Category: **Resources: ESPC Documents:

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Note: This is excerpted from the March 2021 edition of our “Research Update” publication. The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews, prepared by our volunteers, on recently published social research reports and publications.

A review by Jessica Shannon

Authored by Alison H. McIntosh, an Edmonton-based academic researcher and organizer, Privatization Pressures in Alberta Health Care was published by Parkland Institute (2020), an Alberta research network that examines public policy issues.

McIntosh discusses the current pressures to expand privatization within three areas of Alberta’s health care system: diagnostic laboratory services, home care, and telehealth. Revealing parallels between the United Conservative Party’s (UCP) privatization effort and public sector budget cuts with Klein-era neo-liberal policies, McIntosh highlights a reoccurring pattern of adverse effects that impact working conditions, equitable access to care, and quality of care for Albertans. 

Diagnostic Laboratories

The Klein-era of the 90s saw massive cuts to diagnostic laboratories, leading to a restructure and ultimately a “brain drain” of experts from the province. The consequences resulted in a shortage of skilled workers who could run these labs. Diagnostic errors increased—which remains an issue. Even so, McIntosh reports that there has been some success in moving service delivery to private non-profit labs. However, it is difficult to compare costs between private non-profit and for-profit labs at this time. The author recommends greater government oversight of transparency and accountability within the for-profit private sector’s health services, as well as provisions for standards of care and necessary skill level. 

Home Care

The privatization of home care, McIntosh reports, is problematic because profit margins in this sector are low. Such margins underscore how home care workers and recipients—often already marginalized populations—are placed at further risk when this vital service is privately contracted out. McIntosh recommends the expansion of the Canada Health Act to accommodate formal care, insured under universal health care. Moreover, unions should increase capacity for bargaining power with governments. Both measures would ensure equal access to care for all patients and improve working conditions and living wages for workers.

Bolstering her argument, McIntosh points out that home care is a tool meant to promote independence within homes and communities. It is also preventative in measure, cost-wise and health-wise. For events related to long-term care, a “one-day stay in the hospital can cost up to $1,000, while a day in a long-term care facility costs around $130, and home care costs about $55″ (p.16). Furthermore, those receiving formal home care experience increased physical and mental health. There lies a balance between fiscal and qualitative measures, however, the current UCP budget does not reflect this balance. Rather, it fixates on the fiscal at the expense of the health outcomes and needs of Alberta’s aging population.

McIntosh also reports that expanding public home care services could greatly improve the lives of not just recipients of this service but also the lives of informal caregivers, freeing them up to generate more income and pension contributions. A better quality of life for both parties—such are the benefits of a public form of home care. 

Telehealth

Telehealth is a tool meant to expand access to care. However, McIntosh points out that the target populations of telehealth services (e.g., rural populations or seniors) have not been reached. Instead, younger urban populations are utilizing these services. Moreover, McIntosh reports that telehealth is often overused due to ease of accessibility, leading to a decrease in quality of care. The danger is that publicly funded health care sees an increased usage of these services, yet this rise in frequency and cost does not necessarily correlate to improvements in care or equitable access. 

Discussion

McIntosh provides an informative overview of relevant issues regarding health care privatization in Alberta, related to three key areas that the UCP government wishes to capitalize on. She clearly discusses what these intentions mean for Albertans and their health, doing well to show that the debate to privatize needs go well beyond questions concerning “the bottom line.” A sharp reminder echoed through the report: cuts to public funds means costs are recuperated elsewhere, whether through working conditions, quality of care, or patient outcomes—all of which are ultimately cuts in quality of life for Albertans. The irony is that these three areas ought to be considered as the primary measures for a sound health care system—not only fiscal measures.

Fiscal considerations alone, the report shows, clearly fall short of providing adequate care for Albertans. Profit motives do not translate well into motives to improve outcomes for those involved with health care services—whether for staff members, patients, or informal caregivers. That said, McIntosh does well to show that fiscal concerns are important too, and that in some areas, such as home care, both may be possible.

McIntosh makes a clear case for the power of investing in a public service and how a healthy society is a prosperous society. Her report begs the question: if government support and oversight—as well as transparency, fair wages, expertise, and standards of care—are all related to health outcomes, can we afford to neglect them?  Can we really afford the many and varied hidden costs of privatization?

Publication Source:

McIntosh, A. H. (2020). Privatization pressures in Alberta health care: Laboratory services, home care, and telehealth under austerity. Parkland Institute. https://d3n8a8pro7vhmx.cloudfront.net/parklandinstitute/pages/1801/attachments/original/1599505978/privatization_pressures.pdf?1599505978  

Get to know our volunteer:

Jessica has a background in Kinesiology and Physical Therapy from Dalhousie University (2016) and the University of Alberta (2019), respectively. A local to Edmonton, Jessica cares about her community and how health and wellness policy impacts the activity, mobility, and well-being of its citizens.

