The results of a two-year partnership, My Health My Community, give us a lot of insight into Metro Vancouver’s active transportation trends: 43% of residents say their primary transportation mode is walking, cycling, or public transit.

Transportation agencies and municipal transit providers do a lot of their own research, but most of this is not open data and is summarized in publicly available reports. In the absence of Census data or a national transportation survey, transportation researchers often have to collect their own data. The My Health My Community study surveyed over 28,000 residents in Metro Vancouver on their primary mode of transportation, health outcomes, lifestyle behaviours and neighbourhood characteristics.

Key findings from the study include:

  • Active transportation users have lower body mass index, walk more each day, and are twice as likely to meet the requirement for 30 minutes or more of daily recommended walking
  • Car users with longer commute times have a lower sense of community belonging
  • Transit use is highest among lower income, visible minorities and recent immigrants–it is 69% lower among parents with dependent children and 70% lower among households with incomes of over $100,000 annually

Screen Shot 2015-04-29 at 4.23.42 PMAnother interesting result is shown on this map which depicts areas with higher than average active transportation (the darkest purple) in relation to existing and proposed transit infrastructure–and there is a second map showing the same for car users.

My Health My Community is a partnership between Vancouver Coastal Health, the Fraser Health, and the e-Health Strategy Office at the University of British Columbia.  The survey was conducted in 2013-2014 and the results are just beginning to be released. Dr. Jat Sandhu of Vancouver Coastal Health will be presenting the research tomorrow, April 30th at the SFU Segal School of Business, from 7:30-9:00.

In mid-October, in between the Association of Collegiate Schools of Planning (ACSP) conference in Minneapolis and a much-anticipated trip to Spain, I had the pleasure of witnessing the final doctoral exam of Ugo Lachapelle. Ugo came to SCARP under the supervision of Dr. Larry Frank, our Bombardier Chair of Sustainable Transportation. Ugo started his PhD the same year that I started my Masters at SCARP (2005), so it was particularly exciting to witness his exam and to hear that he passed and will graduate in the Spring of 2011.

Ugo chose to write his dissertation in the format of three papers, which could be published separately. His research focuses on the travel behaviour of public transit users and the relationship between transit and walking. Interestingly, the three-paper dissertation format, a relatively new innovation at UBC, has now been discontinued, making Ugo’s the only dissertation ever produced at SCARP to be published in this format. The dissertation, “Public transit use as a catalyst for an active lifestyle: mechanisms, predispositions and hindrances”, can be read here.

Ugo’s other work has been published in the Journal of Public Health Policy, in an article that examined whether people with employer-sponsored transit passes got more than the minimum recommended level of physical activity through walking. Ugo also published in the American Journal of Preventive Medicine last year on how public health and transportation researchers study non-motorized transportation. His work, along with others spanning urban planning, public health and urban design, is a great example of the interdisciplinary nature of our research at SCARP.

Dr. Lachapelle is now a Postdoctoral Research Associate at the Alan M. Voorhees Transportation Center at Rutgers University in the company of noted researchers Robert Noland, John Pucher and Devajyoti Deka. I’m sure he is also madly publishing his results, in between conference presentations at ACSP and the Transportation Research Board. Congratulations Ugo!

Update: Ugo will begin teaching at Université de Québec at Montréal, Département d’études urbaines et touristiques (Department of Urban Studies and Tourism) in Fall 2011.

It’s so rare that I see a headline on my parents’ home state of Kerala that I couldn’t resist writing about this article in the Globe and Mail. For those of you who don’t know, Kerala (pronounced CARE-ah-la, and not cur-AH-la) is a mass of contradictions. It has the highest literacy rate in India but still has arranged marriages. The population of the state is the same as that of Canada, but Kerala’s birth rate is lower that the US rate, thanks to the intense family planning advocacy that’s gone on since my parents were children in the 1950s. A relatively high quality of life is contradicted by a very low GDP. And most paradoxical, the state has a Communist history: democratically-elected Communist governments.

