Dian Cohen

By Dian Cohen

Local Journalism Initiative

Canadians, including those living in Quebec, seem united in their desire for independence, sovereignty, and viability. There is so much we can do to advance this goal without constantly looking over our shoulders at the looming threat of American repression.

One improvement isn’t immediately apparent in the list of barriers to free trade within Canada: making our healthcare system more responsive. This means giving doctors more freedom to see patients while ensuring faster and easier access to healthcare professionals.

During the pandemic, all provinces expanded reimbursement for virtual care and removed administrative barriers. Before COVID-19, fewer than 3 percent of outpatient visits were virtual, but at the peak of the crisis, that number exceeded 70 percent. Feedback from patients was overwhelmingly positive: 79 percent wanted access to their personal health information, 77 percent desired electronic prescription renewals, 75 percent wanted the ability to book appointments online, and 86 percent felt more informed about their health as a result of accessing their health information electronically.

In 2021, Health Canada advocated for virtual care to become “a permanent, equitable, and fully integrated part of our healthcare system.” The Canadian Institute for Advanced Research (CIFAR) was working towards making Canada a world leader in artificial intelligence (AI) and ensuring the success of digitization. In June 2024, the government introduced Bill 72 to ensure that core digital health assets—such as patient records, diagnostic imaging, lab results, and prescribing systems—are interoperable and universally accessible nationwide. In December 2024, then-Health Minister Mark Miller urged Parliament to pass Bill 72, stating, “Just one example [of connected care] allowing AI scribes to be used in our system would create the equivalent of 1,000 new doctors in a very short period. Connected care can open up new avenues of care, and that is something this Parliament can do.”

Healthcare is under provincial jurisdiction. Passing Bill 72 at the national level would have facilitated provinces’ adoption of virtual care. However, Bill 72 did not progress through the parliamentary stages to become law before Parliament prorogued. Now that the COVID crisis has passed, many jurisdictions have reverted to pre-pandemic policies. The federal government has exacerbated this issue by failing to provide clear guidance on virtual care. The 2025 Canada Health Act (CHA) Interpretation Letter didn’t mention it, leaving it unclear whether virtual services fall within the insured basket of what the CHA regards as “medically necessary services.”

Addressing this gap is crucial because not having connected care is a barrier not just to interprovincial trade but also to our good health. Ensuring that healthcare is interoperable, accessible, and ready for AI-driven improvements is vital to better healthcare access. Canada already lags behind other countries in its adoption of new technology. Skepticism about its usefulness is equivalent to negligence.

A 2023 Canadian Federation of Independent Business report estimated that Canadian doctors spend 49 million hours a year on administrative tasks. AI scribe technology holds the promise of removing some of that burden. Studies suggest that it can save doctors multiple hours of paperwork each week, allowing them to dedicate more time to patient care. One study, commissioned by the Ontario Medical Association, found that family physicians, who report spending an average of 19 hours per week on paperwork, spent 70 to 90 percent less time on administrative tasks when using AI scribes.

The uptake of AI scribes in Canada has been low due to concerns about privacy and cost; fewer than 10 per cent of family doctors currently use the technology. Most physicians surveyed in the Ontario study indicated they were unwilling to pay the current price for AI scribes, which typically ranges from $135 to $400 per month for unlimited use. While this price may decline with wider adoption, a quarter of respondents stated they would only consider using the technology if it were free.

In March 2025, Canada Health Infoway announced it would cover the first-year licensing fee for the first 10,000 primary care providers who sign up to implement AI script technology into their practices. Even more enticing is that providers can choose from a list of pre-qualified AI script products vetted for privacy and other concerns by Canada Health Infoway and its provincial and territorial partners.

While we claim that our healthcare system is universal, many indications suggest otherwise. It imposes unequal costs on patients in time, travel, and lost income. A 15-minute doctor’s appointment can mean half a day of lost income for some. Patients in rural and remote communities don’t just wait longer for specialists—they also face flight costs, overnight stays, and logistical headaches just to see them. Check out this out-of-pocket cost calculator from a 2020 Infoway study: https://insights.infoway-inforoute.ca/calculator.

Many participants eager to reduce interprovincial barriers are on the job and pushing hard for results. Their efforts must not get lost in the disruption and upheaval caused by the election of a new government and Parliament.

Cohendian560@gmail.com

By Dian Cohen

Local Journalism Initiative

I’ve been passionate about estate planning and financial wellness for over fifty years, and I want to share some thoughts that might be helpful for those who are retired or getting ready to retire.

It’s tax time. Whether you do your tax return or have someone do it for you, it’s important to know how your retirement income is taxed and what tax perks are available to seniors. Not knowing this can make it tough to figure out how much money you have for living expenses.

Table 1 shows the major ‘pots’ from which retirement income comes and how they are taxed:

Table 2 shows the major federal tax perks — make sure to check if there are any provincial-level tax credits or tax deductions for seniors. For example, for Quebecers aged 70 and over, there’s a Senior Assistance Tax Credit which offers up to a maximum of $4,000 for eligible couples and $2,000 for individuals.

Just because you need to withdraw money from a tax shelter does not mean you have to spend it. If you don’t need the funds for your living expenses, consider investing them in a taxable, non-registered account. If you’re one of the lucky ones who can do this, this is good. Consider this: if you retire at 65 and live until 95, you’ll need 30 years of annual income, which could nearly match the income you earned during your working career. People are living longer, and the odds are good that at least one spouse, if not both, will live into his or her 90s.

It’s a good time to think about protecting yourself against “longevity risk” – the risk of outliving your money. Aside from investing in the stock market, an advanced life deferred annuity (ALDA) can help address this problem. This annuity can be purchased from a life insurance company and the income payments can be deferred to any age up to 85. Because the guaranteed payments are deferred, this type of annuity is cheaper than other annuities.

Another area of concern has been brought to my attention. It has to do with the internet. Older people can be more susceptible to scams. Maybe it’s because we grew up before the internet and tend to be more trusting, or perhaps we aren’t as aware of the latest digital scams. Whatever the reason, it’s important to know what to watch out for.

If you get a phone call, email, or text from someone claiming to be with the income tax department—whether it’s the CRA or Revenu Quebec—just hang up or delete the message without clicking anything. Legitimate agencies know how to reach out to you properly – and this is not it!

Never, ever, click on or open an email from someone you don’t know, and never, ever, download anything from a website you’ve been directed to. Never click on a pop-up window or open an attachment sent by someone you don’t know. One wrong click could expose all your computer files to a scammer.

Just recently, a news story highlighted a man who Googled “best GIC rates” and then received an email from what appeared to be a legitimate financial institution offering him a 6 percent return. Despite never having worked with them before and knowing that the typical rate was 3 to 3.5 percent, he transferred $750,000 from his trusted bank to what turned out to be a scam. Tragically, he lost all that money. If you are doing financial stuff online, consider doing it with a friend or family member. It’s always better to be safe than sorry.

Cohendian560@gmail.com

Courtesy www.easterntownships.org

By Dian Cohen

Local Journalism Initiative

Those of us who live in Quebec’s Eastern Townships (aka Estrie) know how good it can be. We have a selection of universities and colleges to feed our brains and sufficient internet connections to improve ourselves without leaving home. We have one of the best research and teaching hospitals anywhere, several other regional hospitals we should try not to go to and many local health clinics we should work hard to expand. We have a regional airport. Two innovation zones and five poles of excellence provide (relatively) strong economic and business development. We can enjoy an observatory and the first international dark sky reserve for star-gazing. And of course the natural beauty of four national parks and a global reputation for year-round outdoor activities serves us all well.

The Institute for Socioeconomic Research and Information (IRIS) wants life here to be even better. IRIS is a 20-year-old, independent non-profit founded to analyze Quebec’s public policies with a view to creating a better life. The Institute recently turned its attention to the Townships. (IRIS: Revenu Viable En Estrie 2024). There’s an amazing difference in the amount of money it takes to live modestly in each of our nine municipal regions (MRCs). The researchers suggest that life could be infinitely more affordable for many of the half-million people who call Estrie home if only a few missing services could be provided. The big question is whether their prescription is possible.

The study looked at three types of households — a single person living alone, a single parent with one pre-school child and a two-parent family with two preschool-aged children. Drawing from both Statistics Canada and Institut de la statistique du Québec, it paints a detailed portrait of life here. In general, Estrie looks much like the rest of Quebec. Except that we’re growing faster because more people are choosing to live here – especially in the municipalities of Saint-Denis-de-Brompton (MRC du Val-Saint-François), Waterville (MRC de Coaticook), Bromont (MRC de Brome-Missisquoi) and Roxton Pond (MRC de La Haute-Yamaska).

We have a stronger manufacturing sector (16.6 percent) than in the rest of Quebec (10.1 percent.) We’re older than Quebec as a whole: while every fifth Quebecer is 65 years old or more, in the Townships, one in four belongs to this age group.

In a city like Bromont, the high concentration of wealthy households pushes up prices for all categories of expenses, including a basket of quality food.  A single person needs more than $50,000/year to live there.  A household of two adults and two preschool-age children needs nearly $95,000. These amounts are considerably higher than for a single person in Granby ($33,490) or for a family of four in Lac-Mégantic ($71,044). It’s therefore not surprising that relatively few poor people live in Bromont.

In the majority of MRCs, the supply of childcare services, particularly subsidized childcare, doesn’t meet the demand. Even in the two MRCs where supply is slightly higher than demand (Granit and La Haute-Yamaska), there’s a significant lack of places. In other words, to find an available facility, families sometimes have to travel quite far from where they live. Unless there is reliable public transportation, these families need access to a car.

