Suchergebnisse

With most of the country situated above the latitude of the 42nd parallel north, there is a significant portion of the Canadian population that is not getting enough of the sunshine vitamin during the winter. Vitamin D is naturally produced when skin is exposed to sunlight, however during the winter months in Canada the sun is too low in the sky for this to occur. A full quarter of the Canadian population is estimated to have vitamin D levels so low as to be considered insufficient or deficient by Health Canada guidelines. Increasing vitamin D intake should be considered a public health priority. Vitamin D deficiency is known to be linked to rickets in children and osteomalacia in adults (bone softening and malformation) as well as osteoporosis (loss of bone density, increasing susceptibility to fractures). However a growing body of evidence also suggests that vitamin D may have a role in the prevention of chronic diseases such as heart disease, high blood pressure, diabetes, cancer, cognitive decline, Parkinson's disease, multiple sclerosis and arthritis. There is, of course, no way to change Canada's proximity to the equator. But there are ways to help Canadians get more vitamin D through dietary intake. Improving the vitamin D status of the Canadian population through food fortification and dietary supplements represents an inexpensive intervention that can improve the health of the population, but debate remains over how much vitamin D the Canadian population needs and how to ensure the population adheres to whatever recommendations are made. Food fortification has already demonstrated its effectiveness in improving vitamin D levels (as it has for other public health priorities, such as with iodized salt). Decades ago, the prevalence of rickets in Canadian children led health professionals to lobby for, and win, legislation making vitamin D fortification mandatory for milk. Other foods, such as orange juice, milk of plant origin and margarine are sometimes also fortified with vitamin D. However many Canadians do not consume milk or the other fortified foods or do not take dietary supplements at the current recommended levels, increasing their risk of vitamin D insufficiency. It is clear there is a need to gain a better understanding of the benefits and the costs of strategies associated with vitamin D intake in the general population. There have been longstanding concerns about the risk of people consuming too much vitamin D (leading to hypercalcemia). More recently there has emerged great disagreement in the scientific and regulatory communities over what constitutes an excessive dosage of vitamin D, and even what constitutes the optimal blood-serum level for vitamin D. The inability to settle on firm guidelines is paralyzing any movement towards increasing vitamin D intake in the Canadian population. Fortification and public health strategies are needed to ensure current vitamin D targets are met. Health Canada's proposal to allow greater levels of vitamins and minerals to be added to foods, to meet consumer demand (within maximum limits), has been on the table since 2005. A decade later, the Canadian winters have grown no shorter, and the solar zenith angle has not changed. It is becoming an increasingly urgent matter of public health to reach a consensus on updated guidelines for vitamin D intake levels and limits, to better inform Canadians.

The COVID-19 pandemic demonstrates how vital it is for the Alberta government to incorporate precision health (PH) planning into its public health ecosystem. Public health shocks demand quick thinking, rapid adaptation and good decision- making driven by data. PH offers all that and more, and not just in health care. In ordinary times, PH tailors diagnosis and treatment to an individual patient's needs. When a crisis arises, PH focuses on assessing risks to provide targeted interventions and treatments to larger populations.

The recent report by Alberta's Blue ribbon panel on the province's finances denounced Alberta's Fee-for-Service (FFS) model as a significant source of inefficiency and cost within the health system, going as far as to suggest legislating a non-FFS model. If pursued, Alberta would be the first province since the start of Canadian Medicare to fully shift away from FFS. There has already been considerable study and debate on which FFS alternative is most appropriate in different care settings, but little discussion has been generated on the best practices for implementing such a reform. This paper explores physician compensation reform work for physicians, patients and government alike, focusing on compensation of primary care physicians. Since the early 2000s, family physician costs in Alberta have significantly outpaced specialist costs, which has drawn attention to reconsidering compensation models for primary care specifically. Alberta has two options beyond the FFS-dominant status quo to consider: (1) legislate in an alternative payment plan (APP) to replace FFS, or (2) phase out FFS by implementing policies that make APP a progressively more attractive option for primary care physicians. This paper provides a scan of emerging practice and evidence from across Canada. The practical and political lessons learned point to the need for a systematic phase-out of the FFS payment model in primary care. However, there is no evidence to suggest that legislating in a mandatory replacement of FFS is the optimal way forward. Experience across the country demonstrates that physicians when presented with a viable alternative to FFS will uptake, but for that alternative to be viable the status quo must not retain the upper-hand.

