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P3s help manage a project's scope, schedule, and budget, and shifts much of the risk to the private sector. In return the public benefits from facilities that are built on time and on budget, but the value of the P3 model goes far beyond the construction of a building, it lives on for decades in the operation and maintenance of the facility. "In the past, we've seen infrastructure deficits with a lot of our facilities, because of deferred maintenance" says Farrell. "But with a P3, a standard of performance quality in maintaining the asset continues for the life of the agreement, which typically is 30 years."

P3s well-suited to health care environment While Farrell concedes that P3s suit some projects better than others, such as new hospital builds, she has seen a lot of innovation with health care P3s because of the collaboration between industry and clinical stake-

holders during the development of bid proposals. Clinical planners work with the design and construction team to optimize clinical flow and function, which means the best possible outcome for patients and clinicians. "Industry is bringing world class expertise to these projects," says Farrell, "they have embraced the model, which has led to a lot of success, and we are seeing broad industry participation, with lots of local contractors involved."

Kim Johnson, Chief Strategy Officer and Senior VP Commercial and Shared Services at Graham Group credits a supportive political environment and growing public acceptance of private sector involvement for the success of these large projects. "People understand that P3s provide a huge public benefit," he says, "and there is an extensive track record with these types of projects, especially in health care, where there is a critical mass of knowledge and expertise."

Collaboration and continual learning lead to successes Canadian jurisdictions looked at what was happening in the UK and Australia in the 1990s with P3s, and refined that knowledge for use domestically. "We've learned from those mature markets, and made it even better, and become a leader globally," Johnson adds. Experience with large projects is that they can often run into problems with design, construction and maintenance, but under a P3 model there is a single production team that is performance based, drives innovation, manages costs, and delivers the project quicker.

Two new Ontario health facilities have benefited from the P3 model, most notably the New Oakville and Humber River Hospitals, the prior set to open in the new few months.

P3s show positive results Despite the wealth of P3 experience in Canada, there are still some naysayers who say these projects end up costing the public more, and contend that government should just build these facilities on their own.

"We think it's simplistic to say that a P3 costs more in the long run than if government just built the projects on their own, because they are not taking into account the risk factor that is passed on to the private sector and the long-term cost of operating and maintaining facilities, which is built into the P3 agreement," says Farrell. "Under the right circumstances, P3s have been proven to deliver value for money."

Johnson echoes those comments and adds that government could build these projects on their own but they will end up costing more. He adds, "with a P3, you can deliver the same project in less time and at less cost."

During the debate at the CMA general council in Halifax on Wednesday, there was significant opposition to divestment, with the primary concern being the impact to the group's bottom line. The meeting heard, however, that the move will have very little financial impact on the CMA or its members. It has only about $29-million in its reserves, and $1.8-million of those investments are in fossil-fuel companies. That money will instead be invested in companies that work in the renewable energy field, such as solar and wind power.

She likened the move to earlier decisions by the organization to divest out of tobacco companies. The move by the CMA is part of an accelerating trend of high-profile institutions such as universities and faith-based organizations to take a stand on climate change by pulling their investments out of oil and gas companies.

The new policy does not apply to MD Financial Management Inc., a CMA-owned wealth-management company that manages more than $40-billion in investments for physicians and their family members. (Because most physicians do not have pension plans, they have significant investments.) But some members made it clear that could be a next step.

Brian Peters, CEO of MD Financial Management, said that its fossil-fuel investments are not a large part of the portfolio, but it is studying what the impact of divestment would be, and the practicalities. Canada's doctors are following the lead of their counterparts in Britain and Australia, whose national associations have both divested from fossil fuels.

At least 30 campuses in Canada have divestment campaigns to move out of fossil-fuel holdings. No university has announced plans to divest, and some, such as the University of Calgary, have ruled out that option. But change is afoot: Concordia University is creating a $5-million fossil-free fund, while faculty and students at the University of British Columbia and University of Victoria have voted in favour of divesting. Several churches have divested.

And one Toronto-based foundation this year took its investments out of oil sands and coal and is putting them into renewable energy - including one initiative that converts zoo manure into biogas. The medical journal The Lancet has called climate change "the biggest global health threat of the 21st century." The World Health Organization has estimated that by 2030, the direct health costs of climate change could be $2-billion (U.S.) to $4-billion annually.

