US health care businesses chasing profits into Canada

Some fear corporate health care will kill equality of treatment

By David South

Now Magazine (Toronto, Canada), April 8-14, 1993

American-style private health care is slipping across the Canadian border under the noses of three provincial NDP governments, say researchers representing an association of health care workers.

Jackie Henwood and Colleen Fuller of the 7,500-member Health Sciences Association of British Columbia charge in a recent report that a combination of free trade and tightfisted government spending is undermining the universality of medicare and ushering in the beginnings of a two-tier system.

While the health care industry created more jobs than any other sector of the economy between 1984 and 1991, they point out, things have changed dramatically since the Canada-US free trade agreement came into effect in 1989. Now much of this growth is clustering in the private sector.

And they expect that this trend will continue under the forthcoming North American free trade agreement.

“NAFTA will accelerate trends towards a privatized, nonunion and corporate dominated system of health care in Canada,” says the report.

Binding provisions

Chapter 14 of the Canada-US free trade agreement opened competition for health-care facilities management services to US companies. Certain NAFTA provisions will bind all levels of government to consider for-profit health care companies on equal footing with public providers when bidding for services, and entitles them to compensation if they can prove to an arbitration board that they’ve been wronged.

“That represents a substantial encroachment on the democratic right of local, provincial and federal governments to make decisions,” says Cathleen Connors, who chairs the Canadian Health Coalition, which includes labour activists, nurses, doctors and other health-care workers.

This, in combination with health care cutbacks – both federal and provincial – is resulting in service and job cuts, bed closures, increased drug costs and an increase in privatization, the report says.

In the area of home care, for example – visiting nurses, physiotherapists, homemakers and other services – private firms now take in close to half of all OHIP billings. Many of their clients pay out of their own pockets for services.

The Ontario ministry of health doesn’t keep statistics on the private home health care sector in the province, but the Ontario Home Health Care Providers’ Association, a trade group, estimates that private firms in the industry now employ 20,000 people.

The industry is dominated by a small number of large firms, including Paramed, Comcare and Med+Care.

“It’s a market situation,” says Henwood. “If the services aren’t available to people within the public sector, they will go outside of it.

“We’ve seen this in other countries like England, where they had a public system and now have a parallel private system. If you erode a system enough that people get pissed off, they are going to start to look for alternatives, and the people with the greatest liberty are those with money.”

Connors says that because the Canada Health Act only covers the provision of hospital and physician services, the prinicples of universality and comprehensiveness don’t extend down to community-based services like home care.

The study also found that giant US private health insurers are positioning themselves to reap profits in the fertile Canadian market.

Last week, Wisconsin-based American Medical Security Inc. announced it will begin offering American hospital insurance to Ontario residents this month, citing a demand in Canada to bypass lengthening waiting lists for medical treatment.

Giant US west-coast insurer Kaiser Permanente declared in the March 1992 issue of Fortune magazine that they have targeted Canada as the next growth market. And American Express membership now offers the privilege of health insurance.

With private health care services sprouting up like spring weeds, says Henwood, provinces are placing yearly limits on the number of private services covered under provincial health plans, thus preventing people shopping around for services, no matter what their income.

Sheila Corriveau, corporate relations coordinator at Toronto-based Dynacare, Canada’s largest full-range private health care company – which operates labs, retirement homes, homecare services and consulting services – is enthusiastic about expansion plans, and says that removing patients from hospitals into their homes has been a boon for private health-care services.

“I think the health system will benefit, because what you are really doing is off-loading the cost from the public sector and from the treasury to private enterprise,” says Harry Shapiro of Dynacare. “Private enterprise depends on its own ingenuity for survival and its own levels of efficiency.”

But advocates of the public system say the free-market option now looming is being ushered in by the very parties that Canadians have come to rely on to defend medicare.

Medicare stance

Ontario’s new health minister, Ruth Grier, however, denies her government is jeopardizing medicare.

“I want to disagree with that as profoundly as I can,” she says, fidgeting with an ashtray during a recent interview. “Our government has reaffirmed its commitment to medicare. Over the last decade, under conservative and liberal governments, health care costs have increased in double-digit figures. The system would have collapsed at that rate of growth.

“I guess I haven’t found a way of blaming free trade for failures of the health care system at this point,” she says.

But critics say in the last year alone, Ontario’s ministry of health has capped health coverage for travellers abroad, removed coverage for physical exams requested by employers, chopped hospital beds and cut back the number of drugs covered on the provincial drug plan.

