Month: June 2022

From the CBC News article

Ontario’s New Democrats would work with Ottawa on decriminalizing drugs for personal use if the party is elected to form government this week, but the provincial Liberals aren’t considering a similar move.

The issue emerged on the last day of the election campaign in Ontario, following the announcement of a three-year agreement between British Columbia and the federal government that means people won’t be charged for possessing up to 2.5 grams of some illicit drugs in an effort to curb overdose deaths.

Ontario has not submitted a proposal to follow suit, but Toronto’s top doctor did earlier this year.

NDP Leader Andrea Horwath said decriminalizing simple possession of drugs is part of her party’s plan to address the overdose crisis, along with lifting a cap on safe drug consumption sites and improving access to treatment.

“It is about saving lives, and that’s what we have to do,” Horwath said at a Wednesday campaign event in Brampton, Ont.

“We have to do better, and we can do better, so yes, absolutely, making sure that we have a safe drug supply, that we decriminalize simple possession, but most importantly, that we provide the services that people need to try to help them get well.”

Horwath also noted that it was a New Democrat government in British Columbia that made the first-in-Canada decriminalization policy happen.

Ontario’s New Democrats have also promised to declare the opioid crisis a public health emergency. Horwath said conversations around the limit of drugs exempted under a decriminalization policy — whether she would ask for a 4.5 gram limit as B.C. did — would have to happen with experts before making a submission to the federal government.

A spokeswoman for the Liberal campaign said the party isn’t considering decriminalizing drugs.

At an afternoon media event in Toronto, Liberal Leader Steven Del Duca said decriminalization is “not in our plan right now” but pointed to other things his party is proposing to fight the overdose crisis.

The Liberal party has said it will restart an opioid task force, expand access to the overdose reversal medication naloxone and lift the cap on new consumption and treatment sites that was brought in by the Progressive Conservative government.

But Dr. Tara Gomes, a researcher at Unity Health in Toronto and lead of the Ontario Drug Policy Research Network, said taking a localized approach to decriminalization isn’t the best way forward.

“There’s a real concern if just Toronto decriminalizes drug use people who move outside of those boundaries, or are visiting Toronto, aren’t going to always understand the complexities of that,” Gomes said.

“So I think that these really localized approaches are really challenging and we need to broaden it across the country.”

Op-ed in the Toronto Star by Daniel Bierstone and Shazeen Suleman

“I eat whatever is leftover, so my children can eat enough.”

“I can’t afford their therapy anymore so we had to stop.”

With nearly one in five children in Canada living in poverty, Canada scores poorly compared to other countries, ranking 24th out of 35 industrialized nations. In Toronto — dubbed the “child poverty capital of Canada” — nearly 25 per cent of children live in poverty. A damning report in 2017 found that racialized children in Toronto were twice as likely to be living in poverty compared to non-racialized children. Many of these children have caregivers earning low-wages or in precarious employment, worsened by the COVID-19 pandemic.

Inadequate income has deep and wide-ranging impacts on a child’s well-being, from their physical health to their educational outcomes. Families in poverty may struggle to afford healthy and nutritious food choices; childhood food insecurity can lead to obesity and malnutrition.

Children and families in poverty face rising rent prices across the province, and may be forced to live in poor housing conditions with limited access to outdoor spaces or opportunity for physical activities, both crucial for physical and mental health. The education gap between low- and high-income students is growing, as low-income students face significant barriers to completing high school and pursuing post-secondary opportunities.

From the CityNews article

With at least one confirmed monkeypox case in Toronto, efforts are ramping up to address any early misconceptions about the virus and reduce potential stigma.

“I think what we’re really hearing really spans from curiosity, plenty of questions,” Dane Griffiths, the director of the Gay Men’s Sexual Health Alliance, said when asked about how members of the LGBTQ2S+ community say they’re feeling.

He is among those on the frontlines working on getting factual information about monkeypox as it’s being learned out in the community.

“We’re really just saying that this is something to pay attention to. There’s certainly a lot that we know about monkeypox, but there are plenty of outstanding questions with regards to the current dynamics of transmission within our community,” Griffiths said.

The need to get out as much accurate information as possible is escalating amid reports several of the confirmed and suspected monkeypox cases involve men who have sex with men, something that has fueled intolerance before.

“I think our histories as gay men and queer people, of course, lived and living through the HIV and AIDS epidemic, have plenty of experience with stigma, with discrimination, with connecting our sex or our sexual health with notions of danger and of risk broader public,” Griffiths said.

“I think that sensitivity is to be expected. It goes without saying as many health officials even here in Ontario will say, illnesses, viruses and diseases like monkeypox don’t have a sexual orientation.

