News from the WHA

This is a long one - I promise the next several notes will be MUCH shorter reads!

So the World Health Assembly (WHA) has been going strong for about a week and is officially nearing an end. While just about every health topic under the sun was discussed, I'll highlight a few here - in particular, the international brain drain of health workers; Bird Flu in Indonesia; and Taiwan's attempted entrance into the WHO. This note builds on information from previous notes by Carolyn Bennett (Taiwan and the WHO; Gender, Docs and Canadians at the WHO) and myself (WHO must shift vaccine policy). I believe Carolyn (MP for Federal riding of St Paul's) attended the WHA in Geneva, so if you're reading her blog/notes I'm pretty sure it reflects views from somebody who was actually there shooting the sh^t with people and participating first hand. For additional information on all of the agenda items discussed, visit http://www.who.int . Ok here we go...

1. International brain drain of health workers

In one of her notes, Carolyn touched on a meeting she had with Dr Ndioro Ndiaye (Deputy Director, IOM) on how much the poor health status of so many developing nations is exacerbated by the exodus of their best health workers to the schools and salaries of wealthier countries. Some leave knowing they will not return, with the idea that their future holds more promise in Europe, USA or Canada. Many others leaving for educational reasons, for example, go away with the plan of a return to their native land, but often find incentive to stay and work in their new home. This type of international brain drain leaves behind in 'source countries,' a tremendous void in already-resource-limited sectors, with public health care leading the way. In Malawi alone, for example, the past five years have seen 85% of doctors/64% nurses/52% of health administrators leaving the local health care system for international NGOs or for work overseas (UK, followed by NAmerica). To say they are nowhere close to meeting their countries' needs would be an understatement of astronomical proportions - yet the case of Malawi is not dissimilar to what is happening elsewhere in sub-Saharan Africa and the poorer countries of Asia and Latin America. This cycle continues while countries such as the UK, USA and my home of Canada continue to have immigration policies that recruit highly skilled workers from developing nations, many of whom come to service health sectors which we are perfectly capable of producing homegrown talent for. So what can we do about it? In a globalized world, immigration provides so many economic and cultural benefits, not to mention a potential for increased tolerance across borders. For all the benefits I have to ponder the Q - can we do a better job of it? When managing our immigration trends can we consider the consequences to elsewhere in the world instead of only the benefits or potential for prosperity an applicant brings to our society? For the health professionals who have come to this country and found employment, can we develop a mechanism to work with them and provide incentives to return home for short/periodic professional rotations in their field? Finally, we must look at this not just from an immigration perspective but from a development one. In providing greater assistance to countries to develop their own industries, improve their schools and health systems, we can help reduce so many of the reasons that force people to leave their homes in the first place.

For further reading on this I recommend you to the following article: Coombes R. 2005. “Developed world is robbing African countries of health staff.” British Medical Journal. Volume 230, p.923.

2. Bird Flu & Indonesia
(For CBCs take on this, check out http://www.cbc.ca/health/story/2007/05/23/bird-flu.html)

Earlier this year I discussed Indonesia's role in spearheading the developing world's campaign for a fairer mechanism to distribute pharmaceutical products. For the past 50 years WHO has been collecting virus samples from all over the world, and sharing them with vaccine companies who generally charge prices for their products which are far too expensive for developing countries to afford. Fed up with the process, Indonesia (where majority of human bird flu cases exist) stopped sharing samples for a couple months earlier this year, putting global pandemic vaccine production on hold. They later resumed sharing once WHO acknowledged there must be a change in course from traditional policies and promised to negotiate a fairer deal with the developing world with all parties. This issue was once again debated at the WHA where all 193 members agreed that virus sharing will continue with it being conditional that a better mechanism be developed. While it is wonderful news that the sharing process has resumed, I am concerned at the prospects for success at reaching such a deal anytime soon. While this story has been developing, a handful of reports have brought to light the fact that most of the companies that are making PanFlu vaccines are based in Europe - and that these countries have national crises/public safety laws making it illegal for vaccine products to be exported during a pandemic before their own citizens have access to it, and that even if a guaranteed stockpile is allocated to the developing world free of charge (to them) - it may be too late in reaching them for their needs to be met. This means that solving this problem of fair access is not just about finances and the developed world putting up the funds for poorer countries to have a supply in a time of crises - the issue of timing and being able to get the vaccine to them at the time they need it is just as critical, making WHOs plate even fuller with these negotiations. A new imagination is needed about this - and if several countries lose patience in how long it will take to develop a new mechanism and consider another stop of sharing, then we've all got bigger problems.