Karl Rinas, 61, who was treated for a bleeding ulcer at a Leamington, Ont., hospital last February, says he ended up wiping down the bathroom himself after his complaints about the dried liquid waste he found on the floor and toilet seat failed to get a reaction, but he worried about older, less mobile patients.

Despite all her efforts, Martin says she has no doubt that the antibiotic-resistant superbug Clostridium difficile infection her mother contracted soon after surgery was related to the hospital's level of cleanliness.

"I know everybody nowadays has to work more with less, but to me, a hospital should be absolutely clean," she said.

Of the respondents who wrote into the fifth estate's survey about being harmed in hospital, most said the harm was a hospital-acquired infection such as MRSA and C. difficile.

Unlike in the food industry, there are no standardized inspections for cleanliness in hospitals.

A World Health Organization report that compared Canada's infection data with that of 12 other wealthy countries found that Canada had the second-highest prevalence (11.6 per cent) of hospital-acquired infections after New Zealand — much higher than that of Germany (3.6 per cent) or France (4.4 per cent).

Is outsourcing to blame?Those who work in hospitals have pointed to the increased outsourcing of housekeeping in recent years as one reason behind the decline in hospital cleanliness that patients and hospital workers have observed

"There's no question there's been an impact on the quality of cleaning, and you can see that throughout the years as various hospitals have struggled with very high-profile superbug outbreaks," said Margi Blamey, spokesperson for the Hospital Employees' Union (HEU), which represents 41,000 hospital cleaning and support staff in B.C.

But health authorities in other countries are moving away from private cleaning services. Four years ago, Scotland reversed its decision to allow outsourcing of cleaning and catering services because it felt private contractors were not doing a good enough job keeping the spread of infections in check.

Blamey says as long as housekeeping is done on a for-profit basis, employers will reduce the number of staff and cut corners on staff training and cleaning supplies.

The Canadian Nosocomial Infection Surveillance Program is the closest thing to a federal overview that Canada has, but it relies on voluntary reporting by only 54 hospitals in 10 provinces, most of them teaching facilities, which, according to infection control experts, generally have higher infection rates than other acute care hospitals because they tend to see more seriously ill patients.

Michael Gardam, who oversees infection prevention and control at the three hospitals that are part of Toronto's University Health Network, agrees that hospitals have fewer resources for housekeeping these days and have to concentrate cleaning on areas that are most likely to transmit bacteria — primarily the surfaces that multiple patients touch.

"I probably get more emails about dust bunnies in the stairwells than anything else in the hospital, and yet, we've done that for a reason. You're not going to catch anything from a stairwell, but you're going to catch it from your bed rails," Gardam said.

About two-thirds of hospital-acquired infections are preventable, Gardam said, but making a direct link between cleanliness and infection is not as straightforward as it might seem. Some hospital-acquired infections such as ventilator-associated pneumonia or central line-associated bloodstream infections have little to do with the hospital environment and can be controlled through proper protocols around equipment use. But a superbug like C. difficile is a lot trickier because it is hard to pinpoint its source.

Increasing cleaning staff on nights and weekends could also help. A typical medium-sized B.C. hospital that contracts out cleaning services has 24 cleaners by day but only four at night, says Blamey, and workers are often not backfilled when ill or on vacation.

"Bacteria don't care what time it is," said Gardam.

The infection expert says it doesn’t matter whether a private or public entity oversees cleaning; both have had problems with cleanliness. The bottom line is that hospitals generally undervalue the importance of cleaning staff, Gardam said.

"People don't really think of them as part of the team, but if you think about how infections are spread in hospitals, they're actually an incredibly important part of the team that goes far beyond just the cosmetic appearance of the room."

Speaking before his appearance at the Health Select Committee, he conceded that urgent care services were “getting closer to the cliff edge,” with A&E admission increasing by 51 per cent over the past 10 years

The letter from the 20 A&E leaders talks of the “institutional exhaustion” of the nursing, medical and even clerical staff who being pushed ever harder by the growing volume of work with little outside support

. It also describes how doctors and nurses are being forced to work in what are verging on dangerous environments

They further warn that overcrowding is likely to lead to more deaths in hospitals and reveal that standards of care are deteriorating as serious clinical incidents and delays are rising.