Those who are a part of, and work with, the LGBTQ2S+ community said we’re hearing about this connection now likely because of a commitment to sexual health testing and assessments.

“There are folks in our community who are seeking out testing, getting assessed, that continues I think a long history of health-seeking behaviour by gay and bisexual men to engage with public health and with our sexual health clinics and we certainly want to see that continue,” Griffiths added.

“The folks who are presenting at the sexual health clinics as was the case in Montreal just happened to be gay and bisexual men. There is nothing to suggest that monkeypox won’t impact other populations and other communities, that just remains to be seen.”

It’s a sentiment Dr. Darrell Tan, an infectious diseases physician and clinician-scientist at St. Michael’s Hospital, said he agrees with.

“Sexual minority communities… have a history of resilience, of self-reliance, of looking out for each other, of creativity in the face of adversity that I think we can really lean on in a very uncertain time like we find ourselves right now with monkeypox,” he told CityNews.

Tan recently met with LGBTQ2S+ community organizations to address questions, but said he and other medical professionals are trying to quickly learn more about.

“As a scientist and as a physician, I feel it really, really acutely just how much we don’t know. We know some things, but there’s an awful lot that we still don’t know,” he said.

“It’s been literally since the beginning of this month, really just a couple of weeks, since reports anywhere in these non-endemic countries have even come out recognizing this was happening.”

UNITY HEALTH TORONTO

June 1, 2022 — Throughout her nearly 29-year career in research and medicine, Dr. Janet Smylie has focused on addressing health inequities faced by Indigenous peoples in Canada. At its core, her work is about using knowledge to propel change through action.

“In the modern world, we can get away with a focus on knowing and knowledge but where I come from, as a Métis Cree woman and from an Indigenous knowledge perspective, the gap between knowing and doing doesn’t exist,” she says. “The key to reconciliation is bridging the gaps between what we know and what we do. It’s the key to life and to solving most problems.”

Now, the first Strategic Lead of Indigenous Wellness, Reconciliation and Partnerships at Unity Health, Dr. Smylie is bringing that focus into this new role. Over the next seven months, she’ll lead several projects that support Unity Health’s ongoing efforts to develop a strategy and framework for the advancement of Indigenous health and reconciliation across the network.

We sat down with Dr. Smylie, who holds a Tier 1 Canada Research Chair in Advancing Generative Health Services for Indigenous Populations in Canada, to learn more about her new role and the challenges Unity Health faces repairing relationships with Indigenous peoples as a Catholic health care network.

What drew you to this role?

Like many people, I was deeply impacted in June 2021 when the first unmarked graves of Indigenous children were confirmed at a residential school in Kamloops, B.C. At the time, I committed to doing three things – helping address the role of the Catholic Church in the residential school system, marking Indigenous History Month at Unity Health and throwing my hat in the ring for this role. As I get older, having worked in health care for some time, I really try to think about the future. What can I do now to make it better? This role gets at that. But most of all, I was really inspired by those children and their families.

This role was designed with the support of Unity Health’s First Nations, Inuit and Métis Community Advisory Panel (CAP) and is intended to be collaborative in nature, working with the Indigenous community in Toronto. Why are these collaborative efforts so important?

Nothing about us without us. In the Canadian Constitution, First Nations, Inuit and Métis peoples are granted the right to live in a way that builds on the continuity of their respective cultural and societal norms. There’s also a domestic and international legal requirement to involve Indigenous peoples in decisions that affect them. It’s also simply more effective to work with the Indigenous community. No one knows what Indigenous people need more than the Indigenous community.

Do you have any specific goals or priorities in your first couple of months in this role?

One of my first priorities is to build a human resources plan for the network. We’ve heard from the First Nations, Inuit and Métis Community Advisory Panel (CAP) and other community leaders that to become a preferred place for Indigenous peoples to seek care, we need to recruit a team of people who can advance transformational change. This might include an Elder, a cultural coordinator, care navigators and a clinical care lead. Indigenous people often expect that they’ll experience differential or unfair treatment when they visit a hospital. We want Unity Health to be a place where Indigenous people feel safe accessing care.

Another priority of mine is building Indigenous care pathways within our hospitals. Defined referral pathways can be really helpful as they provide comfort and build on the notion of trust relationships.

I’ll also be doing some work with the CAP to develop a renewed terms of reference and explore how we can harmonize the efforts of the CAP and Unity Health’s Council on Anti-Racism, Equity and Social Accountability (CARESA). When working with Indigenous communities, it’s important that we establish a leadership structure and governance model to provide clarity and build trust. I’m working on that too.