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Note: This is excerpted from the March 2021 edition of our “Research Update” publication. The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews, prepared by our volunteers, on recently published social research reports and publications.

A review by Jayme Wong

“System Impacts and Responses” and “Shelter Impacts and Responses” are both part of a three-part series called A Brief Scan of COVID-19 Impacts on People Experiencing Homelessness written by Jakob Koziel, Maria Savidov, and Andrea Frick. The series was published in 2020 by the Bissell Centre, an Edmonton-based non-profit organization that works with communities to empower people to move from poverty toward cultural, social, and economic prosperity. The first part of the series, “Health Impacts and Responses” can be found on the Homeless Hub’s website (see source link).  

Research for part two, “System Impacts and Responses,” and part three, “Shelter Impacts and Responses,” was conducted between March and September, 2020. The authors state in part three that it “is not meant to be an academic paper or systematic review but rather a summary and snapshot of the emerging media reporting and academic investigations of the pandemic’s impact on [vulnerable] populations during a specific timeframe” (p. 4). They suggest that the series’ purpose is to spark further research interest into the links between homelessness and COVID-19. 

Koziel et al. suggest that COVID-19 will cause a greater burden on the hospital care system and that individuals experiencing homelessness “will be twice as likely to be hospitalized and two to four times more likely to require critical care than the general population . . . in addition to a higher infection and fatality rate” (p. 4). In “Shelter Impacts and Responses,” the authors state that transmission rates are especially high among individuals experiencing homelessness due to transiency, challenges to physical distancing in crowded and communal spaces, and the lack of access to personal protective equipment (PPE). 

The number of individuals experiencing homelessness is predicted to increase due to rising trends in unemployment and home evictions. Social service agencies are anticipating an increase in the need for housing support. Providing more options for permanent housing is the best solution to combat COVID-19 among homeless populations, the report suggests. This is due to the fact that permanent housing supports opportunities for isolation and reduces the strain on hospital and shelter space. However, a long-term solution is only possible if access to food, health education, and resources for addiction, mental health, and trauma are also available. 

Temporary housing in hotels or motels is considered the second-best strategy to mitigating system impacts. Converting unused public space into temporary housing is a promising alternative to shelters, which may already be over-capacitated or forced to turn people away due to social distancing measures and limited bed space. However, using public spaces to house individuals experiencing homelessness is not a permanent solution. These public spaces lack the additional resources needed to provide food, hygiene, and testing, and are not staffed with people equipped to deal with trauma, homelessness, and drug use. In part two, Koziel et al. state that “sheltering those experiencing homelessness is the preferential strategy in mitigating the spread of COVID-19 compared to doing nothing” (p. 6). The temporary housing strategy has been successfully utilized in several American and Canadian cities, including Edmonton. 

Despite the significant system and shelter impacts, Koziel et al. note that innovative collaborations have developed as a result of the unique issues posed by COVID-19. These collaborations include partnerships between non-profit organizations and governments to provide more resources to homeless individuals, restaurants and food banks to provide meals to camps and medical services, and even health care providers and telecom companies to provide affordable phone services that help isolated individuals stay connected. 

The reports fail to adequately address responses and strategies on mitigating shelter impacts. Koziel et al. suggest three responses: (1) enforcing protective measures in shelters (e.g., social distancing and PPE), (2) enforcing shelter closures and restrictions, and (3) finding alternatives to shelters. Given the already limited funds and resources accessible to shelters, protective measures are difficult—reduced staffing makes it difficult to consistently and constantly disinfect areas; social distancing in shelters is challenging due to the rising number of individuals facing homelessness. Even the authors admit in part three that, although protective measures are the most effective to prevent the spread of infection, “addiction and mental health challenges among residents, as well as a lack of medical care access, can make it difficult for residents to adhere to public health directives while costs and potential unavailability of PPE may make it difficult to implement PPE procedures” (p. 5–6). Similarly, shelter closures and restrictions may cause more problems for people seeking shelter and additional support, and alternatives to shelters, as discussed in part two, are only temporary solutions. 

While the series was only published in 2020, we are now living the reality of the research predictions. Evidence of the disproportionate impact of COVID-19 on people experiencing homelessness is supported by emerging research. The trends observed within the three-part series will only increase and worsen if social action is not taken immediately. 

Publication Source:

Koziel, J., Savidov, M., & Frick. A. (2020). A brief scan of COVID-19 impacts on people experiencing homelessness. Bissell Centre. https://www.homelesshub.ca/resource/brief-scan-covid-19-impacts-people-experiencing-homelessness 

Get to know our volunteer:

Jayme Wong graduated from the University of Lethbridge in 2014 with a BA in English and Philosophy, and more recently graduated from the University of Alberta in 2020 with an MA in English and Film Studies. She currently works at a local non-profit, the Learning Centre Literacy Association.

