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Included in the statement released by Canada and the EU to mark the end of the legal review was the announcement that the investor-state arbitration model long entrenched in Canada’s international agreements has been replaced by a system that more closely resembles an international court. The new court-like system includes independent judges, an appeals process and, generally, more transparency and predictability. There can be little doubt that this is a significant improvement over the previous arbitration process.

Trade Minister Chrystia Freeland, after referring to CETA as a gold-plated trade agreement, stated that with these changes, “Our dispute resolution process is brought up in this agreement to the 21st century democratic standards that Canadians demand.” This view begs two questions. First, why have a new international court that can override domestic courts that already meet the democratic expectations of Canadians? Second, does the rest of the agreement also reflect 21st century democratic needs and standards?

The investment chapter and its international court will still give foreign investors special rights and remedies to challenge government actions that they see as unfavourable to them. This gives one economic stakeholder a significant legal advantage over all other actors and stakeholders in the economy. It will allow this one class of economic actor to circumvent domestic courts by going directly to an international court whose role is to apply international law to protect their investor rights.

The justification for this is that these mechanisms will attract new investors to new places. However, this fails to stand up to empirical evidence developed over the past 10 to 15 years that shows these types of special rights for investors have no impact on investment flows. In short, there is no payoff for governments that put their countries at risk of exposure to international dispute settlement processes that circumvent domestic courts.

So do the other provisions of CETA reflect 21st century goals and standards? In both the TPP and CETA, it is the chapters that don’t directly relate to trade that make the agreements ‘comprehensive.’ It is these rules that are becoming increasingly broad and ever more favourable to large economic actors.

Let’s take the Intellectual Property Rights (IPR) rules, for example, which go farther to favour European drug manufacturers over Canadian manufacturers, and Canada’s health care system, than any previous IPR agreement. There is also the chapter on “Domestic Regulation” that goes farther in limiting government rights to review and regulate new investments in every sector of the economy than any previous treaty has gone. The CETA also features a long list of limitations on government’s ability to maximize the value that Canadians derive from foreign investment, including such future projects as Ontario’s ring of fire for mining.

These non-trade chapters will contribute to the ongoing growth of legal and economic inequality of average citizens and small and medium-size businesses compared to the large economic actors. These chapters simply replicate and deepen provisions from 10, 15 and 20 years ago, or more, with no new assessment of their impacts in today’s world, on climate change responses, or on the needs of sustainable development.

The UN Sustainable Development Goals adopted in 2015 provide a framework to realign the goals of trade and economic agreements for the future rather than just replicate the measures of the past, measures that continue to work against sustainable development needs. With the growing concerns over TPP, the inconsistent approaches between TPP and CETA on key democratic principles, and the obvious need to prioritize climate responses over trade policy, it is time for Canada to lead in re-evaluating what type of trade agreements are needed for this century.

Canada now has a unique opportunity to step back, reflect, and then return to lead global trade-law into a sustainable development era.

Howard Mann is the senior international law adviser with the International Institute for Sustainable Development.

Imagine if a Canadian diagnosed with cancer were told she could receive chemotherapy paid for by the health-care system, but would have to cough up the cash herself if she needed radiation. Or that she could have a few weeks of treatment, and then be sent home even if she needed more. That would never fly. If doctors, say, find a tumour in a patient's colon, the government kicks in and offers the mainstream treatment that is most effective. But for many Canadians diagnosed with a mental illness, the prescription is very different. The treatment they receive, and how much of it they get, will largely be decided not on evidence-based best practices but on their employment benefits and income level: Those who can afford it pay for it privately. Those who cannot are stuck on long wait lists, or have to fall back on prescription medications. Or get no help at all. But according to a large and growing body of research, psychotherapy is not simply a nice-to-have option; it should be a front-line treatment, particularly for the two most costly mental illnesses in Canada: anxiety and depression - which also constitute more than 80 per cent of all psychiatric diagnoses.

Why aren't we providing evidence-based care?" .. The case for psychotherapy Research has found that psychotherapy is as effective as medication - and in some cases works better. It also often does a better job of preventing or forestalling relapse, reducing doctor's appointments and emergency-room visits, and making it more cost-effective in the long run.

Therapy works, researchers say, because it engages the mind of the patient, requires active participation in treatment, and specifically targets the social and stress-related factors that contribute to poor mental health. There are a variety of therapies, but the evidence is strongest for cognitive behavioural therapy - an approach that focuses on changing negative thinking - in large part because CBT, which is timelimited and very structured, lends itself to clinical trials. (Similar support exists for interpersonal therapy, and it is emerging for mindfulness, with researchers trying to find out what works best for which disorders.) Research into the efficacy of therapy is increasing, but there is less of it overall than for drugs - as therapy doesn't have the advantage of well-heeled Big Pharma benefactors. In 2013, a team of European researchers collated the results of 67 studies comparing drugs to therapy; after adjusting for dropouts, there was no significant difference between the most often-used drugs - selective serotonin reuptake inhibitors (SSRIs) - and psychotherapy.

