Confronting the crisis in public health

Author: Aqsa Malik
Release Date: May 22, 2013
Pages: 26
This paper was prepared as background material for the Canada 2020 event ‘Confronting the crisis in public health’ on May 28, 2013 in Ottawa, Canada. It was written by Aqsa Malik, who is finishing her Ph.D. in Neuroscience at the University of British Columbia’s Brain Research Centre. The Foreword was written by Diana Carney, Canada 2020’s Vice President, Research, who was also the editor.
It is our conviction at Canada 2020 that there is and should be a role for the federal government in assuring the health of Canadians. While the provinces work on the mechanics of healthcare delivery, is there scope for the federal government to provide true leadership around public health issues, both to ease the financial burden on health systems and increase Canadians’ quality of life?
This paper joins other research and commentary written for our Securing the Health System for the Future policy stream, one of five areas of work that comprise the Canada We Want in 2020 project.
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The modern university: relevant? Yes, but is this enough?

On May 9, 2013 Canada 2020 staff attended a Canadian Club of Ottawa lunch at which Allan Rock, President of the University of Ottawa and former Chretien-era cabinet minister, delivered a speech entitled “The Skills Mismatch and the Myth of the Irrelevant University”.
The speech reiterated that getting a university degree continues to lead to higher lifetime wages. Rock emphasized the pursuit of knowledge as the main goal of education (and, by extension, of the university). He stressed that thoughtful analysis and critical thinking will always be essential skills, and that universities remain the sole institutions where these core competencies are inculcated amongst the next generation.
As we perhaps should have expected, the speech and the short discussion that followed were somewhat self-congratulatory. Rock stressed the continued relevance of universities, especially in today’s knowledge economy. This is beyond dispute but, upon further reflection, I wonder if perhaps we should be asking another question: is simply being ‘relevant’ enough? The answer is no.
This narrow view of knowledge trivializes learning outside of the academic setting, which is both crucial and complementary.
When asked if universities were doing enough to prepare young graduates for the job market, Rock answered that graduates were still being hired and this in itself proved that universities were fulfilling their duties. Is this proof enough? In the United States, the McKinsey Centre for Government found that while 70% of educators thought that graduates were adequately prepared for the job market, less than 50% of employers and young graduates agreed. This is a disconnect, and a concerning one, especially in view of ever increasing tuition fees and higher and higher degree requirements to get a “good job”.
While I will not argue against having a university degree (I, after all, have a master’s degree) I do find that President Rock’s arguments trivialize the challenges facing the next generation. McKinsey & Company rather elegantly points out the paradox: “Higher education has never been more valuable but 48% of university graduates in the U.S. are now in jobs that don’t require degrees”. Although there is a lack of data on this phenomenon in Canada, the situation is likely not much different here.
One of the only comprehensive reports on the issue in Canada, by the Certified General Accountants Association of Canada, finds that in 2005, 24.6% of young university graduates held jobs that required less than a university degree.
Apparently the future is bright for University of Ottawa grads, though. The university self-reports that two years after graduation 82% of graduates working full time are employed in a field related to their studies. It would be interesting to know what they define as a related field, what percentage are actually working full time, and what methodology has been used, since these findings seem contrary to overall employment trends. The full-time/part-time/temporary axis is particularly important: working on temporary contracts is an increasingly normal – if shaky – reality for many young Canadians.
This is not to trivialize the university experience, nor the importance of higher education in general. But we must recognize that the modern university has to adapt and continually strive to do better. Young graduates are facing tremendous challenges and universities must open their eyes to these. In a world where the job market evolves at such a rapid pace, all actors – from industry to the not-for-profit sector – must be involved in creating interactive, dynamic and innovative learning environments. As demand for skills evolves faster than universities are adapting, partnerships beyond co-ops and internships are all the more crucial to training graduates.
Universities could do more by involving companies, multiple levels of governments and not-for-profits in their institutions – and, yes, this can be achieved without compromising academic freedom.
Courses should include more hands-on and practical case studies: in an ideal world, public policy students should take part in real strategic policy development in partnership with government departments and business students should develop and participate in the implementation of new supply chain systems for existing SMEs, not fictitious ones. Some universities have been better than others at providing such an experience for their students (notably the University of Waterloo and its tech industry partners).
Such a model would require more resources from all actors and likely yield smaller cohorts of students, but the young graduates trained would be the best and brightest in their field. The next generation of students expects interactive learning environments, with meaningful outlets for their ideas and entrepreneurial spirits. Millennials have more tools than ever to realize their aspirations: universities must keep up or risk losing this cohort. Indeed the demand for entrepreneurial university programs (diplomas and degrees in innovation, strategy and entrepreneurship) is already at an all-time high in Canada.
Certainly universities are still relevant and they are getting better at creating opportunities for their students. But could they be doing better? Yes. And unless university administrators recognize this, the ‘myth’ of the irrelevant university will persist.

