Government urged to limit free drugs for seniors

By David South

Today’s Seniors (Canada), May 1993

Another blow may be coming to seniors on top of last August’s cuts to the Ontario Drug Benefit Plan (ODBP). Health minister Ruth Grier has been advised to terminate the policy offering free drugs for Ontario residents over 65. 

Assistant deputy health minister Mary Catherine Lindberg says the 13-page report from the Ontario Drug Reform Secretariat urges the government to replace universal coverage with a system based on income. 

The government argues that fiscal problems, a desire to make wealthy seniors pay, and a need to extend the program to the working poor has driven them to consider the move, while critics argue it will hurt modest-to-lower-income seniors. They say costs could be better contained by keeping universal coverage and attacking the source of escalating costs: pharmaceutical manufacturers and doctors who over-prescribe or misprescribe. 

Concession

If implemented, the cuts will represent a concession by the NDP on the once-sacred principle of universality. Just last year, former health minister Francis Lankin said, “I believe strongly in universality, and we’re not looking at ending it for drug coverage of seniors.”

The proposed plan calls for single people, regardless of age, who earn over $20,000 a year, and families earning over $40,000, to pay a premium of up to $300 for drug coverage. 

Those earning less than that amount will have to pay for their own drugs until they reach a limit tied to their income to become eligible for free drugs. 

The government says this changes qualifying for coverage from age to income-based. 

In a recent interview, health minister Ruth Grier wouldn’t be specific about what plan she would go for. But she agrees with the report’s authors that the drug plan needs reform. 

“While the drug plan makes drugs available in an open-ended way to everybody over 65,” says Grier. “In many cases it doesn’t help the low-income family with parents in minimum wage jobs and has a child needing constant drugs. And when we reform the system we aren’t just looking at how we can contain costs, but also how we can make it fairer. The underlying principle of all that we are doing is equity and fairness.”

The drug benefit plan, which also covers welfare recipients, hit $1.2 billion last year out of an almost $17 billion health budget. That was an increase of 13.8 per cent from 1991, but lower than the 18.1 per cent average for the last 10 years. 

David Kelly at Toronto’s multi-service agency Senior Link suggests the government go after the drug industry for wasting money promoting drugs and duplicating research projects. 

According to the industry advocate Pharmaceutical Manufacturers Association of Canada’s own statistics, drug companies spent $186 million on “marketing” in 1990 while $286 million actually went to research and development. 

The federal government’s own Patent Medicine Prices Review Board, in an internal study leaked to The Globe and Mail, found Canada to have some of the highest drug prices among the seven industrialized nations. 

Anger

Seniors organizations and agencies almost overwhelmingly expressed anger over the report, seeing it as another attack on universality of medicare. They feel the government isn’t being creative enough solving fiscal problems. 

“I strongly disapprove,” says Sara Wayman, chairperson of the Ontario board of Canadian Pensioners Concerned. “The concept of universality when it comes to services is a basic democratic principle we support strongly. People who earn $20,000 a year are still struggling to make ends meet. This would represent a real hardship. 

“We also feel strongly that the high medical costs that everybody is talking about aren’t really due to universality. They are really due to the high cost of drugs, and because there has been a restraint of generic drugs by our legislature.

“They are tip toeing around the medical profession. I hope people will speak out.”

Kelly feels savings could be reaped by taxing back any benefits given to wealthy seniors, while maintaining the universality of programs. 

“The group they are talking about is very tiny,” says Kelly. “And so the cost savings to the government are going to be really minimal. A whole process will have to be set up to decide who gets free drugs, and what you get is another layer of bureaucracy everyone has to go through. Studies have shown this adds to the net costs of government in the long run.”

Changing health care careers a sign of the times

By David South

Hospital News (Canada), June 1992

Ontario’s health care system is in the midst of a big change. But where are the new jobs going to be and how can health care workers prepare for the coming crunch?

“Anybody who thought they could progress through the health care system until retirement is in for a shock,” said Ruth Robinson, a national health care consultant for Peat Marwick Stevenson and Kellogg management consultants. 

Radical changes are taking place in the health care system and it looks like traditionally safe occupations are in for a shake-up. 

“Hospitals are being pressured to change fundamentally,” said Ms. Robinson. “The net effect is fewer jobs. A lot of people will have to think about new careers.”