The issue is not one against the other," says Montreal psychiatrist Alain Lesage, director of research at the Douglas Mental Health University Institute. "I am a physician; whatever works, I am good. We know that when patients prefer one to another, they do better if they have choice." Several studies have backed up that notion. Many patients are reluctant to take medication for fear of side effects and the possibility of difficult withdrawal; research shows that more than half of patients receiving medication stop taking it after six months. A small collection of recent studies has found that therapy can cause changes in the brain similar to those brought about by medication. In people with depression, for instance, the amygdala (located deep within the brain, it processes basic memories and controls our instinctive fight-or-flight reaction) works in overdrive, while the prefrontal cortex (which regulates rational thought) is sluggish. Research shows that antidepressants calm the amygdala; therapy does the same, though to a lesser extent.

But psychotherapy also appears to tune up the prefrontal cortex more than does medication. This is why, researchers believe, therapy works especially well in preventing relapse - an important benefit, since extending the time between acute episodes of illnesses prevents them from becoming chronic and more debilitating. The theory, then, is that psychotherapy does a better job of helping patients consciously cope with their unconscious responses to stress.

According to treatment guidelines by leading international professional and scientific organizations - including Canada's own expert panel, the Canadian Network for Mood and Anxiety Treatments - psychotherapy should be considered as a first option in treatment, alone or in combination with medication. And it is "highly recommended" in maintaining recovery in the long term. Britain's independent, research-guided scientific body, the National Institute for Health and Care Excellence, has concluded that therapy should be tried before drugs in mild to moderate cases of depression and anxiety - a finding that led to the creation of a $760million public system, which now handles therapy referrals for nearly one million people a year.

In 2012, Canada's Mental Health Commission estimated that only about one in three adults and one in four children are receiving support and treatment when they need it. Ironically, anti-stigma campaigns designed to help people understand mental illness may only make those statistics worse. In Toronto, for instance, putting up posters in subway stations in 2010 had the unexpected effect of spiking the volume of walk-ins at nearby emergency rooms by as much as 45 per cent in 12 months. Dr. Kurdyak treated many of them at CAMH. The system, he says, "has been conveniently ignoring this unmet need. It functions as if two-thirds of the people suffering won't get help." What would happen if the healthcare system outright "ignored" two-third of tumour diagnoses?

Essentially, argues Dr. Lesage, adding therapy into the health-care system is like putting a new, highly effective drug on the table for doctors. "Think about it," he says. "We have a new antidepressant. It works as well as many others, and it may even have some advantages - it works better for remission - with fewer side effects. The patients may prefer it. And [in the long run] it doesn't cost more than what we have. How can it not be covered?" ..

A heavy price This isn't just a medical issue; it's an economic one. Mental illness accounts for roughly 50 per cent of family doctors' time, and more hospital-bed days than cancer. Nearly four million Canadians have a mood disorder: more than all cases of diabetes (2.2 million) and heart disease (1.4 million) combined.

Mental illness - and depression, in particular - is the leading cause of disability, accounting for 30 per cent of workplace-insurance claims, and 70 per cent of total compensation costs. In 2012, an Ontario study calculated that the burden of mental illness and addiction was 1.5 times that of all cancers, and more than seven times the cost of all infectious diseases. Mental illness is so debilitating because, unlike physical ailments, it often takes root in adolescence and peaks among Canadians in their 20s and 30s, just as they are heading into higher education, or building careers and families. Untreated, symptoms reverberate through all aspects of life, routinely trapping people in poverty and homelessness. More than one-third of Ontario residents receiving social assistance have a mental illness. The cost to society is clearly immense.

Yet, when family doctors were asked why they didn't refer more patients to therapy in a 2008 Canadian survey, the main reason they gave was cost. For many Canadians, private therapy is a luxury, especially if families are already wrestling with the economic fallout from mental illness. Costs vary across provinces, but psychologists in private practice may charge more than $200 an hour in major centres. And it's not just the uninsured who are affected.

