Tag Archives: Canada

Maggie Hulbert is a medical student in the Class of 2020 at Queen's University


Medicine Unbundled: A Journey through the Minefields of Indigenous Health Care
(Heritage House, 2017)

Imagine working in a hospital where a child is admitted and kept on the wards for seven years without being allowed to see their family. Now imagine being that child, and growing up to be an adult in today’s healthcare system. Would you ever set foot in a hospital again? Would you ever trust a doctor? These are the kind of questions that come to mind while reading Medicine Unbundled: A Journey through the Minefields of Indigenous Health Care, a book written by investigative journalist Gary Geddes. By travelling across Canada and interviewing Indigenous leaders, Elders, and members of a wide variety of First Nations, Geddes provides a powerful account of how Canada’s historic Indian Hospitals and Tuberculosis Sanatoriums directly and intentionally contributed to the genocide of Indigenous people. ...continue reading


CSE_photoshot_KPKirsten Patrick is Deputy Editor at CMAJ


Yes I did wake up at 3 am today and think, "I'll just check the U.S. election results..." and boy do I regret not going to bed earlier because there was no sleeping after that. Since 3am I’ve read at least a hundred articles analyzing the election’s outcome. I’ve been openly “with her” throughout the campaign. I’m a UK citizen living in Canada so nobody cares, but I'm a woman and the misogyny that the campaign has brought into sharp focus has upset me greatly, so I care. It means I’ve been zipping back and forth through the stages of loss for the past few hours. ...continue reading

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Dr. Kirsten Patrick, deputy editor, interviews both Dr. Ronald Labonté, Canada Research Chair in Globalization and Health Equity at the Institute of Population Health and Professor at the University of Ottawa, and Dr. Raphael Lencucha, Assistant Professor in the School of Physical and Occupational Therapy at McGill University. In their commentary, published in CMAJ, Labonté and Lencucha propose a pragmatic approach to regulating electronic nicotine delivery systems in Canada: cautious measures similar to tobacco control, while using price incentives to shift tobacco users to electronic devices as a harm reduction mechanism until useful data accumulate on relative health outcomes. ...continue reading

William Hogg is Senior Research Advisor at the C.T. Lamont Primary Health Care Research Centre at the Bruyère Research Institute in Ottawa, Ontario



Primary care in Canada

What do populations need?

Canada ranks last among the developed countries surveyed by the Commonwealth Fund for access to primary care services. About 10% of Canadians do not have a primary care provider, and those who do have difficulty seeing their provider in a timely fashion. ...continue reading

BMiedema 1Baukje (Bo) Miedema is Professor and Director of Research at the Dalhousie University Family Medicine Teaching Unit and Adjunct Professor in the Sociology Department, University of New Brunswick

 “The constitution” of primary health internationally, as a core component of the structure of health, care can be traced back to the Declaration of Alma-Ata (1978), even though its origins go much further back in time: 1941 in the Netherlands and 1948 in the United Kingdom. The Declaration states that governments have to be responsible for the health of their people. Primary health care is seen as an important vehicle to deliver health care to the population, and is defined as care that “addresses the main health problems in the community, providing promotive, preventative, curative and rehabilitative services accordingly.” The Declaration of Alma-Ata also states that by the year 2000 there should be “health for all.” ...continue reading

Duckett_Steven_cropStephen Duckett is Director, Health Program at the Grattan Institute, Australia, an expert adviser with EvidenceNetwork.ca and the former President and Chief Executive Officer of Alberta Health Services


If you look at an old map of Canadian healthcare policy, just near Privatization Island is a big warning: “Here be dragons.” So it proved for Alberta Health Services recently when a seemingly innocuous decision -- to swap the tender for laboratory services from a United States-based transnational corporation to an Australian one -- provoked a furore fueled by discontent.

Part of the problem is that ‘privatization’ has two meanings. One refers to an increase in the private funding of healthcare. In the Canadian context that is unequivocally bad. It breaks the compact between Canadians that they are all in the same boat in terms of access to healthcare and strikes at one of the key differences between the U.S. and Canada. On one side of the border, people can sleep easy knowing they are protected against the costs of healthcare if something goes wrong for them or their family. On the southern side, the spectre of bankruptcy or no care looms, even in the post-Obamacare world.

But Alberta’s controversy over lab contracts is about a different sort of privatization. It is about who delivers care within the publically funded system. ...continue reading

Grant Russell is a primary care clinician and health services researcher, as well as Head of School of Primary Health Care, Director of the Southern Academic Primary Care Research Unit (SAPCRU) and Professor of General Practice Research at Monash University in Australia. He spent 6 years working in Ontario, Canada


A CMAJ editorial once, famously, described Canada as being the ‘country of perpetual pilot projects’. “Pilotomania” is nowhere better seen than in Canada’s long running experimentation with models of delivering primary care. Given that experiments need some sort of professional interpretation, in 2007 the Canadian Health Services Research Foundation (as it was then) commissioned our team at the University of Ottawa (where I was working at the time) to review Canada’s primary care research capacity. Our report: Mapping the future of primary health care research in Canada, allowed us to unpack what turned out to be a fragile enterprise.