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Note: this is excerpted from the March 2021 edition of our “Research Update” publication. The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews, prepared by our volunteers, on recently published social research reports and publications.

A review by Shawna Ladouceur

In 2011, the Royal Society of Canada (RSC) published End-of-Life Decision Making. This timely report framed the findings and recommendations of an expert panel convened by the RSC in response to questions of public policy around the legalization of medical assistance in dying (MAiD). A decade on, the RSC assembled a Policy Briefing Committee to assess the impact of the 2011 report to track policy and statutory progress and to identify ongoing challenges. Summarized here, the policy brief lauds success, but also looks ahead to next steps and work still to be done.

Recognizing the impossibility of addressing MAiD in isolation, in preparing the 2011 report the RSC conducted an extensive review of literature exploring the full continuum of end-of-life care, which includes:

• withholding and withdrawal of potentially life-sustaining treatment,
• advance directives,
• palliative care,
• potentially life-shortening symptom relief,
• terminal sedation, and
• assisted suicide and voluntary euthanasia (i.e., MAiD).

This in-depth examination of social attitudes, ethical issues, and legal statutes led the RSC to conclude that Canada should move forward with provisions for MAiD—for which they provided 30 recommendations to guide the process.

Proving fortuitous, the 2011 report coincided with arguments heard in the groundbreaking case, Carter v. Canada (2015). Heard by the British Columbia Supreme Court, the case challenged Criminal Code statutes forbidding euthanasia and physician assisted suicide. Admitted into evidence on the grounds of providing expert opinion on the matter, the report was quoted and later echoed in the judge’s decision to declare the statutes in violation of the Charter of Rights and Freedoms (the Charter). Insisting that inherent risks of legalization “could be very substantially mitigated through a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced,” the Supreme Court of Canada affirmed findings in this case (p. 11). Given 12 months to amend the Criminal Code, the judgement required Parliament to move forward with legislation allowing legal access to MAiD in Canada. The resulting Bill C-14, however, departed from both the report and from recommendations of Parliament’s own commissioned experts on some key provisions.

This divergence left work to be done at all six points along the continuum of end-of-life care and the door open to ongoing policy and statutory challenges. Although the policy brief shows there has been good progress in facilitating advanced care planning and moderate progress in expanding access to palliative care, the remaining areas have yet to be addressed—that is, clarifying legal status of withholding and withdrawal of potentially life-sustaining treatment, terminal sedation, and potentially life-shortening symptom relief. The policy brief outlines 31 remedial recommendations to address these deficiencies as well as those of current MAiD legislation. Ongoing challenges also hold promise in remedying several enduring expert concerns with current MAiD legislation. These concerns include the exclusion of persons not at the end of life or whose natural death is not reasonably foreseeable; lack of provision for advance requests; exclusion of mature minors; and a 10-day waiting period.

One challenge resulted in the important 2019 Truchon and Gladu v. Canada and Québec decision, in which the Québec Superior Court found MAiD eligibility criterion, including the requirement for death to be reasonably foreseeable, too restrictive and thus in violation the Charter. This provision therefore ceased to have any effect in Québec as of March 2020. The federal government chose not to appeal the decision. Québec has, however, “indicated its intention to address the issue of eligibility for MAiD where mental disorder is the sole underlying medical condition” (p. 29).

Currently before the House of Commons, the federal government’s own Bill C-7 would mitigate other outstanding expert concerns. This Bill would allow advanced requests for MAiD in cases of reasonably foreseeable death and would eliminate the associated waiting period. Bill C-7 also appears to concede some ground to Truchon and Gladu (2019), adding language regarding natural death that has not become reasonably foreseeable. The federal government has also agreed to further study the issues of advance requests and mature minors during the five-year review required by the 2016 MAiD law.

The retrospective provided by the policy brief indicates the 2011 report has been cited many times since its publication—most significantly in the landmark case heralding the advent of MAiD, but also in scholarly literature, policy documents, and the media—certainly exerting an effect on public opinion and events in intervening years. However, despite progress, concerns remain. The brief provides recommendations to redress deficiencies along the continuum of end-of-life care—including prevailing concerns with existing MAiD legislation—and leading options to address the issues that most certainly lie ahead.

Publication Source:

Sumner, L. W., Downie, J., Gupta, M., & Wales, J. (2020). End-of-life decision making: Policy and statutory progress (2011-2020). Royal Society of Canada https://rsc-src.ca/sites/default/files/EOL%20PB_EN.pdf 

Get to know our volunteer:

Shawna Ladouceur is a Registered Nurse who sees the impacts of the social determinants of health in ways that demand action. She has extensive experience working directly with vulnerable populations in the inner city. Her personal interests include skiing, hiking, biking, running, reading, and travelling.

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