Although about 60 per cent of Canadians have some form of private insurance, the amount available for therapy may cover only a handful of sessions. Those with the best benefits are more likely to be higherincome workers with stable employment. Federal public servants, notably, have one of the best plans in the country - their benefits were doubled in 2014 to $2,000 annually for psychotherapy. Many of those who can pay for therapy are doing so: A 2013 consultant's study commissioned by the Canadian Psychological Association found that $950-million is spent annually on private-practice psychologists by Canadians, insurance companies and workers compensation boards. The CPA estimates t

These are the patients that family doctors juggle, the ones who eat up appointment time, and never seem to get better, the ones caught on waiting lists. Sometimes, they have already been bounced in and out of the system, received little help, and have become wary of trying again. A 40-something mother recovering from breast cancer, suffering from chronic depression post-treatment, debilitated by fear her cancer will return. A university student, struggling with anxiety, who hasn't been to class for three weeks and may soon be kicked out of school. A teenager with bulimia removed from an eatingdisorder program because she couldn't follow the rules. They are the ones dangling on waiting lists in the public system for what often amounts to a handful of talk-therapy sessions, who don't have the money to pay for private therapy, or have too little coverage to get the full course of appointments they need.

Canada's investment does not match that burden. Only about 7 per cent of health-care spending goes to mental health. Even recent increases pale when compared to other countries: According to a study by the Canadian Mental Health Association, Canada increased per-capita funding by $5.22 in 2011. The British government, meanwhile, kicked in an extra 12 times that amount per citizen, and Australia added nearly 20 times as much as we did. Falling off a cliff, again and again

In Winnipeg, Dr. Stanley Szajkowski watched for months as his patient, a woman in her 80s, slowly declined. Her husband had died and she was spiralling into a severe depression. At every appointment, she looked thinner, more dishevelled. She wasn't sleeping, she admitted, often through tears. Sometimes she thought of suicide. She lived alone, with no family nearby, and no resources of her own to pay for therapy. "You do what you can," says Dr. Szajkowksi. "You provide some support and encouragement." He did his best, but he always had other patients waiting.

hat 30 per cent of private patients pay out-ofpocket themselves. When the afflicted don't seek help, the cost isn't restricted to their own pocketbook. People with mental-health problems are significantly more likely to abuse drugs and alcohol, and to become physically sick, further increasing health-care costs. A 2014 study by Oxford University researchers found that having a mental illness reduced life expectancy by 10 to 20 years, roughly the same as did smoking and obesity. A 2008 Statistics Canada study linked depression to new-onset heart disease in the general population. A 2014 U.S. study found that women under the age of 55 are twice as likely to suffer or die from a heart attack, or require heart surgery, if they have moderate to severe depression. The result: clogged-up doctors' offices, ERs, and operating rooms. And an inexorable burden for the patients' families forced to fill the gaps in caregiving - or carry on when they lose a loved one.

Patients refer to it as falling repeatedly off a cliff. And they can only manage the climb back up so many times. Family doctors interviewed for this story admitted that they are often "handholding" patients with nowhere else to go. "I am making them feel cared for, I am providing a supportive ear that they may not get anywhere else," says Dr. Batya Grundland, a physician who has been in family practice at Toronto's Women's College Hospital for almost a decade. "But do I think I am moving them forward with regard to their illness, and helping them cope better? I am going to say rarely." More senior doctors have told her that once in a while "a light bulb goes off" for the patients, but often only after many years. That's not an efficient use of health dollars, she points out - not when there are trained therapists who could do the job better. However, she says, "in some cases, I may be the only person they have."

Family doctors aren't the only ones struggling to find therapy for their patients. "I do a hundred consultations a year," says clinical psychiatrist Joel Paris, a professor at McGill University and research associate at the Montreal Jewish General, "and one of the most common situations is that the patient has tried a few anti-depressants, they have not responded very well, and from their story it is obvious they would benefit from psychotherapy. But where do they go? We have community clinics here in Montreal with six-to-12-month waiting lists even for brief therapy." A fractured, inefficient system

"You fall into the role that is handed to you," says Antoine Gagnon, a family doctor in Osgoode, on the outskirts of Ottawa. He tries to set aside 20-minute appointments before lunch or at the end of the day to provide "active listening" to his patients with anxiety and depression. Many of them are farmers or self-employed, without any private coverage for therapy. "Five of those minutes are spent talking about the weather," he says, "and then maybe you get into the meat of the problem, but the reality is we don't have the appropriate amount of time to give to therapy, even to listen, really." Often, he watches his patients' symptoms worsen over several months, until they meet the threshold of a clinical diagnosis. "The whole system could save on productivity and money if people were actually able to get the treatment they needed."

But these issues aren't insurmountable, as other countries have demonstrated. Britain, for instance, has trained thousands of university graduates to become therapists in its new public program, following research showing that, as long they have the proper skills, people don't need PhDs to be effective therapists. Australia, which has created a pay-for-service system, also makes wide use of online support to cost-effectively reach remote communities.

