Reduce Drug Addictions
    • Address drug addiction as a health problem by legalizing marijuana and focusing efforts on harm reduction, treatment and prevention.
    • Augment funding to the provinces earmarked to increase the number of detoxification facilities and treatment beds for drug and alcohol rehabilitation, establish more safe injection clinics and needle exchange programs to provide certified addicts with prescription-procured drugs in small, safe doses, and develop educational prevention programs. Ensure the creation of spaces with a non-threatening climate for young people. Young people with drug addictions should not be sharing spaces with far older people going through detoxification programs.
  • Prevent the Spread of HIV/AIDS and Better Manage Its Impacts
    • Reduce the stigma associated with having HIV. This stigma is a significant barrier to delivery of effective, non-judgmental prevention and treatment programs.
    • Put greater resources into the treatment and delivery of antiretroviral therapies to HIV- positive drug users, a marginalized group in Canada, which is currently receiving third-world levels of medical support.
    • Put greater resources into harm reduction, prevention and education efforts directed towards high-risk populations.
    • Eliminate bureaucratic barriers of misunderstanding and prejudice for HIV-positive foreigners who wish to visit Canada.
    • Be a world leader in providing low-cost AIDS medicines and medical services for HIV- positive people in third-world countries, especially the most impacted countries of Africa.
  • Combat Fetal Alcohol Syndrome
    • Take action to educate the public about the underpublicized but widespread problem of fetal alcohol syndrome
    • Develop and fund a program to greatly reduce the entirely preventable occurrence of fetal alcohol syndrome.
  • Sexual Abuse Survivors Support
    • Advocate for the rights of male and female sex abuse survivors and for adequate federal funding for research, for public education, on judicial remedies, and for social service organizations that provide support for survivors.