3. Taiwan & International Health

Also in her blog, Carolyn informed us that it seemed as if several of WHO's members were prepared to vote to allow Taiwan meaningful participation in the WHA and in shaping the agenda for the coming year. When the motion was called, however, it asked the assembly of WHOs members to consider granting Taipei full membership (as opposed to a partial option) which was ultimately defeated after a long day of voting. For those who are out of the loop on this one, Taiwan has a tremendous interest in using its health workforce and technological brainpower in becoming more active in global health affairs, and as an important part of their strategy to do so they are seeking formal membership to the WHO. WHO, as an agency of the United Nations, has a membership consisting of independent countries. The big controversy in all of this is that China, being an important member of the WHO, considers Taiwan to be part of their country and does not recognize them as an independent sovereign nation. So when the annual vote comes to pass at the WHA, the majority of delegations have elected to vote with the Chinese and will likely continue to do so as long as the motion being voted on is asking for Taiwan to receive full membership. Now questions and proposals of various kinds debating the prospect of some special type of *partial membership* have been floated around, but (to my knowledge) have not been voted on. With several members in the position of wanting Taiwan to play a meaningful role in things, while not being comfortable voting for them to have full status - if a motion calling for some unique level of partial membership was ever put to a vote, it is certainly much more likely to pass than traditional motions on this have been and Taipei will be able to be much more involved than ever before - even if it's not to the level that they want.

PPAO, Elder Abuse ... & getting you a bloody Will already!!

Last month I finished my most recent tenure with the Patient Advocate Office of Ontario's Ministry of Health & Long Term Care. Among other things, the PPAO works to:

- provide advocacy & rights advice services to patients;
- address hospital/facility-based or provincial systemic issues impacting on patients' rights;
- public and health care professional education through speaking engagements, publishing reports and engaging with the media.

Since my first contract with them, a decent share of my job involved policy research into things like the rights of mental health consumers; the impact of patient advocacy services on health outcomes; as well as elder abuse issues in our province's Long Term Care facilities and policies that have been identified to counter these problems. As one might imagine they weren't the most uplifting of files - but I was glad to have had it as this experience taught me a great deal about some of the most vulnerable members of society, and the limits of our health & social services in being able to meet their needs.

If there is one lesson above all others that I can take with me and shout out to all uh yall - it is that everybody should consider making a living will or power of attorney, even if you're one who thinks you have nothing to lose. While planning how to and who can distribute one's finances are what most people think of (definitely important) - it is only one aspect of why such documents exist. What's also at stake is who can make your medical decisions should you ever be diagnosed with a condition or have suferred a trauma which has left you incapable of making your own treatment decisions. Do you want to be kept alive at all costs? Do you want to be given a controversial or unproven experimental new therapy that might make you worse off for that chance to be a little better? The truth of the matter is that many of us (esp us younger cats) haven't even considered these types of things well enough to know how we really feel - but if we don't make these decisions and leave it to chance - by default these decisions are going to our closest relatives or worse perhaps, a public appointed guardian whose never met you. The Toronto Start reports that a whopping 80% of North Americans have not signed any sort of living will.

Yet while family might seem the logical choice in such unfortunate scenarios - even in the case of relatives who we don't doubt love us unconditionally, we may still disagree on many many things, let alone something as personal as this. Heck - when it comes to treatment decisions love may even be a weakness, as some people have great difficulty letting go or making the difficult decisions the patient might have wanted in favour of their own self interests or ideologies. While health facilities have a great deal to work on themselves - the reality is that the lion's share of abusive decisions or one's against what a patient wants or would have wanted are taken by the relatives they know and love who have been empowered with the legal voice of consent. Once you know what you want it's not hard to control your fate here - it's about finding someone you trust to act out your wishes, putting it down on paper, and then putting copies of it in the rights hands or an easy to find place should it ever be needed.