Except for a small fraction of GPs who specialize in psychotherapy, few family doctors have the training - or the time - to provide structured therapy. Saadia Hameed, a GP in a family-health team in London, Ont., has been researching access to psychotherapy for an advanced degree. Many of the doctors she has interviewed had trouble even producing a clear definition of therapy. One told her, "If a patient cries, than it's psychotherapy." Another described it as "listening to their woes." A 2007 survey of 163 family doctors in Ontario found that almost four out of five had not received training in cognitive behavioural therapy, and knew little about it. "Do family doctors really need to do that much psychotherapy," Dr. Hameed asks, "when there are other people trained - and better trained - to do it?"

What further frustrates treatment for physicians and patients is lack of access to specialists within the system. Across the country, family doctors describe the difficulty of reaching a psychiatrist to consult on a diagnosis or followup with their patients. In a telling 2011 study, published in the Canadian Journal of Psychiatry, researchers conducted a real-world experiment to see how easily a GP could locate a psychiatrist willing to see a patient with depression. Researchers called 297 psychiatrists in Vancouver, and reached 230. Of the 70 who said they would consider taking referrals, 64 required extensive written documentation, and could not give a wait-time estimate. Only six were willing to take the patient "immediately," but even then, their wait times ranged from four to 55 days. Psychiatrists are in increasingly short supply in Canada, and there's strong evidence that we're not making the best use of these highly trained specialists. They can - and often do - provide fee-for-service psychotherapy in a private setting, which limits their ability to meet the huge demand to consult with family doctors and treat the most severe cases.

A recent Ontario study by a team at CAMH found that while waiting lists exist in both urban and rural centres, the practices of psychiatrists in those locations tend to look very different. Among full-time psychiatrists in Toronto, 10 per cent saw fewer than 40 patients, and 40 per cent saw fewer than 100 - on average, their practices were half the size of psychiatrists in smaller centres. The patients for those urban psychiatrists with the smallest practices were also more likely to fall in the highest income bracket, and less likely to have been previously hospitalized for a mental illness than those in the smaller centres.

And those therapy sessions are being billed with no monitoring from a health-care system already scrimping on dollars, yet spending a lot on this care: On average, psychiatrists earn $216,000 a year. There is nothing to stop psychiatrists from seeing the same patients for years, and no system to ensure the patients with the greatest need get priority. In Australia, Britain and the United States, by contrast, billing for psychiatrists has been adjusted to encourage them to reduce psychotherapy sessions and serve more as consultants, particularly for the most severe cases, as other specialists do.

As the Canadian system exists now, says Benoit Mulsant, the physician-in-chief at CAMH and also a psychiatrist, the doctors in his specialty "can do whatever they please. If I wanted, I could have a roster of actor patients who tell me entertaining stories, and I would be paid the same as someone who is treating homeless people. ... By treating the rich and famous, there is zero risk of being punched in the face by a patient." Left out in all this, by and large, are other professionals who can provide therapy. It doesn't help that the rules are often murky around who can call themselves psychotherapists. While psychologists and social workers are licensed under their professional associations, in some provinces a person can call himself a marriage counsellor or music therapist with no one demanding they be certified. In 2007, Ontario passed a law to regulate psychotherapists, requiring them to register with a provincial college that would set standards and handle complaints. Currently, however, the law is in limbo, although the government has said it will finally bring it into force by December. The brain keeps many secrets

Science, however, has yet to find depression's equivalent of insulin. Despite being scanned, poked and stimulated over and over and over again, the brain keeps its secrets. The "chemical imbalance" theory is now viewed as simplistic at best. It may not do much for patients, either: A 2014 study published in the journal Behaviour Research and Therapy suggested that, rather than reassuring them, focusing on the biological explanation for depression actually made patients feel more pessimistic and lacking in control. SSRIs work by increasing the amount of serotonin, a chemical that helps deliver messages within the brain and is known to influence mood. But researchers aren't sure why the drugs help some patients and fail with others. "Basically, it's like we have a bucket of water and we pour it over the patient's head," says Dr. Georg Northoff, the University of Ottawa's Michael Smith chair of Neurosciences and Mental Health. "But you want a drug that injects the water in a very specific brain regions or brain system, which we don't have."

Critics of therapy have argued that it's basically "good listening" - comparable to having a sympathetic friend across the kitchen table - and that in the real world of mercurial patients and practitioners of varying abilities, a pill just works better. That's true in many cases, especially when the symptoms are severe and the patients is suicidal: a fast-acting medication is safer, and may even be necessary before starting talk therapy. The staunchest advocates of therapy do not suggest it should be the first course of treatment for psychosis, or debilitating chronic depression, or mania - although, in those cases, there is evidence that psychotherapy and medication work well in tandem. (A 2011 meta-analysis found that patients with severe depression who received a combination approach had higher recovery rates and were less likely to drop out of treatment.) But drugs also don't work as well as the manufacturers would like us to think. Roughly one-third of patients given a drug will see no benefit (although they often respond to a second or third medication). In randomly controlled trials, drugs often perform only marginally better than sugar pills.

