After seven years at the Broadbent Institute, Alejandra will leave the organization at the end of September.

As Director of Leadership and Training, Alejandra helped built the backbone for progressive organizing in Canada. She led the Institute’s campaigns for electoral reform, has led countless workshops and training sessions for progressives across the country and was the Director of the Power Lab, a joint project between the Broadbent Institute and the Atkinson Foundation, which built capacity for local organizing. Most recently, Alejandra curated the 2022 Progress Summit, our first in-person Summit since the pandemic began. Her work in this role brought together the different corners of the progressive community and helped us know each other and work better together. 

I want to thank Alejandra for her commitment to the progressive movement the power that we can have when we work as a collective. On behalf of the board and staff, I say a Big Thank You and wish you all the best. 

- Ed Broadbent, founder

When thinking about mental health care, one would expect medication coverage to be included. While mental health and pharmacare are parts of universal health care for many countries, Canada lags behind as the exception. 

Currently, pharmacare coverage only includes medically necessary medications given in hospitals and physician services. In Ontario for instance, those below 24 years and over 65 years may qualify for the Ontario Drug Benefit program, however this program only covers a select number of medications. Unfortunately, there is no coverage for community-based, non-physician mental health services or prescription medication for mental health therapies.

According to the Advisory Council on Implementation of National Pharmacare 1 in 5 Canadians struggle to pay for medications and either do not have prescription drug insurance or the plan they have is inadequate to cover their medical needs. According to Statistics Canada, 2.3 million Canadians do not have their mental health care needs adequately met. The limited access to medications does not help save money, either. In actuality, the pharmaceuticals industry plays a big role in our economy with medications being the second biggest expenditure in the Canadian healthcare system after hospitals. 

The current mix of private and public drug programs leaves us with a fragmented system that creates accessibility gaps and high costs of medication, putting many Canadians' health and well-being at risk. In addition, each province governs its pharmaceutical system, leading to disparities in the system. This has also led to disparities in mental health services across Canada.

The financial barriers Canadians face to accessing pharmaceuticals is an important factor to the under-use of mental health treatments. Even those with private insurance lack access to some mental health medications, with only 19.3% of individuals actually receiving treatment.

Canada is the only country with a “universal” healthcare system that does not include pharmacare. Countries such as Germany and the United Kingdom offer universal drug coverage that includes access to psychiatric medication. The United Kingdom, for example, provides free prescriptions in Scotland and Wales. While England requires some prescription charges, however, the majority of prescribed medications are offered free of charge, or come with the option to purchase a prescription prepayment certificate.

Where do we go from here?

Building a universal public drug coverage program has been attempted throughout Canada’s history of medicare, but it has been a continued political struggle. Opponents of universal pharmacare believe the current system works well for most Canadians, and we should just fill the gaps in coverage without building a real alternative to the for-profit system. However, this is far from true. We have seen in the United States that the fragmented system of filling in the gaps actually widens the accessibility gap of resources. Without pharmacare, we cannot truly make progress in treating mental health illnesses. The Broadbent Institute report Pharmacare Now outlines two pathways for Canada to achieve a national Pharamcare program. 

One option is to have a Federal-Provincial-Territorial program, which has the federal government set standards similar to the Canada Health Act while providing some transfer funding. Under this option, the funding would be provided under two kinds of schemes: universal coverage for essential drugs with no co-payments or deductible; or have an arms-length body identify a list of essential drugs and negotiate with drug companies on prices. 

The second option to consider is a federally funded agency in charge of financing, regulating, and administering coverage programs. This approach was successfully used to establish Canadian Blood Services and was able to achieve cost savings. 

Solving the inequality in medicine is not something that can be solved by one policy change. Still, if we want mental health to truly be a part of our healthcare system, we need pharmacare to treat these health issues. A major shift is needed towards a universal pharmacare plan. It is not a matter of if we can do it, but a matter of when our government will take action and make the change.

Amal Abdulrahman is a fellow of the Diversity Youth Fellowship hosted by the Urban Alliance on Race Relations, and graduate student in International Health at Johns Hopkins Bloomberg School of Public Health.

Header photo by Laurynas Mereckas on Unsplash.

