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And while estimates put the cost to Canadian tax coffers at $6-$7.8 billion per year, the effect on developing countries is far greater, said Haroon Akram-Lodhi an economist and professor of international development at Trent University. "The amount of capital flight from sub-Saharan Africa is absolutely huge and it's all going into these tax havens," said Akram-Lodhi, one of the signatories of the letter. "This is reducing the ability to fight poverty on a global scale." The letter, made public on the eve of this week's global anti-corruption summit in London, calls on world leaders to act against financial secrecy both in tax havens and at home. "To lift the veil of secrecy surrounding tax havens we need new global agreements on issues such as public country-by-country reporting, including for tax havens. Governments must also put their own houses in order by ensuring that all the territories, for which they are responsible, make publicly available information about the real 'beneficial' owners of company and trusts." On Monday, Transparency International Canada issued a parallel call for the Canadian government to make its own corporate registry more transparent.

There is a pressing need for the Government of Canada to take concrete steps to address the ability of some Canadians to shield themselves, and their financial activities, from Canadian authorities," said Peter Dent, president of Transparency International Canada. "That some can rig the system to hide their wealth, whether amassed legally or not, is not merely unjust. It also masks corruption and harms global development by siphoning off revenues that could be directed to education, health care and infrastructure," Dent said in a statement. While the growing movement to crack down on tax havens has been spearheaded by the richest countries through the Organization of Economic Cooperation and Development, the negative effects of depleted government revenues hit the poorest countries the hardest. Uganda, an East African country which has often been described as a "donor darling," remains stuck in a cycle of poverty largely due to its inability to provide state services, said Akram-Lodhi.

They don't collect enough tax (because) multinational corporations evade their fair share," he said. While the U.K. government collects 25 per cent of its GDP in tax revenue, Uganda is only able to get 11 per cent, according to World Bank statistics. Instead of having to wait longer for a new subway, low tax revenue has far graver consequences in the developing world, he said. "Tax avoidance in Canada doesn't lead to people going hungry. Tax avoidance in sub-Saharan Africa leads to people dying of hunger. It's that clear," said Akram-Lodhi. "It's criminality that ruins people's lives." Another signatory of the letter, Peter Dietsch, a professor of philosophy and economics at the Université de Montréal, said the Panama Papers have "opened a window of opportunity for action." Describing the underlying conflict over tax havens as being between people who have capital and those who don't, Dietsch said anti-tax haven forces are growing.

"There's now a growing coalition of individuals without capital who pay their taxes and small and medium enterprises who don't have resources to move their assets abroad." Canadian signatories A. Haroon Akram-Lodhi, professor of international development studies, Trent University. Peter Dietsch, professor of philosophy, Université de Montréal Hashmat Khan, professor of economics, Carleton University Kiari Liman-Tinguiri, president of IEDAS Inc., Ottawa Patricia E. Perkins, professor, faculty of Environmental Studies, York University Toby Sanger, senior economist, CUPE

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.

t follows that humanity’s very provision for the universal human life necessities that have evolved over millennia are blinkered out by the life-blind value measures of what is miscalled ‘the economy’. Everything that makes a society civilised or liveable is excluded from view – life-protective laws including sufficient minimum wages and environmental regulations, common water and sewage systems for all, free movement pathways and life spaces without cost to use, non-profit healthcare and disease-prevention by public institution

public income security from disemployment, old age and disability, primary to higher education without multiplying debts, family housing, food and life means assistance for children without sufficient parental money, and public libraries and arts facilities with accessible books, films and works of art and art creation. This is more or less a complete index of the collective life capital bases modern society has evolved, but all are dismantled by the global corporate disorder to maximally profit from.

e know that the best way to reduce these high drug prices and improve access to treatment is through generic competition. In fact, everyone from ministries of health to medical humanitarian organizations such as Doctors Without Borders and donorsupported global health institutions rely on affordable, quality generic medicines for 85% of their health programming. Yet certain provisions proposed by the U.S. and other countries in the TPP could greatly limit the reach and effectiveness of these programs, thereby diverting badly needed resources away from patient care. Canada supports many important global health programs but the effectiveness of this support is at risk. This year, Canada contributed $500 million to the replenishment of the Gavi Vaccine Alliance's fund. Canada is also one of the leading donors to the Global Fund to Fight AIDS, Tuberculosis and