Public transit exists in each MRC, but with the exception of Sherbrooke, it’s intermittent and unreliable. For rural villages, it’s rare to find a shuttle service to bigger towns that have services. La Haute-Yamaska and Coaticook MRCs stand out by the high proportion of their populations who work in their locality. In contrast, the majority of residents in Val-Saint-François and Haut-Saint-François commute outside their local MRC. These are also the MRCs with the fewest people able to get to their jobs in less than 30 minutes. The situation is better for workers in Granit and La Haute-Yamaska Granit and La Haute-Yamaska, where the vast majority have a shorter commute. Sherbrooke stands out for its ability to retain workers on its territory.

That said, there are wide variations within each MRC. In many villages and towns, the absence of local shops, health clinics (dental, medical, etc.) and cultural venues requires travel to varying distances.

All MRCs have public and adapted public and paratransit services. In most cases, you need to book your trip a day in advance. While the service is punctual and predictable, it does not, for example, allow for emergencies such as a child becoming ill at the day-care center while the parent is at work. This not ideal for a single-parent family.

The study suggests than if a public transit network could be established and all families who wanted it could obtain a quality and affordable childcare place near their home, single-parent families as well as households of two adults and two children in Granby, or even in Cowansville, could consider a life without a car, thus making living more comfortable on a modest income.

Considering the times in which we live – namely the unsettling and often terrifying demands coming from the president of the United States — we can be appreciative that the researchers at IRIS have produced such an interesting portrait of our home region. As for their suggestions for more taxpayer-funded childcare spaces and public transit, it’s possible that more childcare spaces could be created some time in the future – perhaps after the federal and provincial debts have been paid down a bit. It’s unlikely that affordable public transportation can be established in a land area where the population density is only 31 souls/km² — minimal density at least 10 times this number is necessary.

For now, let’s give ourselves a little pat on the back and savour our good fortune to be living in this particularly well-endowed and relatively peaceful corner of the world.

Cohendian560@gmail.com

By Dian Cohen

Local Journalism Initiative

In hindsight, the first Trump presidency playbook is easy to read: Step #1: Gut punch. Step #2: Waiting for your response.

The 2.0 playbook is shaping up. The threat of tariffs directed at us is not a one-off. Trump is nothing if not an equal-opportunity bully. Trump’s 2.0 Day 1 to-do list is long, but Canada has to respond to only a few of the directives. Unless our opinion is sought, we have nothing to do with rolling back protection of transgender students from discrimination, reshaping the US federal government by firing thousands of employees, halting wind projects, rolling back targets that encourage the switch to electric cars, or abolishing standards for companies to become more environmentally friendly. Nor do we have to consider options for ending the Ukraine-Russia war, firing Jack Smith, the special counsel who prosecuted federal cases against him, starting the mass deportation of illegal migrants, pardoning people who were arrested during the riot at the Capitol on Jan. 6, 2021 or dealing with Hamas.

All these are on the Day 1 list, and while some can be accomplished immediately by executive order, others need the approval of Congress and still others will take months and years for the Trump administration to put the apparatus in place to accomplish the task.

Our Prime Minister is, as of this date, paying mucho attention to the stuff that’s important to our economic wellbeing, namely, tariffs, national security, trade, fossil fuels and the US dollar. These are also on the Day 1 list, which is why the president-elect is starting early, before he’s officially president. He’s busy and expecting to be busier.

That being said, let’s look at the issues in no particular order. They’re all of long-standing importance to the president-elect and all interconnected.

1. He wants the US to be self-sufficient in energy — as a climate change skeptic, Trump sees greater value in the US’s as-yet-unexploited fossil fuels than in the transition to cleaner energy. Canada can help in several ways. First, we can point out that as a time-honored trade partner, the vast amount of oil and gas we religiously send to the US each year is almost as good as made in the USA. We can point out that because of the vast amount of electricity we send to America – mainly New England, New York, the Midwestern states, and the Pacific Northwest — not only will Americans not freeze in the dark, but it’s also clean energy. We can either offer to help develop fossil fuels via pipelines or something else or offer our views on climate change and the need to transition.
2. Trump sees trade not as a mutually beneficial exchange but as a zero-sum game — a “win” for the US means a loss for others. If others benefit, it must come at the expense of the US. Hence a trade deficit is a bad thing. Canada is way down the list of countries the US owes. China, the ten southeast Asian states that make up Asean, and Mexico are at the top of the list. Canada’s job is to keep this perspective in view along with the fact that what we export to the US is for the most part totally integrated into American refining and manufacturing facilities. Hence it can be truly said that when Canada exports petroleum and natural gas, auto parts and other components to the US, it is contributing to the protection of American jobs.
3. The president-elect wants the US dollar to remain the strongest currency in the world and the world’s reserve currency. The US dollar has held this primacy since before World War II and is in no danger of losing it. The BRICS alliance (Brazil, Russia, India, China, South Africa, Iran, Egypt, Ethiopia, and the United Arab Emirates) angered Trump by saying it’s fed up with America’s dominance of the global financial system. Hence the tariff threat against them. Canada’s role is to reiterate that our trade with the United States is settled in US dollars and that there is zero possibility the Canadian dollar will ever be a threat.
4. If the US agrees to be in an alliance, Trump expects everyone to pay their fair share of the cost. Trump is not a fan of alliances, preferring to go it alone. He wants to deal with the few alliances the US is in: trade alliances like CUSMA (the Canada-US-Mexico trade agreement or as the US prefers USMCA); defence alliances of which NATO is the most prominent. Besides these, the US and Canada have several national security agreements, which include defense, immigration, and law enforcement. The North American Aerospace Defense Command (NORAD) provides for aerospace warning, aerospace control and maritime warning for all of North America. The Safe Third Country Agreement is to manage refugee access at the Canada–US land border; cross-border crime agreements are to exchange information on immigration and visa applicants and to work together to counter crime.

Tariff threats against us are linked specifically to these agreements. Canada has to come clean where it has fumbled the ball. We need to present a plan which closes the gap between where we are and where we should be. For NATO, that means getting to 2-3 percent of GDP asap. For NORAD it means stepping up our presence in the Arctic – China and Russia are already there. For the other agreements, it means demonstrating that Canadian border security has already been stepped up in response to the growing numbers of illegal migrants and drugs crossing the border, while acknowledging that border security needs tightening and more coordination with US Border Control.

For the president-in-waiting, threatening or activating tariffs will bring any of the above issues into sharp focus of a trading partner. Whether threatening or activating, the nature of the relationship will change, with the partner either changing behavior or losing more than the US. Team Canada is now fleshing out the nitty-gritty of policy possibilities that will placate the head of the world’s most powerful nation, a nation that has leverage over virtually every other and a president with little compunction about using it. That’s all we need to know about Trump 2.0. That and a sentiment the President-elect expressed in a Time magazine interview last April: He said he made a crucial mistake in his first term: he was too nice. “I don’t think I’ll do that again…” 

Cohendian560@gmail.com

Courtesy of Dian Cohen

By Dian Cohen

Local Journalism Initiative

This little item appeared in the newspapers I submitted to back in 1973. Most women didn’t work outside the home, and with the average salary being around $10,000/year, this was pretty off-the-wall revolutionary.

And maybe subversive. After all, women weren’t meant to work in the real world  — being a woman meant being passive, kind, nurturing, helpful and caring – everything required for rearing children, pacifying husbands and keeping a clean and welcoming home. The women’s lib referred to in that long ago piece was in its second wave in Canada, having benefitted from the women who transformed the idea of women as natural caregivers into women holding public office to care for and civilize society. That was happening just around the time I was born. Hail to the Persons Five.  

Of course, the more masculine characteristics of problem-solving with brute force made women who went into the workforce acceptable — by 1944, more than a million women worked full-time in Canada’s paid labour force. Many women expressed the view that after the war, they should be trained or retrained for jobs on the same basis as men and that household workers should receive labor benefits like unemployment insurance. Not to be. Five years after the war ended, more than half a million women were back at home.

The same equity suggestions were raised decades later in the 1970 Royal Commission on the Status of Women. It was not as widely promoted as a stunningly bold advertising campaign that touted smoking as the key to female empowerment, independence, confidence and liberation. To this day, a lot more of us know the phrase “you’ve come a long way, baby” than what was accomplished by the Royal Commission. (Women couldn’t open a bank account, get a credit card or a mortgage without a male co-signer. The Royal Commission made this illegal.)

Women’s rights legislation has continued onward and upward – the Canadian Human Rights Charter, Canadian Charter of Rights and Freedoms, Employment Equity Act, Public Sector Equitable Compensation Act, Pay Equity Act. They undoubtedly helped — in the ‘70s, about 3 million women were in the workforce and the pay gap was close to 40 percent.   Today, there are 10 million women in the paid workforce, still a participation rate that is less than men, and now earning, on average, 12 percent less than men.

To understand why the gap remains, we need go no further than Harvard professor Claudia Goldin. She’s now 77 and has spent her whole working life filling in the data gaps and misconceptions about women in the work force – for which she received the Nobel Prize in economics last year.  Canadian data is not as detailed but supports Goldin’s conclusions. Here’s what we now know: back in the day, the wage gap can be explained through differences in education and occupational choices – since women were expected to stay at home, they didn’t get as much education, and those that did paid work did it in ‘domestic’ professions like looking after children or housecleaning, which were lower-paying jobs.

More recently, women in general are more educated than men. The pay differences between men and women in the same profession have more to do with lifestyle choices. The wage gap widens after the birth of the first child. Women still do most of the unpaid caregiving so they still take more time off from work. Their career path has gaps and they make less. Interestingly, while mothers make less than non-mothers because they work less, fathers make more than non-fathers over the course of their careers.

Couples make these choices together. Employers pay a premium now for people who will be on call 24/7. Many couples find it makes sense for fathers to respond to the needs of paid work and mothers to answer to the needs of kids. Goldin says, “Why can’t dual-career families share the joys and duties of parenting equally? They could, but if they did, they would be leaving money on the table, often quite a lot. The 50-50 couple might be happier but would be poorer.” (A small, aside: now that men get paternity leave, a study out of Spain provides evidence that while women take “maternity leave full-time and immediately after childbirth, men split their leave entitlement into several periods that are spread out during the first year of the child’s life, with a significant spike in the summer months… We find that a disproportionate number of men were on paternity leave during the exact dates of the 2022 soccer World Cup, relative to the surrounding dates.” Do men really do more caregiving?)

