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the price tag — an estimated $1.2 trillion over the next 35 years

backed up by a 27-page study

The final speaker was Michael Decter

The challenge is not insurmountable, he assured the audience. Germany has done it. Several other nations — Japan, Korea, the Netherlands and Luxembourg — are following the same path. But it will require a mix of public and private funding.

What all three speakers agreed on was that it is critical to get Canadians thinking and talking about this issue. The existing elder care system is breaking under the strain — the waiting list for a spot in a nursing home is approximately 20,000 in Ontario alone — and the baby boom hasn’t even hit its heavy-need years. Home care is severely underfunded. And hospitals, the most expensive option, can’t accommodate an influx of frail, elderly patients.

the impact of Liberal health-care policy in southern Ontario is "bad enough." The model Mehra said the province is using to centralize services into fewer communities is especially detrimental to the North. "That doesn't work for the south," she added. "It definitely, in no way, works for Northern Ontario." The state of Northern health care was brought to the floor of Queen's Park this week when, on Wednesday during Question Period, NDP health critic France Gélinas called on the government to stop continued cuts to care in the region. Funding based on volumes doesn't jibe with regional population distributions, Mehra said. "It just doesn't make any sense at all," she said, adding Northern Ontario has many common complaints with small, rural southern Ontario communities.

The coalition argues the entire Ontario system has received short shrift for years and is below the Canadian per capita average by about $350 per person. The provincial Liberals ended a four-year hospital base funding freeze in its latest budget, pledging to spend $60 million on hospital budgets, along with $75 million for palliative care and $130 million for cancer care. The Ontario Health Coalition - and Sault and Area Health Coalition - are not impressed. The local group argues on a regular bases, 22 admitted patients often wait in SAH's Emergency Department for inpatient beds and admitted patients stay in emergency for as long as five days. Patients are lined along hallways on the floors or put in areas that were designed to be stretcher storage areas or lounges with no call buttons, oxygen, out of the nurses' usual treatment areas. Late last month, the Ontario Health Coalition launched an Ontario-wide, unofficial referendum to raise awareness about what it contends is a system in critical condition. The unofficial referendum asks Ontarians if they're for or against the idea: "Ontario's government must stop the cuts to our community hospitals and restore services, funding and staffto meet our communities' needs for care." Ballot boxes will be distributed to businesses, workplaces and community

centres across the province before May 28, when votes will be tallied and presented to Premier Kathleen Wynne. "We have to make it so visible, and so impossible to ignore, the widespread public opposition to the cuts to local public hospitals so the province cannot continue to see all those cuts through," Mehra said. Similar public OHC-led lobbying helped limit and "significantly" change policy in a past Sault Area Hospital bid to usher in publicprivate partnerships (P3s), she added. "The referendum is a way to make that so visible, so impossible to ignore by the provincial government, that we actually stop the cuts," Mehra said. Other speakers Thursday included Sault coalition member Peter Deluca, who spoke of the many challenges his elderly parents have endured thanks to what he dubbed less-than-stellar hospital experiences. "We deserve the truth, we deserve answers, not just political talk," said Deluca, adding concerned citizens must band together in order to prompt change and halt healthcare cuts.

Sharon Richer, of Ontario Council of Hospital Unions/CUPE, said as a Health Sciences North employee, she's seen "first-hand" how cuts affect health care. "There won't be change if we don't make a ripple," she said. Laurie Lessard-Brown, president of Unifor Local 1359, told the meeting of how SAH's recent "wiping out" of the personal support worker classification is wreaking havoc on staff and patients, alike. Registered nurses and registered practical nurse must now pick up the slack, she added. "Morale is lowest I've ever seen," Lessard-Brown said. And, as recent as last Tuesday, Unifor learned of a further four full-time RPN positions being cut while supervisor positions were being added. "Cutting front-line workers is not acceptable," Lessard-Brown said. jougler@postmedia.com On Twitter: @JeffreyOugler © 2016 Postmedia Network Inc. All rights reserved.