Yet it's talk therapy that the public often views most skeptically. "Until you go to a therapist, or a member of your family has a serious psychological problem, people are unsympathetic [about therapy]," says Dr. Paris, the Montreal psychiatrist. "They are very skeptical, and they don't believe the research. It's amazing, because pharmaceutical trials will get approval for a drug on the basis of two clinical trials that they paid for. And we have 100 clinical trials and no one believes us."

Dr. Ajantha Jayabarathan, an assistant professor at Dalhousie University's medical school, spent her early years as a family doctor in Spryfield, N.S., trying to manage an overload of mental-health cases. Most of her patients had little insurance; there was one reduced-cost counselling service in town, but the waiting lists were long. In 2000, her group practice became a test site for a shared-care project, which gave the doctors access to a mental-health team, including weekly in-person consultations with a psychiatrist. "It was transformative," she says. "We looked after everything in-house.

Over time, Dr. Jayabarathan says, she learned how to properly assess mental illness in patients, and how to use medication more effectively. "I just made it my business to teach myself what to do." It's the kind of workaround GPs are increasingly experimenting with, waiting for the system to catch up. Who would pay - and how?

The case for expanding publicly funded access to therapy is gaining traction in Canada. In 2012, the health commissioner of Quebec recommended therapy be covered by the province; it is now being studied by Quebec's science-based health body (INESSS), which is expected to report back next year. A new Quebec-based organization of doctors, researchers and mental-health advocates called the Coalition for Access to Psychotherapy (CAP) is lobbying the government.

In Manitoba, the Liberal Party - albeit well behind in the polls - has made the public funding of psychologists one of its campaign platforms for the province's spring 2016 election. In Saskatchewan, the government commissioned, and has since endorsed, a mental-health action plan that includes providing online therapy - though politicians have given themselves 10 years to accomplish it. Michael Kirby, the former head of the Canadian Mental Health Commission, has been advocating for eight annual sessions of therapy to be covered for children and youth in need.

There are significant hurdles: Which practitioners would provide therapy, and how would they be paid? What therapies would be covered, and for how long? Complicating every aspect of major mentalhealth change in Canada is the question of who should shoulder the cost: the provinces or Ottawa. In a written statement in response to questions from The Globe and Mail, federal Health Minister Rona Ambrose lobbed the issue back at her provincial counterparts, pointing out that the Canada Health Act does not "preclude provinces and territories from extending public coverage to other services or providers such as psychologists."

One result can be overloaded family doctors minimizing mental-health problems. "If you have nothing to offer someone," asks Dr. Anderson, "how much are you going to dig around to find out what is going on?" Some doctors also admit that the lack of resources can lead to physicians cherry-picking patients who don't have mental illness. And yet family physicians alone bill about $361million a year for counselling or psychotherapy in Canada - 5.6 million visits of roughly 30 minutes each. This is a broad category, and not always specifically related to mental health (some of it includes drug counselling, and a certain amount of coaching is a necessary part of the patient-doctor relationship). When it is psychotherapy, however, doctors admit it's often more supportive listening than actual therapy.

So how would Canada pay for access to such therapy? It wouldn't be cheap, in the short term. The savings would come from what Canadians would not have to spend in the long term: in additional medical and drug costs, emergency-room visits and hospital stays, and in unnecessary disability payments, to say nothing of better long-term health outcomes for patients given good care earlier. Some of the figures being tossed around sound staggering. Rolling out a version of Britain's centre-based program across Canada would cost $950-million. Michael Kirby's plan would amount to $1,000 annually per patient. A 2013 report commissioned by the Canadian Psychological Association calculated that, based on predicted need, and assuming no coverage from private health-care plans, providing an average of six sessions of therapy a year would cost an estimated $2.8-billion annually.

But any of those figures would still be a fraction of the roughly $210-billion that Canada spends annually on health care. Figuring out how to make the system most costeffective is, according to sources, currently delaying the INESSS report to the Quebec government. "You need to facilitate the government," says Helen- Maria Vasiliadis, a professor of community health at the University of Sherbrooke. "You can't be going to policymakers and showing them billions and billions of dollars. People start having heart attacks. With evidence in hand, we have to present possible solutions."