Ok so I've rambled way beyond the realm of Elder Abuse here as the whole issue of consent is important for all situtations were one's ability to manage their financial or treatment decisions is in question. Nevertheless it was the issue of Elder Abuse (both financial and physical/mental) that started me down this path and which I continue to remain interested in. I'm working on a longer piece about the past and present situation in Long Term Care facilities. I know a number of you have a wealth of knowledge in this area from either work or personal experience with friends/family ... if you care to share your stories/ideas/anything with me I'd love to hear it - feel free to email me at bryan.heal@learnlink.mcmaster.ca

Recognizing a Stroke

As published by most of the heart & stroke associations, the 5 hallmark warning signs of a stroke are:

- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause

If you experience these symptoms, or know someone who is - Immediately call 9-11 or whatever the emergency services number is where you are. Chances of recovery with minimal disability is GREATLY enhanced if the victim reaches hospital within 3 hours of the onset of symptoms.

Spread the word to everyone you know - especially to all in regular contact with elderly individuals. Too many victims could have been better off if they or those around them were able to sooner recognize the combination of symptoms as what they were and called for medical help.

Heart & Stroke conditions are the leading causes of death and disability in Canada. For more information on risk factors, and what you can do help prevent your chances of developing complications - visit http://www.heartandstroke.ca

WHO must shift vaccine policy

Although it’s been overshadowed in the news by all kinds of events, there’s been a new global health dilemma brewing in recent months that’s worth talking about. Highlighted by the recent standoff between the Indonesian Government and the World Health Organisation (WHO) over highly coveted Avian Influenza samples, a long standing practice of pharmaceutical companies and the WHO has been called into question and looks like it could forever change – with many of us potentially footing the bill.

Health officials all over the world are scrambling over how best to prepare their country’s people in the event that the dreaded *Bird Flu* should mutate and unleash itself as the next killer global pandemic. With much scepticism as to the feasibility of existing response plans to something this massive, there is much hope being placed in the development of a vaccine which if engineered successfully and used appropriately would theoretically keep fatalities to a minimum. One of the challenges scientists face with this modern day hunt for the cure, however, is the nature of the virus itself … Influenza is known to be highly prone to mutation (even for a virus), and current strains are rapidly evolving into new ones – many of which are significantly different from their predecessors. What this means is that for a vaccine to be effective it is important that it is based on the most current strain(s) possible – and therein lies the opening of this can of worms.

Indonesia has thus far been the unfortunate home to most of the human cases of H5N1 Influenza, including the most recent ones. As the lead agency monitoring global progress of the bug, it has been customary practice for local health officials to send samples of newly identified strains to WHO. WHO, in turn, historically shares these samples with vaccine makers so they can get to work on the most effective concoctions for prevention and treatment. These vaccine makers, however, are for profit corporations, whose products have largely been far too expensive for most countries to afford for their people. Increasingly angry, the Indonesian Government in recent months has championed the call for the developing world and stopped sending WHO H5N1 samples until this policy changes. Donor governments (e.g. USA, Canada) have in response stated that developing an H5N1 Flu vaccine is a matter of theirs and everybody’s security, and vaccine makers have complimented such remarks by stating that without access to recent strains, it will be near impossible to develop an effective vaccine. While both of these facts are certainly true, Indonesia’s concerns are nevertheless compelling, and include:

- International vaccine makers use strains identified locally to develop and mass produce commercial vaccines at a price which Indonesia cannot afford

- Since developed nations can afford the vaccine, and developing nations cannot, the current system reinforces & propagates already large global health inequities

- Indonesia’s position is supported by many other developing nations who agree the sharing/cooperation system must change so that it becomes practical for all people to reap the benefits of medical discovery

In recognizing the potential impact of these events, WHO has moved quickly to broker a compromise, and as of Tuesday (27 March 2007) Indonesia has resumed sharing samples with WHO. WHO has promised that they will not misuse any vaccine shared with them; that while new strains will still be used for vaccine research, they will facilitate technology & assistance transfers to set up local vaccine production capabilities. It has also been rumoured that WHO is considering brokering a *guarantee* of sorts such that in the case of a worldwide Pandemic, as incentive for pharmaceutical companies to manufacture enough vaccines they will purchase a large stockpile strictly to meet developing country needs.

