An Introduction to the Canada Health Act

In 1984 Canada and the provinces agreed to five principles as part of the Health Act. Originally it was agreed that the budget would be split 50 – 50 (federal funds – provincial funds), but this has since changed with more money being provided by the provincial governments.

These five principles, as you will see, are open to interpretation – and actually opened to formal discussion as of December 14th, 2010.

Health Act Principles (1984)

  1. Public Administration
    The government will control the operation of the health care system on a not-for-profit basis.
  2. Comprehensiveness
    This depends on the province. For example, in some places physiotherapy is covered. Provinces can also have different criteria for allowing patients into nursing homes.
    Truly comprehensive services across the country include the following, however criteria leading to these services may differ:

    • Physician Visits,
    • Hospital Stays; and
    • Hospital Dental Services.
  3. Universality
    All Canadians have access to health care – 100%.
  4. Portability
    Canadians can move around and still get health care, even out of country. However, if payment is required then the province will adequately reimburse the resident/patient at the rate of the home province, NOT the rate where health care was received.
  5. Accessibility
    There should be no barriers to health care.

The two principles that are most often multi-interpreted are Comprehensiveness and Accessibility. It is imperative that we take a closer look at these.


As stated above, the truly comprehensive services that are available for every Canadian citizen are Physician Visits, Hospital Stays and Hospital Dental Services. Let us look at each of these in a little more detail.

Physician Visits

Physicians are paid on a fee-for-service basis (i.e. they get paid per medical act). These fees are negotiated between the government and the medical association (the act is called Physician Remuneration…and yes, there is a lot of paperwork). For a visit to the General Practitioner (GP) that occurs in his/her office (i.e. the patient is an ‘outpatient’), the fee is $37.00. For a visit that occurs in a hospital (i.e. the patient is an ‘inpatient’), the fee is $17.00. This difference exists to help physicians cover the overhead costs of running an office. Keep in mind that being ‘seen’ by a doctor could involve a five minute conversation or a simple sweep of your chart and vitals.

Hospital Stays

Hospitals are expensive. They involve the costs of personnel, pharmaceuticals, food, building expenses, etc. It is averaged that a single day at the hospital costs $1000.00. This is why hospitals are constantly trying to reduce the length of hospital stay required before and after procedures. For example, new mothers without complications are sometimes out the next day.

Hospital Dental Services

Dentistry in general does not fall under health care (although if we consider cost-effectiveness it really ought to). However, dental services can be part of emergency procedures at which point they would be covered through the Canada Health Act.


Oh, this is so complicated. Here, you take a look:

12.1.a. In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province must provide for insured health services on uniform terms and conditions and a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons.

Or, insured persons (i.e. tax payers) should not have barriers to health care. One barrier is finances, therefore patients should not be met with user fees or administration fees (direct charges) in order to access health care.

I know you’re wondering why some services (e.g. Québec walk-in clinics) are allowed to charge money. The answer is simple, you don’t NEED to go to that clinic. There exists a clinic that will not charge you fees (even if it IS the emergency room where you will wait 6 hours to be seen, where your condition will potentially worsen, and which will decrease your economic productivity – sigh). In Québec clinics charge $95.00 a visit. Compare that to the $37.00 physician remuneration I mention above. That is a ‘user fee’ or ‘facility fee’ or ‘service fee’ of $58.00.

So, if you have money you can visit a faster user-fee-charging clinic and get back to making money. If not, then either you live with being ill or cram into a free clinic with other sick people and wait – one of the reasons that socio-economic status is an excellent indicator of health. These two speeds, called a two-tiered system, are just the beginning of provincial rule bending in regards to the Canada Health Act.

Personal Note:

I would like to propose that finances are NOT the only issue of accessibility. Consider rural areas. Where I come from the closest ‘hospital’ is over 30 minutes away – and that is only if it is open. If a physician is not available I may need to continue ANOTHER 30 minutes (that’s a hour if you’re adding) to reach the next hospital. The act of getting to a doctor suddenly becomes difficult, so there are three choices:

  1. Call an ambulance
    The ambulance (expensive) must travel the same 30 minutes to get to you (20 minutes if they are heavy-footed) and then turn around and go back. Remember that irreparable brain damage occurs after four minutes.
  2. Travel
    Elderly, handicapped or poor patients would see travel as a infringement to the accessibility of their health care. Without a car, gas, a licence and the physical ability, these distances cannot be traversed (especially since there is no local transportation in this area).
  3. Avoid
    Ignoring a small health concern will likely lead to it escalating (see option #1).