Many of your research projects and foundational contributions in Indigenous health have relied on data collection. For instance, you co-led Our Health Counts, a collaborative research project that brought to light missing population-based health information on First Nations adults and children in urban settings. Where did this interest in data collection come from and why is it important?

Early in my career, I was working at an Indigenous health centre in Ottawa and we were trying to set up an information system that would help us understand who was coming into the clinic for care. But over time, I started to worry more about the people who don’t come to us or who only come on occasion and then we don’t see them. I wanted a way to identify these people and assess their health needs. I also just really like math. My dad was a theoretical physicist and I’m not afraid to use math as a tool. These factors motivated me to go back to graduate school at Johns Hopkins University. Then, a colleague introduced me to a new type of sampling that works well to count the people who don’t seek care. Everyone deserves to be counted.

Other early work of mine made sure that First Nations, Inuit and Métis identity was accurately recorded on infant birth and death registrations. Infant mortality is a key indicator of the broader population health of a community. We then discovered that the Canadian census was undercounting the size of Indigenous populations in Toronto by a factor of 3 to 5. Identifying that undercount had an immediate benefit, providing a better match between the unmet needs and aspirations for wellbeing of local First Nations, Inuit and Métis communities and the funding and resources made available.

What are some of the biggest barriers to health care for Indigenous peoples in Toronto?

There are approximately 90,000 First Nations, Inuit and Métis peoples living in Toronto and about 90 per cent are living under the low income cut off. Many of these individuals are young people or single caregivers, which can make it difficult to access care. For example, if you need to take the TTC with multiple children in-hand to access care, this makes it much more difficult than if you have a car and childcare. Another barrier, perhaps the biggest one, is a lack of trust in the health care system. There’s a lot of fear among Indigenous peoples that they’ll be treated differently because they’re Indigenous. Some other common barriers are a lack of access to regular primary care providers and not knowing where to seek care. There are also challenges navigating the transportation system.

It’s been nearly two years since Joyce Echaquan, a 37-year-old mother and member of Atikamekw Nation of Manawan, died in a Joliette, Que. hospital after staff dismissed her symptoms and subjected her to racist language and behaviour. A few days later, you co-authored an opinion piece in the Globe and Mail on racism in the medical system. Have we seen any improvements in the system since then?

No. Unfortunately, slow progress with respect to tangible change is a common challenge in systems transformation work – we could ask the same question about anti-Black racism and discrimination towards members of the 2SLGBTQ+ community. We know what works but we don’t have the political will to act on our knowledge. Human beings are funny that way – it’s hard for us to change our minds or act differently.

The Catholic Church was a leader in colonization and ran most of Canada’s residential schools. Unity Health Toronto is one of Canada’s largest catholic health care networks. How does our identity and affiliation with the church change the work we have to do?

First Nations, Inuit and Métis peoples have a complicated relationship with the church because of the role that the church played as a leader in the colonization of the Americas. Every person and community has navigated that relationship in their own way and we respect those ways of navigation. Some people feel safe and happy at Unity Health, while others could be triggered or feel uncomfortable given the legacy of multi-generational harms stemming directly from the policies and actions of the church. We need to figure out how to support that range of responses so that people say “Yes, this is a Catholic hospital but they did something good for my relative.”

Pope Francis is expected to visit Canada in July to meet residential school survivors and deliver an apology on Canadian soil for the church’s role in running residential schools. What does this visit mean to Indigenous peoples?

It’ll mean many different things to different First Nations, Inuit and Métis people. For some survivors of the residential school system and their families, it’ll bring healing and relief from pain. For others, it could bring pain and anger. I think it’s an important step though. If this visit helps anybody, it should happen. Where I come from, restorative justice is important; we need to acknowledge wrongdoing. I hope that’s what this visit represents. It’s what a lot of people wanted and a step in the right direction.

Do you have any advice for those who want to learn more about Indigenous history and culture or who want to help build and repair relationships but are afraid of offending others?

One of the best things people can do is learn more about cultural safety. The San’yas Anti-Racism Indigenous Cultural Safety Training Program, which many staff at Unity Health have completed, has shown to be better than a placebo when measuring how likely Indigenous patients are to recommend someone as a health care provider. I also encourage people to find a peer and read the summary report of the Truth and Reconciliation Commission. It’s painful but we need to be witnesses. It’s also good to attend events celebrating Indigenous people, if the community is willing to share. After the event, spend some time self-reflecting on what it was like to be there. And remember that this is a learning journey.

This interview has been edited and condensed.

By: Anna Wassermann