In the Ministry of Health working document entitled Goals and Strategic Priorities, released in January, the fundamental shift from treatment to disease prevention and health promotion is laid out in generalities. 

The goals range from health equity for aboriginals, women, children and AIDS patients to better management of costs to development of a stronger health care industry that will jump start the economy. And they range from the reorganization of professional responsibilities to promotion of services outside institutions with the goal of keeping people out of hospitals. 

One thing is clear, the talk is about big changes. But talk is cheap to laid-off health care workers looking for new jobs. 

The provincial government’s recently passed, but yet to be proclaimed, Regulated Health Professions Act will have serious repercusions for all health care providers. 

“Traditionally, doctors have an exclusive domain over a wide area,” said Charlie Bigenwald, executive director of health human resources planning at the Ministry of Health. “Even though other people could do things, they had to be delegated by a doctor. With the legislation, we have pushed back what doctors can do. This means there will be more opportunity for a wider variety of health care workers to get into those areas.”

Midwifery is one of the benefactors of changes in regulations. The Ministry of Health is looking into having a university-based program for midwives. 

Ms. Robinson predicted nurses and middle management will suffer the most in the change to community-based health care. 

“Nurses will need to get a bachelor degree if they hope to compete for jobs,” she said. 

As for middle managers, who often have clinical skills, they will have to reconsider staying in health care, she said. “They will disappear significantly. They can advance themselves by getting back to clinical skills or consider management positions in non-health care areas.

“There is nothing to be ashamed of about career changes these days,” she added. 

In the shift towards community-based care, opportunities will arise for health care workers who can offer creative solutions to improve service delivery. 

“For nurses, we currently have something called the Nursing Innovation Fund where individuals can apply for a wide variety of developmental things like attending workshops, conferences and training programs. We process 2,500 applications a year,” said Mr. Bigenwald. 

The Ministry of Health hopes the future sees a health care system that adds to the province’s economy rather than drains it. 

“We spend $17 billion a year on health care. We never looked a the health care system as an economic motor in the past. The question we are asking right now is ‘why can’t an Ontario firm make the carpets, beds, sutures etc?’, said Mr. Bigenwald. 

Ms. Robinson said “Governments are running out of money and can’t increase funding. They will be looking for more partnerships in the private sector. In this climate, creative solutions to health care delivery have a great opportunity.” 

Feds call for AIDS, blood system inquiry: Some seniors infected

By David South

Today’s Seniors (Canada), July 1993

HIV-tainted blood transfusions given in the early 1980s have left some seniors with AIDS, but it is feared many are unaware of their HIV-positive status. 

Between 1979 and 1985 - before testing of blood products for HIV became mandatory - 266 transfusion recipients and over 677 hemophiliacs are known to have been infected in Canada, according to the Centre for AIDS Statistics. 

But the final numbers are unkown - estimates range from 400 to 1,000 cases of HIV transmission among the 1.5 million Canadians given blood products during this time. 

This uncertainty is fueling public concern. With such a serious public health danger, many are shocked by the confusing messages being sent by governments, the Canadian Red Cross Society and hospitals. 

But it took the report of an all-party Parliamentary subcommittee on health, released at the end of May, to shock the federal government into calling for a public inquiry into the blood system. The report is highly critical of the decision-making process involved in blood collection and distribution. 

“We have members of our group who are seniors,” says Jerry Freise, spokesperson for advocacy organization HIV-BT (Blood Transfusion) Group, whose wife was infected with HIV due to a blood transfusion. “And many of them went for years being misdiagnosed and treated for something other than HIV. Others have gotten sick, and one died without knowing it because nobody told him. 

“A classic case is Kenneth Pittman who was infected in 1984. The Red Cross found out in 1985 and they allegedly took two years to tell The Toronto Hospital. The hospital took two years to tell his doctor, and his doctor decided not to tell anybody. 

Infected

“Another couple, a lady of 59 and a man of 64, called us April 1. She found she was infected, and the reason she took a test is because her husband turned out to be HIV-positive three weeks before a transfusion in 1983. He had gone for years without a diagnosis from doctors.” 

This runs counter to the Red Cross’s story. 

“Whenever a blood donor tests positive for HIV antibodies, we go back and trace the prior donations,” says spokesperson Angela Prokoptak at the Society’s national office. “The Red Cross supplies blood to hospitals, so we know which units went to which hospital. But the hospital must go through their records to find who they transfused. 