Grier says that the government’s vision relies on a new view of medical care seekers as consumers who are going to take more responsibility for their own health care

“Government can’t do it all,” she says.

"US health care businesses chasing profits into Canada": Now Magazine April 1993

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Peaceniks questioning air-raid strategy in Bosnia

Muslims say peaceful alternatives will aid cleansing

By David South

Now Magazine (Toronto, Canada), May 13-19, 1993

While Bosnian Muslims continue to demand either airstrikes against the Serbians or weapons to defend themselves, there is little consensus among Canadian peace groups and political parties that these measures are the key to a long-lasting peace.

The differences are as graphic as those between Washington and Ottawa. While president Bill Clinton is asking European nations to support air strikes, prime minister Brian Mulroney has publicly opposed such bombing raids as an answer to the brutal ethnic cleansing of Muslims being carried out by the Serbs.

“We are still developing our position in terms of support for military intervention,” says Roxanne Dube, assistant to Liberal foreign policy critic Lloyd Axworthy.

Dube says, “We need something more comprehensive than just airstrikes, which alone could jeopardize our troops.”

NDP foreign affairs critic Svend Robinson is more willing to consider military action under UN auspices. But first he wants “a vice-like embargo on Serbia and the establishment of safe havens and humanitarian corridors.

“If the slaughter continues, I personally would not exclude the posibility of further military action,” he says.

“The response of the United Nations, and NATO in particular, has been appallingly inadequate. It has allowed the Bosnian Serbs to consolidate their territorial position. And their latest sabotage of the Vance/Owen proposal has left the international community with no alternative but to isolate Serbia.

“The Bosnian Serbs are just continuing their widespread rape of Muslim women, ethnic cleansing, torture – the world has got to say, stop.”

Among peace groups there is a feeling that military intervention is not a longterm solution.

“We don’t have a position,” says Tamara Storic of Greenpeace Canada, a response echoed by the Toronto Disarmament Network. “We’re in much the same situation as the UN. Nobody knows what to do.”

No position

The Canadian Peace Alliance’s Gideon Forman understands the frustration that fuels calls for bombing, but doesn’t believe it is a longterm solution.

“Those who say go in there and bomb are not all crazy,” he says. “They hear about ethnic cleansing, they hear about rape camps – and they see bombing as a way to stop that. But our position is that a little more restraint has to be shown.”

He advocates a combination of sanctions and diplomacy for a longterm peaceful solution.

Maggie Helwig of ACT for Disarmament says she has little to offer in the short term, pointing out, “Maybe at this point there is little anyone can do.” She is also sympathetic to those who want to arm Bosnian Muslims, but feels it wouldn’t help the situation.

She says, “I believe they are the legitimate government. But providing weapons is not going to contribute to a lasting peace.”

Helwig favours targeted sanctions that would allow opposition organizations in Serbia to receive supplies while the government wouldn’t, combined with international support for peace and opposition groups.

“The only way we can end the Serbian aggression to to support the opposition in Serbia, the peace movement and the women’s movement. The reason they aren’t having much influence is that they aren’t getting any international support.”

Fatima Basic, spokesperson for the Canadian Bosnian refugee groups, says that while she supports Helwig’s plans for helping opposition and women’s groups, she is angry that it is being put out as an alternative to military intervention and air strikes. She says the West “should have done something before we lost half a million people.”

Imam Tajib Pasanbegovic, religious leader of Canadian Bosnian Muslims, says of Helwig’s thoughts, “It’s a ridiculous idea by itself. It will take several years, and by then there will be no Bosnian Muslims left. There is not time. Imagine if we gave this chance to Hitler in the second world war – another 5 million Jews would have disappeared.”

Both he and Basic are bitter that while Clinton seeks European support for bombing, “Prime minister Brian Mulroney is going behind his back telling the world not to interfere.”

Life embargo

Pasanbegovic says if the West will not intervene with at least half the bombing if did in the Gulf War, “They should life the arms embargo and return things to a starting point. If the West is not going to defend us, at least let us defend ourselves.”

However, Carolyn Langdon of Voice of Women, a peace group working with peace and women’s organizations in the former Yugoslav republics, says, “Our position is against intervention, including limited military strikes. We are supporting the civil society groups, the opposition against the nationalism and war policies of their governments.”

Her group sets up rape crisis centres and sponsors women to come to Canada to raise awareness.

David Isenverg, a senior research analyst at the left-leaning Washington-based Center for Defense Information, says sources tell him that the Clinton administration believes air strikes are only a means of levelling the playing field for the Muslims.