Malaria, which has provided antiretroviral therapy to more than six-million people living with HIV in developing countries. In addition, Canada provides international assistance to five of the 12 TPP-negotiating countries, amounting to more than $83 million in 2012 and 2013. Two countries involved in the TPP negotiations, Vietnam and Peru, are also on Canada's "Development Countries of Focus" list, due to an even greater need for development assistance. If harmful provisions in the TPP are accepted, driving up the cost of medicines and vaccines, the impact of this use of Canadian taxpayers' money could be seriously diminished. Access to affordable medicines could also become a major concern in Canada. Drug expenditures in this country have been the fastest growing sector of health spending in the last 25 years. Since the mid-1980s, prescription drug spending has more than doubled, costing $27.7 billion in 2012. If Canada does not strongly reject the new protections proposed in the TPP, these expenditures could cost our health-care systems, and all Canadians, billions more per year.

Thankfully, a version of the TPP text leaked in 2013 shows that Canada and other countries are opposing some of the most harmful provisions in the agreement. As the negotiations are nearing an end, countries will be under immense pressure to reach a deal. Canada has a humanitarian duty to resist that pressure and to stand up to the U.S. and others who would seek to benefit their pharmaceutical industries through the TPP negotiations, at the expense of poor countries and of Canadians. More than 32,000 Canadians have already signed a petition at www.msf. ca/tpp calling on Canada to stand up for public health. Together we must ensure the TPP does not undermine access to affordable drugs, whether here in Canada or around the world. When it comes to access to medicines, it is imperative that Canada does not give in and trade away our health. Stephen Cornish is executive director of Doctors Without Borders Canada.

The latest Intergovernmental Panel on Climate Change report, released in 2014, outlined more clearly and with greater certainty than ever before how both climate change and pollution from the combustion of fossil fuels have killed thousands of people and will threaten the lives of many more.2

In 2010, a position statement from the Canadian Medical Association3 called for physicians to take action, but it focused largely on developing strategies to deal with the impending effects of climate change on health and health systems. In 2013, a CMAJ editorial4 discussed the role of physicians on the front line of climate change and examined how they can make a difference at the political, professional and individual levels. These recommendations remain pertinent.

Prompt action on reducing fossil fuel emissions in the near term, to prevent irredeemable downstream effects, is just as important as responding to current and imminent threats. An emergency medicine physician based in Yellowknife summed it up well when she likened the relatively small window for action to the urgency following a myocardial infarction or the onset of sepsis. “We either get the job done in the next decade or so or we prepare for palliative care.”5

Yet achieving international binding agreements seems to be happening at a slower pace than that of receding glaciers. When world leaders convene, issues related to saving the world from economic collapse, terrorist threats and oil crises seem to come before those related to saving the world from the threat of climate change. However, things are changing at the macro-economic level. The World Bank has made strides in coordinating international efforts to develop renewable energy, develop globally networked carbon markets and “enhance the flow of finance toward the ongoing effort to limit global warming.”6 One can perhaps see the influence of the current president of the World Bank, who is a physician and social anthropologist, in these recent actions.

Humans are bad at envisioning or appreciating the long-term consequences of behaviour. Behavioural scientists call the phenomenon “delayed reward discounting.” In short, we need salience now. In developed countries such as Canada, many of the adverse effects of climate change will only affect future generations. Although we may believe the science and many of us may support our government in making binding agreements to reduce carbon emissions, changing our personal behaviours may be costly, inconvenient and difficult. How do we galvanize to combat global warming?