“After identifying the recipient, the hospital contacts the recipient’s physician, and then they have them tested. There are of course limitations.

“Since 1987, the Red Cross has been advising people who may be concerned to consult their physician for counselling and advice.”

But subcommitte member Chris Axworthy, an NDP MP, found that hospitals and the Red Cross hesitated to notify former patients for fear of lawsuits. He says the federal government should show some leadership and stop passing the buck to other agencies and departments. 

Only two hospitals in Ontario - Toronto’s Hospital for Sick Children and Princess Margaret Hospital - have tried systematically to contact former patients. 

Ontario health ministry spokesperson Layne Verbeek says it is a laborious and costly task for hospitals to notify former patients. “We’ve always informed people if they are thought to be at risk, but many hospitals aren’t in the position to trace. If people are at risk or have doubts, they should be tested.”

Verbeek says recent media coverage has caused an increase in the number of people seeking HIV blood tests - requests for the test doubled after the Sick Kids hospital went public. The provincial government’s lab went from 700 tests per day to 1,300, but Verbeek says that has started to taper off. 

The ministry of health is happy with the number of people coming forward to be tested, says Verbeek. 

But Friese says the different players are more concerned about lawsuits than informing the public. He is especially upset at the Red Cross for not taking a leadership role in disseminating information. 

“The Red Cross and the medical system have failed miserably to contact people. Even today they are reticent to tell people they were part of a risk group and should get treated.” Friese feels the various governments and the Red Cross are leaving the job of informing the public to his group and the Canadian Hemophiliacs Society. 

Beat the drums

“It’s my job to beat the drums for the media while I’m dealing with my wife being infected? That’s my job, when these are the ministers of health?”, Friese says with anger.

The effect of AIDS on seniors isn’t new to US-based National Institute on Aging researcher Marcia Ory. She and colleagues helped sound the alarm back in 1989 with the book “AIDS In An Aging Society: What We Need To Know.” In the US, over 10 per cent of AIDS cases have occurred in people over 50. 

“Surprisingly, people have ignored older people and the AIDS issue,” says Ory. “You had older people in hospitals who might have complained about fatigue which was thought to be age-related. Older people aren’t as likely to be diagnosed as early because of the assumption that they are not at risk from AIDS.

“We don’t want older people in general to be overly fearful, but we want them to acknowledge the possibility, and to engage in good preventative practices if they are at risk.” 

Ron deBurger, director of AIDS prevention for the Canadian Public Health Association, would like assurances that the security of the blood supply has improved. 

“The subcommittee came to the right conclusion asking for a public inquiry,” says deBurger. “I would hope the terms of reference are broad enough to take a look at the whole issue of the safety of the blood supply, not only in terms of what happened in the past, but, more importantly, what’s happening today.”

Other than hemophiliacs, who require large quantities of blood, deBurger believes anybody who received one transfusion has a small risk. “If you had blood once, I think the odds are pretty long that you are going to end up with tainted blood. But AIDS does take eight to 10 years to manifest itself, and we might still be picking up pieces for the next four to five years that we don’t know about yet.” 

Friese recommends that anybody who received blood or blood products between 1979 and 1985 get an HIV test. If their doctor says it isn’t necessary, they should call the AIDS Hotline about anonymous testing. 

Anybody who has tested positive for HIV and would like support and counselling can call Robert St-Pierre of the Canadian Hemophilia Society at 1-800-668-2686.

For information on anonymous testing call the Ontario government’s AIDS Hotline in Toronto at 416-392-2437. For support write HIV-BT Group, 257 Eglinton Avenue W., Suite 206, Toronto, Ont., M4R 1B1. 

Solar-Powered Mobile Clinics to Boost Rural Healthcare in Africa

Around the world, innovative thinking is finding new ways of using solar power technology to bring electricity to underserved areas of the global South. Innovators are experimenting with new technologies, new business models and new ways to finance getting solar power into the hands of the poor.

One recently launched new solution is a solar-powered mobile health clinic that is bringing 21st-century medical diagnostic services to rural areas.

The US $250,000 Solar Powered Health Centre has been built by the Korean technology company Samsung (http://www.samsung.com/africa_en/news/localnews/2013/samsung-launches-solar-powered-health-centre-model-to-bring-quality-healthcare-to-rural-areas).