He says a Pentagon report released this Wednesday will discredit the claims of air strikes’ accuracy, citing failures during the Gulf War. Clinton will decide on air strikes after Saturday’s referendum in Bosnia, when Serbs will vote on whether to accept a Western peace plan.

"Peaceniks questioning air-raid strategy in Bosnia": Now Magazine, May 1993.

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Somali killings reveal ugly side of elite regiment

By David South

Now Magazine (Toronto, Canada), May 6-12, 1993

Canada is touted around the world for its commitment to the ideals of peacekeeping. But something went seriously wrong with the Canadian Airborne Regiment at Belet Huen in Somalia.

Since the revelation of the March 16 shooting death of Somali civilian Shidane Omar Aroni at the hands of members of the regiment, three more killings of civilians by Canadian troops have come to light. Two of the deaths, including Aroni’s, are being investigated internally by the military, while others are subject to a government-ordered inquiry.

Military watchers say the problem permeating the Canadian Armed Forces' approach to peacekeeping goes beyond the inappropriate behaviour of a few gung-ho members of the airborne.

Warning ignored

They say the department of national defence has ignored the warnings of the United Nations and its own internal papers regarding the ever more complex duties of international peacemaking and peacekeeping. The Canadian forces and other coalition partners, they say, are playing with fire in Somalia by neglecting to prepare troops with the skills they need in negotiation, conflict resolution and cultural sensitivity.

And they point out that the assigning of peacekeeping duties to the Canadian airborne – an elite force with a fearsome reputation – illuminates everything that is wrong with the current approach.

“The opposition is calling for the airborne to be dismantled, but they are prepared for high-intensity combat,” says defence consultant Peter Langille. “It’s just a dumb decision – somebody used them for the wrong thing.”

If Canadian personnel were properly trained, the incidents at Belet Huen would not have happened, says Gideon Forman of the Canadian Peace Alliance.

“Peacekeeping is a special skill that requires courses in non-violent conflict resolution and negotiation. A peacekeeping training centre – which the Canadian Forces pooh-pooh – would be very useful.”

Indeed, the unfolding of the horrifying drama in Belet Huen posed acutely difficult problems for army personnel. It took a small-town journalist on a press junket intended to show off the work of the airborne to force the army to go public with the death of Aroni.

Jim Day of the Pembroke Observer, located near the airborne’s home base at CFB Petawawa, spotted a commotion over the attempted suicide of master corporal Clayton Matchee, one of the soldiers arrested in the death.

It wasn’t until March 31, two weeks after an internal military investigation had begun, that the military admitted to the investigation.

Day says watching the troops in Somalia made it clear there was a mismatch between the personnel and the mission.

“They are trained for a combative role. They’re considered the cream of the crop, very tough physically. They want to use their training, as opposed to being trained for combat in rugged exercises and then ending up handing out water.

“What hit me quite strongly down in the camp was how they spent their leisure time. I watched them set up a spider fight. They had such intensity – they were watching these two spiders devour each other for 20 or 25 minutes, coaching them along, pumping their arms in the air and rooting and screaming.”

Creates aggression

Observers who know the regiment say the training is meant to create extremely aggressive behaviour while reinforcing elite status. Through “jump school” – three weeks of punishing training where subjects drop from planes – soldiers experience exhilarating highs and terrifying lows.

Anecdotes abound about the secretive and violent behaviour of the regiment.

“There’s a good deal of resentment,” says Dave Henderson, who puts together a weekly news infomercial called Base Petawawa Journal for Ottawa’s CHRO TV. “A lot of the other soldiers on the base shun them. Their nickname in some quarters is ‘stillborne.’

“I know from people in other military outfits that when you go up against the airborne, there is a fear factor,” says Langille, whose company Common Security Consultants, has lobbied the government to change peacekeeping training.

“In exercises where the airborne take over a base or something, if they catch you, they beat the shit out of you. It’s not surprising they got carried away in an ugly environment.”

Frustrating pace

Nor is it strange that the regiment chafed at the pace of the Somalian daily round. “The soldiers believe the Somalis are very slow in their ways,” says Day. “They’re used to ‘boom, boom.’ Whatever it is they do, even if it’s building a trench or putting up a fence, they are very quick about it.”

But the military argues that the best preparation for peacemaking and peacekeeping duties is the general combat training every soldier receives.

“The best peacekeeper is a well-trained soldier,” says veteran peacekeeper colonel Sean Henry of the Conference of Defence Associations.

