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As your Member of Parliament, I will work to...
I have heard from so many of you how important health care is – ensuring that you have access to the right care, at the right time. In fact, health care ranks among the top three issues that Canadians are concerned about in this election. We are particularly concerned with addressing the critical need for mental health services, the shortage of qualified health care providers, and above all else, access to universal pharmacare. As your Independent Member of Parliament, I represent the specific interests of our riding at the national level, including on Healthcare. Moving forward, my priority will be to work across party lines to finally make universal pharmacare a reality.
It is important to remember that while health care is a provincial jurisdiction and delivered at the provincial level, the federal government has a key role to play and sets the direction and national priorities for programs that are delivered by the provinces. Health care delivery is bound by the principles of the Canada Health Act, namely the principles of public administration, comprehensiveness, universality, portability, and accessibility. These five principles aim to ensure all Canadians have access to the same quality of publicly available health care regardless of where they live in Canada.
It is also important to remember that health care is one of the top fives areas of expense at the federal level, with over $36 billion in health care transfers to the provinces, and significantly more investment at the provincial level. Provinces are allocated funding by the federal government according to the Canada Health Transfer which provides the federal government with an opportunity to tie funding to key health care issues of national importance, and in accordance with the Canada Health Act. This is a key mechanism for the federal government to direct health care spending. In August 2017 under the lead of my colleague, the Honourable Jane Philpott, and fellow Independent, the federal government and the provinces came to an agreement on the Common Statement of Principles on Shared Health Priorities. This new Health Accord provides direction to the provinces on health priorities, including improvements to access to mental health and addiction services, improving access to home and community care, indigenous health, performance measurement, and ongoing collaboration.
In this post I share some of my thoughts on universal pharmacare, mental heath services, the need for more qualified health care providers and, finally, the opioid crisis.
While as Canadians we are fortunate to have access to some of the best health care in the world through our acute care hospitals and primary care physicians in the community, we fail when it comes to prescription drugs. We fail to ensure those same Canadians have access to critical medications outside of a hospital admission. We are, in fact, the only high-income country with universal healthcare that does not also have universal pharmacare. This is not right. Universal pharmacare makes fiscal as well as social sense. Recent research suggests investment of $1 billion in a universal pharmacare program would save the country over $8 billion in associated costs. We are in dire need of a universal pharmacare system aligned with the principles of the Canada Health Act.
In 2018 the federal government convened an advisory council to look into universal pharmacare. In June of this year, the Hoskins Report was released: A Prescription for Canada: Achieving Pharmacare for All: Final Report of the Advisory Council on the Implementation of National Pharmacare. The advisory council was made up of a diverse coalition representing health care providers, non-profit organizations, workers, seniors, patients and academics. The Hoskins Report lays out a plan for a national pharmacare program which would meet the needs of Canadians. The experts envision a system of pharmacare that functions in harmony with the principles of the Canada Health Act. As such it would be governed by the following principles:
Universal first dollar coverage for all residents of Canada: First dollar coverage ensures that all costs for eligible medications are paid by the National Pharmacare program.
Comprehensive coverage for medications on a national formulary: A national formulary provides clear direction on covered medications, and allows cost containment through bulk procurement.
Accessibility to ensure access to necessary medications without financial barriers: Many Canadians struggle with financial barriers associated with necessary medications.
Portability of coverage for those travelling or moving within Canada: Aligned with the Canada Health Act, Canadians must have coverage from coast to coast to coast, regardless of where they choose to live or travel.
Public, single-payer administration with bulk procurement to maximize buying power: Purchasing medications listed on a national formulary in bulk allows increased buying power to reduce overall costs for health care delivery.
As an Independent Member of Parliament, I would support Parliament implementing this plan. To make this plan work the federal government would need to commit to substantial and sustainable funding. Provinces would also need to collaborate in the development of the national formulary. This work could also quite logically be integrated with Health Canada’s current efforts on drug safety and effectiveness, as well as ongoing work to ensure value for money.
Mental Health Services
Those of us living in Vancouver are acutely aware of the mental health and addictions crises facing the region. A recent report from the Canadian Mental Health Association (CMHA), Mental Health in the Balance, reveals that more than half of Canadians consider depression, anxiety, and addiction to be epidemic in Canada. While we have benefitted from a universal health care system in Canada for over 50 years, we have not always addressed mental health concerns with the same attention as physical health concerns. This has prompted calls for more robust access to mental health services – both in hospital and in the community. Mental health services have also been chronically underfunded, yet the majority of Canadians believe mental health services should be funded at the same rate as physical health services. I support the CMHA priorities for addressing the disparity in health care services for physical and mental health:
Publicly Funding Evidence-Based Therapies: Government investment in mental health care must support those therapies which have documented effectiveness, and to promote research to establish effectiveness for new and promising therapies.
Improving the Quality of Care through a Continuum of Integrated Services: Integrated services promote health care by ensuring patients and care providers are working towards a common goal. This is key to improving the quality of mental health care.
Investments in promotion, prevention, and early intervention: All too often, we address challenges in health after they occur. We need to invest in promotion of good mental health, programs which are effective in prevention, and early intervention, which has been documented to reduce associated health care costs.
Addressing stigma and discrimination and ensuring equitable access: Many Canadians continue to face stigma and discrimination associated with mental health concerns. Addressing these, and ensuring equitable access to services means more people with access to more services, resulting in better mental health for all.