A truck packed with medical equipment that draws electricity from solar panels, it is traveling to rural, underserved parts of sub-Saharan Africa.

The truck is seven metres in length and comes packed with medical goodies, including a fully equipped eye and blood clinic and a dental surgery. It hopes to make it easier to reach the six in 10 residents of sub-Saharan Africa who live in rural areas, and who are often very far from affordable medical services. There is a blood analyzer, spectacle repair kit, and a non-contact tonometry test to measure the inside of a person’s eye. People can also be tested for HIV, malaria and many other conditions.

Samsung (samsung.com) developed the truck as part of its efforts to create “Built for Africa” technologies. The truck was built in Johannesburg, South Africa, helping create local jobs and skills.

Samsung hopes to scale the initiative to a million people in Africa by 2015.

The clinics were launched in Cape Town at the 2013 Samsung Africa Forum and are being rolled out by Samsung Electronics Africa (http://www.samsung.com/africa_en/#latest-home) as part of what the company calls a “large-scale medical initiative on the continent”.

The roaming trucks will be staffed by qualified medical professionals and will educate people about the importance of preventive medical screening.

Targeted conditions include diabetes, high blood pressure, tooth decay and cataracts. The clinics will also conduct public health education campaigns about the importance of preventive medicine (http://en.wikipedia.org/wiki/Preventive_medicine).

“What many see as minor health issues will not only get worse over time, but will affect other aspects of quality of life. The child that cannot see properly cannot learn properly,” said Dr. Mandlalele Mhinga, a member of the Nelson Mandela Children’s Hospital (http://nelsonmandelachildrenshospital.org/). “Mobile solutions help address this issue by making medical services accessible to more people in rural areas, and educating them about health care at the same time.”

The mobile clinics hope to reduce the vast difference between the quality of health care available to rural residents and people in urban areas.

Even in countries such as South Africa with the highest level of development in the region, medical care coverage is patchy and unreliable. For those who can afford it, 20 per cent of the population, there are private medical schemes. But everyone else must rely on an over-stretched and under-funded public health sector.

Samsung has based this innovation on its first-hand experience with providing medical services to rural areas in Africa.

“This experience has shown us how desperately medical treatment is needed across the continent, and inspired us to develop a sustainable and innovative solution to reach the people who need it most,” said Ntutule Tshenye, Business-to-Government and Corporate Citizenship Lead for Samsung Africa. “While our CSR (corporate social responsibility) strategy in Africa is largely focused on education, our efforts to enrich lives will not be felt if people’s basic needs, such as access to healthcare, are not met.”

Samsung’s “Built for Africa” product range (http://www.samsung.com/africa_en/africancitizenship/home4.html) also has a wide range of other projects and initiatives to boost health and living standards on the continent. These include education programmes, such as the Samsung Electronics Engineering Academy, Samsung Solar Powered Internet Schools, the Samsung Power Generator, and the Samsung eLearning Centres.

Samsung Electronics Co., Ltd. is a consumer electronics multinational and employs 227,000 people worldwide.

By David South, Development Challenges, South-South Solutions

Published: August 2013

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

Follow @SouthSouth1

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Southern Innovator Issue 1: https://books.google.co.uk/books?id=Q1O54YSE2BgC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 2: https://books.google.co.uk/books?id=Ty0N969dcssC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 3: https://books.google.co.uk/books?id=AQNt4YmhZagC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 4: https://books.google.co.uk/books?id=9T_n2tA7l4EC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 5: https://books.google.co.uk/books?id=6ILdAgAAQBAJ&dq=southern+innovator&source=gbs_navlinks_s

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Staple Foods Are Becoming More Secure in the South

Finding ways to ensure food security in countries experiencing profound economic and social change and stress is critical to achievement of development goals.

Food security is crucial to ensuring economic development is sustainable, and it is vital to long-term human health. Just one bout of famine can damage a generation of youth, stunting brain development and leaving bodies smaller and weaker than they should be.

Thankfully, many innovators are working on this problem and are making significant progress. A report from the Asian Development Bank, The Quiet Revolution in Staple Food Value Chains (http://www.adb.org/publications/quiet-revolution-staple-food-value-chains), found improvements to security of rice and potatoes – common staple foods in many countries. It said the so-called value chains – the various activities a company does to deliver a product or service to the marketplace (http://en.wikipedia.org/wiki/Value_chain) – for potatoes and rice have seen significant improvements in Bangladesh, China and India.

