Health care dollars, health care sense

This will be one of my (rapidly becoming less) rare posts in which I discuss something I’m actually qualified to talk about – health care and economic allocation. The reason I do this so rarely is that I emphatically do not wish to have my blogging here confused with my day job. Nothing that I have written here should be seen as reflective of policies or attitudes endorsed by my employer, any university I have been or may become affiliated with, nor any person other than myself as a private individual. While I recognize that this kind of disclaimer carries no legal weight with it, I just want it to be as clear as possible that my comments on health care are as affiliated to my professional life as my comments on racism or religion are – not at all in any way.

With that out of the way, it’s not an accident that I landed in the line of work I am in. I am curious about science and always have been; however, I am also passionate about the idea of publicly-administrated health care and the need to fight for its sustainability. I strongly believe that not-for-profit health care delivery funded by the public sector is the best method of delivery, and that if we approach the challenges inherent in the idea (i.e., waiting lists, resource scarcity) through evidence-based decision making, then we will have far better outcomes than a privately-funded scheme.

To this end I have pursued (and achieved, to a certain extent) some measure of fancy book learnin’ on the subject of useful models for health care delivery and the issues surrounding the way we allocate health care resources. The problem with the way we (I am referring explicitly to Canada here – the American system is a whole other bag of stupid that I have attempted to tackle elsewhere) deliver care here is that it is based on a model that establishes hospitals as the best method of providing service. At the time the relevant legislation was passed, hospitals were where one would expect to go for the most common types of ailments. However, in the past few decades the burden of disease has shifted away from infectious and acute causes toward chronic and end-of-life ones. The system, which should have shifted along with it, did not.

Why is this a big deal? Because it means we are burning money: [Read more…]

Nation will rise against Nations

It is difficult to be Canadian sometimes. We pride ourselves (well, most of us at least) on being tolerant, forward-thinking people. Part of our national neurotic need to be seen as distinct from our American cousins pushes us to be more collective, more restrained, more self-effacing; a contrast to the stereotype of our indvidualistic, brash and assertive southern neighbours.

The reason this stance is difficult is because of the cognitive dissonance present in seeing ourselves as progressive and inclusive, and yet becoming increasingly aware of the abhorrent way we have treated our most-maligned minority group: First Nations and other aboriginal people. Whereas slavery is America’s admitted national shame, Canada has not yet donned the sackcloth and ash required to atone for our past (and current) sins. We saw a dramatic manifestation of those sins this morning.

It is not enough to simply allocate increased funding to First Nations communities, or to issue public apologies for past mistakes (although both of those are helpful in their own way). We need to instead change the narrative we have about the relationship between the nation of Canada and its First Nations across the country. High-profile discussions like this may yield some hope: [Read more…]

Canada doesn’t have a race problem – Attawapiskat edition

Canadians have a reputation as being polite and rather passive. I am not sure what in our history has given us this docile stereotype, or if it is even actually true that Canadians are more well-mannered than our American cousins. What I do know is that there is no faster way to completely invalidate the myth of Canadian civility or progressiveness more quickly than bringing up the fraught relationship between the government of Canada and our First Nations people.

Immediately upon bringing up reserves, or federal cash transfers, or treaty rights, or ceded lands, even the most self-effacing and convivial Canuck is likely to start frothing at the mouth and denouncing the “culture of poverty” or the “laziness” and “corruption” that apparently runs rampant through every single First Nations community in the country. It’s amazing how quick my fellow countrymen are to lay all blame for the problems affecting our indigenous peoples at the feet of the victims.

A commenter last week remarked how much better the relationship seemed between Canadians and our First Nations, compared to Americans and their aboriginal populations. I decided not to step on the point too hard, because I knew that this week I’d be talking about this story: [Read more…]

Vox populi, pox dei

Which, in my pidgin Latin, translates into “the voice of the people is the pox of god”.

One of the weird, seemingly counterintuitive things about Canada is that despite having no official segregation of church and state in our Charter, religion is more or less absent from the larger issues our government deals with. We don’t have national fights about crosses at memorials or references to God in our national anthem. References to a deity are more or less absent from our various Throne Speeches (commonwealth readers will understand this phrase – Yankees should think of the State of the Union), and doesn’t play a major role in our elections except in the most bizarre ways.

Which is why when a high-ranking federal minister appears in an article about the Vatican, it’s always an interesting story: [Read more…]

To deceive and project

I spotted a pretty clever tweet a few weeks ago that went something like: “Police are beating you for slight or nonexistent legal transgressions? Wow… shocking!” – Black people. The joke being, of course, that the kind of ham-fisted tactics that police are turning against peaceful protesters have been leveled against black people, particularly young men, for decades with scarcely any comment from the majority.

That’s one of the galling facets of privilege – it completely skews what your view of ‘normal’ is. Faced with stories about cops brutally beating young black men, many people reacted with incredulity. “I’ve never seen an officer hit someone. Are you saying that all cops are racist? I find that hard to believe.” I had a similar conversation with a friend when we both saw a police officer pull over a young black man driving in a nice car with dealer plates. When I cynically observed that the driver’s first mistake was driving a nice car while being black, my buddy expressed his disbelief, saying that dealer plates come with certain restrictions, and that he didn’t see it being a case of racial profiling.