“When you look at the make-up of the coalition force in Somalia, you find that just about every other nation has contributed either airborne troops or special troops, simply because they wanted a well-trained unit at short notice.”

Henry thinks those who argue for peacekeeping training are missing the essence of the armed forces mandate. “It’s counter-productive. You might as well forget about the armed forces and sign up a bunch of social workers.”

Does the UN know what it’s doing?

By David South

Now Magazine (Toronto, Canada), July 22-28, 1993

The United Nations’ bloody hunt for elusive Mogadishu warlord general Mohamed Farah Aideed has many observers wondering whether the world body is making up the rules as it goes along.

Some critics, such as George Cram of the Canadian Council for International Cooperation, an influential umbrella group for Canadian non-governmental organizations of NGOs, question if the obsession with Aideed isn’t just burying the UN in a deeper image problem with the Third World.

Critics point to the fallout of growing resentment from the July 12 attack on Aideed’s compound – killing more than 70 civilians – boding ill for a peaceful reconstruction of Somali society.

The fact that among those killed within the compound were clan elders who were negotiating a peace has upset Somalis even more, says Cram, a Horn of Africa researcher.

“The UN has lost its credibility, its moral authority, lost its blue-beret neutrality,” says Cram bluntly.

The degree to which Aideed should be the main focus of current UN actions has some relief agencies scratching their heads. Aideed has become Somalian bogey man number one with UNOSOM’s (United Nations Operations in Somalia) head, US Admiral Johnathon Howe. He has placed a $25,000 price on Aideed for an arrest.

“I don’t recall the UN ever going out and actually attempting to arrest individuals – they certainly haven’t done it in other conflict zones,” says reverend David Hardy of Saskatoon-based Lutheran Relief, who has organized relief flights into Somalia.

Cambodian example

He cites the example of Cambodia, where the UN brokered a controversial peace with those purveyors of the genocidal killing fields, the Khmer Rouge, in order to secure free elections.

David Isenverg of the Center for Defense Information, a liberal Washington-based think tank, worries that doggedly going after Aideed while ignoring the other factions will paint the UN as siding with one faction over another.

“The protracted effect is to turn the US and UN into partisans to the conflict.”

Hardy believes Aideed, who is adept at seeing which way the wind blows, has inflated his stature as an opponent of the UN as foreign invader.

Then there are other criticisms. Some observers wonder whether the UN is too proud or too blind, or simply oblivious when it comes to seeking advice from the locals it went in to protect.

Even Canada, while supporting the UN’s military effort since Aideed “is obstructing relief supplies,” believes that national reconciliation should be a main focus, says external affairs spokesperson Rodney Moore.

He says Canada continues to urge the UN to move quickly on national reconciliation, bringing together women’s groups, clan elders and other non-warlord groups.

“One of the areas where the UN operation went wrong is the tendency to deal with the ‘superpowers’ of Somalia while ignoring groups like women’s collectives,” says World Visions’ Philip Maher, who has just returned from Somalia.

“Part of the problem is misunderstanding,” Maher says. “The UN hasn’t done a great job of telling Somalis what they are doing.”

Many point to the peaceful north, where the as yet internationally unrecognized Somaliland offers a successful model, combining women’s groups and elders to wrest control.

"Does the UN know what it's doing?": Now Magazine, July 1993.

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Aid organization gives overseas hungry diet food: Diet giant Slim-Fast gets tax write-off for donating products

By David South

Now Magazine (Toronto, Canada), December 2-8, 1993

Doling out diet supplements to recipients of food aid may sound bizarre, but that’s what US diet giant Slim-Fast has been doing.

The company’s cans of powder have been distributed to the conflict-ridden former Soviet republic of Georgia and other parts of the collapsed Soviet Union by the aid agency Americares.

Critics say Slim-Fast is far from appropriate and is, at best, in bad taste. New York-based food-aid critic and writer Michael Maren says such contributions are simply the result of agencies being used as dumping grounds for tax write-offs.

As an example, he cites Somalia, where he recenly spent time researching an upcoming book critical of aid programs. Pharmaceutical firms, he charges, are dumping unnecessary drugs in that country.

“If you want to help people, give them what they need, not the crap we have around here. That a so-called aid agency would bring over Slim-Fast is absurd.

“The attitude that they should take any shit we give them – it’s arrogance,” says Maren, who believes many donors have a beggars-can’t-be-choosers attitude to people in need of help.

At Slim-Fast’s corporate headquarters in New York, Adena Pruzansky acknowledges that the donations are tax write-offs, but insists that their product is very nutritious. No one, she says, has complained about their contribution.