Were I to write the article today, I would note that the shape of paid work is changing – remote and online work play to women’s strengths. Otherwise, not much is different. Unpaid housewives still work about 15 hours a day – about 100 hours a week. Their tasks have expanded beyond what I could think of 50 years ago: Salary.com lists chief financial officer, chief operating officer, logistics analyst, housekeeper, laundry manager, van driver, public school teacher, facilities manager, event planner, kitchen manager, assistant athletics director, staff nurse, bookkeeper, physical therapy supervisor, nutrition director, consumer loan officer, fast food cook, server, conflicts manager, interior designer, fundraising coordinator. According to several different surveys, the value of this unpaid work has risen to around $190,000/year.

Cohendian560@gmail.com

By Dian Cohen

Local Journalism Initiative

While there’s not much we can do to fix the overall healthcare system, there are ways to use the system we have to our best advantage. One way is to know what our health professionals are saying about the state of our health so that we can be part of the team trying to improve it and the quality of our lives. We can do that by accessing our personal health information and medical records – we’ve had the legal right to do so since 2004.

There are two streams of information in Quebec. One is Quebec’s Health Booklet. It’s an online service that lists the medications you get from the pharmacy, your lab test results, medical imaging reports, medical services you’ve received that are paid on a fee-for-service basis, health workers who’ve consulted your health information. It also allows you to make an appointment in family medicine online using the Québec Medical Appointment Scheduler or register with the Québec Family Doctor Finder (GAMF). It’s all in one place and it’s free.

The second stream is your health professionals’ notes. Your always-curious reporter has had experience requesting health records in Ontario, and like most Canadians, has found the process both frustrating and confusing. You’re given paper photocopies of documents in the file. They’re difficult to  understand as they’re written in medical jargon and barely intelligible shorthand.

A quick review of Statistics Canada findings on the subject shows that just over 50 per cent of Canadians reported accessing electronic health information in 2023; 27 per cent were unaware of the existence of such records, and the rest were uninterested or uncomfortable and so never asked.

On Sept. 22, 2024, Quebec added a new phase to its Law 25, that says, among other things, that, at the applicant’s request, computerized personal information must be communicated in the form of a written and intelligible transcript. Your reporter has been running late following up in Quebec; this provided a perfect opportunity to evaluate the provincial system.

To register for your Québec Health Booklet, the only eligibility criteria are having a health insurance (RAMQ) card and being 14 years of age or over.

The first step is to be computer-literate – this is an online service. Next, you have to prove that you’re you — the Government Authentication Service. This is a new service “that will gradually replace clicSÉQUR for authentication to online government services,” according to the website. Opening an account and verifying who you are gives you access to everything you may have to do officially with the government — SAAQclic – Société de l’assurance automobile du Québec online service; Québec certification service for early childhood educators; registration for Public Prescription Drug Insurance Plan; replacement of a RAMQ card if it is damaged, lost or stolen; making your consent to organ and tissue donation official; issuing your directives in case of incapacity; and of course the Québec Health Booklet.

There are more eligibility criteria to authenticate yourself to the government. To open an account you must be over 14, have a social insurance number (SIN), a RAMQ card and ensure that your Quebec-issued identity cards (RAMQ card and driver’s licence) show the same first and last names. Your reporter immediately ran into trouble — driver’s licence has the married surname but the RAMQ card has the maiden name. This situation arises because Quebec’s digital platforms don’t talk to one another. If they did, they would know from other identity markers that the person holding both cards was one and the same. Until this is corrected by your disgruntled reporter going in person to a Service Outlet with other identifiers like a passport, birth certificate, marriage certificate, she is locked out of the system. A big red flag for newcomers to Quebec – make sure the names on your driver’s licence and your health insurance card are the same! And understand that as of 1981, RAMQ for your health insurance card insists on the maiden name, but SAAQ for your driver’s licence doesn’t.

Fortunately a friend became a surrogate – he opened an account without a snag and was able to access his Québec Health Booklet. He reviewed the prescription drugs he takes and the lab tests he’s had and thought the Booklet was complete. A couple of things to add: When you go into the Québec Family Doctor Finder, the first thing you see is that as of April 2024, you will be registering for a nurse-practitioner. The site tells you that it’s not possible to say how long you’ll be on the waiting list.

Bludgeoned but unbowed, your reporter moved on to accessing her files from her local healthcare provider. This doesn’t seem to be difficult. You ask. They print out your file, charge you a small amount for the paper and you’re on your way. Asked why the doctor’s/nurse’s notes can’t be emailed, the answer is concern about security. This is but one of many local healthcare providers. All of them operate in more or less the same manner. The difference between them and other aspects of our lives is striking: we live in the age of email, e-banking and e-commerce. We can not only access, but also manage our private banking, insurance, purchasing and investing online from anywhere. Securely. Why isn’t access to our health information as convenient and secure as it is in banking or buying? Because no one has put in the effort – they’re so far back in the dark ages that the digital systems can’t even speak to each other. 

Patient access to information is valuable. It helps us manage our own health. It saves the system money! Our money! Almost half the people surveyed by Canada Health Infoway said that having their health information saved them from having to see a doctor at least once. “The return on investment is significant when we can avoid wasted patient and physician time when a visit isn’t necessary,” says Canada Health Infoway.

What we have is way better than nothing. But we need to keep pushing to ensure that different platforms can talk to each other and then to us. In confidence. We should be able to access to our health information whenever we want and from wherever we connect.

Cohendian560@gmail.com

By Dian Cohen

Local Journalism Initiative

The gentle souls who so astutely peruse this august publication excluded, we are an unenlightened lot that, when it comes to electricity, exhibit a stunning amount of internal conflict.

Electricity is so everywhere all the time that we think about it only when it’s not. And when it’s not, life is really tough. If the power goes out in summer, we can’t have air-conditioning. If it goes out in winter, we can’t have heat. Not to mention light. Or in the country, water. In the space of a hundred years give or take, we’ve gone from zero to total dependence. (How many candles, whale oil or kerosene lamps, ice and iceboxes, wood- or coal-burning stoves do you keep on hand for light, heat and refrigeration?)

We are among the largest electricity consumers in the world – maybe it’s because it’s cold here. Or maybe it’s because we have a huge global advantage – our water resources and our technological resourcefulness have created hydroelectric powerhouses around the country – Quebec alone produces more than half our domestic electricity, BC’s facilities notch it up to two-thirds. These developed natural resources allow us to produce mostly clean energy in sufficient quantities that we can export about 10 per cent of what we produce. And we have a ready taker right next door.

There’s a huge demand for electricity and it’s growing at its fastest rate in years. Leaving aside developing economies like India and China, the increasing uptake of technologies that run on electricity – electric vehicles, a charging system for them, heat pumps and the data centres that teach artificial intelligences – are on course to set new demand records.

Canada’s gearing up for a lollapalooza future, right? Well, sort of.

Clean and relatively cheap electricity is made from manipulating water – Quebec does this most. Less environmentally-friendly electricity is made from fossil fuels (coal, natural gas, and petroleum) of which the western provinces have a lot. More expensive electricity comes from nuclear and renewable energy (on- and offshore wind, solar panels). We make electricity using all these methods and we argue a lot about how bad it is to use less-than-pristine-but-plentiful fossil fuels.   

Our ace in the hole is our water – we’re one of the top five countries in the world with the most renewable fresh water. Here’s the double-edged sword. Unless we live on a reserve, whom the powers-that-be have despicably neglected, we’ve taken it for granted – we’ve failed to look after its infrastructure (think Calgary water main rupture), we haven’t priced it properly, we waste it.  

Not only don’t we have a water conservation ethic, but we’re also oblivious to the dimensions of a world with less of it. Scientists at Environment Canada say that in the past four decades, snowfall in both Canada and the United States has dropped by about 4.6 billion tonnes per year. That’s a lot of lost water. According to a 2019 report commissioned by Environment and Climate Change Canada, temperatures in the country are increasing faster, on average, than the rest of the globe. With hotter summers and less snowfall in winter, water reservoirs aren’t filling up the way they used to. Without water, we can’t make cheap, clean electricity. Overall, exports to the US fell nearly 25 per cent last year, to the lowest level since 2016.  Quebec, BC and Manitoba all reported less hydro production; the latter two reported more power imports from the US.

Less water may not be forever, but greater variability from Mother Nature seems assured. Water inflow variability is actually well understood in the hydropower industry – specialists have many ways to capture what’s available. It’s less clear that we have any interest in conserving water for purposes such as drinking, bathing and other somewhat civilized endeavors.

We don’t respect our natural resource bounty but we’re ingenious at exploiting it. Along with hydroelectric power, renewable energy sources such as solar, wind, and biomass are practically infinite. We’re in the world’s top-10 in onshore wind capacity, even though it produces only a small fraction of our electricity. The idea of placing turbines at sea to harness wind energy over open water has come to Newfoundland and Labrador – it hopes to have offshore wind areas leased by 2025 and has the federal government’s blessing to proceed with approvals in provincial waters. Unconstrained by hills or cities, offshore winds tend to be stronger and more consistent than onshore ones, able to produce three times the power of their onshore facilities.

We can do solar too, although solar energy’s potential varies across the country. Not so good on the coasts lower because of increased cloud cover, much better in the central areas. Solar panels on the roofs of these sunny residential homes could possibly supply half of Canada’s home energy demands. Notwithstanding the dozens of residential solar incentive programs currently available across the country, we’ve hamstrung ourselves with an equal number of legislative, regulatory, and infrastructure hurdles that prevent these installations.