This last point is the key to all the others. Since 1957, the Communist party has been democratically elected and in office, either alone or working with other left wing parties. The leftist governments prioritized public services, small scale co-ops and rural land reforms, resisting rabid globalization and the corporatization of agriculture. In other words, the governments have built upon Kerala’s strengths rather than following popular, often disastrous, employment trends. Strong labour unions are also responsible: workers of all stripes go on strike regularly in Kerala, with the result that the state has some of the best working conditions in the country.

Most importantly, Kerala illustrates one of the classic postwar economic paradoxes: it has a very low GDP but excellent labour conditions, lower poverty than the rest of the country, very strong women’s rights, and excellent health outcomes. How can that be when the state governments haven’t bought into the ideas of neoliberalism, globalization and corporate agriculture? For one, the excellent public health initiatives in Kerala are a direct result of a strong, affordable, health care system that was only possible with consistent leftist governments. Ditto education, which is the key to women’s economic and social independence. State education in Kerala, including free public and high schools, mean that Kerala doesn’t have untouchables: the caste system barely exists at all in the state. It has a very low incidence of religious intolerance (Hindus killing Christians, Muslims killing Hindus, etc.) The strength of the public sector balances out the lower employment in niche areas like traditional Kerala crafts and small-scale manufacturing and production.

All is not sunshine, however: the traffic and pressure on local roads is growing by 10% each year and the rate of road accidents is the highest in India. And unemployment, particularly among youth and women, is fairly high (a handy side effect of strong labour unions and a very well-educated population). This has resulted in massive emigration of Kerala’s population to the Arabian Gulf, the US, Canada, the UK, and Australia. More than 50% of Kerala’s population relies on wells for fresh water, which are still responsible for water-borne diseases such as typhoid, dysentery, and hepatitis. Environmental conditions are no picnic either: Booker Prize winning author Arundati Roy (The God of Small Things), who hails from Kerala, famously donated her prize winnings to fighting the Sardar Sarovar Dam project across the Narmada river.

Nevertheless, Kerala has achieved a remarkable amount with, measurably, very little. The state is just one more example that money may not be the key to happiness after all.

In the past ten days, US policymakers seem to have achieved the impossible. On March 11, 2010, US Secretary of Transportation Ray Lahood pronounced the end of favouring motorized transportation over non-motorized transportation. And on March 21, 2010, the US finally passed its health care legislation. Aren’t these the first signs of the apocalypse?

Lahood, at this year’s National Bike Summit, announced his new Policy Statement on Bicycle and Pedestrian Accommodation Regulations and Recommendations. Key recommendations for state DOTs and communities include treating walking and cycling as equal transportation modes, ensuring convenient accessibility for all ages and abilities, going beyond minimum design standards, collecting data on walking and cycling trips, setting a mode share target for walking and cycling, protecting sidewalks and paths in the same way roads are protected, and improving non-motorized facilities during maintenance projects. At this point of course, it’s a Policy Statement; it’s not law. But it marks the profound shift that is occurring in North America away from car-dominated discourse and policy.

On the health care front, the health care bill passed in the House December 24, 2009 served as the basis for HR 4872, the Health Care and Education Affordability Reconciliation Act of 2010. HR 3590, the Patient Protection and Affordable Care Act, was passed by the Senate on Christmas Eve 2009, as I reported in an earlier post. Its main measures, taking effect six months after its passage, prevent insurers from denying coverage to people with pre-existing conditions, prevents increased rates for children with pre-existing conditions, forces insurance policies to cover preventative care without co-pays, allows children to remain on parents’ plans until the age of 26, and bans lifetime monetary caps on insurance policies. In the future (by 2014), it will prevent insurers from charging higher rates for those with pre-existing conditions, expand Medicaid eligibility, offer tax credits to small businesses (fewer than 25 employees) who offer insurance, impose tax penalties on businesses with over 50 employees who do not offer insurance, impose a fine on individuals who do not have insurance, give tax credits to individuals who have heath insurance, and offer a state-controlled insurance option. However, it differed significantly from the bill passed in the House, HR 3962, the Affordable Health Care for America Act, particularly in terms of financing and subsidies. Because they were so different, President Obama and House Speaker Nancy Pelosi introduced the reconciliation bill. HR4872 was passed in the House of Representatives March 21, 2010, in a close 219-212 vote (216 votes were need to pass the bill). Not a single Republican supported its passage, but it doesn’t matter: the bill will be signed into law by the president as early as tomorrow.