Powdered cure

“If you look at our powdered products, there is a lot of nutrition in there. Certainly for people who don’t have food, this is something that could be useful to them.”

A spokesperson for Connecticut-based Americares, which directs surpluses donated by 1,100 firms to relief operations in 80 countries, praises Slim-Fast.

“They are a fine group of humanitarians,” says Elizabeth Close.

“Americares was just written up in Money magazine as the most cost-effective nonprofit agency,” she says of the organization, whose donations consist of overstocked, discontinued or obsolete items.

“We only accept a product for donation when we know we have a home for it. So we are not giving something inappropriate,” she says.

Close provides no details, however, about Slim-Fast’s participation. “Without their permission, I’m not really supposed to go into any further description of what they donated,” she says.

But those who see the devastating effects of eating disorders on women say Americares exercises poor judgement when it accepts such diet supplements.

“I think it’s quite bizarre,” says Merryl Bear of the National Eating Disorder Information Centre. “Many of these diet plans are starvation diets. In many of the diets, the caloric intake is less than or equivalent to what the Nazi concentration camps delivered.”

Slim-Fast’s chocolate drink powder, for instance, is made of skim milk powder, sugar, whey powder, cocoa, fibre, calcium caseinate, corn oil, fructose, lecithin, salt and carrageenan. It relies on mixing with milk to gets its nutrition.

Lynne Martin of the Toronto Hospital’s eating disorder clinic says Americares is encouraging dieting among starving people who need calories first.

“Women need a minimum of 1,800 to 2,100 calories per day – to meet that requirement with Slim-Fast, you would need eight glasses per day,” she says.

Low calories

Martin say the low calories available in the supplement become even lower if recipients don’t have access to milk and try to mix it with water.

“The protein level isn’t given without the milk, so you don’t know how much is in the powder, but certainly the calories would change if one were to mix it with water.”

At food relief agency CARE in Ottawa, program officer Ivan Connoir says what “the hungry need isn’t Slim-Fast but what is called a human daily ration (HDR).

“It is prepared in the United States especially for emergencies. It has no pork, so it can go to any country,” he says. “It is a kind of lentil stew and vegetable soup – just add water and it’s ready to eat. You even find bread in it. It can last for years.

“Of course the best thing is family food parcels that last one month.”

"Aid organization gives overseas hungry diet food": Now Magazine, December 1993.

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Taking Medicine to the People: Four Innovators in Community Health

Preventing and treating illness at home or in small local clinics makes financial sense. It also makes patients a whole lot happier.

By David South

Canadian Living (Canada), January 1993

Your health is your wealth, my grandmother used to say. It certainly is our most valuable resource – and when its caretaker, universal health care, is under attack, people take notice

Provincial health ministries across Canada are scrambling to find new cost-efficient ways to deliver health care, and community health care is an increasingly talked-about option.

“Every royal commission has suggested we need to shift resources to community care and stop focusing on institutions,” says Carol Kushner, co-author, with Dr. Michael Rachlis, of Second Opinion (HarperCollins, 1990), a blockbuster book that challenges the way we approach health care in Canada. According to Rachlis, health care nationally cost more than $60 billion in 1992 and is primarily delivered through hospitals and doctors’ private practices. Yet 20 per cent of all patients in acute care hospitals don’t belong there, and about five per cent of hospital admissions for people over age 65 are the result of improper use of prescription drugs.

One study of the Toronto Health Unit found that as many as 50 per cent of seniors residing in nursing homes who were admitted to hospitals with pneumonia had contracted it through mouth infections. If they had received regular dental check-ups in the community or at institutions, these unnecessary and costly admissions could have been avoided.

Increasing numbers of people see community health care as the way of the future. In this model, health care providers – doctors, nurses and support staff – work as a team, and users of health care are involved in making important decisions. Community-based care supplements a medical approach to illness, with emphasis on social and environmental factors like work-related stress. Its advocates say community care can wean us off our addication to expensive hospitals (where one bed costs at least $100,000 a year), drugs and surgery – and make us all healthier.

“Fee for service” encourages doctors to see as many people as possible, emphasizing quantity over quality. In community health centres, doctors are put on a salary and encouraged to give as much attention as necessary to each patient. By simply spending more time with each patient, and by taking into account factors such as illiteracy and cultural differences, community clinics can cut down on misuse of medication.