As for storing electricity, Canada is #1 among 30 countries that were assessed for their potential to build a secure, reliable, and sustainable lithium-ion battery supply chain. “This [2024] marks the first time China has not claimed the number one position. Canada’s consistent manufacturing and production advances, and strong ESG credentials, have helped it become a leader in forming the battery supply chains of the future. Strong integration with the US automotive sector means Canada is also a big winner of the ‘friendshoring’ ambitions of the Inflation Reduction Act. The country’s position in BNEF’s ranking is propelled by policy commitment at both the provincial and federal level,” says a Bloomberg entity that specializes in energy.

Who’da thunk it? Where would we be if we pulled together?

Cohendian560@gmail.com

Your Personal Carbon Calculator? Photo: Mastercard

By Dian Cohen

Local Journalism Initiative

We’ve been hearing for years now that the big challenge is to limit global warming to below 1.5C above the pre-industrial era. Now comes word from the European Union’s Copernicus Climate Change Service that June was the hottest ever, the 13th consecutive time a month has set a new average temperature record. The average for the year through June 2024 was 1.64C higher than the era from 1850 to 1900. This suggests that, if we don’t want to spontaneously go up in flames, we will have to work our tails off to achieve the emissions targets to which Canada has agreed.

How we get motivated to do that is the challenge. Most of us are broadly aware that a flight from Montreal or Toronto to Rome or Riyadh makes a lot of CO₂ emissions. COVID provided concrete proof that less flying reduces CO₂ emissions – they went down more than 5 per cent in just the first few months of COVID. But we have no real idea what difference it makes to the environment if we recycle our plastics, or if we go out for a nice steak dinner, or if we buy a brand-new outfit in a high-end retail store.

The fact is that the vast majority of global greenhouse gas emissions are generated from our lifestyle choices. Industry and regulators are unlikely to solve the climate crisis — most emissions are directly connected to consumer demand. So if we’re going reach our global decarbonization targets, we have to change our habits, and it would help if we could know how much our individual actions count.

There may be a way to do just that, although email conversations with the creators leave some doubt. A Sustainable Consumption Index has been developed by Mastercard and Doconomy, a Swedish fintech company. Here’s how they say it works. Mastercard takes its total debit transactions (it makes them anonymous) and categorizes them into spending categories – food, transportation, retail, etc. Then it adjusts for inflation so comparison with past years is possible. Doconomy has created an index of estimated CO₂  emissions for each of the spending transactions. The index can create interactive simulations of the impact of a population-wide shift to low-carbon consumption. For example, it can answer the question, “what’s the impact of everyone using a carpool or public transit, or eating less meat, or buying more second-hand ‘vintage’ goods compared to current emission levels from driving a car, eating lots of steak and burgers or buying new retail goods?”

Does it work? That’s as yet unknown. Sweden was motivated to try it out apparently because they already knew that individual Swedes need to reduce their emissions fivefold by 2050 to meet that country’s climate change commitments. So they took it on: the two companies created the index starting in Q1 2021, using Swedish data. The quantitative measure of Sweden’s aggregate consumer carbon footprint was launched publicly this past June.  So far, one example of the consumption index shows that emissions resulting from spending on air travel and fuel are not declining as fast as those on retail spending. It also shows that there’s been a 2 per cent reduction in national emissions from Q1 2023 to Q1 2024.

Maybe this new measurement tool could be a step forward in the battle for a cooler planet. Up to now, we’ve been working in hindsight, looking at what has happened in the past to inform our decisions going forward. The Doconomy index purports to be forward looking, reaching people before they back out of the driveway, book their cabs, buy their T-shirts or fire up the barbeque. The Swedish Environmental Protection Agency says the simulation models can be used by manufacturers, advertisers and policy-makers to encourage Swedes to change their buying habits toward more sustainable choices.

The two companies have also created a personal Carbon Calculator app that’s supposed to show the impact of individual users’ purchases. The idea is that if we have insight into the effect our day-to-day footprint has on the planet, we can make small adjustments resulting in real change. The Carbon Calculator allows us to view the estimated carbon footprint of all our purchases. Our footprint is tracked month by month across a variety of spending categories so we can better understand where we’re having the greatest impact.

Except of course that the index is available only in Sweden right now and it’s still not clear that a majority of Swedes are aware of it. The spokespeople for Mastercard and Docomony were most forthcoming about what they had already published in their own news releases. But then your spunky reporter asked questions like

How would Canada begin if we wanted an index like the one created for Sweden? Who would have to contract with Doconomy and Mastercard? Would it be the government? the financial community? how does that work? How much does it cost to have an index created? How long does it take? Once you were contracted, would you use earlier years of Mastercard spending to create the index? Has there been a lot of publicity in Sweden about the index and how to use it? Have you had a lot of feedback from consumers? Do any other countries have such an index?

Your waiting-with-bated-breath-reporter has been ghosted. It’s been a month since our last correspondence with either Mastercard or Doconomy.

It’s an interesting idea, and maybe the two companies will be more forthcoming. I’m still hoping for a response.

Cohendian560@gmail.com

By Dian Cohen

Local Journalism Initiative

Shortly after becoming prime minister in 2015, Justin Trudeau took Jean-Yves Duclos aside and told him to develop Canada’s first-ever national poverty reduction strategy. Thus began many months of roundtables and town halls, in person and online, via conversations and conferences, informing the then minister of Families, Children and Social Development on how to reduce poverty in this country.

Two and a half years later, “Opportunity for All – Canada’s First Poverty Reduction Strategy” was published. Its primary goal was to reduce poverty by 20 percent by 2020 and 50 percent by 2030 based on the official measure of poverty. (This article won’t deal with the secondary goals of reducing chronic homelessness by 50 percent, ending all long-term drinking water advisories on reserves by 2021 and reducing or eliminating housing need for 530,000.)

There are well over 100 benefit, credit, incentive and other programs offered up by federal, provincial and territorial governments, all designed to transfer cash to low-income Canadians to further the primary goal of reducing poverty. They are all administered, not by the department of Families, Children and Social Development but by the Canada Revenue Agency (CRA), the tax-collector-in-chief. In Canada almost all government cash benefit payments require recipients to file a tax return. Individuals who don’t participate in the tax system, often the most vulnerable in society, may forego these benefits or even entitlements to government services when such services are tied to tax return information.

For the 31 million of us who filed a personal income tax return this year, it’s a tedious but necessary pain in the ass. Tedious because the basic tax return has 172 lines and 15 different schedules to pore over before you get to “Refund or Balance Owing”. Necessary, because failing to file gets you the double whammy of draconian interest penalties to pay and missing out on possible cash transfers like the Guaranteed Income Supplement or the Canada Workers Benefit.

Do you know how many of us don’t file a return? Neither does the CRA. They think it’s between 4 and 5 million people. They also don’t know why these people don’t file, since the estimated value of cash benefits lost to working-age non-filers is at least $1.5 billion.

Leaving seniors’ benefits aside, the largest benefit is the Canada Child Benefit, which pays out over $24 billion/year to parents. As an example, a low-income family of four with two young children in Ontario is in line for about $19,000 in federal/provincial child and family benefits. Benefits are similar in other provinces. The growing financial importance of these benefits leaves eligible recipients who don’t file a tax return increasingly penalized. As important, it reduces the effectiveness of our poverty-reduction goals.

In the interests of getting potential cash benefits into the hands of low-income earners, the CRA has, for the past six years, offered an automated phone service that allows low-income Canadians to file their tax return over the phone by answering a short list of questions. The uptake has not been good, averaging only about 60,000/year. Close to half the people invited to file for free may have paid a professional to help them file. The CRA can’t say why people would choose more expensive filing methods, although to an outside observer it looks like people don’t know about file-by-phone or the benefits for which they may be eligible, or the system is just too complicated or there are other reasons.

Indeed, there’ve been sufficient academic studies that say there are lots of ‘other reasons’. Many low-income people are suspicious of government and unfavorably disposed to tax filing. Some concerns are based on ignorance, like, for example, that cash benefit entitlements administered through the tax system will be clawed back from their social assistance benefits. Or they don’t understand how tax refunds work. Or they’re scared, fearing that by filing they might invite the CRA to dig into past income sources and expose them to serious actions by government.

 In Budget 2023, the government announced its intention to increase the number of Canadians eligible for “SimpleFile by Phone” to two million by 2025, as well as to introduce a new automatic income tax filing service. Budget 2024 says the CRA will pilot a digital and paper version of its SimpleFile by Phone service intended for individuals who have gaps in their filing history or have never filed a tax return. It doesn’t say how the CRA will do that, but it does say it will provide an update in the fall of 2024.

So we really can’t say how much all this will cost – either the administrative costs to develop and deliver the file-by-phone program, or costs related to cash benefits delivered to individuals who would have otherwise not filed a tax return and would have foregone the benefits to which they were entitled. And we can’t say whether the CRA’s renewed efforts will be any more successful at convincing non-filers to file than their past efforts over the past six years.

In spite of the many billions of dollars that have been devoted to this project since 2018, the poverty level has moved from 11.2 percent in 2018 to an estimated 11.2 percent in 2024.

No doubt a lot of bad luck and real time issues – Covid 19, inflation, etc. – have intruded. Nevertheless, there’s a serious question to be asked. Is there not a better way to reach non-filers, get cash benefits into their hands and improve our track record of reducing the number of Canadians living in poverty? Other countries don’t require everyone to file a tax return and they manage to transfer money to low-income earners. Canada’s record on poverty reduction compared to other countries is not good. Is this new CRA initiative that builds on a failed old initiative the best we have?

Cohendian560@gmail.com

Photo courtesy of the National Research Council of Canada

Dian Cohen

Local Journalism Initiative

In 2001, the federal government created Sustainable Development Technology Canada (SDTC), a foundation specifically to invest in “technologies that will create economic and environmental prosperity for all Canadians.” According to the SDTC website, it “is the single-biggest investor in Canadian sustainability entrepreneurs.” Again, reading from the website, and the 2022-2023 Annual Report, 316 Canadian companies, of which 229 are still active, have been funded to the tune of $1.7 billion taxpayer dollars. (In the interests of transparency, they’re all listed on the website.)