Natalie Mehra, Ontario Health Coalition executive director, decries what she describes as the profound lack of funding being divvied out to Ontario hospitals during a town hall meeting Thursday evening, hosted by the Sault and Area Health Coalition at Royal Canadian Legion, Branch 25.

That question dominated the recent Public Health 2016 conference in Toronto. Speakers described persistent inequity and inaction across the health system, from research to medical training to hospital care. “The common response is to deny that the problem lies in the structures,” said Charlotte Loppie, director of the Centre for Indigenous Research and Community-led Engagement at the University of Victoria in British Columbia.

She argued that it’s a mistake to see “colonization” as something that happened in the past. “It’s about the control that some people have over other people, which obviously continues today in the health policies and programs that are developed and expanded on indigenous communities, rather than with those communities.”

Research Loppie spoke at a panel hosted by the Canadian Institutes of Health Research (CIHR), which faced criticism in February for awarding less than 1% of funding to Aboriginal health projects in its first major competition since restructuring. “We know we have to work to get this right and get this better and I think we’re learning as we go,” said Nancy Edwards, scientific director of the Institute of Population and Public Health at CIHR.

According to Edwards, Aboriginal health is now a “standing item” at science council meetings, which bring together CIHR top brass every four to six weeks. There has also been “a lot of consultation” with indigenous researchers and communities. There isn’t a single barrier standing in the way. “It’s not that simple,” she said.

Speakers at the Canadian Public Health Association’s annual conference urged structural change to improve indigenous health.

Loppie said she considers Edwards an ally, but noted that CIHR has “a long way to go” to correct the disadvantage to Aboriginal health research under the new funding structure. “Change is a difficult point,” particularly at the most senior levels of administration, she said.

Medical education Australia’s experience integrating indi genous health education into medical training shows how change at that level can help transform a system. Australia’s version of a Truth and Reconciliation Commission recommended compulsory courses for all health professionals in 1989. But this didn’t become reality for doctors until 2006, when the Australian Medical Council set standards that the indigenous health training schools must provide.

With accreditation on the line, change was rapid and meaningful, said Janie Smith, a professor of innovations in medical education at Bond University in Australia. “If you don’t meet the standards, you can’t run your program, so it’s very powerful.” Bond’s medical program overhauled its case-based curriculum to include indigenous examples to teach core concepts. Students also complete a two-day cultural immersion workshop in first year and a remote clinical placement in fifth year.

“It’s a really important principle that this is the normal program and it’s funded out of the normal budget,” Smith said. Integration in core curriculum teaches students that cultural sensitivity is fundamental to being a good doctor, like understanding anatomy. It also protects indigenous health education from “toe cutters” when budgets are tight. Although Canadian medical schools are expanding their indigenous health content, some educators noted that it’s still peripheral to core training.

Lloy Wylie teaches medical students as an assistant professor of public health at Western University in London, Ontario. She recalled one indigenous health session that only a third of students attended. “When it’s voluntary, only the people who don’t need the training show up.”

Hospital care Wylie said she encountered the same indifference among some medical colleagues at Victoria Hospital in London, Ont., where she is appointed to the psychiatry department. “There are still some very unsettling things that I see going on in our hospital system.” She shared stories of “huge jurisdictional gaps” between the hospital and reserve, of patients with cancer denied adequate pain medication because of assumptions about addiction, and of health workers “woefully unaware” of indigenous culture and services.

People in the hospital weren’t even aware of the Aboriginal patient liaison that was in the hospital,” Wylie said. There are some recent bright spots; for example, British Columbia and Ontario are boosting cultural sensitivity training for health workers. But Wylie noted that the same workers “go back to institutions that are very culturally unsafe, so we need to look at changing those institutions as a whole.”

Brock Pitawanakwat, an assistant professor of indigenous studies at the University of Sudbury in Ontario, cited the importance of creating space for traditional healing alongside clinical care. In some cases, it’s a physical space: Health Sciences North in Sudbury has an on-site medicine lodge that provides traditional ceremonies and medicines.

These services are as much about healing mistrust as any physical remedy, Pitawanakwat said. “Going into a hospital after attending a residential school, there’s still that negative emotion,” he explained. “If you look at these buildings in archival photos, they’re almost identical.”