This personal note is corroborated by the Canadian government’s September 2006 Report “How Healthy are Rural Canadians?”:

The reality of living in rural and remote areas is that there are fewer health care services. Geographic isolation and problems with access to and shortage of providers and services are multidimensional problems. For instance, poor road quality combined with greater periods spent on the road not only contribute directly to higher incidence of injury, but also compromise access to health services. Moreover, difficult economic circumstances, travelling time to the city and the lack of car ownership can affect access to and demand for health services.

Global Health, Well-Being, and Conflict

According to the WHO (World Health Organization), “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.

In Global Health terms, health has a lot to do with conflict. Today, 90% of deaths in wars are civilians. Conflict used to be confined to inter-state wars (consider the world wars), but increasingly regular are intra-state conflicts (feuds within political boundaries).

The United Nations (UN) has always had the mandate to take care of Refugees (those who leave their country’s borders). However, just recently has the UN finally been mandated to take care of Internally Displaced peoples (those who don’t leave their country’s borders). This means that the numbers have increase substantially, considering that Refugees number somewhere around 9 million, while Internally Displaced peoples amount to over 22 million.

Also important to consider are the causes of conflicts. Sources of conflict include race, religion and natural disasters. Consider these images of Lake Chad which indicate the physical source of strife that has escalated to the Darfur conflict.

The shrinking of Lake Chad

(Image found at A Town Square)

The impact that a source (such as drought) can have is a direct result of susceptibility. Impact includes things like:

  1. Increase in morbidity and mortality
  2. Forced migration
  3. Disease
  4. Increasing competition for resources

Number Four is best exemplified by this image:

Haiti - Dominican Republic Border

(Image found at Wiley GeoDiscoveries)

This is the border between Haiti and the Dominican Republic – the raging deforestation in Haiti is extremely evident.

The first section was presented by Dr. Kirsten Johnson, MPH.


Dr. Tarek Razek (rightmost white man)

(Image from Outpost)

Dr. Tarek Razek is a medical doctor as well as the Director of the McGill Trauma Program. In his spare time, Dr. Razek is a trauma physician with the International Committee of the Red Cross (ICRC) and educator with the Canadian Network for International Surgery (CNIS).

Dr. Razek notes that Canada is odd. That we really are rare in terms of our consideration of multiculturalism as normal. This facet of our society leads to Canadians being excellent members of Emergency Response Units (ERUs). This was imperative in the past when Canadians were deployed as part of ERUs of other countries. Just recently Canada has acquired its own Emergency Response Unit (including kits, pharmaceuticals, tents, teams, etc.) which has just been sent to Haiti to help fight an outbreak of cholera.

Safety is a continued issue for Dr. Razek, who has a family. The threat of death, injury and kidnapping is real. The position of trauma surgeon in a conflict area is not entered lightly. But Dr. Razek acknowledges that his work is necessary and rewarding.

Dr. Razek tells the story of his experience doing surgeries 10 hours a day for 7 days a week. Each of his surgeries required the permission of the patient (or guardian). As such, there needed to be translators present. Because the Red Cross camp was located in an area that was surrounded by multiple tribes it seemed like it would be a challenge to decipher which translator was needed. However, tribal customs differed in an interesting way in that area, so translators were able to lift the shirts of the patients and use the tribal markings on their chests to determine the correct dialect.

Trauma is an unrecognized epidemic. It is the leading cause of death, and in 2020 will become the number one cause of years of life loss. Dr. Razek has many stories and pictures to share detailing bullet wounds, bullet wounds, bullet wounds, and landmine injuries.

He shares this story. In some areas where landmines are prevalent, parents make the youngest child walk in front of the family. If that child is too light to set off the landmines then the child will be weighted down. Dr. Razek goes on to explain that the father and the mother are necessary entities in the family, without which the family would cease to operate. The older children are also necessary members because their labour abilities help bring in revenue for the entire family. The youngest child is dispensable – not yet offering tangible benefits to the family unit except for through its dispensability.

Dr. Razek’s presentation was one that offered insight into global emergency care. And more importantly he offered palpable stories and feelings to a room full of medical personnel who are also interested in working in a global context.

Next Week: Access to Essential Medicines

Learning about Health Care

Dear whoever is interested,

I am currently enrolled in Health Care Management, a Master’s course taught at McGill University. Some of you have shown an interest in the subject as well as voiced very interesting and provocative questions and ideas.