Looks like a reasonable use of taxpayers’ dollars – a 72+ per cent success rate in environmentally and economically attuned companies in every province and every economic sector. The SDTC website says,” Every dollar SDTC has invested since 2001 has resulted in more than seven dollars in follow-on financing from the public and private sectors.”

So it is somewhat surprising to see in tiny print at the bottom of the website the following:

On June 4, 2024 the Government of Canada announced that SDTC will be transitioning to the National Research Council of Canada. The transition process is expected to take several months. In the interim, SDTC will be resuming full business operations. Please check back here for updates.

What prompted this is the Auditor General’s most recent report. According to Report #6, “Overall, we found significant lapses in STDC’s governance and stewardship of public funds… the foundation awarded funding to projects that were ineligible, conflicts of interest existed in some instances, and certain requirements in the Canada Foundation for Sustainable Development Technology Act were not met.”

The Report goes on to say that 10 projects were awarded $59 million even though they did not meet key requirements…  we found 90 cases … representing nearly $76 million awarded to projects where the foundation’s conflict-of-interest policies were not followed.”

The enabling legislation requires that SDTC have a member council of 15. The Board of Directors reduced the council to 2. The A-G laid ultimate blame at the doorstep of the Minister of Innovation, to whom SDTC reports.  No wonder Minister François-Philippe Champagne shut SDTC down – ‘transitioning’ the remaining money and all the employees (ex the executives that resigned) to the National Research Council.  

Does the National Research Council have an exemplary record for doing its job? Not so much. It has been audited by the A-G three times, in 2004, 2007 and 2016. In 2004, NRC’s governance, management of projects, management of personnel, performance measurement and reporting were inadequate. In 2007, the A-G saw improvement but was still unhappy that half the seats on the member council were vacant. The 2016 audit was specifically focussed on mitigating the effects of severe weather. “Overall, we found that the federal government had not done enough to help mitigate the anticipated impacts of severe weather events… National Research Council Canada did not incorporate climate change trends into National Building Code updates, which could impact buildings and structures for decades to come. Although federal information and tools largely met departmental mandates, they did not fully meet decision makers’ needs…”

In a related story, the Public Policy Forum newsletter reminds us that at the height of the COVID-19 pandemic, Prime Minister Justin Trudeau made a $130 million dollar funding commitment to build a vaccine plant in Montreal to churn out Canadian-made Novavax COVID-19 shots by the end of 2020.

The National Research Council partnered with a private entity to set up Biologics Manufacturing Centre (BMC) Inc. as a not-for-profit corporation. BMC was completed on NRC land in June 2021 and certified by Health Canada as compliant with its regulations in July 2022. As of today, not a single vaccine has been produced at the facility. Meanwhile, the global demand for COVID-19 vaccines is plummeting. Even more worrying for Canada’s taxpayer investment is that Novavax is far and away the least desired of the vaccines available. Taxpayers are still funding the NRC for $17 million every year to keep the plant operational with about 100 staff on site. Novavax is still expected to use the plant, but the firm has already delayed that start three times.

Minister Champagne is counting on the NRC to do better than the SDTC. In a press release he said, “As a Government of Canada organization, the NRC is subject to rigorous and stringent oversight of its personnel and finances. This structure will help rebuild public trust while increasing accountability, transparency and integrity.” 

Maybe the auditor general will get to it soon and let us know.

Meanwhile, the PM followed Ontario Premier Doug Ford in directing lots of other taxpayer funds: he handed Sanofi $50 million to help with its new vaccine manufacturing facility in Toronto and the PM handed them $20 million. It’s the largest biomanufacturing facility in Canadian history (at 200,000 square feet). It will employ 200 people and is intended to produce vaccines for whooping cough, tetanus and diphtheria for domestic and international use. Sanofi is building a second new facility in Toronto to increase production of a flu vaccine specifically formulated for people 65 years and older. It’s now scheduled to open in 2027 (a year later than originally planned when it was announced in 2021.)

Interestingly, last month Novavax and Sanofi announced an exclusive licensing agreement to commercialize COVID-19 vaccine and develop novel COVID-19-influenza combination vaccines. There’s no mention in the press release that any of these will be produced in Canada.

Cohendian560@gmail.com

Total number of COVID-19 cases reported to WHO January 5, 2020 to May 19, 2024
World 775,522,000
Canada 4,800,000
Courtesy WHO Dashboard

By Dian Cohen

Local Journalism Initiative

We humans are hard-wired to react to immediate threats. So we’ll jump if a speeding car is coming at us or an angry T-Rex is about to pounce. It’s not that we can’t plan for other less immediate threats: we can take an umbrella in the morning if it looks like rain by the end of the day. We can open a savings account that automatically gets a percentage of our paycheque. Our problem is that we aren’t good at hanging onto ideas once the threat has passed.

When the pandemic had us all spooked in 2021, when four million people had already died and were dying at the rate of 100,000 a month, all 194 member countries of the World Health Organization agreed to negotiate a global treaty that would govern their behavior ‘next time’ to make the next health emergency less deadly and disruptive than COVID-19 was.

Cut to today. The pandemic has waned – the immediate threat is gone. The whole world reported only 1,867 deaths in the 28 days ended May 19, 2024. Canada was a hotspot, reporting 30 deaths, although in a country of 40 million, it didn’t make many headlines. So maybe it’s understandable that when the World Health Assembly opened its 77^th meeting in Geneva last month, the first announcement was that there was no agreed upon global accord. The high- middle- and low-income countries of the world couldn’t agree on how to share relevant knowledge and technology nor how to produce and distribute vaccines, tests and treatments.

A look at how the market economy works provides the answer to why the global accord never happened. Pharmaceutical companies are in business to make money by developing products that solve medical problems. They can spend tens or even hundreds of millions doing so. Legislation gives them several years’ monopoly on their products so that when they’re successful, they can charge buyers enough to get their development money back and pay dividends to their shareholders and reward their executives.

When COVID was declared a pandemic, scientists all over the world shared their research, otherwise known as intellectual property, freely and urgently. That’s how safe, effective vaccines were developed so quickly. But in this case, the money to develop the vaccines came from governments around the world – estimates are that the US, UK, Germany and others publicly funded (read taxpayer-funded) tens of billions of dollars to help scientists do their work. Moderna, BioNTech and Pfizer turned out to be the winners. At the height of the pandemic, it was assumed that they would share the vaccine technology and know-how with the WHO so that vaccines could be manufactured around the world. That didn’t happen. No restrictions were put on their monopolies over pricing and distributing their vaccines.

All three companies made billions by charging multiple times the cost of production and selling almost all their vaccines to rich countries. Kim Campbell was one of many former heads of state or Nobel Prize winners imploring western governments in 2021 to lift the monopoly protection on COVID vaccines. To no avail.

That’s pretty much the whole story. The sticking points that shot down the global accord were the high income countries’ refusal to share with the low-and middle-income countries their intellectual property and manufacturing rights. The WHO has given their members another year to come to an agreement. It’s not going to happen without some consideration of how a market economy, driven by profit and protected by legislation, works.

Meanwhile, the World Assembly and its 2,000+ delegates proceeded to the week-long meeting at hand, “All for Health, Health for All.” Canada is one of 17 countries championing a resolution entitled “Economics of health for all”. The vision is captured in a 90 second info-clip:  “What if we could design an economy that would prioritize the health of all people and the planet we live on? Where … health is seen not as an additional cost or potential budget cut, but as a necessary investment for our future. A world in which health innovations are shared for the common good, so that everyone can access the health care they need and where governments have the capacity and resources to drive these changes.” In other words, to infuse capitalism with more public interest than private gain.

This resolution has passed, and with it, a mandate to the Assembly to complete a ‘how-to’ manual to transform the world’s economies and report on it at the 79^th World Health Assembly in 2026.

The info-clip ends with an inspirational, “the question is not why should we, but what’s holding us back?” The answer to that question is chronicled in our past behavior. Even with the COVID  pandemic raging, we couldn’t agree to share vaccines. Neither did we share 30 years ago when the HIV/AIDS pandemic was raging.

You be the judge of the likelihood of a pandemic accord within the year and/or agreement among all of the 194 member nations that their economy should be built around health and well-being rather than command and control, the market, or whatever else it’s built around now. Humans not only find it difficult to hang onto ideas, but we’re also fundamentally irrational — reasoning, choice, and problem solving are often overwhelmed by fallacies, illusions, biases, and other shortcomings. Vaccine hesitancy and conspiracy mentality are but two more recent illustrations. A more long-standing one related to the economy is ‘the backfire effect’. It describes how we continue to hold onto established beliefs even when faced with clear, contradictory evidence.

cohendian560@gmail.com

By Dian Cohen

Local Journalism Initiative

COVID-19 killed over 53,000 Canadians – reasons enough to put a plan in place for the next time. The appalling thing is that there were plans in place last time — plans that were neglected, outdated, ignored. The Auditor General’s Report #8 to Parliament in 2021 notes that despite nearly two decades of warnings, planning and government spending, the Public Health Agency of Canada (PHAC) was not ready for the global pandemic and did not appreciate the threat it posed in its early stages. Moreover, the PHAC failed to improve its information technology after 2003’s SARS epidemic and 2009’s H1N1 pandemic. It took some steps to develop plans and national guidance after H1N1, but, prior to the COVID-19 pandemic, the agency failed to update all of the plans or complete a test exercise with provincial and territorial governments. The 1997-established Global Public Health Intelligence Network (GPHIN) was supposed to offer alerts and risk assessments. Instead, it offered only links to news articles for its 450 domestic and 520 international subscribers. The auditor general found that no alert from the GPHIN was issued to provide early warning of the virus. Nor were there any risk assessments, data-sharing with the provinces or follow-up on Canadian travellers who were ordered into quarantine. Canada’s auditor general says, “I am discouraged that the Public Health Agency of Canada did not address long-standing issues, some of which were raised repeatedly for more than two decades…”

It has not been easy for the PHAC to own its past performance. In answer to written questions about Canada’s preparedness for the next pandemic, PHAC sent this reporter links to its Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP), the very one the A-G deemed inadequate in 2021. Originally written in 2004 and intermittently updated, the latest iteration before the pandemic was in 2018. Updates began in 2022, after the A-G’s criticisms and recommendations, but the independent review of the systems that were promised to the auditor general were not included.