An insurance-based plan is the proposal that has emerged from the Quebec-based CAP group, which sent its proposal to Quebec's health minister last month. In its design, the system would work much like Quebec's public drug plan - Quebeckers not covered through work plans would contribute to a provincial insurance program for therapy. That would be similar to the system that Germany has used for decades. One step forward, one step back

Last year, the Sherbrooke clinic where Marie Hayes works received provincial funding for a part-time psychologist and a full-time social worker. With a roster of 25,000 patients, the clinic team laid out clear guidelines for the psychologist, who would consult on cases and screen patients, and be limited to a mere four sessions of actual counselling with any one patient. "We wanted to be careful she didn't become a waiting list - like everything in the system," says Dr. Hayes. The social worker helps guide patients into services such as housing and addiction counselling. They have also offered group sessions for depression management at the clinic. As stretched as those new professionals are in such a large practice, Dr. Hayes says the addition of that mental-health team is improving the care she can provide patients. Recently, for instance, the 32- year-old mother with anxiety attended sessions with the psychologist. "She is making progress," says Dr. Hayes, "slowly."

At Women's College Hospital in Toronto, Dr. Grundland is not so lucky. Asked to describe a difficult case, the family-practice physician mentions a patient suffering from depression after a lifechanging accident. Every month, doctor and patient would repeat the same conversation they'd already had more than a dozen times - and make little real headway. Her patient, says Dr. Grundland, needs a trained therapist: someone she can see regularly, to help her move past her frustration, counsel her about addiction, and ease the burden on her family.

But there's no extra money in the patient's budget for a psychologist. "I do my best," Dr. Grundland says, "but it's not my area of expertise." Meanwhile, the patient isn't getting better, and in the time that it takes to make it through one appointment with her, Dr. Grundland could see three other people with problems she was actually trained to treat. "But," says Dr. Grundland, "she has nowhere else to go." Erin Anderssen is a feature writer at The Globe and Mail. OPEN MINDS How to build a better mental health care system

The Centre for Addiction and Mental Health has purchased advertisements to accompany this series. While CAMH professionals are quoted in this story, the organization had no involvement in the creation or production of this, or any other story in the series. $20.7-billion The cost, according to a 2012 Conference Board of Canada report, of lost productivity each year due to mental illness. What else does $20-billion represent?

$20B: Canadian spending on national defence, 2012-13 $20B: Market valuation of Airbnb, 2015 $21B: Kitchener-CambridgeWaterloo region's GDP, 2009 $21B: Amount food manufacturing contributed to the economy, 2012

full-time employment during each recession was, in many ways, permanent," Tal wrote in the report. The findings come as no surprise to professors who study Canada's labour market. "There's been this idea that now that oil prices are low and the dollar is low and now we'll see these big plants come back to Canada. I think that's overly optimistic," said Mike Moffatt, assistant professor at the Richard Ivey School of Business at the University of Western Ontario. "The big takeaway from this is that the issues that we have in Canada and Ontario, in particular, aren't just recession-based. Policy-makers need to figure out other ways of economic growth and job growth that don't just assume those manufacturing jobs are coming back." The number of self-employed workers rose four times faster than the number of paid employees during the year-ended January 2015, CIBC noted in the report.

While self-employment can provide flexibility and other advantages, it is considered to be of lower quality because on average it pays less than salaried positions. The number of low-paying jobs has risen faster than the number of mid-paying jobs, which in turn has risen faster than the number of high-paying jobs. In the last year, the number of low-paying full-time positions rose twice as fast as the number of high-paying positions, CIBC said. Over the past decade, wages in high-paying sectors rose almost twice as fast as wages in low-paying sectors. "In other words, the fastest-growing segment of the labour market is also the one with the weakest bargaining power," Tal wrote. Unemployment insurance, the Canada Pension Plan, as well as health care, education, and child care, were built to suit the labour market from the 1960s and 1970s, when a single breadwinner had a good-paying job with steady income, hours, and benefits that could support an entire family, said Wayne Lewchuk, a professor at McMaster University who has researched precarious employment.

"I think we're coming to terms with the fact that we have the wrong institutions for a modern labour market," Lewchuk said. "If we get the institutions right, then these people who are precarious, they become flexible employees. That's not necessarily a bad thing, and the supports are around them make this a viable way of operating." Lewchuk points to the public discourse around the perils of precarious employment, as well as the proposed Ontario pension plan, the Canadian Skills Training and Employment Coalition, and worker protection legislation passed last year, as evidence of change, Lewchuk said. "It has taken 20 or 30 years for us to get here. It will take that kind of time to move away. But I think the momentum has shifted," Lewchuk said. "There are all kinds of reasons to be optimistic but it's going to take time and it's going to be through struggle."