So you want to build a progressive movement in Canada

Last November, Larry Summers opened his talk at our packed Canada 2020 event, by saying that think tanks, such as Canada 2020, were vital to the political process. In his view, much of the North American political discourse is the result of a carefully placed op-ed, or a strategically researched issue brief from a think tank.
We were delighted to hear this. But we were also mindful that Dr. Summers was speaking from a U.S. perspective: think tanks do indeed play a crucial role in shaping the policy agenda in Washington. Our long-time U.S. associate, The Center for American Progress (CAP), was seen by many as a government-in-waiting during the Bush years. This was not far from the truth as many staff – including Melody Barnes whom we will host at our health event next week – and even more ideas made their way from CAP to the Obama Whitehouse. What John Podesta has built in the past ten years, and the impact that CAP has had on the U.S. policy agenda, is nothing short of extraordinary.
In Canada think tanks have generally been thin on the ground, and typically associated with specific political parties. This remains true today.
We launched Canada 2020 in 2006 because we wanted a space for progressives of all stripes to meet, discuss, and share ideas in an environment that was free of the partisan mentality of old. For seven years we have been hard at work building out that space with our sold-out free events, online engagement, conferences, debates, research briefs and yes, carefully placed op-eds. We’re proud of the work we have done and the voices and ideas that we have featured: we have never had more momentum than we do now.
Other organizations are now beginning to join us.  That’s a good thing – we welcome these additions to the conversation. But as the progressive movement grows, it becomes increasingly important to carve out a unique vision, and a substantive offering.
This is what we have been doing in our marquee project, The Canada We Want in 2020. We identified five areas in which the federal government can and should play a more progressive, strategic role: reducing income inequality, increasing innovation and productivity, rising to meet the Asia challenge, securing our health system for the future, and squaring the carbon circle.
In each of these areas we have fueled new thinking, and engaged different voices in our effort to build a more progressive Canada for 2020 and beyond.
Ultimately, we at Canada 2020 believe that governing is about making choices. Sometimes, and ideally, the choices that governments make are strategic – the product of hard thinking to address major hurdles which coalesce at a particular point in time.
We believe that Canada is at such a point in time today – and that Canada 2020 is playing an important role in driving a discussion about the role of the federal government in Canada.
A serious public policy strategy for the country means doing less of some things, while focusing decisively and aggressively on a few important things. This requires in-depth analysis of the really big challenges and opportunities facing the country. It requires governments to be straight with Canadians about the risks and rewards that lie ahead, so that citizens will buy into a clear direction set by government.
The basic orientation of Canada 2020 is that the federal government has a vitally important role to play in developing and implementing strategic policies, focusing governments and other institutions in society on the big challenges the country faces, and mobilizing consensus for action. In other words, we believe that the federal government can be a force for significant and positive change.
This does not necessarily mean big government. But it does mean intelligent, innovative, analytical and strategic government. It could conceivably result in smaller government, focused on a few big and important areas of public policy that really matter to the Canada’s future.
Canada 2020 is very proud of what we have achieved in our first seven years and we look forward to continuing to build a progressive community around our shared interest.