Despite the supports that have been put in place, Canadians with developmental disabilities (DD) continue to face obstacles in gaining and maintaining employment. In 2012 two out of three Canadians with DD were out of the workforce and not looking for a job. This dismal statistic means that a large number of capable people are chronically unemployed, a situation that leads to poorer quality of life, with accompanying declines in cognitive function and general well-being. For these neurodiverse Canadians, the cascading effects of unemployment include financial insecurity, poor self-esteem, less ability to live independently and lower community participation. For employers, it means that a pool of diverse talent and resources that would benefit their companies is untapped. Of all disabilities, Canadians with DD face the worst employment levels. Educating employers about neurodiversity and incentivising them to make accommodations in hiring practices and in the workplace would go far toward reducing the number of jobless neurodiverse people. As a signatory to the UN Convention on the Rights of Persons with Disabilities, Canada is expected to provide inclusive and accessible job training, education and labour market opportunities. Yet, labour market activation programs, welfare reforms and equality laws have so far failed to make a difference in the unemployment numbers. A recent study reveals that the top three barriers to unemployment for neurodiverse Albertans include employers' knowledge, attitude, capacity and management practices; a late start to the concept of work among people with DD; and the stigma of their disability. Programs to remedy the situation abound at the federal and provincial levels and lately, the focus has been shifted to employer education initiatives. Much remains to be done, however, and this communiqué offers suggestions for policy changes that may benefit all parties concerned. One policy could entail changing the design of income assistance programs like Assured Income for the Severely Handicapped (AISH) to remove disincentives to work, such as ensuring continued access to important health benefits. Governments could also offer financial incentives such as wage subsidies and tax credits to employers who hire neurodiverse people, as well as provide monetary incentives for neurodiverse Canadians who wish to be self-employed. Training programs could be available for employers to teach them the value of having a diverse workforce, as well as instructing them in how their companies can become inclusive and accessible. Putting the proper supports in place in the early years would assist neurodiverse high-school youth to participate in career planning, work internships and job training. Helping Canada's neurodiverse population to get and keep jobs provides benefits to the economy in terms of increased GDP, to employers in terms of talent and ability, and to people with DD who will enjoy a higher quality of life, greater self-esteem and reduced stigma and isolation.

Labour force participation is lowest for persons with developmental disabilities (DD) compared to any other disability in Canada, even though many are ready, willing and able to work. Those who are employed often work for below minimum wage and have minimum protection by labour legislation. Yet little detail is known about employment outcomes for persons with DD in a Canadian context. Using national population survey data, this study explored the unmet employment, education and daily living needs of persons with two types of developmental disability, autism spectrum disorder (ASD) and cerebral palsy (CP; Zwicker, Zaresani and Emery 2017)[1]. Disability was cited as a key barrier to employment for those not in the labour force, highlighting an urgent need for policies that promote accessibility and equal opportunity, as well as improved workplace practices and employment services and supports. These findings contribute to a better understanding of the experiences and challenges pertaining to the workplace, education and social supports, necessary in designing policies that deliver efficient and equitable services and better address the needs of Canadians with DD – a group that has been largely absent from policy dialogue.[1] ASD and CP are two of the most common chronic developmental conditions that result in disability in Canadian children.

Effective and accessible disability programs are essential to supporting Canadians with disabilities and achieving Canada's commitment to the United Nations Convention on the Rights of Persons with Disabilities. The limited availability of centralized data on disability programs in Canada makes it difficult to understand, let alone evaluate, existing programs. To address this issue, we used government publications to create a database that compiles expenditure data, caseload data, and information about disability programs for each Canadian province from fiscal year 1999/00 to 2017/18, where available. We discuss the value of these data by presenting preliminary analyses. We also detail limitations associated with our database and highlight areas for future study.