The federal government recently announced a number of new measures to help ease the effects of inflation, especially for low-income families facing the brunt of these economic pressures. Among them are the immediate delivery of $650 per uninsured child for dental care, a one-time Canada Housing Benefit, and a 6-month doubling of the GST tax credit to help working-class families make ends meet.

While each of these measures will help Canadians today who are hurting from high inflation, the Liberals should have acted much sooner to build stronger relief programs. 

Despite the Liberals and NDP signing a supply and confidence agreement in March, it has taken months for the Liberals to start fulfilling the promises they made. Canadians need relief now, but the federal government was much slower to react to the cost of living crisis than when it took immediate action to introduce relief during the early days of the COVID-19 pandemic. It is only through political pressure from Jagmeet Singh and the NDP, committed to the spirit of the supply and confidence agreement, that people will get the help they need. As with the creation of our public health care system, we have the NDP to thank once again for advocating for all of us and tightening the social safety net.

Let us not forget the stability, sustainability, and equity that can come from a social democratic method of government.

Ottawans have a lot on their minds when it comes to their municipal election ballots this fall: the City’s mismanagement of the response to the convoy occupation, cuts to bus service while the public-private partnership (P3) LRT continues to fail and derail, and $2,890 monthly rent in the city being considered “affordable housing”. With the retirement of Mayor Jim Watson and several members of the current City Council, there are opportunities for progressive electoral breakthroughs and renewed vision for change for the city, but how strong is Ottawa’s desire for change?

The Broadbent Institute was recently in the field in August, with Viewpoints Research, digging into this question.

Right away, it’s apparent that there’s a strong desire for change from the status quo in Ottawa. Nearly half of survey respondents felt that the City of Ottawa was “off on the wrong track.” In our follow up, some survey respondents felt as though the city was run by the “Watson Club” or an “old boys club” that hindered community engagement and development that worked for residents. Those that felt Ottawa was on the wrong track also expressed a desire for new leadership that worked collaboratively with communities, instead of steam rolling an agenda set by the well-connected through City Council.

Looking into the priorities and direction that Ottawa voters want to take City Hall gives us a good look at what that change ought to look like.

The cost of housing, OC Transpo reliability, as well as honesty and accountability at City Hall rounded out the top three concerns for Ottawa voters. Given the aforementioned high profile issues, it becomes clear how these priorities are stacked against other big issues of concern.

Of note is the high proportion of Ottawa voters unsure (8%) about real estate developer influence on municipal politics, while concern for the cost of housing is the highest priority. Developers have had a major influence on Ottawa’s city planning and housing affordability, which have had questionable and negative impacts on neighbourhoods and the environment. Developer influence on Ottawa City Hall has been behind the largest housing eviction in Canadian history, a lack of consultation on the failing Lansdowne development, and suburban sprawl into ecologically necessary Greenbelt land. Following up with survey respondents, they expressed that newly built housing was necessary, but that new units being built were still inaccessible and unaffordable as developers pocketed the profits.

Despite middling concern around developer influence on Council proceedings, Ottawa voters are clear (84%) that they do not want to see real estate developers donating to municipal candidates.

An overwhelming 84% of Ottawa voters do not want mayoral and city council candidates to accept donations for real estate developers. Digging deeper with voters, there is deep concern about developer donations, with feelings that it’s a “conflict of interest” to be so close to City Hall, even feeling that the relationship feels “a little icky.”

Horizon Ottawa’s Follow the Money database shows that almost half of Ottawa City Councillors and Mayor Jim Watson received a majority of their 2018 municipal election campaign from people connected to the development industry. When it comes to developer influence on Ottawa City Hall’s housing and planning decisions, there’s a clear connection to the suburban ward City Councillors receiving campaign donations. For instance, one Kanata-area Councillor received 99% of his campaign contributions from those directly connected to the real estate industry.

Tied to the cost of housing concern and developer donations is strong support to increase protection for renters and changing planning priorities to require the development of affordable housing. Support for a progressive municipal housing agenda is strong in Ottawa, and any recognition that municipal candidates would be influenced by real estate developers could draw public outcry.