The two towers of the development look very much like an upscale residential development. They are connected with a gracious lobby manned around the clock by attentive concierges. There's a gym - complete with personal trainers - on an upper floor, as well as a communal kitchen that can be used for cooking demonstrations. There is enough polished stone and fancy millwork in the suites to satisfy even the most sophisticated of tastes. Outside, residents can putter in the gardens or host a barbecue on the terrace.

The executive chef - who previously worked at high-end Vancouver restaurant Italian Kitchen - sources produce directly from the nearby UBC Farm and refreshes the menu quarterly, with input from the residents.

A community shuttle can take people around to various neighbourhood destinations, although grocery shopping, banking, and medical appointments are all within very easy walking distance. A private car with driver can also be booked for an additional cost.

The meal options at Tapestry may be where it differs the most significantly from other seniors' facilities. Residents can cook for themselves in the fully-equipped kitchens in their individual suites, have meals brought to their suites, meet up with friends at the on-site pub, or entertain friends and family at the restaurant-style dining room. There are no set meal times and there is no assigned seating. The cost of the restaurant meals are debited individually from a monthly credit, much like the dining plan used by students living in dorms.

However, the services available go far beyond what you might find in most condo buildings. People can also take advantage of a beauty salon and spa, play a couple of rounds in a golf simulator, or engage in some mental stimulation in the brain fitness centre. Housekeeping is provided weekly, with medical staff on call around the clock. Medical treatments are delivered privately in the homes of residents, rather than requiring people to move to a hospital wing if they are ill.

"A lot of facilities come from a nursing or hospital style approach," explains Catherine Wallbank, vice-president of operations for Leisure Care. That firm manages Tapestry for developer Concert Properties. "We think about it from the hospitality perspective, and offering opportunities to enjoy life to the fullest."

It's an approach that suits 73-year-old Carol Byram and her 68-year-old husband Adrian. They purchased a home at Tapestry at Wesbrook after Adrian decided to return to school, and after Carol read a September 2010 Vancouver Sun profile of the project. After a long tech and entrepreneurial career in the U.S., Adrian is now working

toward a PhD in neuroethics at UBC. Carol is busy on the strata council and various committees for the building, as well as her work with Ballet BC "I tell people that living here is like being on a cruise ship or at the Four Seasons with all your friends," the former communications director for Sony Electronics says. "There is something to do all the time if you want to."

With isolation being a known hazard for seniors, Byram says she doesn't understand people who hang on to living in single-family homes until the bitter end. Activities at Tapestry include movie nights, day trips, fitness classes, and musical performances. She also says there is no shortage of people to go for a walk or meal with.

Byram enjoys being part of the larger community at UBC, saying there is a noticeable energy on campus as students stream in and out of classes. She volunteered to be a subject for a study examining the effects of companionship and exercise on aging. She is also involved in Project Chef, where students from a nearby elementary school come and cook with residents.

She often runs into her neighbours Yul and Joanne Kwon in the gym. Yul is 79, and Joanne is 77.

Yul has qualified to run the Boston Marathon next year, and is an adjunct professor of economics at SFU, after decades teaching at the University of Regina and a university in Australia. He tends to have his daughter accompany him on his longer runs through Pacific Spirit Park. "I am writing a book, so I am too busy to take advantage of all of these programs right now," he laughs. "But Joanne participates, and as time goes on, we appreciate that the events are available to us." They purchased their home three years ago at the urging of their son, and at the time, had no idea it was even a seniors residence. He and Carol agree that downsizing directly to Tapestry was the right choice to make, because of all of the amenities and the peace of mind offered by the staff.

Public drug plans in Canada continue to grapple with public sector pharmaceutical drug spending growth that exceeds revenue growth. Public drug spending is expected to account for 9% of public sector healthcare expenditures in 2010 (approximately 12.1 billion dollars) (CIHI, 2010).

This issue persists despite the introduction over the last two decades of various drug reimbursement policies to control cost, including beneficiary cost sharing, mandatory generic drug substitution as well as prior authorization and other forms of utilization review. Other approaches are needed.

Furthermore, some of these policies may have unintended consequences on patient health, access to drugs for those without comprehensive drug coverage, pharmaceutical innovation, the timely market entry of generic drugs, the provision of professional pharmacy services and spending on drugs.

Bulk purchasing and reference pricing policy have numerous advantages for all Canadians compared to the practice of best price policies by some provinces.