Several non-government think tanks have made suggestions for ‘the next time’. Says the non-partisan public-private organization, Public Policy Forum (PPF), “No one wants a repeat of the SARS experience, in which extensive post-mortem recommendations sat on the shelf with limited action taken, leaving Canada to start almost from scratch when confronting COVID. That must not happen again.”

At this point, it looks like that is exactly what will happen again. “The pandemic laid bare a glaring absence”, PPF says. “Canada lacks an institution to connect a chain of urgent requirements and roles in the face of a health crisis… Other countries — the US, UK, European Union, Japan — are applying this lesson and creating such institutions… The unwavering goal: to address future health threats, even before the extent and impact of a specific threat is known… [In particular,] the new entity must undertake regular updates to Canada’s health security strategic plan, including public reporting on the status of the health security system.”  To date, Canada has not gone this route. The Public Health Agency does little public reporting within Canada and has not publicized its strategy or its plans going forward. The federal government has funded $575-million in “preparedness” projects in 14 research institutions. Health security experts say a more sustained investment is needed – without directly taking to task our present departments and agencies, their commentaries make it clear that our standards for health security preparedness are not up to scratch.   

Things seem little better on the international stage. Two years ago, all 194 member nations of the WHO sat down to hammer out a binding global accord for how the world might better share scarce resources and stop future viruses from spreading. That accord was to be adopted at the World Health Assembly meeting in Geneva this week. One of the first announcements out of the Assembly was that they had failed to reach consensus on how to share data and information on pathogens and, most contentiously, how to share vaccines and medicines during international health emergencies.  

The co-chairs of the negotiating team said they will continue to work toward an agreement on some sort of treaty. They didn’t pinpoint the sticking points, but insiders say it’s still a battle of rich countries versus poor. American critics worried that the agreement “is shredding intellectual property rights” and “supercharging the WHO.” Britain’s department of health said it would only agree to an accord if it was “firmly in the UK national interest and respects national sovereignty.” In answer to a question about WHO’s authority over Canada, a spokesperson for PHAC confirmed that “the WHO has no jurisdiction in Canada, and Canada will remain in control of any future domestic decisions about national restrictions or other measures related to pandemics.” Many developing countries say it’s unfair that they might be expected to provide virus samples to help develop vaccines and treatments, but then be unable to afford them. All this is reminiscent of the COVID-19 debacle that South Africa called “vaccine apartheid,” where countries had vastly unequal access to COVID vaccines and drugs.

It is not at all clear what we’ve learned from our experiences with COVID-19. It is even less clear that ‘the next time’ will not be a replay of our past history. Four years later, there are no known internal plans in the works for federal-provincial-territorial cooperation and response, and no international agreement on sharing.

The COVID-19 pandemic has changed our world in unprecedented ways –we’re still grappling with the short term implications of this and resisting the changes as much as embracing them. Assessing the longer-term implications of the pandemic and building workable policies has a finite window of opportunity: it’s open now and will stay open only until the next public health threat materializes. From the vantage point of the general public, this period is fraught with uncertainty about Canada’s overall wellbeing; many Canadians are dwelling on more immediate issues, not whether those in charge are preparing for the next health emergency. The PPF warns that “Canadians will not be forgiving — nor should they be — if the country is caught ill-prepared in the face of the next health threat.” It is to be hoped that Canadians will demand more and better, and more to the point, demand proof of it well before ‘the next time’.

Dian Cohen

Local Journalism Initiative

The scientific and medical wins that came out of the pandemic are clear – vaccine development and virtual care most prominent. Of course, they aren’t without detractors – we’ll get to them as well.

The COVID-19 vaccines were the fastest vaccines ever created. From identifying a new pathogen — the novel coronavirus formally known as SARS-CoV-2 and colloquially called COVID-19 — to discovering an immune response against it to developing and testing a safe and effective vaccine for it, all in less than 12 months. Typically, vaccine development is 5 to 10 years or more because the process is so rigorous: first find something that works, then test whether it’s safe and effective in clinical trials, then pass the regulatory approval processes, then manufacture enough doses for widespread distribution and finally roll it out to the population. Before this spectacular cooperative win, the fastest vaccine to go from development to deployment was the mumps vaccine in the 1960s — it took four years.

It’s hard to identify a public health tool that has had a more positive impact than vaccination, or one that has done more to promote health equity. Vaccination coverage for COVID-19 is high in Canada, with more than 80 per cent of the population having received at least one dose. Coverage for other preventable childhood killer viruses is high too — 77 per cent for diphtheria, whooping cough and tetanus to 92 per cent for polio and measles.

Still, a palpable downside has emerged. Before the pandemic, 70 per cent of survey respondents agreed that before children attended daycare or school, they had to be vaccinated. Now 38 per cent of respondents say vaccination should be the parent’s choice and fully 17 per cent say they are “really against” vaccinating their children. Regionally, support for mandatory vaccination is highest in Ontario and lowest in Quebec.  This anti-vaccination movement poses a threat to public health and could help trigger an outbreak of preventable diseases that were once thought to be all but eradicated in much of the developed world – for example, we have seen 29 cases of measles this year, compared to 3 cases last year.

‘Long COVID’ is another downside. More than a million Canadians are still waiting for a medical advance to provide relief for their symptoms. One in nine people who contracted COVID-19 still suffers from cognitive impairment, fatigue, shortness of breath and other ailments that affect their health and ability to pick up their lives from before the pandemic. The medical community is still working to understand it — there is no agreed-on definition of the condition or its diagnosis and few if any clinical practice guidelines.

Increased accessibility to healthcare through telehealth — predominantly by telephone, but also by video and text messaging has been a significant win.  Before the pandemic, fewer than 1 in 4 primary care doctors offered their patients online appointment scheduling or the ability to ask a medical question through a secure website. And with good reason – Canada’s healthcare system had no fee codes that allowed doctors to be paid for virtual consultations. That changed quickly. By early 2021, all Canadian jurisdictions had instituted a variety of fee codes to support virtual care. The rate of virtual consultations rose from 20 per cent to 60 per cent. Half of all Canadians reported to the Canadian Institute for Health Information (CIHI) that they had been offered a virtual visit alongside other non-virtual modes.

The benefits of virtual care are crystal clear — improved access to healthcare services anywhere, but especially for those who live in rural or remote areas.

Virtual care, however, is not without resistance and concerns. Some downsides require that healthcare providers learn to practice in different ways: they may not be able to palpate an abdomen as they do in an in-person physical exam, but they can take vital signs and listen to the heart and lungs over a virtual platform. Of course, they have to invest in the technology — only 5 per cent of physicians outside hospitals have done so. In addition, virtual consultations lack the personal touch that comes with in-person visits, so healthcare providers have to find other ways to build a relationship with their patients.

Other downsides are significant: patients who don’t have a reliable internet connection, a computer, and a camera may be excluded, raising equity concerns. Storage and sharing of personal health information raises privacy and security issues. Then there are issues surrounding private companies offering virtual care services outside of the publicly funded health care system. If you visit a doctor virtually through a commercial app, there is no continuity of care — you know neither the doctor nor the quality of his/her competency. Moreover, the information you submit in the app could be used as a promotional tool.

For whichever of these reasons, our uptake of telehealth has been significantly less than other G7 countries, and the proportion of visits that are virtual today has decreased from the days when many in-person health services were unavailable. It is not a stretch to believe that the healthcare system itself is a victim of COVID: it is in worse shape and less universal than it used to be.

When COVID-19 was scaring us all, virtual formats almost overnight became a dominant means of delivering care. With the waning of the pandemic, the “virtual first” approach was challenged in favor of delivering care the old-fashioned way — in-person. Only a few provinces have indicated that the virtual consultation fee codes in the public system are permanent. New data shows that we are still struggling to clear surgical backlogs created during the pandemic, with Canadians needing joint replacements and cancer surgeries facing some of the longest wait times. The doctor shortage is worse — health professionals who are suffering from pandemic-related burnout and/or low-grade PTSD are retiring early. New graduates are shying away from family medicine. The aging population, along with its younger relatives face fast-degrading access to and quality of healthcare.

Yet the possibilities of telemedicine and virtual care are endless. Our mindsets are simply not yet attuned to embracing the wins that accompany it. Incorporating telehealth permanently into the Canadian health sector requires a champion. The federal/provincial/territorial governments and national organizations need to embrace its positive features to relieve the strain of people without doctors going to emergency rooms. They need to agree on the principles of virtual care design, deployment and governance across all jurisdictions of the country. Without question, it would be an improvement over the system we have now.

Tomorrow, wins, losses and lessons learned four years later.

By Dian Cohen

Local Journalism Initiative

The COVID-19 pandemic has changed us. While the short-term effects have been felt and recognized by many, the long-term effects are still unknown in scope and impact. Many of us are adjusting to different ways of working, learning and socializing while hoping for a “return to normal.” In time, something will become a “new normal.”

The impact of the pandemic on work can’t be overstated. Canada experienced the largest and quickest transition to remote work ever. COVID became an “ah-ha” moment for many: do I really want to do this job? Do I really want to spend so much time traveling to work? It became the impetus for a rethink of what personal autonomy and freedom might look like. For many, it meant working from home, at least some of the time. For others, the online world of work became as much a reality as buying goods online, with independent ‘gigs’ taking the place of 9 to 5 jobs.