Research mental illness and evaluate health outcomes: It is critical that we prioritize research into the root causes of mental illness, evidence to support effective treatments, and evaluate health outcomes associated with mental health treatment in Canada.
To address the disparity requires a sustained and integrated inter-sectoral approach across all levels of government. As your Independent Member of Parliament, I will be uniquely positioned to work across party lines and ministries to support the implementation of an evidence-informed strategy for improving the mental health of all Canadians.
More Qualified Health Care Providers
British Columbia is facing unprecedented shortages in health care providers including nurses, physicians, and allied health services. We feel these issues acutely in Vancouver Granville, with four key hospitals in our riding: Vancouver General Hospital – the largest tertiary care facility in the province, and one of the largest hospitals in Canada; GF Strong Rehabilitation Centre – the largest rehabilitation centre in British Columbia; BC Women’s Hospital and Health Centre – the only facility in western Canada which is solely committed to the health and wellbeing of women, newborns, and families; and, BC Children’s Hospital – the provincial tertiary care centre for children and adolescents.
In addition to the hospitals, Vancouver Granville is also home to over 100,000 residents who each need access to quality and timely primary health care services in the community, including access to family physicians, home care, and allied health services. Addressing the shortage of qualified health care providers to meet the needs of Vancouver Granville is a complex issue, and not one which can be addressed in isolation within our riding. At the federal level, we have opportunities to address this in several ways:
Investment in education to address the shortage of skilled workers: British Columbia is facing shortages in nearly every health profession – nurses, physicians, occupational and physical therapists, and mental health professionals. There is an urgent need for investment in educational programs to train more qualified health professionals to fill these gaps.
Addressing systematic challenges in our communities to reduce staffing shortages: Ensuring enough qualified staff to provide health care services means ensuring those staff are able to live in the communities they serve. Systematic issue such as lack of affordable housing and the need for efficient public transit have an impact on the recruitment and retention of these much needed professionals. The high cost of living in Vancouver, in particular, has made it difficult for professionals, especially young professionals, to stay in the area and work when they have completed their education. Addressing these key issues is part of a multi-faceted approach to ensuring we have availability of skilled staff to provide necessary health care services. You can read more about my thoughts on the related issue of affordable housing here.
Working with the provinces to promote primary health care team based approaches: The current model of delivery of a single care provider with a single reimbursement is not meeting the needs of our citizens, and does not effectively use health care dollars. Primary care team based models provide more comprehensive care that is suited to a patient’s need, and has been used successfully in many jurisdictions throughout Canada. In fact, a recent study suggests the majority of the physicians working in BC would prefer a team-based approach with an alternative compensation model to the one we have today. This requires sustained advocacy at the provincial level, with support from the federal government in terms of setting direction.
Ensuring foreign trained health care professionals are able to work in Canada: Canada has a robust immigration system, however falls short on ensuring newcomers to Canada, particularly those trained as health care professionals outside of the country, are able to work in their chosen professions. Bureaucratic processes and red tape make it difficult for these highly skilled individuals to offer their services to Canadians. In BC in particular, a shortage of residency spaces for foreign trained physicians contributes to difficulty integrating these individuals into much needed positions. As your Independent Member of Parliament, I can work with the Federal government to provide leadership on this issue by promoting programs which bridge these newcomers, and ensure they are able to provide the same quality of service Canadians expect from their health care providers.
The Opioid Crisis
One of the saddest and most troubling realities of our present society has been the unconscionable number of people who are dying from tainted illicit drug supply. Our City and our county are in a state of emergency. Commonly referred to as the “opioid crisis”, nationally the number of people who have died from tainted illicit drug supply is well over 9,000. In our City alone over 3,600 people have died since 2016, and in 2018 we averaged a death a day. You can track the current weekly rate here. While these deaths are typically reported as overdoses, the truth is, is that people are not overdosing at all, they are being poisoned. The drugs they are taking are being tainted with Fentanyl, a cheap and synthetic opioid, as well as other substances that are even harder to detect. The crisis affects people from all walks of life and regardless of whether they use regularly or occasionally.
The travesty is that the vast majority of these deaths are preventable with good public policy. While all levels of government are trying to do something about this emergency, there is more we can do. There is more Ottawa can do. There is more we can all do as a caring and compassionate society. For its part, Ottawa needs to, in partnership with the Province and the City, increase access to safer drugs. Ultimately I believe this means decriminalization. While I know this is politically unpopular for some, it is nevertheless the just and right public policy choice. For more on decriminalization please read the BC Provincial Health Officers Report, Stopping the Harm: Decriminalization of People Using Drugs in BC which clearly and convincingly lays out the public policy case.
When Dr. Philpott and I were in Cabinet we did try to advance the discussion on decriminalization. In fact, Jane and I travelled to Portugal to study their approach and the positive experience they have had with decriminalization. Unfortunately but there was little political appetite from the center.
As your Independent Member of Parliament for Vancouver Granville, I would continue to raise the issue of decriminalization with like-minded parliamentarians and across party lines, so that we can have a renewed and educated conversation, which hopefully leads to action. This conversation would be consistent with more evidence-based strategies, such as reinstating harm reduction as a pillar of the national drug strategy, and building on progressive legislation that has already been enacted, namely the Cannabis Act and the Good Samaritan Drug Overdose Act.