Health promotion campaigns are most effective when delivered on multiple levels at once, combining information on the health benefits of a behaviour change with modelling of the behaviour, reduced barriers to its adoption, a good system of social support for those who adopt it, and person-to-person promotional initiatives and media campaigns.7

We need such a multipronged campaign to drive real action on climate change. Physicians are agents for change at all levels, and we can do more to bring climate change to the forefront of people’s consciousness. With our unique comprehension of stages of change and skill at intervening to help individuals make lifestyle changes at whichever stage they may find themselves, we can make a big impact.

We have managed to effect social change regarding smoking despite the power of industry, and we are beginning to turn the tide against the anti-vaccine lobby. Our approach to overcoming the stalling tactics of climate-change deniers should be no different. A few years ago, it was unusual to ask patients about how much physical activity they engaged in or how much sitting their job demanded. Now, we counsel about the risks of being underactive and write exercise prescriptions. It is time for physicians to talk about the effects of climate change routinely in daily practice. We should not forget that we are respected, influential advocates.

She said a lot of work is already being done by Canadian physicians but the CMA "is committed to finding the best way to support efforts that are taking place from coast-to-coastto-coast." Dr. Orbinski presented delegates with a grim catalogue of the health impacts of climate change, including a rise in infectious disease, drought and rising water levels that cause mass displacement, and even violent conflict. But, worst of all, he said, "climate change is a threat that magnifies other threats." Dr. Orbinski cited the example of the Darfur region of Sudan, where tensions between farmers and herders over disappearing pasture and evaporating water holes have degenerated into violent clashes and civil war.

"You will do anything to feed your children, even if it means going to war," he said. Darfur is often described as the world's first climate-change war, but there could be many more to come, Dr. Orbinski warned. He noted that the world is in the midst of an unprecedented refugee crisis - with 60 million people worldwide displaced - and increasingly those mass movements are driven by drought and climate change. For example, 29 million people are now on food assistance in southern Africa. "The No. 1 health issue there is no longer AIDS; it's drought." Dr. Orbinski, who currently holds the research chair in global health at the Balsillie School of International Affairs in Waterloo, Ont., said that while climate change disproportionally affects developing countries, especially the poor and marginalized, even wealthy countries such as Canada are not immune from the devastation wrought by climate change.

The rate of increase in temperature in Canada is two times higher than the global average," he said, and that will have dramatic impacts, especially in the Far North and the country's coastal regions. "There are real questions about the viability of Vancouver as a city due to rising sea levels in the coming decades," Dr. Orbinski said. A study published in 2008 by the Canadian Medical Association estimated that 21,000 Canadians die prematurely each year due to air pollution. (Worldwide, there are eight million preventable deaths attributed to bad air.)

The rise of carbon dioxide emissions, caused largely by the burning of fossil fuels, is one of the principal drivers of climate change. With the global population increasing by one billion people every 13 years, "we're going to see massive increases in CO2 emissions unless we take radical action," Dr. Orbinski said. The Canadian Medical Association, which represents the country's 83,000 physicians, is holding its 149th annual general council meeting in Vancouver this week.

Meanwhile, a third UNAIDS report published jointly with the Kaiser Family Foundation reveals that international government financing for HIV and AIDS is at a standstill. It has flatlined at approximately $8.6 billion (U.S.) per year from donor governments (together, the most affected countries are contributing in excess of $10 billion) and, even more troubling, there are signs that some governments - such as Australia, Canada, Denmark, France, Ireland, Sweden and the European Commission - may be starting to pull back. Not a trend that bodes well. It risks sending the HIV and AIDS epidemic directly to scenario No. 2.

The world is at a crossroads. The most important message in the deluge of information tabled in recent weeks is that we have arrived at a moment of choice, and that the next five years will be absolutely crucial. Now, in 2015, what governments do as a matter of political will and human decision will shape the future of AIDS. This was not at all the case in 2005, or even 2010, when the crisis was enormous, the need was overwhelming, but there was no guarantee of success. In 30 years we've lost 39 million men, women and children to AIDS globally. Communities have rallied, African governments have joined the struggle, and the international community is now making a concerted effort to make significantly more drugs for HIV and AIDS available.