The most obvious way to fix the problem would be to bring prescription drugs under Medicare. To do so would also make economic sense: in a recent Canadian Medical Association Journal study I coauthored, we found that implementing universal public drug coverage would save the private sector a whopping $8.2 billion annually. It seems counterintuitive to think that covering more people would cost us less. However, if we bargained more effectively and purchased medications in bulk, the prices we pay for those drugs we already buy publicly would go down. If access to health care in Canada is truly based on need, not ability to pay, there is no justifiable reason to exclude prescription medications from our public plans. As we head into election season, let's demand some big ideas from our politicians that will really improve the health of Canadians. A basic income and universal pharmacare would be a good start. If we did those two things, there would be a real, measurable impact on the health of our communities. After all, that's what government is for. Dr. Danielle Martin is a family physician and vice-president of medical affairs at Women's College Hospital in Toronto. A renowned advocate for Medicare, Martin will be speaking about "Creating a Healthy Canada: An Agenda for Today ... and Tomorrow" on Wednesday at City Hall.

Sousa reckons that Ontario is coming out of the economic slump. Progress is slow and uneven. But the government estimates, with some justification, that matters are beginning to look up, that more people are being employed and that government tax receipts will therefore rise. The reasons are well-known. The oil price slump may be bad news for Alberta. But it's good news for the consumers and manufacturers of this province. More important, the U.S. economy is on the rebound - which helps Ontario exporters. And finally the dollar has slipped. That's tough for those buying, say, Florida oranges. But again it's good news for Ontario manufacturers, who now have a built-in price advantage in the U.S. market. Interestingly, Sousa's budget shows that the growth-driven gains in tax revenues will contribute far more to the elimination of the province's deficit than either spending cuts or asset sales. Which suggests two things: First, budgets do often balance themselves - when the business cycle picks up. Sousa calculates that Ontario will reap

$10 billion in new revenue over the next two years, more than enough to eliminate the current $8.5-billion deficit. Second, many of the other things the Wynne government has done to balance the books may not have been necessary. Which is the confusing part of this budget. Why is Wynne's government going out of its way to cause itself to political grief? Exhibit A: the proposal to sell to private investors 60 per cent of Hydro One, the publicly owned electricity transmission utility. After paying off Hydro One's debts, the province expects to net $4 billion from the sale. The government says it wants to use the proceeds to build transit infrastructure over the next 10 years. But by selling a chunk of the electricity monopoly, Queen's Park is also giving up close to $5 billion in guaranteed revenue over the next 10 years. It would be cheaper to hold onto

100 per cent of Hydro One and use the utility's profits to fund infrastructure. In a press conference Thursday, a jovial Sousa was asked about Hydro One. In effect, he answered that selling most the utility was a good deal for the government. He didn't really explain why. Other matters mentioned in, but not seriously addressed by, the budget include Wynne's decision to fight climate change through a so-called cap-and-trade system, her proposed Ontario Retirement Pension Plan and the Liberal promise to cut auto insurance premiums by 15 per cent. On cap-and-trade, the budget confirmed that crucial details have not yet been decided. On pensions, it revealed that the government has talked to a lot of people and heard a lot of different things. Auto insurance? Two years ago, the insurers grudgingly agreed to cut rates, but only if they were allowed to provide accident victims with fewer benefits. The government was fine with this. According to the budget, it still is.

Some Canadian-made generic drugs are twice the price in Canada compared with the U.S., U.K. and elsewhere. Retail pharmacies continue to get substantial rebates on generics, at our expense. In some cases, this accounts for up to 20 per cent of a store's revenues. Access to medications is more difficult for lowincome families and the underinsured. One-third of prescriptions are never filled, often related to household income and cost. As physicians, we do not prescribe as appropriately as we could and should. We do a shameful job of inflicting polypharmacy on seniors, particularly the frail elderly.

As patients, we have high and often unrealistic expectations of pharmaceuticals, and we consume too many. Ours is an overmedicated society. It's time to change the channel on pharmaceuticals. Universal pharmacare for Albertans and Canadians is both possible and necessary. Provinces need to act collectively and co-operate. Designed properly, with advantages such as joint policies, bulk acquisition and improved purchasing power, it can be affordable. Ontario has recently announced its intentions to move on this, and Alberta should join. Ultimately, federal participation is required for a truly national strategy, as was the case in the creation of medicare. This is a prime issue, sooner or later relevant and important to all Canadians, and should be seen as such in the upcoming federal election.

It can be anticipated that those with vested interests will say we cannot afford, and do not need, universal pharmacare. Those who care about a high-performing, equitable, patient-centred health system say we cannot afford to do without it. Health care faces a tough financial future. The time has never been better to expand public coverage for medically necessary pharmaceuticals, making appropriate, affordable, cost-effective medications available to all.

Dr. Tom Noseworthy, formerly of Edmonton, is professor of community health sciences at the Cumming School of Medicine O'Brien Institute for Public Health at the University of Calgary.