Buffeted by harsh economic winds,medical schools turn a wary eye to the future

All parts of Canada''s health care system are facing fiscal pressures these days, but they are particularly great at Canada''s medical schools. However, Dr. David Hawkins of the Association of Canadian Medical Colleges is optimistic that all 16 of Canada''s medical schools will remain open, mainly because of the huge impact they have on health care in their local communities. “We don''t just turn out students — we raise the standard of health care in a whole community,” he says.     

Medical schools seeking new ways to cope with funding cutbacks

Cuts in government funding mean that Canada''s medical schools have to seek new ways to raise funds. Susan Thorne examines some of the ways faculties of medicine are coping with change. In the brave new world of medical education, schools are combining classes for medical students and other health professionals, seeking business alliances, encouraging attendance by full-tuition students from other countries and diversifying revenue bases through new programs, such as McGill''s new 5-year MD-MBA degree.     

Lessons my $3101 cat taught me about universal health care

Dr. Brian Goldman describes how his cat''s experience with veterinary medicine has helped shape his views about Canada''s health care system.     

A system worth saving.

The country will mark Canada Health Day on May 12, so CMAJ asked Dr. Michael Gordon to reflect on Canada''s health care system and the changes it has seen and will see. The special day, cosponsored by the Canadian Public Health Association, is designed to highlight "the need for better communication between health professionals and the communities they serve." In this article, Gordon reflects on the dangers facing Canada''s medicare system and the need to protect it from the inroads threatened by privatization.     

The private sector invades medicare's home town

If Canada''s medicare system has a home town it is probably Ottawa, where the system was first welded together 30 years ago. Charlotte Gray reports that there is a certain irony now that examples of private health care are sprouting up in the nations''s capital.     

Victoria conference highlights differences in federal,provincial stands on health care issues

When Canada''s health ministers met in Victoria recently, the number of issues debated were yet another sign of the many problems facing Canada''s health care system. There were dis-agreements about the use of facility fees by private clinics, and concern about the huge impact federal cuts to transfer payments are going to have on provincial governments. British Columbia, for instance, faces 1996 federal cuts totalling $375 million — 5.8% of the province''s health care budget. As well, ministers debated the merits of a report discussing alternatives to the fee-for-service method of paying physicians. Dr. Jack Armstrong, the president, said the CMA does not favour one particular remuneration system over another, but feels strongly that doctors should have the right to choose the system they want.     

Future of health care system tops agenda as CMA Board of Directors meets

The first part of the CMA''s efforts to spark a public debate on the future of Canada''s health care system is a “visioning exercise” in which the Board of Directors will attempt to spell out the association''s views on how the system should develop. The board also discussed CMA initiatives concerning two major public-health issues — smoking and blood transfusions.     

Private health care dominates meeting as general council calls for national debate on issue.

The CMA''s General Council has decided to withhold its stamp of approval for a "private parallel" health care system by voting against a motion to remove legislative barriers to private insurance. However, General Council did call on the CMA to take the issue directly to Canadians and conduct a national debate. General Council did pass a "Blueprint for Action"--16 resolutions spelling out the CMA''s views on ways to protect Canada''s medicare system.     

Drought-induced increase in tree mortality and corresponding decrease in the carbon sink capacity of Canada's boreal forests from 1970 to 2020

Canada's boreal forests, which occupy approximately 30% of boreal forests worldwide, play an important role in the global carbon budget. However, there is little quantitative information available regarding the spatiotemporal changes in the drought-induced tree mortality of Canada's boreal forests overall and their associated impacts on biomass carbon dynamics. Here, we develop spatiotemporally explicit estimates of drought-induced tree mortality and corresponding biomass carbon sink capacity changes in Canada's boreal forests from 1970 to 2020. We show that the average annual tree mortality rate is approximately 2.7%. Approximately 43% of Canada's boreal forests have experienced significantly increasing tree mortality trends (71% of which are located in the western region of the country), and these trends have accelerated since 2002. This increase in tree mortality has resulted in significant biomass carbon losses at an approximate rate of 1.51 ± 0.29 MgC ha⁻¹ year⁻¹ (95% confidence interval) with an approximate total loss of 0.46 ± 0.09 PgC year⁻¹ (95% confidence interval). Under the drought condition increases predicted for this century, the capacity of Canada's boreal forests to act as a carbon sink will be further reduced, potentially leading to a significant positive climate feedback effect.     

"Cash-for-blood" companies still thriving in US

Unlike Canada''s voluntary blood-collection system, the US system routinely makes use of donations from paid donors. Milan Korcok reports that this is starting to cause some concern, since infection levels tend to be higher among those who are paid for their blood.     

A new primary care rostering and capitation system in Norway: Lessons for Canada?