The moment has arrived. We will either chart a course to bring about the end of AIDS in Africa, or, for the lack of adequate funding, watch as the epidemic regains its stranglehold. The UNAIDS-Lancet Commission has produced a cogent and compelling analysis of what that path must look like. Yes, there's no doubt that funding must increase. But the commission's report also makes it very clear that in addition, there must be a critical shift in how this money is being used.

For instance, donors have to expand their horizons beyond the technical matters of drug delivery, and start paying more attention to what it takes for people to avoid infection in the first place - and to actually stay on the medication. More support has to go to efforts at the grassroots level to help people bring their own communities back to life and to health. Above all, it's time to powerfully respond to the fact that gender inequality is at the heart of the epidemic. African women and girls are by far the most affected population.

And while the global death rate from AIDS has gone down over the past 10 years, it has increased by 50 per cent for adolescents in sub-Saharan Africa, where girls are up to five times more likely to be infected than boys their own age. In many of its recent comments, UNAIDS has understandably - or at least predictably - been stressing an optimistic view and the opportunity that lies before us. But we shouldn't be distracted by the easy comfort offered up by public relations messaging. Make no mistake, the end of the HIV and AIDS epidemic is not set to arrive on its own speed. Everything will depend on the decisions made in the next five years about the level and allocation of funding for the HIV and AIDS response. For the first time in the history of the HIV and AIDS epidemic, fate is truly and utterly in our own hands. Millions of lives are at stake. Let that truth drive us forward.

Ilana Landsberg-Lewis is executive director at the Stephen Lewis Foundation. Lee Waldorf is policy director at the Stephen Lewis Foundation.

An HIV-infected woman holds her antiretroviral drugs at her home in New Delhi. New HIV infections have dropped • by 35 per cent since 2000, but the world needs to dramatically step up investment and access to treatment, UNAIDS says. • Andrew Caballero-Reynolds/AFP/Getty Images file photo

earlier this month, the World Economic Forum included antibiotic drug resistance in its Global Risks 2013 report, calling it “arguably the greatest risk of hubris to human health.”

The existing market model simply doesn’t work, McGeer said. Pharmaceutical companies profit more from drugs used to treat chronic diseases, not antibiotics that patients use for just a few days, she said.

prevention will have to be a cornerstone. “The most effective way of not using antibiotics is to not have the infection in the first place,” McGeer said.

There are good reasons for the Minister’s concern. As World Bank President Jim Kim warned in Huffington Post, “We cannot afford to put off action any longer...in the next 30 years, we are likely to face a pandemic like the 1918 Spanish Flu, which could kill as many as 30 million people in 250 days — and reduce global GDP by nearly five percent, or close to $4 trillion.”

including universal health coverage (UHC.) In recent years the global health priorities spelled out by the Foreign Ministers are the ones the adopted by the G7 leaders. Unfortunately, healthcare workers didn’t make the Minister’s priority list.

There is a worldwide shortage of 10.3 million of the health workers needed to provide universal access including significant regional gaps in Asia (7.1 million) and Africa (2.8 million) according to estimates by International Labor Organization (ILO) experts. They also found understaffing in 97 countries with substantially higher gaps in rural than in urban areas.

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.

Under this approach, hospitals begin to admit more patients and discharge them more quickly.More patients are treated for the same number of beds.

New models of funding healthcare that use shared incentives to motivate communication and safe transitions between providers are needed for today's complex patients.

Elsewhere, countries that have used per-patient funding for years, like the U.S. and England, are now wondering if it's time to move on

Traditional hospital-focused patient funding does a good job of buying more surgeries, but it doesn't do much to address the challenge of coordinating care across healthcare providers.

Only a few types of patients are funded with the new 'Quality-Based Procedures' policy, with little cash to spare for buying additional volumes of care.

Instead of pouring money, time and effort into upgrading our 8-track funding models to cassettes, we can learn from what others have done and skip a generation in payment reform.

By introducing per-patient funding approaches that also integrate payments across hospitals, physicians and community care providers, Ontario can begin to tackle the triple challenge of access, cost and quality rather than passing the buck from one healthcare sector to the other.