From the Editor / L. Ian MacDonald

Welcome to our issue on health care; a subject we like to check in on regularly, given its priority among Canadians in general and thought leaders in particular as a dynamic policy issue, a perennial fed-prov scrimmage file and a longstanding values question. 

Historian Ed Whitcomb lays out the history of Medicare, largely funded by Ottawa but within provincial jurisdiction. It’s a story of cash and confrontation over the last half century.

BIOTECanada President Andrew Casey makes the case for holistic public policy, and breaking out of “silos of responsibilities between federal departments” to make sure Canada is world-competitive in biotechnology.

From the Institute of Fiscal Studies at Democracy at University of Ottawa, Alannah McBride and Randall Bartlett look at the Trudeau government’s overture on pharmacare and conclude its time has come. As they point out, Canada is the only major country with universal health care but not universal drug coverage.

Peter Vaughan, former Nova Scotia deputy health minister and now chair of Canada Infoway, remarks that Canada is not digitally connected on health care. Only six per cent of Canadians, he notes, have looked at their own health information online in the last two years. “We need to quickly reimagine a digital Medicare 2.0,” he writes, or digital platforms “will be providing health care to Canadians for a fee.”

Genome Canada President Marc LePage presents Canadian success stories in precision health, describing the genomics-driven transformation in health care as “bringing new hope for Canadians living with cancer, cystic fibrosis, juvenile arthritis, childhood asthma and other diseases.”

From the Centre for Drug Research and Development in Vancouver, President and CEO Gordon McCauley provides an update on R&D in that corner of the health care universe.

Kimberley Hanson, director of federal affairs at Diabetes Canada, warns of the diabetes epidemic in Canada. As she writes: “Altogether, 11 million Canadians—nearly one Canadian in three—are living with or threatened by diabetes.”

Russell Williams, board chair of Canadian Frailty Networks, notes that more than one million Canadians over 65 are living with frailty, and with the aging of the boomer generation, that number is expected to double over the next decade. That’s a major challenge looming in health and home care.

Contributing Writer Robin V. Sears examines Indigenous peoples’ health care, a “legacy of disastrous health impacts (that) continues,” and which is demonstrably the biggest challenge to reconciliation. He calls for “a generous increase in funding, incubating new prevention and delivery models for Indigenous communities, and focusing on outputs, not inputs.”

Baxter Canada President Stephen Thompson writes that innovation in dialysis technology is now bringing end-stage kidney treatment to patients in remote communities. He notes a 2017 report from the Canadian Institute for Health Information stating that Indigenous patients with end-stage kidney disease “are 30 per cent more likely to be admitted to a hospital due to a dialysis infection, partly because they must travel longer to receive treatment, meaning problems don’t get caught early. We now have the technology to address these issues.”

Canada has seven medical schools in the Top 100 in the world in the 2017 Times Higher Education annual rankings. University of Toronto med school is ranked 19th, but McMaster University’s school is ranked 23rd, ahead of McGill University at 27th. Contributing Writer Yaroslav Baran tells the story of how a med school in the mid-sized industrial town of Hamilton became a world leader.

Margaret Clarke, herself an alumna of McMaster med school, makes the case for the Trudeau government’s new information exchange on autism, which affects one in 66 Canadian families. 

George Weber, President and CEO of the Royal Ottawa Health Care Group, writes that public awareness of mental health issues is much higher than a decade ago, with the stigma of mental illness greatly reduced. But policy lags and mental illness remains costly in both personal and economic terms, “with a cost to the economy of more than $50 billion” a year.

Michael Nashat, President and CEO of TerrAscend, a leading Canadian manufacturer of medical cannabis, explains the already-legalized segment of the marijuana market, which has grown from only 12 private cultivators four years ago to more than 90 today.

Finally, columnist Don Newman writes that the path to better health care does not lie through tax cuts, as recently implemented in the United States, along with a debate on ending Obamacare. “Can you imagine such a shameful argument even being entertained in Canada?” he asks. “Luckily, no one can.”