Canada has also had a few firsts lately, although they are small potatoes compared to these major American policy shifts. One was the announcement that woonerfs are coming to Toronto. A West Donlands neighbourhood, currently under development, would include these Dutch streets, narrow, mixed-use affairs without curbs, which are thought to encourage pedestrian and cyclists while discouraging cars. Dutch woonerfs include traffic-calming measures like speed bumps and planter “bump-outs,” and the streets are more like outdoor urban social spaces than thoroughfares. The other was the announcement that Canada had opened the first school to ever require students to use non-motorized transportation to get to school. The Halton Public School Board just opened a new school, P.L. Robertson Elementary in Milton, where the students who live within 1.6 km (1 mile) of the school are required to get there on their own two feet, and parents are forbidden from driving their kids. 98% of the 700 students walk, bike, skateboard or ride scooters to school, while the remainder, who live more than 1.6km away, are bused. The school board is running the pilot project for one year, and hope to expand it to other schools soon. If it is a success, project manager Jennifer Jenkins knows that other schools will rapidly jump on board; the wealth of research on this topic shows how much is at stake with increases in childhood obesity and diabetes.

All I can say is where is our national policy on transportation? Where is our Ray Lahood? And more importantly, where is our Obama?

December 24, 2009 will become a date to remember: today the US Senate passed its landmark health care legislation in the first Christmas Eve vote since 1895. I wrote earlier on Canada’s rough ride to Medicare, and Bill HR 3962 (the Affordable Health Care for America Act) passed in the House of Representatives in another post. It’s an electrifying issue which is exciting regardless of where you stand on this complex issue. Health care, and the delivery of health services, are crucial issues for cities in the US. While there is a lot of debate about the differences between the Senate and House bills and the numerous concessions required to pass the Senate version (Bill HR 676, the National Health Care Act or Expanded and Improved Medicare for All Act), the legislation is a particular success for the still-young Obama administration. According to the White House, the main goals of the bill are to reduce long-term health insurance costs for governments and companies, ensure a choice of doctors and health insurance, prevent bankruptcies, invest in patients and wellness, improve patient safety and quality of care, ensure quality affordable health care for all Americans, maintain coverage when people change jobs or leave work, and end barriers to coverage for people with pre-existing health conditions.

Earlier this week, the Senate narrowly agreed on Bill 676, which they endorsed 60-40 at 1am on Monday. Sixty votes are required to bypass a lengthy debate (filibuster) and the Democrats have 58 Senate seats, so they need every vote plus the two Independents. Nebraska Democrat Sen. Ben Nelson was the keystone in cementing the 60-40 vote. Critics feel the bill is too expensive (CNN’s David Frum), delivers too little, and excludes too many (Michael Moore). Republican critics maintain that health care will be “rationed” and overall patient care will suffer: House minority leader John Boehner said it “puts bureaucrats in charge of decisions that should be made by patients and doctors.” Many Democrats are still divided on the issues of abortion represented in the bill (Huffington Post’s Judy Patrick) while others say it diminishes choice by forcing Americans to buy heath insurance. Most agree that the bill was diluted significantly in order to ensure its passage, citing the exclusion of a government-run insurance option that had been included in the House bill, but as Michael Tomasky wrote for the Guardian, “Half a loaf is better than none.” Nelson, in particular, held out for concessions like a federal contribution to Nebraska’s Medicare program. The “Senate test” on Monday was said to predict the passage of the bill today.