The letter states: “The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis

Recent developments such as the introduction of 111 and financial penalties for holding ambulance crews in ED are touted as solutions to the crisis: however we as ED physicians recognise that these measures will actually make the problem worse instead of better, and evidence is already emerging to support our opinions.

Furthermore, we firmly believe and strongly recommend that ED leads should be intimately involved with and consulted on the commissioning of Emergency services in the region, as well as other related emergency care changes-such as 111.

There is toxic ED overcrowding, the likes of which we have never seen before.

whether or not the home had failed to provide that “safe environment” was not an issue for police to investigate. “That is the exclusive jurisdiction of the Ministry of Health. They oversee long term care homes, not the police.”

Statistics obtained by W5 reveal that there were more than 10,000 resident-on-resident incidents reported at long term care homes across Canada in one year.

Extendicare has promised to do better in the future and has drafted a voluntary plan of action

Staff at long term care homes and advocates for seniors believe a major contributing factor is the ratio of staff to residents. Despite claims from many homes that the average day-time ratio is one staff for every eight patients, personal care workers interviewed for this story claim that ratio is rarely met.

“You could be one PSW [personal support worker] on a floor of 25, and if two residents start going at it, what do you do?“ said Miranda Ferrier, President of the Ontario Personal Support Workers’ Association.

The reports were taken to the University of Toronto’s Institute for Life Course and Aging for analysis. “I can say in Canada we’ve never had a study on abuse in any institution, let alone on resident-to-resident,” said Lynn McDonald, the director of the Institute. “In fact, when CTV came to me I thought ‘Oh, my goodness; this is the most data I’ve ever seen on this particular issue.’

Theresa doesn’t blame Frank’s attacker, or the staff. She blames Extendicare and has taken her story to the street, picketing in front of Extendicare’s Lakeside Long Term Care Facility

The program, called Healthy Foods in Champlain Hospitals, is aimed at setting an example for society by reducing unhealthy food and drink choices and increasing healthy ones.

10,000 marched against a proposed coal plant in Batangas, the Philippines

3,500 people shut down one of Europe’s biggest carbon polluters in Germany, occupying a lignite mine and nearby power station for over 48 hours, reducing the plant’s capacity by 80 percent.

Dozens of people occupied train tracks overnight on both coasts of the United States to stop oil-filled ‘bomb trains’ from rolling through communities — including less than 100 feet from low-income public housing in Albany, New York.

On land and water, indigenous communities and local activists blockaded the Kinder Morgan tar sands facility in Metro-Vancouver, unceded Coast Salish Territories.

es," said Dr. Liz Tayler, senior technical adviser on antimicrobial resistance with WHO. There are many reasons why antibiotic resistance has struggled to gain traction as global priority, however. For one, it's a complex issue that can prove difficult to explain - a headache-inducing combination of molecular chemistry, evolutionary concepts, and bacteria with unpronounceable names. WHO has compared the problem to a "silent tsunami." Unlike

a high-profile killer like cancer, deaths caused by antibiotic resistance tend to be less obvious or visible. "It never goes on anyone's death certificate ... when someone has died of a nasty infection, the fact that it's resistant either wasn't known or hasn't been talked about," Tayler said. "And while it's a really big problem in developing countries, the labs there aren't very good and they don't have the resources to do the testing to find out (why someone died)." Antibiotic resistance is also considered a "tragedy of the commons," where the effectiveness of antibiotics has been depleted by people who prioritize their own interests over the public good. And everyone is culpable: patients who demand antibiotics unnecessarily and doctors who cave to their demands; farmers who feed their livestock antibiotics and consumers who demand cheap

meat; low-income countries that allow antibiotics to be widely sold without prescription, and wealthy nations that need to do more to help those countries improve the sanitary conditions that lead to high infection rates. All of this human activity is pouring unprecedented volumes of antibiotics into the environment - and placing evolutionary pressure on microbes to evolve new strategies for defeating them. "I think of this problem as a planetary change at a microscopic level - one that we don't even notice. We're changing microbial ecology in a very significant way," Laxminarayan said. "We need to protect antibiotics with the same seriousness as we protected the ozone layer through the Montreal protocol." Wednesday's UN meeting will likely see countries agreeing to a declaration on combating antimicrobial resistance. This step - while largely symbolic - will draw global attention to the issue, sketch out solutions, and place pressure on countries to address the problem within their own boundaries.