Though I applaud the effort to resolve this dispute and acknowledge efforts from all parties to get the pipeline moving again - it’s this guarantee that is most interesting to me and which merits further discussion. WHO and many of its donors have acknowledged the need for developing countries to be able to access vaccines, or have increased capacity to produce their own. With this new Pandemic ‘insurance’ strategy of sorts, it is appropriate to ask if this will serve as a precedent for how things are to be coordinated when another disease emerges and rings global alarm bells. Secondly, and perhaps most important is a debate around who will pay for this? If this guaranteed purchase is to go forward and be of a meaningful size, and if we are to assume the *discount* they get from vaccine makers will still be earning these companies huge profits, we are talking about a potentially multi billion dollar commitment here. As an agency of the United Nations, the WHO receives its primary funding from its membership – which generally means countries who buy into it, with the lion’s share of financial support coming from the industrialized world. What that means is that the taxpayers of the G8 and other donor countries might have just been asked indirectly to cough up billions in support of these efforts.

Now I am not saying the commitment isn’t worth it – it is – there is no doubt that isolating this virus locally and ensuring its containment everywhere including the developing world is in all of our best interests. It’s just sad that it has come to this. Like most major aspects of international development, it all boils down to the widening gap between the wealthy and the poor. Most people on Earth are living in countries which cannot afford to provide necessary health services or develop strong economies – and many of the reasons for this are a result of our own trade policies, loan conditions or other possibly-well intended development schemes. I’m no economist, but irrespective of the health and welfare of others argument – wouldn’t it also be cost effective for the developed world to assist more developing nations in becoming prosperous so they can produce more of their own solutions, instead of having to cough up billions every time an international threat could potentially reach our shores?

Flu vaccine photo taken by the US Center for Disease Control and Prevention (CDC)

NUNAVUT: Random Facts

Random things I picked up from a Town Hall with MP Nancy Karetak-Lindell …

- The Federal jurisdiction of Nunavut covers 1/5th of Canada’s landmass (about the size of Western Europe)

- Just over 31,000 people live in 25-30 communities which are not connected by roads; one must fly to travel between them

- Capital city: Iqaluit, on Baffin Island

- Official Languages: Inukitut, Inuinnaqtun, English and French

- Natural resource (Inc energy) wealth, global warming and the gradual opening up of the North West Passage have spawned enormous pressures for traditional communities to “develop” in the past 30 years

- There is no tax base; communities rely heavily on Federal government support. I do not know the extent to which royalties are provided from companies engaged in mining, research, fishing, eco-tourism, etc

- As Canada plays host to the 2007 International Polar Year research events, thousands of scientists are/will descend in the Territory to study its geography, ecology and cultures

- People have traditionally been non confrontational and accepting by nature, but are increasingly learning to debate & criticize decisions, especially those made by the Federal Government and foreign entities which affect them

- Most communities live near shorelines, which will have to consistently adapt as long as water levels continue to rise

- All buildings in communities are built on the ground without basements; as the Permafrost is thawing out, the foundation for these buildings are constantly shifting

- High population growth, especially among youth as 50% of the population is under the age of 25

– elevating pressures on education, housing and employment, and helping some look to the Southern Provinces to study and work

- Local cultures and customs are extremely intertwined with the seasons- Emergency Health Services are largely non existent; people with serious health conditions must be air lifted to *nearby* health centers out of the Territory such as Manitoba, if possible

- Mobile Dr’s exist who travel throughout the region, but they are short visits in each stop which are often consumed by urgent requests. As a result, normal family medicine practices and surveilling/monitoring for chronic disease signs are not common

- Food costs are exceptionally high: $12 for 2L of Milk; $10 for a bag of potatoes; $7 for a bag of carrots. Imagine what your monthly grocery tally would be if you were footing the bill at those prices!