I can certainly understand the instinct to dismiss these kinds of stories as exceptional or delusional. Five years ago, if you had told me that police were infiltrating political groups to drum up phony charges against them, I’d have called you a lunatic. Then again, five years ago I wasn’t reading stories like this: [Read more…]

And sometimes it’s just stupid

Racism is one of those tricky things. When we’re accustomed to the vision of racism as overt violent hatred, we’re beginning to wake up to the realization that racism has more wide-spread roots than lynch mobs and white hoods. It’s not an easy transition to make, especially if you don’t spend your life immersed in it. Those of us for whom it is a major contributing factor to our outlook on the world live in it every day – most others don’t give it a lot of thought unless we have to.

And when you grow up with that ‘classic’ vision of racism, sometimes you end up saying stupid things:

England and Manchester United defender Rio Ferdinand says he is stunned by Sepp Blatter’s claim that football does not have on-field problems with racism.

(snip)

Asked whether he thought racism on the pitch was a problem in modern-day football, Blatter told CNN World Sport: “I would deny it. There is no racism. There is maybe one of the players towards another – he has a word or a gesture which is not the correct one. But the one who is affected by that, he should say that this is a game. We are in a game, and at the end of the game, we shake hands, and this can happen, because we have worked so hard against racism and discrimination.”

And the palms hit the face. [Read more…]

Africentric school approved in Toronto

There are periodically – not often, mind you, but occasionally – points in race conversation when I am tempted to throw up my hands and say “you’re white, and you don’t get it! Just accept that I am right!” Oftentimes race issues require so much unpacking – privilege, history, demographics, sociology, the list goes on – that a seemingly innocuous topic or opinion actually takes a monumental effort to resolve.

Of course my “job”, as someone who blogs explicitly about race as I do, is to do such unpacking so that anyone can walk their way through the argument. Most of the time I am game for this, particularly if I can refer the person back to some article or another that I’ve written in the past. I recognize that the conversation doesn’t get completely explored in the span of a single blog post, and I get e-mails from people telling me that my work here has helped them change their minds about some race issue or other (those are really appreciated, by the way).

But there are periodically points in this conversation where I just want to cop out and say “because I’m black and I’m right, dammit!” One of those times has just reared its nuanced and complex head: [Read more…]

When should we stop?

I occasionally discuss the topics on this blog among my friends. Most of the time, out in meatspace, people aren’t too keen to dive into discussions of racism and social inequality (which I can understand, because most of the time we just want to have fun). One such conversation occurred between a friend and former roommate on the topic of affirmative action. She and I agreed on the value of affirmative action, but struggled to reconcile its utility with the fact that it is, at its core, a policy that discriminates based on race. The full case for and against affirmative action is too long to spell out here, but the gist of my take on it is more or less encapsulated by this comic:

That being said, if we grant that affirmative action-style programs work to reduce inequalities between majority groups and minority groups (in this particular case we are talking about race, but the principle can be extended elsewhere), and we extend the ‘preferential’ hiring practices indefinitely over time, we theoretically reach a point where affirmative action becomes discrimination against majority-group members.* One we reach that point, my friend argued, that should be the point at which we should abolish affirmative action legislation, so that everyone gets a fair shot, and race does not enter into the picture at all. [Read more…]

The inherent racism of “Tough on Crime”

I’ve talked about the need for diversity before, as a way of making policy more effective. When you have a plurality of voices articulating their position, you stand a better chance of hearing new ideas. Diverse groups may be more unwieldy, but they are far less limited in scope than homogenous groups because a variety of perspectives are providing input. There is another reason why diversity is important though: it makes us less stupid. Because any in-group is going to subject to its own biases and privilege, the inclusion of diverse voices helps safeguard a movement from being self-serving, or worse, inadvertently harming another group.

It is fairly clear, based on this response, that the Prime Minister’s Office did not have a particularly diverse group building their absolutely moronic crime bill:

A University of Toronto law professor says a new federal crime bill chips away at sentencing provisions that require judges to consider all reasonable alternatives to jail. This, said Kent Roach, will only increase the over-representation of Aboriginal people in the criminal justice system.

“We’re going to have a future where one in every four people in prison are aboriginal,” he said. “And we’re going to have a future where perhaps more aboriginal people are going to go to jail than to university.”

Nearly half of the inmates in some Canadian prisons are Aboriginal people. That’s despite the fact they make up less than three per cent of the general population.

So, funny story. It turns out that when you take away the ability of judges to… well… judge, they also lose the ability to factor in the causes of crime and the best interest of not only the criminal defendant, but society at large. Poverty and crime are inherently linked. Not all crimes, to be sure, are caused by poverty. One would have to stretch the definition of ‘poverty’ pretty thin to claim that Bernie Madoff was impoverished, but the types of violent and property crime that the omnibus crime bill are supposedly targeting is linked to poverty. [Read more…]

Sunlight: the best disinfectant

When I started this blog, I wasn’t anti-police. I saw police as a necessary part of society, with individual officers being basically decent people who react badly when the chips are down, due to over-work and high-stress jobs. My view of individual officers hasn’t changed much, but as I learn more I have begun to see that there is much more to the picture.

The beautiful thing about science is the peer review process. I am not simply referring to the formal process that happens when you submit a manuscript for publication, but the climate of collegial over-shoulder-reading that is de rigeur for the discipline. Scientists do not research in a vacuum – we present our findings at conferences, we discuss them at professional meetings, and of course there are publications. In so doing, not only do we ensure that we learn from each other, but we stand a much better chance of catching each other’s mistakes.

Not so for police – the attitude from various police departments is one of insularity, croneyism and unflagging loyalty, regardless offense. This attitude is perhaps on no better display than in the following tragic story: [Read more…]