"It requires all of these folks to be paying attention that they are now on notice," Laxminarayan said. But the declaration won't be binding, nor will it contain specific targets. For Dr. Brad Spellberg, an antibiotic resistance expert with the University of Southern California, the UN meeting is just one step and "there's still a lot of heavy lifting that has to be done." Tackling antibiotic resistance will require work on multiple fronts, he said - everything from improving prevention efforts to reducing antibiotic use in livestock and fish farms. The world also needs to recognize that antibiotic resistance is a threat we will have to face for not just years, but centuries or millennia, he added.

In the 1980s, Bayer sold Factor VIII concentrate, a blood-clotting medicine acquired from Cutter Laboratories in 1978. Though Factor VIII carried a high risk of transmitting AIDS and Bayer knew, Bayer continued to sell the drug in Asia and Latin America while selling a new, safer product in the West.

takeover would dilute Bayer’s core drug business currently flush with sales of its blood-thinner Xarelto and Eylea, a drug to treat blindness.

Coalition Against Bayer Dangers

Bayer, a history of unsafe drugs

Monsanto’s first entry into Big Pharma.

Blood clotting drug spread AIDS

all three proposed mergers face antitrust reviews by agencies in the U.S., Europe and China,

In Hong Kong and Taiwan alone, more than 100 hemophiliacs got H.I.V. and “many have since died,” reported the New York Times. 

Statin Baycol recalled

In 2001, Bayer withdrew its lucrative new statin drug Baycol because more than 50 people had died and more than six million patients were at risk from the deadly side effects of rapidly dissolving of muscle tissue.

Yaz birth control pill causes deaths

Xarelto, shady approval of a dangerous drug

underreported bright side: Industries that are doing well generally spin off; industries that are performing poorly generally merge and consolidate.

Millions Against Monsanto movement,

Not a chance, On October 14-16, merged or not with Bayer, the OCA and the global grassroots will expose Monsanto’s crimes against humanity and the environment at the Monsanto Tribunal, a citizens’ tribunal which will take place in The Hague, Netherlands.

I recently caught up with Dr. Samir Sinha, Director of Geriatrics of the Sinai Health System and the University Health Network Hospitals in Toronto, and Assistant Professor at the University of Toronto and the Johns Hopkins University School of Medicine. He is leading an evidence-based approach to develop a National Seniors Strategy for Canada. Dr. Sinha speaks passionately and with infectious optimism about the need for a paradigm shift in our approach to health care for older adults. There are five principles that are at the core of this new paradigm: Access, Equity, Choice, Value, and Quality.

ONE MILLION GOOD JOBS

A national climate strategy holds incredible potential for the labour movement. That's why the Canadian Labour Congress teamed up with a number of environmental organizations and First Nations to deliver a proposal to the prime minister in advance of the Vancouver meeting. The proposal, called "One Million Climate Jobs," presents a plan to address poverty and tackle climate change by creating jobs.

EXTREME FIRES, VIABLE ALTERNATIVES In May, Canada experienced one of the worst natural disasters our country has ever seen. The devastating wild fire

Yet most premiers are still intent on developing fossil fuel projects and Trudeau still trumpets pipelines.

A number of recent reports, including a landmark study by a global team of researchers at Stanford University, have demonstrated that Canada could switch to renewables by 2030. Indeed, renewable energy sources are already powerful and efficient enough to be a viable alternative.

Environmental groups and the Canadian Labour Congress have called for an end to fossil fuels by 2050. The extra 20 years provides a realistic timeline that also allows Canada to retrain workers as it gradually shuts down all oil, coal and natural gas projects.

The rate of unionization of all workers has been falling for decades. In 1982, it was 38 per cent. In 2014, it reached an historic low of 28 per cent. That downward trend will continue unless unions find ways to organize new sectors of workers.

Iron and Earth, a non-profit organization led by oil sands workers, plans to retrain over 1,000 oil and gas electricians in solar installation within three years.