In response to that interest, and to aid in my own learning, I am going to make weekly(ish) posts with summaries of what was discussed in the class the previous week.
If you are at all interested in reading or commenting please do so. Discussions are where learning really happens, and where ideas are formed. It will also give us the opportunity to share some field-specific data and perhaps formulate changes that could help improve the system for all of us.

Thank you for your interest. I hope to chat with you soon.


Health Care Management
Summary – Week 1
January 5th, 2011

In health care management there are five key economic principles that come into play:

  1. Costs
    There is no limit to how much money we can throw at health care. Increases in health care spending could continue until immortality is achieved for every citizen.
  2. Outcomes
    There need to be results (presumably benefits) of the health care system.
  3. Effectiveness
    The relationship between Costs and Outcomes is of the utmost importance. Only when a treatment/idea proves adequately effective should it be funded through health care. Take, for example, the cancer drug Avastin. Canada may refuse to offer this (extremely expensive) drug to cancer patients because it seems that in the end it only lengthens lives by two weeks. (Note: This is an average. For some, it may be longer. If there was a clear determining factor for its success it could be used more discerningly, thus increasing its effectiveness.)
  4. Trade Offs
    With a fixed budget, health care is a constant juggling act. When we give more money to pharmaceuticals we must take money from somewhere else. On an even grander scale, if we want more money for health care do we take it from education? transportation? security? Or just increase taxes?
  5. Structure
    Health care can also be manipulated through its structure. Using non-monetary incentives and organization techniques the system may be altered and potentially improved.


Now let’s talk about Health: What makes a healthy society?

An initial reaction is often to say Access to Health Care. Interestingly, this only accounts for 25% of health. Biology accounts for another 15% (including things like gender and genetics). And Physical Environment covers 10% (including clean air and water, food and shelter).

The most influential determinant of health at a whopping 50% is Social and Economic Environment. Topping this list is socio-economic status (i.e. how much money you make), but also important are your social support netoworks (e.g. do your friends keep you physically active? do they smoke or drink? do they engage your mind?).

Clearly these categories are not mutually exclusive. For example, your socio-economic status will often dictate what physical environment you live in and therefore the quality of your air, food, water and shelter.

Also note that this is only one of the percentage-per-category correlations. Other researchers present the data differently. For example, a chart produced by the Georgia Health Policy Centre uses data from the McGinnis and Foege publication “Actual Causes of Death in the United States” (Journal of the American Medical Association, 1993). This chart rates the determinants of health as:

51% – Lifestyle (smoking, obesity, stress, nutrition, blood pressure, alcohol, drug use)

20% – Human Biology

19% – Environment

10% – Health Care

Note: The research article used to support the above percentages only provides data for the Lifestyle section (~50%). It is unclear how they calculated the other sections. Also note that the original article states that Sexual Choices are a high ranking Lifestyle factor.

To hammer home the idea of social factors playing such a crucial role in health, take a look at this video: Judy Heyman Public Health (highly recommended).


To Truly have Health Care in Canada, we need Canadians to care about health.

Let’s start with food.

(Image from Greek Reporter)

In 2008 the British Medical Journal published a meta-analysis of the Mediterranean Diet. The Mediterranean Diet which focuses on whole grains and fresh fruit and vegetables has an astonishing impact on longevity and health. In fact, adherence to the Mediterranean Diet has “been found to be associated with a reduction of overall mortality and mortality from cardiovascular diseases and cancer” (2008, pg. 1).

To completely convince you, take a look at these (from the 2008 article):

Figure 1:

Risk of all cause mortality associated with two point increase in adherence score for Mediterranean diet. Squares represent effect size; extended lines show 95% confidence intervals; diamond represents total effect size.

Figure 2:

Risk of Parkinson’s disease and Alzheimer’s disease associated with two point increase in adherence score for Mediterranean diet. Squares represent effect size; extended lines show 95% confidence intervals; diamond represents total effect size.

A Health Care System alone does not ensure health. As we see in the numbers, without the other systems we support as a society (such as nutrition and lifestyle as part of our education system) we would have decreased health. Clearly a trade off from the education sector to the health sector would be detrimental  – just like reducing the number of preventative general practitioners (GPs) in order to increase emergency room use, which we would never do…errr…more about this next week.

Tips for Reading More

I like to read. This post is about how I have integrated more reading into my life.

