Business
Ongoing water crisis is a national embarrassment
From the MacDonald Laurier Institute
By Matthew Cameron and Ken Coates
Cameron and Coates call for an increased sense of urgency from government and offer several policy initiatives to improve water access for First Nations communities.
Access to clean drinking water is a necessity, yet delivering it to all 40 million Canadians, particularly Indigenous communities, has proven to be elusive. Successive federal governments have both acknowledged the problem, yet have failed to fully eradicate drinking water advisories, which remain in place in at least 27 Indigenous communities.
In a new paper, The water conundrum and Indigenous communities in Canada, Matthew Cameron and Indigenous Program Director Ken Coates shed light on the water insecurity crisis on Canada’s reservations and recommend a number of multijurisdictional policy initiatives, urging policymakers adopt an increased sense of urgency in systematically address the problem – not just throwing money at it.
The authors identify several key barriers to resolving the water insecurity crisis:
- Community location: some communities are located too far away from freshwater reserves; many of these places were settled in the 1950s and 1960s, without scientific study of the suitability of their locations for water purposes;
- Long-term maintenance: trained personnel often work in stressful conditions with little or no local backup, making it difficult to find and retain these workers;
- Little margin for error: nationally determined Canadian water quality standards are, appropriately, difficult to meet, setting a high bar for small, isolated communities;,
- Poor national understanding of the challenges: Canadians who live off reservation are largely unaware of the urgency of the crisis in Indigenous communities.
Cameron and Coates recommend the following policy initiatives to address the crisis:
- Continuous transparency; authorities should make information about water delivery systems and water treatment facility down-times available to the public;
- Region-wide water management systems: these would provide for a sharing of personnel, professional backup, and collective learning about water systems maintenance and treatment facilities, thereby creating a maintenance economy;
- Option of relocation: in extreme cases, where water supplies are unacceptable and alternatives too expensive, communities could be given the option of voluntary relocation and rebuilding in a location with better access to potable water;
- More attention to remote solutions: giving agency to local Indigenous governments and/or companies to resolve the crisis;
- Increasing urgency: Indigenous Canadians wonder if the country cares or even knows about their lack of access to clean water– greater awareness among Canadians can push politicians to seek policy alternatives.
“Understanding the challenges in full, handling emergencies expeditiously, developing and implementing long-term solutions, and committing publicly to providing First Nations with adequate and appropriate water supplies is not an act of generosity or an optional exercise. Maintaining safe drinking water is a foundational responsibility of government,” conclude Cameron and Coates.
“Further delays should not be acceptable.”
To learn more, read the full paper here:
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Matthew Cameron is a Yukon-based researcher and academic. He is an Instructor at Yukon University, where he has taught in the Liberal Arts, Indigenous Governance and Multimedia and Communications programs since 2016.
Ken Coates is a Distinguished Fellow and Director of Indigenous Affairs at the Macdonald-Laurier Institute and a Professor of Indigenous Governance at Yukon University.
Canadian Taxpayers are funding programs in foreign countries with little effect
Back in early November I reached out to Global Affairs Canada (GAC) for a response to questions I later posed in my What Happens When Ministries Go Rogue post. You might recall how GAC has contributed billions of dollars to the Global Fund to Fight AIDS, Tuberculosis and Malaria, only to badly miss their stated program objectives. Here, for the record, is my original email:
I’m doing research into GAC program spending and I’m having trouble tracking down information. For instance, your Project Browser tool tells me that, between 2008 and 2022, Canada committed $3.065 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The tool includes very specific outcomes (like a drop of at least 40 per cent in malaria mortality rates). Unfortunately, according to reliable public health data, none of the targets were even close to being achieved – especially in the years since 2015.
Similarly, Canada’s $125 million of funding to the World Food Programme between 2016 and 2021 to fight hunger in Africa roughly corresponded to a regional rise in malnutrition from 15 to 19.7 percent of the population since 2013.
I’ve been able to find no official documentation that GAC has ever conducted reviews of these programs (and others like it) or that you’ve reconsidered various funding choices in light of such failures. Is there data or information that I’m missing?
Just a few days ago, an official in the Business Intelligence Unit for Global Affairs Canada responded with a detailed email. He first directed me to some slightly dated but comprehensive assessments of the Global Fund, links to related audits and investigations, and a description of the program methodology.