It is somewhat troubling that US health insurance companies like Aetna Inc., Signa Corp. and Humana Inc. instantly posted stock market increases, and Democrat Sen. Joe Lieberman (CT) got major contributions from these and other insurance companies to fight the bill. While the bill is expected to cover 30 million Americans who were previously uninsured (the population of Canada, by the way) the Congressional Budget Office reported earlier this year that there were 45.7 million uninsured people in the US. Although this number has been disputed, there will still be millions uninsured in the US, since health insurance will still be tied to employment and the government option has been eliminated. But it is encouraging that the bill bans discrimination of insurers based on pre-existing conditions and mandates employers to provide health insurance, providing tax breaks for small businesses and penalties for large ones.

Today’s Senate vote required the agreement of all 58 Democrats and 2 Independents to achieve the 60-39 win. Four different administrations have tried to pass health care bills in the US. This particular bill, HR 676, was introduced in 2003 by Representative John Conyers (D-MI), and has been reintroduced in every congress since. However, the release of Michael Moore’s Sicko (2007) focused attention on the country’s inadequate health coverage, in particular discriminatory treatment of insured people and the business ethic that pervades Health Management Organizations (HMOs). American friends told stories about the aftermath of seeing the movie in the theater: afterwards, audience members lingered the lobby, saying, “We’ve got to do something about this.” The DVD release of Sicko included a segment entitled “Sicko goes to Washington” which promoted the health care bill. Although the original bill suggested a single-payer system for universal coverage, public opinion was divided: most Americans are against government-run health care, although the American Medical Association favours the option. The single payer option was dropped from in the Senate bill (it still exists in the House bill). The next step involves harmonizing the Senate and House of Representatives bills, which may take until February.

While everything in HR 676 isn’t perfect, legislation rarely is. We’re currently awaiting the proroguing of Canadian parliament (the termination of the current session) which is how our Conservative Prime Minister deals with the fact that he doesn’t have the agreement of the whole House of Commons. This would mean all bills proposed and worked on in committees would die, including the long-awaited affordable housing act (Bill C-304), which has been introduced three times already. So Merry Christmas to our neighbours to the South, and celebrate your imperfect legislation!

In what has been called “a hard-fought victory for President Obama“, the Affordable Health Care for America Act (HR 3962), passed November 7, 2009 in the House of Representatives. The vote was 220:215, an extremely narrow victory (218 votes were needed to pass the bill). Among other things, the bill prohibits insurers from charging different rates or refusing treatment based on a patient’s medical history or gender, requires most employers to provide health insurance, increases Medicaid eligibility to cover more low-income people, a subsidy plan for low- to middle-income people to buy insurance, a central health insurance exchange where people can compare plans and rates, as well as a government-run insurance program.

In an earlier post, while the US was gearing up for its health care talks, I wrote extensively about some of the myths concerning public health care provision. Among these was the claim that public health care is much more expensive than private health care, which is simply not the case. In addition to the data I provided in that post, the Canadian Institute for Health Information’s annual report on health care spending was released today. According to their figures, Canada’s health care costs rose by 5% to $183.1 billion in 2009 compared to 2008. Canada’s per capita costs are highest at the early and late stages of life: $8,239 for an infant under one year old, and up to $17,469 for an adult over 80 years old. For those aged 1-64, the per capita cost is only $3,809 per person. There are also interesting regional differences, with Alberta and Newfoundland and Labrador having the highest per capita costs and BC and Quebec having the lowest. Our costs are in the top 20% worldwide: presumably the 20% with socialized health care systems, since our costs compare to France, the Netherlands, Germany, and Austria.

How do we compare to the US? The per capita cost in the US is $7,290 US, almost double Canada’s average of $3,895 and the highest of 26 countries surveyed by the Organisation for Economic Co-operation and Development (OECD). While Canada’s increased from 10.8% of the GDP in 2008 to an estimated 11.9% in 2009, the CIHI reported that the US was forecasting a similar increase in spending, up to 17.6% of its GDP. Interestingly, they also write that health care spending spikes during economic recessions.