Health authorities overall in B.C. paid a little over $5 million in 2015 in carbon offsets. School districts paid $3.5 million. Hardest hit are districts like Surrey, where growing enrolment means more portables, which are not energy efficient. The Surrey school district was forced to pay $388,750 in carbon offsets in 2015. Vancouver school district paid $361,950. In 2015, the B.C. government bought $7.2 million worth of credits, the bulk of which went to forestry conservation projects, which are controversial. In 2015, an improved forestry management project for the north and central cost region of the Great Bear Rain Forest received $1 million. The Haida Gwaii area of the Great Bear Rain Forest received $3.1 million. The Cheakamus Community Forest in Whistler received $297,458. Dowlatabadi thinks investing in carbon sinks, like forestry conservation, is the least valuable investment, when it comes to getting actual, measurable carbon reductions. For one thing, the actual carbon reduction that results from simply letting trees grow is difficult to measure, and the investment can be wiped with a single forest fire or pest infestation.

Dowlatabadi would rather see any carbon credits the province collects go into funding energy efficiency projects that will help schools and hospitals actually achieve the carbon neutrality the policy is supposed to encourage. He thinks the amount the government is currently investing is far too little. "If you're the government, you can buy debt at 3% or less, and capitalize all your future offset debt," he said. "You've got $15 million a year, you could borrow $15 million at 3% for years into the future and invest all of that in improving the infrastructure in the province, rather than putting it into a forest that could go up in smoke tomorrow."

However, we should avoid diagnosing this problem merely as a failure of law enforcement. Murders represent the tip of an iceberg of problems related to endemic violence in communities. Many Aboriginal women and girls, and indeed men and boys, live each day under the threat of interpersonal violence and its myriad consequences.

Initial statements from the three federal ministers tasked with leading the forthcoming inquiry — the ministers of Indigenous and Northern Affairs, Justice and Status of Women — suggest that its purpose is to achieve justice, to renew trust between indigenous communities and the Canadian government and law enforcement bodies, and to start a process of healing.

The inquiry surely must also endeavour to lay the groundwork for a clear plan to address the broader problem of interpersonal violence, which, in turn, is rooted in several key determinants. Addressing interpersonal violence is not merely an issue of justice; it is also a public health concern.

Factors associated with both the experience and perpetration of interpersonal violence are manifold. They include but are not limited to mental health issues, drug and alcohol misuse, unemployment, social isolation, low income and a history of experiencing disrupted parenting and physical discipline as a child. The Truth and Reconciliation Commission’s report has highlighted that many of these factors are widespread in the Aboriginal populations of Canada.4 Many of the same factors contribute to disparities between Aboriginal and non-Aboriginal peoples in areas such as education, socioeconomic circumstances and justice. T

here is also substantial overlap with identified determinants of poor health in Aboriginal communities both in Canada and elsewhere.5,6 These are the factors associated with higher rates of youth suicide, adverse birth outcomes and tuberculosis, and poorer child health. It’s clear that a common web — woven of a legacy of colonization and cultural genocide, and a cumulative history of societal neglect, discrimination and injustice — underlies both endemic interpersonal violence and health disparities in Canada’s indigenous populations. There is no conversation to be had about one without a conversation about the other — if the aim is healing — because the root causes are the same.

The World Health Organization (WHO) is currently engaged in developing a global plan of action to strengthen the role of health systems in addressing interpersonal violence, particularly that involving women and girls.7 A draft report by the WHO acknowledges interpersonal violence as a strongly health-related issue that nevertheless requires a multisectoral response tailored to the specific context. Evidence from Aboriginal community models in Canada gives hope for healing.

A recent report from the Canadian Council on Social Determinants of Health highlighted important strides that some Aboriginal communities have made to address the root causes of, and to mitigate, inequities through efforts to restore the people’s connection with indigenous culture.8 Increasing community control over social, political and physical environments has been linked to improvements in health and health determinants.

The public health sector in many parts of Canada has embraced the need for strong community involvement in restoring Aboriginal people to the health that is their right. In many community-led projects over the past few decades, the health care sector has worked with others to address common proximal and distal determinants of disparities.

We are presented with not just an opportunity for renewing trust between indigenous communities and the Government of Canada but also for extending the roles of public health and the health care sector in the facilitation of trust and healing. There is much that the health sector can contribute to the forthcoming inquiry. Health Canada should be involved from the start to ensure that public health is properly represented