On public transit, there’s clear support for progressive change in expanding the system and increasing reliable service that stem from Ottawa’s ongoing experiences with cuts to OC Transpo bus services, that in turn made way for the problem plagued P3 Confederation Line LRT. The stories, scandals, and issues since the LRT project first put shovels in the ground in 2012. The sinkhole that appeared in the middle of Rideau Street in 2016 that collapsed a tunnel and delayed opening well past its 2017 timeline was just the beginning of a long list of issues. From stations that stink of sewage, blowing past four opening deadlines for more than two years, trains that can’t function in Ottawa’s winter weather, constant derailments, to overpaid consultants with questionable ties testifying in front of public inquiries, the LRT situation has been a big mess for downtown Ottawa while, according to our follow up discussions with survey respondents, suburban Ottawans feel ripped off or neglected with a transit system that does not serve them and took their reliable buses away.

The discontents that stem from these episodes show clear support (68%), as well as a large proportion (16%) of respondents who are unsure, for bringing LRT management into City of Ottawa control and out of the auspices of the Rideau Transit Group private sector consortium. While most clearly recognize the dysfunction owned by the private sector on what is ostensibly a public good, the nature of P3s mask the for-profit actors and mechanisms behind these public good projects making it unclear who is to blame for performance or cost issues. However, as issues with the system keep piling on as the model is again being used to expand the dysfunctional system further, public opposition to this model is solidifying given the costs and cuts to service elsewhere.

Given the issues with the LRT, it’s not surprising that there’s even stronger support for investment in expanding public transit into suburban neighbourhoods (73%). In following up with voters, both suburban transit users and even regular automobile commuters noticed the decline in reliable bus service in their neighbourhoods in years prior to the pandemic. For many suburban travelers, bus service on transitways and through neighbourhoods was quick and reliable. In suburban wards, voters concerns about bus service cannot be ignored when it comes to producing a progressive agenda for the city’s transit system.

A 6-month fare free transit pilot program is also supported by a majority of voters (55%), though not as high a priority as expanding service and improving reliability. Fare free transit was previously implemented for a month in December 2021 as a way for the Watson administration to restore confidence in the transit system after the LRT’s numerous failures. With pandemic ridership levels, the month of free transit was estimated to cost the city only $7.2 million which was money withheld from the RTG P3 consortium after delays. As free transit becomes a contested wedge issue in this municipal election, it is worth noting the strong support a 6 month pilot holds among Ottawa voters.

Garnering the least support is a desire to hold on public transit investment and instead invest in further road widening across Ottawa where 48% approve compared to 42% opposing. Road projects are substantial pieces of Ottawa’s 2022 infrastructure budget, with $62 million set aside for a handful of road widening projects for a stretch of a few kilometres around arterial traffic bottlenecks. For comparison, $11.5 million was budgeted for pedestrian and cycling infrastructure, though it enjoys greater appeal (65% support). With the effects on traffic negligible while environmental costs run high, progressive campaigns can point to road widening as an issue championed by developers and their City Hall allies that won’t relieve congestion, cut costs to commuters, or reduce greenhouse gas emissions.

Lastly, looking at support for increased investments to improve municipal services, even if it means a small tax increase (54%) indicates a notable appetite for change in Ottawa. Even Jim Watson in the previous election promised small property tax increases to invest in improved services, though his priorities opted for P3 transit projects, road widening and inflating the Ottawa Police Services budget. A progressive vision for the City of Ottawa should already have the revenue and support to build just and equitable communities, and campaigns to move that agenda forward do not need to fall into rhetoric supporting tax cuts given its meager support (33%).

From our field research, Ottawans are demonstrating a desire for a bold progressive vision that prioritizes equality over tax cuts, investments over austerity, and new leadership that works with communities instead of well-endowed interests. Electoral campaigns and social movements should work with each other in these weeks running up to the October municipal election to ensure that Ottawans recognize that they are in this together with their neighbours and fight for a better city that works for its residents, and not the members of well-connected club.

Clement Nocos (he/him/il/lui) is the Broadbent Institute’s Director of Policy and Engagement, working with the Broadbent Fellows network to build policy agendas that support progressive change.

Download our report on Ottawa public attitudes to municipal issues related to the 2022 municipal election.