These tips vary in their applicability depending on your lifestyle and preferences. This piece is written from my experience alone. It is intended to highlight ideas that may help you integrate more reading into your life.

In this post I detail how to read more by:

  1. Reading during other compatible activities.
  2. Replacing TV with reading.
  3. Make reading material more accessible in your home.
  4. Using audiobooks for reading while walking, running, folding laundry, etc.
  5. Skimming books and articles to see if they are worth reading.
  6. Read what you love. Read what you want to.
  7. Utilizing technology such as ebook readers and smart phones.

Take reading to where you have to wait

I can bring a book to many places that I go during my day. I find that I often have a few minutes of ‘doing nothing’ at several points during my day. Some of these times I can fill with reading.

I have found that reading can be done simultaneously with many other activities. What I focus on here is waiting, or ‘down time’ of different types.

You might think that you don’t spend that much time waiting during your day, but I guarantee you that it can add up to quite a bit even for a busy person. Even a few minutes here and there means a few pages here and there. A few pages per day can mean an extra book or three per year.

Do you find yourself spending time:

  1. in lineups
  2. on the bus
  3. on the train
  4. on a plane
  5. riding in a car
  6. waiting in lobbies
  7. waiting for friends (or your food) at restaurants or cafes
  8. on the toilet
  9. in the bath
  10. at the laundromat

What do you do during these times? Perhaps you are idly staring off into space, or scanning the headlines of tabloids. If you are very performance oriented, you might find yourself stuck thinking circular thoughts about the time you are ‘losing’. Finding something productive to do during these times, such as reading, can help with both passing the time and stimulating new ideas and thoughts.

I am not espousing that you begin to read instead of socializing. I am merely saying that you may have some alone time that you might want to spend reading.

Put a book in every room

Some people swear by this technique. Having an interesting book at hand can be very helpful for integrating more reading into your life.

Replace TV with Books

This concept has been floating around for decades. North Americans watch an average of four hours of TV per day. If you would like to read more, but you find that much of your time is consumed by TV, a change may be in order.

Find the book or books that you want to read the most, and use them as an incentive to drag you away from the TV some of the time. Put them somewhere visible such as on top of the TV or coffee table.

You may be surprised about how engrossing a good book can be, especially if it has been a long time since you read for pleasure.

TV is designed to grab and keep your attention so that you stay there, plastered to the screen between commercials (the primary revenue of TV stations). Books, on the other hand, rely on the quality of your attention and the fact that you care about what the author is saying. It is thus clear that books and TV shows become popular for very different reasons.


My Sandisk Sansa Clip 4gb. Sturdy, reliable, and easy-to-use

I have recently become a fan of audiobooks. Audiobooks still come on tapes or CDs but these mediums are rapidly being replaced by the mp3 and other computer audio formats.

My key point is that audiobooks have some flexibility that normal books do not. I routinely listen to audiobooks:

  1. When walking / jogging.
  2. When biking, though in traffic this can be a bit of a problem. Be sure that you don’t have the audiobook playing overly loudly, or it may seriously hamper your hearing (a very useful sense for an urban cyclist).
  3. When standing in lines or when shopping.
  4. When doing mechanical tasks around the house such as washing dishes or sorting laundry.

In the last two years I estimate that I have used these techniques to read about 25 audiobooks. These have included such hefty titles as Atlas Shrugged and Guns, Germs, and Steel.

My Audiobook setup: Sansa Clip and Sony Headphones. The headphone design is great for walking, jogging, and biking.

I have found this medium to be very useful, and I believe that it may be more socially acceptable for some people because of the growing popularity of headphones in public spaces. If you have a long commute on transit, but do not want to carry around a book, give audiobooks a try, you may be surprised by the results.

If you want to make even better use of your time, you may find it helpful to increase the speed of your audiobooks. I routinely listen to my audiobooks at 1.5 times normal speed. Some of my friends listen at much higher speeds. You can often modify the speed of playback on mp3 players or in computer software.

If you wish to read non-book texts as audio, there are some text-to-speech converters available that may be able to help you transform the text into a mp3 or similar audio format.

Skimming (and Stopping)

Be discerning about what you give your attention to. Not all books will be enthralling for you. If you find yourself getting bored or not learning anything new, don’t be afraid to skim (or just stop). For fiction books this might be a really bad sign, but for non-fiction is may just mean that the ‘meat’ of the book is elsewhere.