Before COVID, improving work-life balance was an aspirational topic for many. Scheduling conflicts, feeling stressed by the pressures of multiple roles were things many Canadians hoped to change. Almost overnight, many did. Today, more than 20 per cent of us work from home full time, down from the number that worked remotely at the beginning of the pandemic, but significantly more than the 7 per cent pre-pandemic. Those with hybrid arrangements – some office time, some home time — has more than tripled, bringing the total to one in three of us working at least some of the time at home. An overwhelming number report feeling more satisfied with their work-life arrangements. Among employees with office jobs, a staggeringly high per cent still say they would change their employment if it meant more flexibility of location and time spent at work. About 40 per cent say they’d take a pay cut if they could work fewer hours. Not all employers are convinced. A new tug-of-war between employers and employees has been created that is not yet resolved.

Data doesn’t show a meaningful reduction in pollution except during the total lockdown in early 2020. Indeed, for several months, COVID-19 brought a new source of plastic pollution in the form of single-use personal protective equipment (PPE), such as masks and gloves.

With no comprehensive emergency plan in place, public officials scrambled to protect the population. The outbreak was a medical, economic and social crisis, but Canada, like many other countries, turned to the medical community to define it. Its preferred strategy was to limit human interaction. The lockdowns invaded our personal spaces, complete with prohibitions of gatherings, masking, curfews, and fines for non-compliance. These restrictions were not normal — interaction with others is a necessity for human beings. Within weeks, groups across the country began protesting the medical solution. A key theme of the protests was anger directed toward governments and scientists. From Vancouver to Charlottetown, anti-mask, anti-lockdown and anti-public health protests formed. “Fake news” and “propaganda” became adjectives to describe public health directives. Even now, more than a year after all restrictions have been lifted, the blame game continues to divide those of us who supported the public health restrictions and those of us who challenged them. It is unclear whether the anti-vaccination movement, which now includes vaccines against many childhood killer diseases, will grow.

How we educate our kids was one of the early losers. Despite early data that suggested that not only was the virus not a serious threat to children but also that the isolation being home 24/7 was likely to harm them psychologically, school closures continued into 2022. Students received vastly different forms of schooling — some attended classes virtually, some in learning groups, some were home schooled and some got no formal learning at all. Studies conducted recently suggest that it is a matter of time before students will catch up with the reading, writing and math they lost. But evidence of psychological damage and socialization deficits is still having detrimental effects on many youngsters. These mental health issues cannot be laid squarely at the feet of COVID; we can say only that its presence made pre-COVID emerging issues worse.

At the other end of the age spectrum, the health, well‐being and quality of life of older adults has been severely affected by the pandemic. Isolation and loneliness had long been recognized as issues among people living alone or in long-term care facilities — they were amplified by newly revealed systemic healthcare gaps. Today, more community groups are involved in providing connections for older adults – helping them learn how to get online, facilitating in-person social events and so on. But many more older adults spend more time at home and less time socializing in public spaces than they did pre-pandemic. According to one study, many older folks worry about getting infected and cite more uncomfortable and hostile social dynamics as reasons to stay at home. This is not an unrealistic view of the world: this is the first time an infectious disease has pushed its way into the top five causes of death during the last 80 years or so of the antibiotic era. Older adults account for most of those deaths.

As for the in-between group, a number of studies indicate that many of us have not yet fully processed the trauma of a virus that brought the world to its knees. According to clinical psychiatrists, not acknowledging the state of high anxiety, fear and grief into which we were thrown has clear drawbacks. While not suggesting that the whole country has post-traumatic stress disorder (PTSD) they are suggesting that the strained relationships, free-floating sadness and anger so many Canadians exhibit have less to do with day-to-day frustrations and more to do with our left-over and unresolved feelings of being unable to control our lives or even protect ourselves for four long years.

Tomorrow,  scientific and medical advances.

Dian Cohen

Local Journalism Initiative

We’re still not sure what’s permanent or whether it’s ultimately going to be a win or a loss. That’s true for all institutional change, no less so because it’s been associated with a pandemic. Indeed, many economic changes have been coming for years as a result of new technologies, shifting preferences and better ways of doing things – the pandemic may just be the final push to something new and permanent. Time will tell.

What we do know is that small businesses – the backbone of the Canadian economy – were hardest hit. The number that closed up shop in 2020, especially in the arts, entertainment and recreation, was the highest in recent history. The federal government was quick to create programs such as the Canada Emergency Wage Subsidy (CEWS) and Canada Emergency Response Benefit (CERB) in an effort to support them and other parts of the economy. Perhaps that’s why business failures actually declined in 2021.

Government policies however both support and distort: business bankruptcies filed in 2023 were up 41 per cent from the year before, the sharpest increase in 36 years of records, according to the Office of the Superintendent of Bankruptcy. The rate of filing has not abated in 2024 as more businesses decide to throw in the towel. Being unable to repay the government support loans may be a factor.

Before the pandemic, in 2019, well over a million small businesses employed 13 million of the 19 million people in the work force. Despite the upheaval and devastating personal tragedies, that’s still true today – one indication of Canadians’ resilience and optimism. Yet it’s not the same. Labor force participation rates – that is, the number of persons who are employed or looking for a job as a per cent of the total working-age population have not yet regained their 2019 levels. Part of this can be attributed to a re-evaluation of meaningful work, which we’ll talk more about in tomorrow’s segment on social and lifestyle changes.

We work and do business differently. Canadian consumers were moving online to purchase goods before the pandemic – for at least a decade, Internet consumer sales were rising at a faster rate than traditional retail sales. The pandemic added rocket fuel – almost all Canadians have access to the internet and we embraced electronic commerce amid the pandemic disruption in retail channels. Growth continues as more retailers invest in digital platforms to reach consumers. There’s still a long way to go — as a share of total retail, ecommerce accounts for just 13 per cent. Time will tell whether we’ll go back to physical shopping as we used to do it, or whether a new hybrid way of shopping – an outlet to see and touch the goods to be purchased online — will become the norm.

The composition of the workforce has changed, mostly because the worst hit sectors — travel, hospitality and entertainment – employed many more women in relatively lower-paying jobs. There’s no data yet to suggest that the gender pay gap has been worsened by the pandemic, but it can’t have helped. And there’s evidence that income inequality has been growing rapidly – during the first two years of the pandemic, income and wealth gaps were shrinking, as we all struggled to find our personal financial footing. Since then, the wealthiest Canadian households, with more savings to fall back on and greater ability to benefit from higher interest rates, have pulled ahead of the poorest both in terms of their share of the country’s total wealth and in terms of how much income they have left over to spend after essentials are paid for.

Not every business suffered during the pandemic. Essential retailers – grocers, pharmacists, discount stores – experienced unbelievably high sales volume as people stockpiled or simply bought more so that they could cook more at home. Advisors in financial institutions were busier than ever advising people on everything from mortgage deferrals to protecting their savings to reviewing their credit status.

Service businesses that asked their employees to work from home pressured telecommunications companies for more high-speed internet; people who were social distancing demanded more bandwidth for watching videos, playing games and keeping in touch with friends and family. It goes without saying that healthcare workers were in great demand. So were manufacturers of everything from toilet paper to personal protective equipment.

By far the biggest surge in employment was in the public sector, undoubtedly to administer — everything. There is no data yet that this trend is being reversed now that the emergency has passed – indeed public sector employment is the biggest part of the most recent statistics on job growth.  Government spending increased by 20 per cent, almost double the advanced economy average of 11 per cent. Canada’s federal COVID spending totaled $359.7 billion, almost all of which was borrowed. It has added $8 billion to interest costs. Much of this may have been appropriate – data is just now being compiled on how much of the support may have been wasted. Regardless, the burden of repaying the debt will weigh on Canadians for years to come. It will hinder development of new social programs, make it more difficult to control inflation or enhance our standards of living. Higher taxes are likely to be in our future.

Not everything that has or is changing has been caused by the pandemic but several things have been aggravated by it. GDP growth is weak but has overcome the pandemic lows. We have avoided a recession. Inflation has fallen, but not enough to force lower interest rates. High levels of immigration and large increases in non-permanent residents have positive and negative effects: many jobs have been filled although both job vacancies and unemployment remain high. The influx of more than a million people has contributed to the housing crisis. We are not competing well globally.

These issues, as well as financial anxiety and pandemic-related stress are making Canadians feel angrier in general. In particular, younger Canadians are more anxious about their future, concerned about their mental health and more disillusioned by politicians than previous generations. While 4 in 10 of us hope for positive outcomes in 2024, there is much dissatisfaction in large swathes of the population. This will affect not just their outlook on their personal lives but the economy as well.

Tomorrow, how our social lives have changed.

Dian Cohen

Local Journalism Initiative

The World Health Organization (WHO) declared the COVID-19 virus a global pandemic on Jan. 30, 2020 and declared it no longer a public health emergency on May 5, 2023. Between the onset and now, more than 700 million people contracted the disease and 7 million people worldwide died. Canada’s experience was little different: almost 5 million contracted COVID-19 here and more than 50,000 died.

Canada, along with the other 193 member countries of the WHO have been meeting regularly to negotiate an international agreement to support pandemic prevention, preparedness, and response globally. The deadline for these negotiations is approaching – the “pandemic accord” is supposed to be delivered at the 77th World Health Assembly that begins today in Geneva and is in session for the entire week. It’s worth a look back to consider how we in Canada managed the worst pandemic in a century, how our economy and our daily lives have been impacted, what we’ve learned that will alleviate the damage of ‘the next time’.  

Today, a quick overview since early 2020. Tomorrow, a look at what the pandemic has done to and for the economy; Wednesday, how our lifestyles and the way we socialize have been impacted; Thursday, wins and losses in the medical and scientific fields. Friday we’ll try to sum up lessons learned, where we are today, how we’re preparing for the next time and the longer-term implications of our actions.