The COVID-19 pandemic and the policy measures adopted in response have disproportionately impacted persons with disabilities. Given the increased risk of COVID-19 and the resulting health impact for this vulnerable population, governments must engage stakeholders such as community organizations to co-design pandemic response plans. Collaboration with key stakeholders could assist in transforming services in crucial areas, such as health, where emergency policies are organized around the needs of persons with disabilities. Unfortunately, there is inadequate data collection and insufficient emergency preparedness planning and responses for persons with disabilities. This knowledge gap means consideration of health and social policy implications specific to the needs and experiences of persons with disabilities is lacking. This research study aimed to evaluate strategies through which decision-makers could engage stakeholders, such as community organizations, to co-design disability-inclusive policy responses during the COVID-19 outbreak in Alberta. Through interviews, the study focused on understanding the level of engagement, barriers to community organizations' engagement and participatory policy aspects best suited for co-design. Key findings from the research highlighted the participants' viewpoints on barriers, facilitators, preferences and other critical approaches through which decision-makers engage with community organizations. Results highlighted that top-down and tokenistic consultation approaches limit community organizations' engagement in designing pandemic planning and response. Inaccessible ways of consultation and navigation barriers exacerbate obstacles to stakeholder engagement. Stakeholder engagement in data surveillance efforts was unclear, and the impact assessment process needs strengthening. The study results also showed that having COVID-19 disability advisory groups at the federal and provincial levels are a robust mechanism to connect communities with the government. However, the process of influencing government decision-making and policy actions needs to be openly communicated to civil society. Solutions are achievable. Political commitment, long-term investments and an accessible engagement environment would significantly improve stakeholder engagement. Governments must transition from traditional consultative methods to sustainable engagement practices while sharing how public policies reflect communities' input. Financial investments must create an accessible consultation environment for designing participatory pandemic policies that reflect the priorities of persons with disabilities. Some key recommendations emerging from our analysis include: Invest financially to create an accessible consultation environment for co- designing policies. Consult stakeholders to develop new regulations or adjust existing ones to create inclusive pandemic response plans. Inform how pandemic response plans include and address community inputs and concerns in a transparent manner. Professionally contract stakeholders to co-design and communicate pandemic information. Engage with multiple stakeholders to evaluate the impact of pandemic response plans.

Health systems globally are shifting towards precision health (PH), the utilization of individual information to inform health and social services delivery to improve health outcomes. PH is a major area of focus for economic development across the globe, however most Canadian provinces do not have a clear strategy for this sector. This research examines Alberta's PH innovation and commercialization (I&C) ecosystem to identify key policy barriers in the development of new technologies and processes. An environmental scan of existing policies for PH through the lens of an innovation framework revealed three gaps in the PH I&C system. There is a lack of formal leadership, such as an I&C decision-making body; public policy development and implementation does not involve industry; and lastly, demand stimulating policies are absent or underrepresented. Qualitative semi-structured interviews were conducted to identify policy challenges utilizing perspectives from senior level executives currently engaged in PH I&C in Alberta. Participants were grouped by category from the Triple Helix Model of Innovation – Government, Industry and Academia. A qualitative thematic analysis of the interviews was conducted on the interview transcripts, coded using NVivo software, to generate thematic policy challenges. The findings from the interviews were grouped into five major policy challenges. Sub-optimal coordination between the various ecosystem players was the most consistent and prevalent findings across all groups. Most respondents identified the absence of a mandated organization for PH I&C as an impediment to decision-making. Multi-sectoral activity and collaboration were identified as concerns despite the importance of these activities in this sector. Tension between academics and government (including health service providers) was present between the research funding mechanisms "discovery-driven" versus "demand-pull". Many respondents were concerned with the low level of local innovation public procurement by the health system. Findings suggest the need for a stronger role of governance structures to coordinate PH innovation ecosystem activity. A group with the capacity to address the multifaceted and interdisciplinary policy challenges may improve PH I&C outcomes in Alberta. Future research is required to inform design of horizontal and vertical governance structures.