The battle isn’t over yet in the US, which plans to take their health care bill to the Senate. Only one Republican in the House of Representatives voted for HR 3962, and 39 Democrats voted against it; the Democrats will need 60 of 100 votes in the Senate to end debate and bring the legislation to a vote. This was in part due to some controversial amendments at the last minute that added in some flexibility for states in dealing with abortion. Speaker of the House Nancy Pelosi compared the passage of the bill to the 1935 passage of Social Security, but it will be a rough run at the Senate if the abortion issue remains unsolved.

Health care is a polarizing issue; it always has been. Because it is a service that is offered privately in some places and publicly in others, there is an ongoing debate about its ethics, its efficiency, and its reliability. The ethical debate is simple: in countries with private health care, the rich receive much better treatment than the poor. The efficiency debate is more complex: most argue a publicly-funded system is more efficient, saves costs, and treats all patients equally, while others argue the private system is superior. Reliability is a characteristic that is frequently brought up in health care discussions: wait times, availability of general practitioners, availability of equipment. But it often is difficult to get behind the political double-speak to the reality of health care provision.

Health care is a crucial factor in planning more socially equitable cities and regions because anyone can be affected by health problems or accidents, and public health care protects the middle and lower classes from bankruptcy and homelessness. Before the US mortgage crisis, medical bills were the leading cause of bankruptcy in the country, affecting 2 million people annually (this 2005 Harvard study showed that three quarters of these had health insurance at one time, 56% were middle class and over half had attended college). A 2009 study published in the American Journal of Medicine reported that 62% of bankruptcies in the US were due to medical bills and 80% of these people had health insurance. A 2008 study in Health Matrix: American Journal of Law-Medicine showed that for 49% of homeowners going through foreclosure, the foreclosure was caused by illness, unmanageable medical bills, lost work due to a medical problem, or caring for sick family members.

The biggest debates at the moment are happening in the US, the only industrialized country that does not have public health care. US President Barack Obama has been getting a lot of flack for his proposed health care reforms, which would introduce a government-run insurance program to make health care more affordable. Obama’s approval ratings have fallen nine percent since July 2009, to 52 percent, which critics say shows waning support for a national health care program. Because of our proximity, the US and Canadian systems are constantly being compared. The scary thing is that while many Americans are terrified of the Canadian system, pro-economy Canadian politicians want our system to be more like the Americans’, with private clinics offering services such as MRIs in Quebec. American politicians will cite long wait times for surgeries and MRIs, inability to find a general practitioner, and rumoured higher costs as evidence that public health care doesn’t work. However, these comparisons are faulty for several reasons.

The myths demystified

First, the long wait times have only existed since 1996, when the Liberal government, faced with a budget shortfall due to a prolonged economic recession, cut overall spending levels and merged health care transfer payments to the provinces with transfers for other social programs. Serious cuts were also made to federal housing programs and education, resulting in an erosion of the social welfare state. These cuts, in addition to an aging population and high inflation rates in health costs, have caused problems with the system such as fewer available beds, shorter recovery time for surgeries, and increased workload for doctors and nurses. Fees have also been introduced for certain services such as travelling to a hospital by ambulance, eye exams, and physiotherapy. In BC and Ontario, each resident now pays a health premium annually. But the government has made significant strides in reducing these wait times: in 2004 a $5.5 billion Wait Time Reduction Fund was established and most provinces now have websites that allow us to check on wait times for specific services in our areas. Long wait lists are not a form of government rationing, as some Americans believe, but an unfortunate side effect of decreased government spending on health care. The wait lists, rather than prioritizing wealthier patients, ensure that all patients have equal access to scarce and high-demand services. Most health statistics in Canada are at or above the OECD average, including life expectancy, infant mortality, perinatal mortality, and percentage of health care costs paid by government. On the contrary, health care in the US is consistently ranked the lowest in the developed world by organizations as venerable as the World Health Organization.