We were particularly struck by the challenges facing the primary care research workforce. Many researchers were isolated, especially those working outside nursing schools or Departments of Family Medicine. While islands of innovation existed, there was little sense of a sustainable system for primary care research and development.

I moved back to Australia a couple of years after Mapping the Future ...continue reading


By Ilona Hale, MD, David Hale, MSc, Env. Mgmt, Courtney Howard, MD, Warren Bell, MD

As physicians we are trained to respond to emergencies – the more serious the diagnosis, the more quickly we respond. The dangers of global warming were recognized by scientists over twenty years ago and there is no longer any serious scientific debate about the existence or cause of anthropogenic climate change. The recently released report from the United Nations Intergovernmental Panel on Climate Change (IPCC) confirmed the many present and future health effects of global warming and climate instability. Increasing drought, food insecurity, extreme weather events, vector-borne disease and wildfires may soon represent some of the most serious threats to human health. Physicians, as guardians of human health, should be actively engaged in addressing this issue. Yet we, as a society and as a profession, are still failing to act in a meaningful and substantive way. Fortunately there are many tools to help us act, one of the most recent being the idea of fossil fuel divestment, similar to the divestment campaign of the 1980s which helped to topple South African apartheid.

The idea of fossil fuel divestment is based on what is referred to as “Terrifying New Math”: Climate experts and governments from around the world have accepted the scientific consensus that an increase in global temperature must be held below 2 degrees Celsius. To remain below this 2-degree target, scientists estimate that we can produce no more than 565 Gt of carbon dioxide. The “terrifying” part is that current known fuel reserves, if burned, represent 2,795 Gt of carbon dioxide. Doing the math, it is evident that this second number is a lot bigger than the first, which means that, if our planet is to survive, most of our current fuel reserves need to stay in the ground - a radical concept challenging our traditional resource-extraction-based approach to economic growth. Clearly, something needs to change.

Despite pledges from governments around the world to cut greenhouse gas emissions, most nations have consistently failed to meet their targets, Canada being among the worst of the offenders.

Expecting that fossil fuel companies themselves will voluntarily move in this direction, leaving their reserves untouched, is unjustified and naive. Corporations simply do what shareholders demand. And therein lies the key to the new divestment campaigns aimed at fossil fuel companies. Proponents are encouraging concerned investors to make their voices heard by withdrawing investments from coal, oil and gas companies, starting with a list of the 200 companies with the largest reserves, and re-directing their investments to other industries that support a healthy climate future. This pressure will provide the stimulus for fossil fuel companies to gradually transition to producing more sustainable forms of energy; it allows them to become part of the solution, building the healthy future that we all want.

Divestment campaigns have been launched at hundreds of colleges and universities, pension funds and religious institutions in a movement that is rapidly gaining momentum. Significantly, members of the British Medical Association have also recently voted to “ transfer their investments from energy companies whose primary business relies upon fossil fuels to those providing renewable energy sources”, the first health organization to do so.

Some investors might fear that divestment could negatively affect their portfolios. On the contrary, many leading economists are predicting an imminent “carbon bubble” based on artificially inflated values of fossil fuel company stocks. This arises from the inclusion of all the reserves which companies hold, without considering that these reserves can never be burned. This “carbon bubble” will leave companies with trillions in “stranded assets” according to the Carbon Tracker Institute, which has links to the London School of Economics. The concept of the carbon bubble has since been supported by the International Energy Agency and the IPCC. Even now, studies looking at divested portfolios found them to provide similar or better returns than their conventional counterparts.

There might also be concerns that abandoning fossil fuel resources in Canada could lead to economic collapse. In fact, the oil and gas industry accounts for only 5% of the Canadian economy. The latest IPCC report concluded that shifting hundreds of billions of dollars into renewable energy from fossil fuels and cutting energy waste would take only 0.06% off of our usual 1.3-3% annual global economic growth. “Waiting to take action will inevitably increase costs, escalate risk, and foreclose options to address the risk.” It has also been estimated that non-fossil fuel industries create 6-8 times as many jobs per dollar invested as fossil fuel companies.

Divestment for physicians is particularly important since we cannot, in good conscience, be strong advocates for addressing climate change while continuing to profit from fossil fuel companies. Physicians, through MD Management, have already made a commitment to divest from other unhealthy industries such as tobacco. Every Canadian physician can start by raising the issue with their investment adviser and encouraging their own university, hospital and medical society to divest from fossil fuels and reinvest in renewable energy sources.

As physicians dedicated to promoting health, we can no longer sit at the bedside while our patient deteriorates. We have more than enough information to start treatment now. Divestment, one of many tools available, is an important first step.

Ilona Hale is a family physician in Kimberly, BC; David Hale is a professional forester with a masters in environmental management; Courtney Howard is an emergency physician in Yellowknife, NT and a board member of the Canadian Association of Physicians for the Environment; Warren Bell is a family physician in Salmon Arm, BC and a board member of the Canadian Association of Physicians for the Environment.