An austerity agenda hidden in an ‘NDP budget’

The Ontario government tries to satisfy everyone.
How does a minority government mired in a big deficit and in the grips of weak economic growth craft a budget that satisfies the NDP opposition and keeps the financial markets content?
Bob Rae, premier of Ontario for five years in the early 1990s, faced economic and fiscal challenges like this throughout his time in office but failed to triangulate such disparate interests. Paul Martin — undisputed master of the fiscal and economic universe for nine years as finance minister under Jean Chrétien — headed a minority government that negotiated a budget in 2005 with the NDP that managed to secure the support of Jack Layton, but was frowned upon by Bay Street.
By contrast, the inaugural budget of Premier Kathleen Wynne and novice Finance Minister Charles Sousa has likely succeeded where these and previous attempts at placating left and right have failed. The NDP will undoubtedly support the budget because it meets most of their demands. And Bay Street should be quite satisfied with a fiscal plan that is consistent with their agenda.
Most of the commentary has characterized this budget as a major victory for the NDP, upon whose support the Wynne government relies to survive, Tim Hudak’s Conservatives having committed to vote against it regardless of its contents. It has even been suggested this is more NDP Leader Andrea Horwath’s budget than anyone else’s.
To be sure, Horwath’s main demands were met, notably closing some corporate tax loopholes, putting in place a youth unemployment strategy, establishing new supports for small business, additional funds for northern Ontario infrastructure and committing to a legislated 15-per-cent cut to auto insurance premiums.
That said, the most important element of the budget runs rather contrary to NDP orthodoxy. This part is buried toward the end of the lengthy tome under the heading “Ontario’s Recovery Plan.” It is in here that we find the stuff the financial markets will like. And it is here that we locate the method to execute a comment Sousa made in a speech on April 22: “The most important and fundamental thing that we can do, together, to secure our future prosperity is eliminate the deficit.”
Put simply, the austerity drive — eliminating Ontario’s $10-billion deficit by 2017-’18 — is the cornerstone of the Wynne government’s agenda, even if the government hasn’t emphasized this.
Importantly, this deficit elimination objective will be achieved by holding program spending increases to less than one per cent per year on average over the next five years. Which might not sound terribly ambitious unless you consider that this is under the rate of inflation, meaning it equals a significant real cut in government spending.
Consider further that health care spending — which has been rising seven per cent per year on average for 30 years — eats up 42 per cent of Ontario’s program costs.
Then add to that the fact that we are on the cusp of the “grey society” — a period of unprecedented aging demographics which will put huge upward pressure on health care budgets — and one starts to realize the magnitude of the fiscal challenge Wynne and Sousa have set out for themselves. The budget document acknowledges this, stating that holding program spending rises to less than one per cent for years to come “will require some difficult choices.” Indeed it will.
Most of these choices have not been grappled with in Budget 2013, and lie in the future for the Wynne government. And despite dire warnings of its imminent demise, this government will almost certainly have a future of at least a few more months, if not another year and another budget.
The Wynne government’s effort at fiscal and economic planning has demonstrated skill on the part of the budget’s architects. They have crafted a document that both left and right can find their values reflected in, which is no small feat. That, in a sense, seems to be the essence of Liberalism today. By injecting into the budget some NDP inspired initiatives — and then emphasizing these publicly — the government is almost certain to survive. And by committing to a fairly tough austerity agenda — even in the context of weak economic growth and relatively high unemployment in Ontario, which might argue for rather less austerity — the government maintains its fiscal prudence credentials. The budget is an impressive piece of political strategy.
In the final analysis, however, what we really have here is a scene setter for a second Wynne-Sousa kick at the fiscal and economic can in a year.
Budget 2014 is where the rubber really hits the road — where the premier and finance minister will have to make some fundamental choices about the basic direction of and role for the Ontario government in the economy and in the lives of citizens.