Second, there are many studies showing private health care is much more expensive. Malcolm Gladwell, in a 2005 New Yorker article, wrote that “One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system.” He writes that efforts have been made to introduce universal health care six times: during the First World War, the Depression, the Truman and Johnson Administrations, the Senate in the 1970s, and the Clinton years. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the US spends more than a thousand dollars per capita per year—close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada spends only about three hundred dollars per capita.

In 2005, Dr. Quentin Young, national coordinator of Physicians for a National Health Program said that “The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured. With national health insurance (‘Medicare for All’), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick.” This year, the World Health Organization showed that the US spends 12.7% of its GDP on health expenditures, well above the worldwide average of 8.7% and 3.4% in South-East Asia. Canada spent 10.5% of its GDP on health expenditures in 2007. A 2007 report from the Coalition for Health Care said that national health expenditures were expected to outpace the growth of the GDP. The higher costs get in the US, the more people are uninsured.

Third, because we have the world’s most inflated health care costs just across the border, many of our more profit-hungry doctors are lured south. This means fewer doctors for Canadians, particularly general practioners. This, in addition to rampant health care cuts by successive neoliberal governments, is the reason for our doctor shortages.

I may as well put to rest other myths of universal health care voiced by the American public and mocked in Michael Moore’s Sicko: yes, we can choose our own doctors. No, the government will not force euthanasia on you. No, we’re not communists. And no, the economy will not collapse if universal health care is introduced.

As Gladwell writes, “moral hazard”, the idea that insurance can change the behaviour of the person insured, has become entrenched in American economic thought, policy and legislation. If Americans had universal health care, the idea goes, they would “waste” it; making them pay for it ensures it’s only used when it’s really necessary. But this only works if we treat health care like a consumer product, which it plainly is not: we only go to the doctor when we’re sick, and even then, we don’t really want to go. And there’s no way of knowing when a visit to the doctor could make sound economic sense: in the case of having moles checked for skin cancer, or having regular Pap smears. Early detection could save the health care system a good deal of money. Many insurance companies have moved to the “actuarial model” which charges more to insured people with serious health conditions, and their employers, basically guaranteeing that, in many states, these people cannot get health insurance. Under the social-insurance model, which Canada, Germany, the UK, Japan, and all other industrialized nations follow, everyone pays equally into health care, and everyone benefits equally.

The long fight for universal health care: Tommy Douglas

The reality is that health care has always been a political issue, and not just in the US. Tommy Douglas, the “father of health care” in Canada, fought long and hard to achieve universal health care in 1961. Douglas was leader of the Co-operative Commonwealth Federation (CCF) from 1942 and premier of Saskatchewan from 1944-1961. The fact that Douglas led the first socialist government in North America was intrinsically tied to his bold introduction of universal health care. There was also a personal connection: Douglas injured his leg at age 10 and developed osteomyelitis. He would have lost the leg to amputation had a local doctor not seen the condition as a good subject for his students, agreeing to treat Douglas for free. Unable to volunteer for service during WWII due to the old leg injury, Douglas set his sights on health care reform.

Douglas attended Brandon College to prepare for his future as a Baptist preacher. He was attracted to the social gospel movement, which fused Christian principles with social reform. While in his religious capacities at Calvary Baptist Church in Weyburn, Saskatchewan during the Great Depression, Douglas became a social activist and joined the CCF. He was elected to the Canadian House of Commons in 1935. He led the CCF to provincial victory on June 14, 1944, winning 47 of 53 seats in the Legislative Assembly of Saskatchewan. They won five straight victories until 1960, and were responsible for the creation of the publicly-owned Saskatchewan Power Corporation; Canada’s first publicly-owned car insurance service; a large number of Crown Corporations; legislation that allowed unionization of the public service; a significant passage of the Saskatchewan Bill of Rights that preceded the adoption the UN’s Bill of Rights by 18 months; and the first program in Canada to offer free hospital care to all citizens. Thanks to the postwar boom, the Douglas government also paid off the huge public debt left by the previous Liberal government and achieved a government surplus.