This is important because improvements in access to staple foods will mean better food security and less threat of extreme hunger events. This matters because it just takes one extreme hunger event and a generation is scarred for life.

The human brain is a heavy user of energy: it uses between 20 and 30 per cent of a person’s energy intake. Failure to consume enough calories means brain functioning begins to  be altered (brain-guide.org).

Hunger and starvation slow a person’s mental responsiveness. Low energy intake from minimal diets leads to apathy, sadness and depression. Fetuses and infants are especially sensitive to brain damage caused by malnutrition. A malnourished child can suffer life-long low intelligence and cognitive defects.

More than 70 per cent of the world’s 146 million underweight children aged five and under live in just 10 countries, with more than 50 per cent located in South Asia alone (UNICEF). A quarter of all children – roughly 146 million – in developing countries are underweight, and it is estimated that 684,000 child deaths worldwide could be prevented by increasing access to vitamin A and zinc (WFP).

Undernutrition contributes to 53 per cent of the 9.7 million deaths of children under five each year in developing countries (UNICEF).

Food insecurity also shows on the faces of people who experience it. This extreme stress scars people and harms their prospects in the labour market and their ability to improve their incomes.

Why is access to staple foods improving? It seems, according to the report, to result from innovations such as rapid modernization, with the increasing roll out of supermarkets, the use of cold storage facilities and large rice mills. It also cites the impact of small farmers taking on modern technologies, such as mechanized farming, and making the most of soil by using fertilizers and efficient techniques.

Supermarkets by their nature encourage highly sophisticated supply lines to ensure a steady stream of fresh produce coming in from farms to urban areas. Because of the variety and vast range of produce on offer, they require finely-tuned organizing models and information technologies. In short, they radically alter the way people buy their food, and what people will expect from food providers.

By negotiating deals with farmers, supermarkets create stability, as well as low and competitive prices. They allow for better traceability for food and give consumers more confidence in what they are purchasing. They use cold storage, which means food lasts longer and there is less waste than if food is left to spoil in a marketplace without refrigeration – a revolutionary change in hot countries.

The downside with supermarkets, as has been the case in some countries, is they can quickly dominate the marketplace and push out all other competitors with their economies of scale. When this happens, farmers can also find themselves with little bargaining power again and be hostage to the price the supermarket tells them to sell their product at.

Another critical improvement is the rapid spread of mobile phones. Armed with a mobile phone, small-scale farmers are able to access critical knowledge and information. This means they can make better decisions and quickly adjust what they are doing when mistakes are made.

The survey found that India is a country where the food-supply game has changed dramatically. In the past, traders would advance cash to farmers in the form of loans. But since the use of mobile phones has increased, the balance of power has shifted: farmers now have many other options to finance their operations than turning to middlemen and traders. This means they are no longer as easily manipulated by the traders and can negotiate better prices. Also, better roads, combined with greater competition to provide services to farmers, are improving farming of staple foods in general.

Among potato farmers in rural areas, 73 to 97 per cent have mobile phones and use them to organize deals with traders or receive market information. The take-up of mobile phones was also a recent development for the farmers: most had acquired a mobile phone in the last four years.

It is clear this quiet revolution in food security for staples is a result of greater use of innovative technology and taking on of new techniques.

By David South, Development Challenges, South-South Solutions

Published: July 2013

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

Follow @SouthSouth1

Google Books: https://books.google.co.uk/books?id=rvVcAwAAQBAJ&dq=development+challenges+july+2013&source=gbs_navlinks_s

Slideshare: http://www.slideshare.net/DavidSouth1/development-challenges-july-2013-issue

Southern Innovator Issue 1: https://books.google.co.uk/books?id=Q1O54YSE2BgC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 2: https://books.google.co.uk/books?id=Ty0N969dcssC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 3: https://books.google.co.uk/books?id=AQNt4YmhZagC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 4: https://books.google.co.uk/books?id=9T_n2tA7l4EC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 5: https://books.google.co.uk/books?id=6ILdAgAAQBAJ&dq=southern+innovator&source=gbs_navlinks_s

This work is licensed under a
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