I have been known to skim entire books in under 5 minutes while standing in a used book store. Sometimes a skim-through informs me that I want to buy the book and read it. Sometimes it tells me that I should read the final concluding chapter that knits together all the topics of the entire books. Sometimes it tells me that I should put the book down and look at other things.

Skimming is more difficult with topics that are new to you, or especially complex. I find that if I have read a lot on a topic, skimming can be a powerful tool for discerning the quality of a possible read.

If you are reading for fun, don’t waste your time on things you don’t enjoy. This may sound straightforward, but I find a lot of people start reading things ‘for fun’ that they don’t even enjoy. If you really want to read for fun, go spend an hour in a bookstore skimming through some books to find an author who has a voice and a topic that you appreciate.

Don’t place heavy restrictions on yourself. What would I classify as a restriction? Here are some habits and beliefs that I would consider restrictive with regards to reading.

Restrictive reading beliefs

  1. I must read only one book at a time. (I must finish my current book before starting a new one, regardless of how uninspiring my current book is.)
  2. I must finish all books I start.
  3. I can only read just before bed. (Or I can only read in bed.)
  4. I can’t read for fun because I have too many textbooks to read (or work books, paperwork, memos, stock reports, post-its, etc).
  5. Reading damages your eyes. (From some reading around on the Internet, this seems to be untrue. If you want to, you can read about more eye health myths.)

Ebook Readers, Smart Phones, etc

These new electronic devices allow increased mobility of information. It is possible to carry many ebooks on a single device, which itself may be smaller than a book. These devices are developing rapidly, and already offer what I would call an impressive reading experience. They are trendy and slick, and may be just the thing for getting more reading into your life.

These devices are often multi-use, meaning that they may be useful for much more than just reading.

The downsides of these devices that I am concerned about are the fact that they often have relatively short battery life (a few hours), and they may have difficulty with wet or very cold weather. Choose a device that fits the usage patterns (and weather) that you expect.

I hope that some of these ideas prove useful for you. If you have further ideas you would like to share, I invite you to comment!

Getting a Feel for Kinesthetic Learners

For a presentation during my Master’s studies I brought along some objects to use as learning aids. I was anticipating the multiple learning styles that may be in the classroom. Just prior to my moment in the spotlight, I looked at some of the more tactile items and said, “These are for the kinesthetic learners, although I doubt they made it this far.”

There is a large amount of truth in this statement, but not for the reasons you may predict. Kinesthetic learners are not inferior in learning capacity, nor are they poor at grasping or retaining concepts. The issue lies in the current teaching methods used in university and school classrooms.

Modern lectures, at best, are comprised of slideshows accompanied by ongoing explanations from the teacher. At worst, lessons may be presented only from a textbook – again, a visual medium. These two ends of the spectrum show how prevalent the visual and auditory learning styles are in today’s classroom. But what about the kinesthetic learners?

Kinesthetic learners gain knowledge through doing and feeling (e.g. some learn best on their feet). If they are to understand the concept of addition, they would rather add physical steps than images on paper. If they are to grasp mechanics, they would rather take a motor apart than study how it works in theory. If they are to memorize anatomy, they would rather touch, feel, poke and prod a dummy.

And when you think about it, wouldn’t you rather do that? Imagine learning geometry by acting out shapes. Or understanding DNA replication by being a nucleus. Or grasping neurotransmitters by turning your classroom into a big brain.

In a TED talk by Ken Robinson, he points out that we tend to educate children first from the waist up, then the neck up, then a little to one side, the left side – where mathematics, logic and language are located. Our education systems fail to incorporate the power of learning through physical motion and touch. Not only that, we systematically educate our children away from this method of learning and expression.

This is a major oversight. After all, the major neurological unit of movement (the cerebellum) is biologically one of the oldest and most important parts of the brain. All of the deliberate actions we make involve the cerebellum.

Due to the lack of support for their learning style many kinesthetic learners do not reach their full potential. But they can.

The incorporation of methods that could benefit all learners, especially of the kinesthetic style, is easy. Here are a few tips for aiding the kinesthetic learner:

  1. Bring appropriate objects to touch and interact with.
  2. Avoid sitting when possible – movement is healthier.
  3. If sitting is necessary, use chewing gum as a backup motion.
  4. Review material while dancing, walking, running, showering, doing the dishes, etc. (associating an action with a subject may help your memory).
  5. Doodle.
  6. Remember that this learning style is the most easily forgotten. Classrooms were not made for kinesthetic learners, but classrooms aren’t the only place to learn. Find a space.