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When the “coronavirus” was declared a global pandemic at the end of January, 2020, Canada had already confirmed its first case. Discussions were both public and private – the government’s message was that the risk to Canadians was low, quarantining was not deemed necessary, it would be discriminatory to exclude travellers from China. By February, contradictory advice began to emerge: the Minister of Health Patty Hajdu recommended that citizens stockpile food and medication while the Health Canada website recommended against such bulk purchases. Theresa Tam, Chief Public Health Officer of Canada thought there was no need to wear a mask.

On March 9, 2020, two months after the declaration of a global pandemic, British Columbia’s provincial health officer Dr. Bonnie Henry announced that a man living in the Lynn Valley Care Centre in North Vancouver had become Canada’s first death. The elderly man had health problems prior to contracting COVID. The feds began to bulk up their bank accounts to deal with the outbreak – the precursor of Bill C-13, the COVID-19 Emergency Response Act – multi-billions of emergency spending legislation for research to manage solutions, for the provinces and territories, and ultimately stimulus packages for everyone affected.

Two weeks after that, on March 20, the Canadian government closed the borders for all travelers except Canadian and American citizens and ordered Canadians to restrict their movements. Lockdowns became the order of the day. The border closure led to a million Canadians returning to Canada – masking was minimal and not officially recommended. There were no temperature checks at airports. Hand sanitizer dispensers had not been installed. There was no system in place to monitor 14-day self-isolation and not everyone knew they were supposed to do it.

Statistics Canada reported the country’s economy lost nearly two million jobs during the first full month of the lockdown, catapulting the unemployment rate to 13 per cent. The annual inflation rate turned negative as the economy came to a standstill. Stocks plummeted, yet Shopify became Canada’s most valuable company — its share price more than doubling as brick-and-mortar retailers were forced to close and consumers turned to online alternatives.

April was a cruel month for the feds to crack down on social distancing and quarantining. The RCMP had the power to enforce the Quarantine Act of 2005 (put in place after the SARs epidemic). Penalties for violations included fines of up to $750,000 and imprisonment for six months. By April it was also known that the vast majority of deaths in the country were connected with long-term care and seniors’ homes. By May, the death toll from COVID-19 passed 5,000 and the country’s overall caseload rose to 70,000. Flaws in the long-term care system were so egregious that more than 1,000 members of Canada’s military — including most of its medical personnel — were deployed to long-term care homes in Quebec and Ontario.

Although thousands of schools had been shut in February, by week 10, Quebec reopened elementary schools and daycares outside the Montreal area while Newfoundland and Labrador’s schools remained closed. Amid anti-lockdown protests, BC, Ontario and Saskatchewan took tentative steps to reopen their economies. By June, Ontario was back to emergency measures — bars and restaurants, except for takeout and delivery, would stay closed. Gatherings were limited to five people. New variants were emerging that rollercoaster-ed illness and deaths. Indeed, five distinct waves of between 100 and 200 days each were tracked from January 2020 to February 2022. The sixth wave, beginning March 2022 is ongoing – now more than 800 days, because reliable tracking on recoveries has stopped.

Canada’s response to the pandemic was less than stellar. The SARS outbreak in 2003 was the impetus for the creation in 2004 of the Public Health Agency of Canada and the appointment of a Chief Public Health Officer. That same year a Canadian Pandemic Influenza Preparedness guide was published, purporting to outline how federal, provincial, and territorial jurisdictions should work together to ensure a coordinated and consistent health-sector approach to pandemic emergencies. According to the government’s website, the plan was tested with the advent of the H1N1 pandemic of 2009. There is no official evaluation of whether the plan worked as expected. Several other guidelines were created between 2013 and 2018. We now know that these guidelines were never updated, coordinated with the provinces or tested. The Auditor General said in 2021 that they were neither used nor useful during the COVID pandemic.  

For the general public in 2020, it appeared that there was no plan in place. Aside from the financial support the government hastily legislated, public sentiment was that the people who were supposed to be in charge, weren’t. Past patience with public and private sector leaders who managed the country gave way to confusion and disillusionment as Canadians contemplated contradictory instructions, draconian lifestyle restrictions and the possibility of financial ruin.

The wait for clear direction and help or a cure seemed interminable. But the wait was less than a year and that was akin to a miracle. Thanks to an unprecedented level of global cooperation, on Dec. 9, 2020 Health Canada authorized the Pfizer-BioNTech COVID-19 vaccine. Canada started injecting COVID-19 vaccines on Dec. 14, 2020.

A surge of ills is being attributed to the pandemic. As social creatures, the pandemic’s disruption and isolation created problems from which we still have not recovered. Among the biggest costs has been learning loss. Students have begun to recover some of the pandemic losses from long school closures but have a long way to go. In addition to deaths from the virus, long COVID — which scientists still don’t understand — has afflicted many people.

On Oct. 1, 2022, the Government of Canada removed all COVID-19 border measures including proof of vaccination, testing, quarantine, isolation and use of the ArriveCAN app. By then, Canada’s federal COVID-19 spending totaled $359.7 billion, added $8.3 billion to present-day interest costs and is generally playing havoc with fiscal prudence. A global bond ratings agency has downgraded Canada’s credit rating from triple-A to double-A-plus.

On April 4, 2024, the government stopped reporting COVID-19 hospital use. Nationally, the number of people getting COVID-19 is decreasing and remains at low levels, although 31,000 tests were reported on that day.

Tomorrow, we’ll look at how the economy has been transformed.

By Dian Cohen

Local Journalism Initiative

I’m also tearing my hair out trying to imagine how we have collectively elected such dunderheads to manage the part of the economy they are responsible for managing.

My rant today focuses on healthcare. The Quebec government has just announced yet another of its seemingly endless ‘innovative’ ideas that, if we’re lucky, will be forgotten before millions of our tax dollars are spent. If we’re unlucky, they’ll spend millions on “mini-hospitals to bridge the gap between family medicine groups (GMFs) and hospitals.”

Leaving aside a description of this profligate idea, remind yourself of our possibilities to access healthcare.

• We can go to a GMF.
• We can go to a hospital.
• We can go to a doctor in private practice.
• We can go to a health co-op.  

With regard to GMFs, last time I looked, most GMFs weren’t taking new clients. That’s one reason there are at least 834,000 people on the government’s Family Doctor Finder list. And why Quebec now allows primary care nurse practitioners to register patients.

Most emergency rooms are operating over 100 percent capacity and wait times range from 5 to 14 hours – something that hasn’t changed despite the many promises and numerous ‘reforms’ over the years aimed at reducing wait times.

There are about 600 Québec GPs working in private clinics, where patients pay for all services from their own pockets. The government has already gotten rid of family physicians who hung out a shingle and practiced on their own, and they have recently said they want to get rid of physicians who have opted out of the public sector.

Health cooperatives are our last, best hope. Quebec’s co-operative movement traces its history back to 1900, when Alphonse Desjardins opened the first Caisse Pop —  Desjardins is now the largest cooperative financial group in North America and fifth largest in the world. Agropur and La Co-op Federée are two of the biggest farm co-ops in the world. This is not an untested business arrangement.

There are 40 health co-ops in the province managing the medical files of 300,000 Quebecers. They have been created by their communities – ordinary people who got together to fill a need. They voted in a board of directors, raised money for the building, furniture and fixtures, hired the doctors, nurses and staff. Start-up costs range up to $500,000 – money raised in the community, unlike the ‘mini-hospitals’ now being touted.

These co-ops are non-profit organizations that for years have been meeting healthcare needs not met by the public network or the private clinics. Most of them most of them are located in rural areas far from the main hubs of integrated health and social services. Their mission is more than helping sick people get well – they are strong proponents of preventative care and wellness. Funding to operate a co-op comes mainly from an annual membership fee by regular users and extends benefits beyond access to a doctor. Non-members also have access to a doctor, as prescribed by the Canada Health Act.

Yet the Quebec government is not benignly oblivious to health co-ops, it is actively discriminating against them. Here’s how:

Family medicine groups (GMFs), which are mostly profit-making corporations, are heavily subsidized by the government. Health co-ops, which are non-profit organizations, have been excluded from any financial subsidies. On March 29, 2022 the CAQ signalled a major shift in the organization of healthcare – it wanted to “think and do differently”. That was Bill 15, creating Santé Québec. What a perfect opportunity to right the wrong of excluding health coops from financial subsidies. Asked specifically by the Federation of Health Co-ops (FQCS) whether health coops were included as eligible organizations, the minister confirmed that they were. Yet nothing has changed.

Health co-ops are specifically excluded from financial subsidy because they’re not designated Non-Profit Organizations (even though they are). They aren’t designated non-profit organizations because they’re incorporated under the Cooperatives Act rather than the Corporations Act. Talk about convoluted! Because of this, co-op fees have been deemed to be “extra billing”, which is a no-no under the Canada Health Act.

The CAQ knows better. Extra-billing is the difference between the provider’s charge and the allowed amount. For example, if the government rate for a procedure is $100 and the doctor wants to charge $150, the doctor would have to bill you for the remaining $50. That’s the no-no. Co-op fees cover the operating costs to run the health facility – offices equipped with examination tables and diagnostic aids, nurses who triage patients, receptionists who make appointments, everything except the doctors’ fees, which are paid by RAMQ, the government’s Health Insurance Agency. These are the same expenses that the government subsidizes in larger, for-profit GMFs.

The Federation of Health Coops delivered a pre-budget paper asking the CAQ to create a funding program to put health coops on an equal footing with everyone else in the public network. Their ask was $2 million/year — not $2 million for each of the 40 co-ops, $2 million/year to be split between all the co-ops. The 2024 Quebec budget documents spending $62 billion on health and social services this year with nary a word about bringing health co-ops — the one group that’s in place and ready to meet the  needs of regular citizens – into the fold. Meanwhile, Health Minister Dubé’s office has confirmed that the government will allocate $35 million in public funds (borrowed or taxpayer) annually for each non-existent, start-from-scratch mini-hospital.

cohendian560@gmail.com