Jane Underwood, director of public health nursing for the regional municipality of Hamilton-Wentworth in Ontario, says we have reached the limit of what hospitals can do to improve health. “Other factors are now more important than a strictly medical approach, which was the foundation of the old health care system. In 1974, a Health and Welfare paper urged a behavioral approach – stop smoking, get more exercise. Now we are moving to a socio-environmental approach, looking at poverty, social isolation, and unemployment, and their effects on health.”

“Community health care is inevitable because we can now do many procedures on an outpatient basis. With the new technology, all kinds of things can be done outside institutions,” says University of Toronto professor Raisa Deber, co-editor of the recently released book Restructuring Canada’s Health Services System (University of Toronto Press, 1992).

“Just as people can work out of their homes because of computers and faxes, technology can take medical care to the home.” This trend can already be seen in the treatment of cancer. Many patients now receive their chemotherapy at home, with the help of computerized IV pumps.”

If the debate over community health care often seems confusing, it may be because of the haphazard patchwork of programs across Canada. Quebec is the only province that took community health care seriously enough to set up clinics across the province in the 1970s and make those clinics an integral part of the provincial system. Elsewhere in Canada, programs sprang up in the ’60s and ’70s at the initiative of community activists but were met with indifference or hostility from government.

The challenge for community care advocates is to educate both the public and governments. Jane Underwood admits it will be a tough struggle. “Governments are beginning to understand, but the public still has reservations. They panic when there are fewer surgeries and feel that lots of high tech will provide a safety net for health. In fact, it is more scientific to probe for the true causes of illness and not think that just taking a pill will make us better.”

Four Innovators in Community Health

South Riverdale Community Health Centre, Toronto

This fully functioning health centre opened in 1976 in Riverdale, a multicultural and economically diverse neighborhood. The staff consists of doctors, nurses, chiropodists, social workers, health promoters and a nutritionist. Innovative in taking on economic concerns of the community, the centre has set up a community food market to provide cheap and healthful food and recently started workshops with business and community members to come up with strategies to recover jobs lost during the recession. "We consider ourselves part of a movement," says executive director Liz Feltes. And this is played out in projects with local groups and citizens on a variety of issues - from wife assault, drug abuse and sexually transmitted diseases, to medication literacy for seniors. 

Victoria Health Project, Victoria

Originally started in 1988 to tackle the problem of poor communication between hospitals and community health providers, the project first targeted Victoria's large senior citizen population. Twelve programs were launched, including Wellness Centres, palliative support teams for patients dying at home and elderly outreach service focused on mental health. The project has been successful at getting local services to cooperate and eliminate duplication. "There are 500 different agencies for seniors in Victoria, so we linked up with them and increased cooperation," says Susan Lles, excutive coordinator of the project.

It was such a great success that the minister of health created the Capital Health Council to expand the program to the rest of the community. Now, for example, in hospital emergency rooms, quick response teams of nurses assess whether a patient would be better served by other services in the community or by being admitted to hospital. 

Centres locaux de services communautaires (CLSC), across Quebec

Started in 1972 as part of province-wide health reforms, these comprehensive health centres now number 158, with more than 500 satellite offices all over Quebec. Every citizen is guaranteed access to a CLSC, even in remote areas. With five per cent of the provincial health budget, they are able to serve 41 pr cent of the population. They also involve the community through elected boards. "We think it is a unique model in that it integrates health and social services in the same place - both prevention and cure," says Maurice Payette, president of the federation of CLSCs. Because CLSCs are close to the community, governments, schools, community groups and other organizations have turned to them for advice during the last five years. In rural areas, CLSCs have been crucial in reducing the number of farm accidents. 

Canadian Healthy Communities Project (CHCP), across Canada

Started in 1989, the program is aimed at municipalities and gets them to pledge that they will review all their actions with community health (including impact on the environment and economy) in mind. CHCP is part of an international movement linked with the World Health Organization's Healthy Cities movement. With more than 150 participating programs, it is an innovative attempt at getting the powers that be to plan for overall health. "We bring together community leaders to make a list of top 10 health problems and then decide what can be done with the existing budgets and staffing," says David Sherwood, project director. The city of Sherbrooke, Que., is a classic example. Facing reduced funds for road and sidewalk repairs, the city concentrated on repairs in neighborhoods with hig numbers of the disabled and elderly, thereby reducing the number of accidents. Unfortunately, funding was recently reduced dramatically by Health and Welfare Canada, but programs in Ontario, British Columbia and Quebec continue with the help of their own provincial government. 

"Taking Medicine to the People" was published by Canadian Living in 1993.

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