Wylie suggested that the fee-for-service model could also be changed to support physicians building better relationships with patients. “Anything we do to make our hospitals more welcoming places for Aboriginal people will be good for everybody,” she said. “Right now, they’re really alienating for everybody.”

the conference will address issues such as for-profit care and factory medicine, staffing ratios, under reporting, shiftwork and working conditions, bullying in the workplace

speakers and contributors will be discussing possible next steps to be taken in the healthcare community

To register for the conference or for more information, please visit the OCHU website: http://www.ochu.on.ca/conferences_conventions.html.

William Charney, is a nine-time published author of healthcare safety books. He has also published more than 30 peer-reviewed articles in the field. For five years, Mr. Charney was a safety officer at the Jewish General Hospital in Montreal, Quebec. For ten years, he was the director of environmental health at the Department of Public Health in San Francisco. Then for five years, he was a safety coordinator for the Washington Hospital Association. For the last ten years, he has been a consultant in the field of occupational health.

Shawn Shank, president of the Canadian Union of Public Employees (CUPE) Local 139 which represents hundreds of front-line hospital staff, said unions expect to be notified within four weeks of the impact to personnel. This announcement has caused more anxiety in the workplace," he said. Now that people have heard that 158 number they are wondering if they are within that 158." According to the council, recently released health data shows an increase in patient readmission rates for North Bay in each year of the provincial funding freeze.

The re-admission spikes signal that the hospital is pushing patients out of hospital faster and faster and before they are well. Patients are being sent home and then re-admitted, acutely ill and often requiring longer, more costly hospital stays. Many individuals are paying with their health for a community hospital that isn't funded properly," Hurley said. Nipissing MPP Vic Fedeli took the government to task in the Ontario Legislature Wednesday afternoon. Fedeli blasted the Liberals in a member's statement for putting the health care of Nipissing residents at even greater risk. Today is an incredibly distressing day in my riding, especially for those people who rely on health services provided at the North Bay Regional Health Centre," he stated.

Today, a further 158 full-time staff at our hospital learned that their jobs are being cut by this government and more than half of those employees were nurses. This is in addition to the 197 front-line health care workers already cut at this hospital - again the majority of them were nurses. Speaker, that's 350 frontline health care workers that are gone." Fedeli said the Liberals are also closing 30 beds in addition to the 30 they already closed at the fiveyear- old hospital. This is not only devastating to the front-line health care workers, but more so for their patients, who are now rightfully concerned about access to the quality health care they need and deserve," he said.

The Liberal government has clearly put self-interest ahead of the health care of Northerners. This much I want to make clear, Speaker -we, the people of Nipissing, will not stand for this. We're fed up with the scandals that leave us to pay the price." j.hamilton-mccharles@sunmedia.ca

NUGGET FILE PHOTO • The elimination of 158 full-time equivalent positions at the North Bay Regional Health Centre brings the total loss of front-line health care workers to 350, Nipissing MPP Vic Fedeli stated Wednesday in the provincial legislature.

Dr. Monika Dutt will be speaking at this year's Progress Summit. This sold-out event is taking place in Ottawa from March 26-28 and will feature a variety of speakers from progressive movements across Canada.

On March 16, the CMAJ released a new study that provides ground-breaking evidence that Canadian governments could include prescription drugs in Medicare at no additional cost. This paper, a collaborative effort of researchers at the University of British Columbia and the University of Toronto, reports that a national pharmacare plan could potentially result in $7.3 billion in savings and a 32% reduction in total spending on medicines. Dr. Danielle Martin, one of the study's authors, spoke with the media this week to discuss how pharmacare could improve health outcomes in Canada as well.

There are far fewer emergency room visits," she says. "This means that in privatizing a long-term care home, a municipality is likely to be transferring higher costs to the health-care system. "They are actually creating more costs for taxpayers, while also reducing publicly held assets." Braedley will be the guest speaker at a CUPE-hosted community forum June 7 in North Bay. The forum will be held at 7 p.m. at the Discovery North Bay Museum.