Providing every patient with a personal primary care physician or, from the physician''s perspective, establishing a stable roster or list of patients is currently being actively debated in Canada. Norway''s system of primary care medicine, similar to Canada''s, faces many of the same problems. In 1992 a trial rostering system with blended funding (capitation, fee-for-service and user fees) was established in 4 Norwegian municipalities. After 3 years of close monitoring, the results of system evaluations have attracted strong interest. This article reports on the benefits and problems encountered with the new rostering system in Norway. If Canada is moving in the same direction, some of the lessons learned may be helpful.     

Long before Krever's report,blood scare had changed face of medicine

The disaster involving blood-borne pathogens and Canada''s blood system was in the spotlight in November with the release of the Krever inquiry report. Many physicians consider the report anticlimactic because action has already been taken on several fronts and the use of donated bloods has declined, but it will still have a far-reaching impact.     

Major merger gives London Canada's second-largest teaching hospital.

Two of London''s three major teaching hospitals joined forces recently to form Canada''s second-largest teaching hospital. The merger is considered a harbinger as teaching hospitals strive to maintain current teaching, research and clinical activities in the face of decreasing government spending.     

Plans to run private facility in public hospital draw some strong opposition in Alberta.

Proposals to create private wings catering mainly to American patients at some public hospitals in Alberta have attracted strong opposition. Physicians at the Leduc General Hospital near Edmonton voted unanimously against a proposal to create a private wing at their hospital. Proponents say such moves would simply provide additional funding for Canada''s cash-strapped health care system.     

Plasma-collection plant has to overcome tainted-blood fallout in search for donors

Canada''s lack of self-sufficiency in blood products has led to the opening of a blood-plasma collection centre in Thunder Bay, Ont.--the first of its type in Canada. In convincing donors to donate plasma, the new centre had to overcome some lingering public concern about the safety of the blood-collection system.     

Northern Health Service in Canada

The current state and future development of Canada''s North present significant medical problems. The medical facilities available at present are inadequate and, although they are improving rapidly, they must keep pace with the coming expansion of the North. Arctic regions of other northern countries do not show the great discrepancies in health standards that Canada''s North does in comparison to her southern areas. To improve the situation adequate communication, transportation, personnel and facilities are needed. It is proposed that residents in hospital training programs work for a period in the North to supplement recommendations of the Hall Commission in this connection and to broaden their own training.     

Climate change and modelled biome representation in Canada's national park system: implications for system planning and park mandates

Aim The study examined the potential for change in biome representation within Canada's national park system under multiple climate change scenarios and subsequent potential vulnerabilities in Parks Canada policy and planning frameworks. Location The study was conducted for Canada's 39 national parks. Methods The vegetation change scenarios were based on modelling results from the BIOME3 and MAPSS equilibrium process‐based global vegetation models (GVM), run with multiple doubled‐CO₂ climate change scenarios. The six vegetation distribution scenarios were calculated at 0.5° latitude–longitude resolution and the boundaries of 39 national parks superimposed in a geographic information system (GIS). Park management plans and other planning documents were also reviewed as part of the analysis. Results The proportional distribution of biomes in Canada's national park system was very similar (within 3% of area for each biome) using BIOME3 and MAPSS under the current climate. Regardless of the GVM and climate change scenario used, the modelling results suggest the potential for substantial change in the biome representation in Canada's national park system. In five of six vegetation scenarios, a novel biome type appeared in more than half of the national parks and greater than 50% of all vegetation grid boxes changed biome type. The proportional representation of tundra and taiga/tundra in the national park system declined in each of the vegetation scenarios, while more southerly biomes (temperate forests and savanna/woodland) increased (in some scenarios doubling to quadrupling). Results for boreal forest varied among the climate change scenarios. A range of potential vulnerabilities in existing policy and planning frameworks were identified, including the national park system plan, individual park objectives, and fire and exotic species management plans. Conclusions Climate change represents an unprecedented challenge to Parks Canada and its ability to achieve its conservation mandate as presently legislated. Research is needed not only on ecosystem responses to climate change, but also on the capacity of conservation systems and agencies to adapt to climate change.     

The National Forum on Health is talking,but is anybody listening?

The federal government''s National Forum on Health is organizing a series of discussion groups across the country to focus on problems facing Canada''s health care system. Although a great deal of time and money is being spent on this and other forum projects, Charlotte Gray asks whether anyone is listening. She says many provincial governments are treating the forum with “elaborate disdain” and the only governments that appear willing to give it a chance to work are found in have-not provinces that rely on Ottawa for handouts in the form of transfer payments.     

Time's running out as physicians await Y2K fallout.

Canada''s hospitals are slowly coming to grips with the millennium bug, but Anita Elash reports that no one really knows what impact the move into the year 2000 will have on computers and medical devices, either in the hospital or doctor''s office.     

Prison became second home for psychiatrist (George Scott).

Retired prison psychiatrist George Scott recalls his career working in Canada''s penal system, including his peacemaking role in a hostage-taking incident and his work with Steven Truscott. Life "inside" is dangerous for guards, inmates, staff and psychiatrists, he says, but he never regretted his decision to devote his career to studying criminal behaviour.