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To their credit, the MOPAN 2022 Global Fund report identified five areas where important targets were missed, including the rollout of anti-corruption and fraud policies and building resilient and sustainable systems for health. That self-awareness inspires some confidence. And, in general, the assessments were comprehensive and serious.
What initially led me to suggest that GAC was running on autopilot and ignoring the real world impact of their spending was, in part, due to the minimalist structure of the GAC’s primary reporting system (their website). But it turns out that the one-dimensional objectives listed there did not fully reflect the actual program goals.
Nevertheless, none of the documents addressed my core questions:
- Why had the programs failed to meet at least some of their mortality targets?
- Why, after years of such shortfalls, did GAC continue to fully fund the programs?
The methodology document did focus a lot of attention on modelling counterfactuals. In other words, estimating how many people didn’t die due to their interventions. One issue with that is, by definition, counterfactuals are speculative. But the bigger problem is that, given at least some of the actual real-world results, they’re simply wrong.
As I originally wrote:
Our World in Data numbers give us a pretty good picture of how things played out in the real world. Tragically, Malaria killed 562,000 people in 2015 and 627,000 in 2020. That’s a jump of 11.6 percent as opposed to the 40 percent decline that was expected. According to the WHO, there were 1.6 million tuberculosis victims in 2015 against 1.2 million in 2023. That’s a 24.7 percent drop – impressive, but not quite the required 35 per cent.
I couldn’t quickly find the precise HIV data mentioned in the program expectations, but I did see that HIV deaths dropped by 26 percent between 2015 and 2021. So that’s a win.
I’m now inclined to acknowledge that the Global Fund is serious about regularly assessing their work. It wouldn’t be fair to characterize GAC operations as completely blind.
But at the same time, over the course of many years, the actual results haven’t come close to matching the programs objectives. Why has the federal government not shifted the significant funding involved to more effective operations?
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From the Fraser Institute
By Mackenzie Moir and Bacchus Barua
At 30 weeks, this year marked the longest total wait for non-emergency surgery in more than 30 years of measurement.
Our system isn’t just worsening over time, it’s also performing badly compared to our universal health-care peers.
Earlier this year, the U.S.-based Commonwealth Fund (in conjunction with the Canadian Institute for Health Information) released the results of their international health policy survey, which includes nine high-income universal health-care countries—Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom. Unfortunately, Canada continued to come in near or dead last on key measures of timely access. Most notably, Canada ranked worst for wait times for specialists and non-emergency surgery.
For example, whereas almost half (46 per cent) of Canadians surveyed indicated they waited two months or more for a specialist appointment, that number was just 15.1 per cent in the Netherlands and 13.2 per cent in Switzerland. And while one in five (19.9 per cent) Canadians reported waiting more than one year for non-emergency surgery, just half a per cent (0.6) of Swiss respondents indicated a similar wait. And no one in the Netherlands reported waiting as long.
What explains the superior performance of these two countries compared to Canada?
Simply put, they do universal health care very differently.
For example, the Netherlands, which ranked first on both indicators, mandates that residents purchase private insurance in a regulated but competitive marketplace. This system allows for private insurance firms to negotiate with health-care providers on prices, but these insurance firms must also accept all applicants and charge their policy holders the same monthly fee for coverage (i.e. they cannot discriminate based on pre-existing conditions).
In Switzerland, which ranked among the top three on both measures, patients must also purchase coverage in a regulated private insurance marketplace and share (10-20 per cent) of the cost of their care (with an annual maximum and protections for the most vulnerable).
Both countries also finance their hospitals based on their activity, which means hospitals are paid for the services they actually provide for each patient, and are incentivized to provide higher volumes of care. Empirical evidence also suggests this approach improves hospital efficiency and potentially lowers wait times. In contrast, governments in Canada provide hospitals with fixed annual budgets (known as “global budgets”) so hospitals treat patients like costs to be minimized and are disincentivized from treating complex cases.
It’s no surprise that in 2022, the latest year of available data, a lot more Swiss (94 per cent) and Dutch (83 per cent) reported satisfaction with their health-care system compared to Canadians (56 per cent).
No matter where you look, evidence on the shortcomings of Canada’s health-care system is clear. Fundamental reform is required for Canadians to have timelier care that matches what’s available in universal health-care countries abroad.
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