In 1958, newly elected Prime Minister John Diefenbaker, also from Saskatchewan, promised that any province seeking to introduce a hospital plan would receive fifty cents on the dollar from the federal government: this promise was renewed in 1959. The Saskatchewan Medical Care Insurance Bill was introduced in October 1961 and given Royal Assent in November, while Douglas went on to lead the newly formed New Democratic Party. Woodrow Lloyd became his successor as premier of Saskatchewan.

On May 1st, 1962, the Saskatchewan Medical Care Insurance Act was to be adopted, but the province’s doctors went on strike and 90% closed their offices, forcing Lloyd to delay adoption of the act. The government brought in doctors from Britain, the United States and other provinces in order to staff community clinics set-up to meet demand for health services. The Act was passed July 1st, 1962. By mid-July some of the striking doctors returned to work. Lord Taylor, a British physician who had helped implement the National Health Service in the United Kingdom, was brought in as a mediator and the “Saskatoon Agreement” ending the strike was signed on July 23, 1962. As a result of the agreement, amendments to the Act were introduced allowing doctors to opt-out of Medicare and raising fee payments to doctors under the plan, as well as increasing the number of physicians sitting on the Medical Care Insurance Commission. By 1965, most doctors favoured the continuation of Medicare. The strike was a significant test for Medicare. Its failure allowed the program to continue and the Saskatchewan model was adopted throughout Canada within a decade. The political divisions within the province aggravated by the strike contributed to the Lloyd’s government defeat in the 1964 provincial election. However, even though the Saskatchewan Liberal Party of Ross Thatcher had opposed the plan, Medicare was so popular that Thatcher’s government left it in place.

The program’s success led Diefenbaker to appoint Justice Emmett Hall, a noted jurist who also hailed from Saskatchewan, to chair a Royal Commission on Health Services in 1962. In 1964, Hall recommended the nationwide adoption of Saskatchwan’s model of public insurance. The program was created in 1966 under Lester B. Pearson’s minority government, with the NDP, who held the balance of seats, putting significant pressure on the Liberals. The federal government was to pay 50% and the provinces the rest. In 1984, the Canada Health Act was passed, prohibiting user fees and extra billing by doctors.

The moral dilemma

As Gladwell writes, the universal health care question is really quite simple: “Do you think that redistribution of risk is a good idea? Do you think that people whose genes predispose them to depression or cancer, or whose poverty complicates asthma or diabetes, or who get hit by a drunk driver, or who have to keep their mouths closed because their teeth are rotting ought to bear a greater share of the costs of their health care than those of us who are lucky enough to escape such misfortunes?”

As a Canadian whose parents (both registered nurses) immigrated to the country the year universal health care was introduced, I’m proud to say that we do not feel this way. Canadians, including Shirley Douglas, daughter of Tommy Douglas, have rallied to save our publicly-funded health care system throughout recessions and political changes. A 2009 poll by Nanos Research found 86.2% of Canadians surveyed supported or strongly supported “public solutions to make our public health care stronger.” A 2009 Harris/Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States, more than ten times as many as the 8% stating a preference for a US-style health care system for Canada. A Strategic Counsel survey in 2008 found 91% of Canadians preferring their healthcare system to that of the US. In the same poll, when asked “overall the Canadian health care system was performing very well, fairly well, not very well or not at all?” 70% of Canadians rated their system as working either “well” or “very well”. Since the passage of the 1984 Canada Health Act, the Canadian Medical Association has been a strong advocate of a publicly-funded health care system, including lobbying the federal government to increase funding, and being a founding member of (and active participant in) the Health Action Lobby (HEAL), although some provincial medical associations would like to see a larger private role. Tommy Douglas was inducted into the Canadian Medical Hall of Fame in 1998 and voted “Greatest Canadian” in a nationwide Canada Broadcasting Corporation (CBC) contest in 2004.

No one should die because they cannot afford health care, and no one should go bankrupt or lose their home because they get sick. Period.