Between Two Worlds

You can say that my life in recent years has been shaped by natural disasters. Working in the aftermath of earthquakes and Tsunamis had taken me on a memorable journey full of interesting places, people and conversation. It has helped shape career aspirations, given me wonderful friends, and has allowed me to develop a more global perspective on current events. Even though I spent much of ‘05-06 working specifically on issues related to the Indian Ocean Earthquake & Tsunami, it really is difficult to analyze that disaster as an isolated incident. The year that followed saw countless human tragedies of massive scale – from a string of hurricanes through Latin America & the Caribbean, to devastating earthquakes in Indonesia and Pakistan, to the United States and Katrina – perhaps the tipping point for many of us to finally force ourselves to step back and reflect on what the heck is actually occurring. Though our African brothers and sisters lacked such ‘sudden onset’ events to captivate the worlds attention, they were not free from disaster as crises’ in Sudan, Niger and elsewhere were further complicated by food insecurity caused by record drought from the drying up of their lakes and rivers.

Whether I was brainstorming with colleagues in Geneva, having drinks with friends, or shooting the sh&t with random faces in far away places – the conversation never failed to turn towards how unstable this world has become. It didn’t matter if we were doctors, lawyers, engineers, public health professionals, insurance agents, journalists, fisherman or farmers – the central role of the environment and the generally poor political acknowledgement of this among donor nations became a sobering reality for us all. Some have said that people have difficulty grasping the importance of things they cannot see; that it takes a truly profound event in their own lives before they are able to connect all the dots. While that maybe true of some places in regards to global warming – for us it wasn’t so – things were happening very quickly all around – all we had to do was look and listen.

For a country that I did not know existed three years ago, the Maldives now occupies a special place with me. As a long north-south archipelago of over 1000 small islands in the Indian Ocean, it is a breathtakingly beautiful country filled with genuinely nice and caring people. After visiting a subset of these islands, however, to simply say these islands are small is a huge understatement as many of them have a circumference that is easily walked in half an hour. With an average elevation of only 1.5m above sea level, they further claim the title of the lowest lying place on Earth. As you might imagine, the impact of rising oceanic water levels are as clear here as anywhere – and this is evident in government priority setting and planning as officials are constantly thinking of tomorrow, pondering land reclamation schemes and forming alliances with other small island chains to search for solutions. This is a nation literally fighting for their very existence because of climate change – and it is of no fault of their own. With minimal industrial emissions, automobiles and energy consumption – they can safely thank the rest of us for much of their current fate. Perhaps the first moral lesson I carry home is that when a country such as my own contributes to this global mess, we have a responsibility to help clean up that same global mess - and not just in our own backyard.

From one extreme face of global warming to another – I visit one of the most famous glaciers on Earth as the summer of 2006 brings three friends and I to Tanzania and the summit of Mt Kilimanjaro – Africa’s lone remaining snow capped peak. Whether you have been there yourself, have watched An Inconvenient Truth, or have been shown photographs from other travelers, scientists or activists – you might have heard that this glacier is melting away. And it is melting FAST – with current thinking that the snows of Kilimanjaro will be no more in as little as 15 years. On the ground these reports were all corroborated by mountain guides, porters, safari drivers and other local residents we spoke to who all claim that scientific measurements are not even necessary – that even by the naked human eye it is visibly shrinking which each passing year. But what we don’t hear amidst all of these reports is how agriculturally, economically and ecologically dependent the nearby towns, communities and wildlife reserves are on the existence of this glacier and the waters that flow from it in the summer months. Even though Tanzania has traditionally been geographically well positioned so as to not experience the extent of drought that plagues elsewhere on the continent – as their internal waterways gradually dry and Kilimanjaro melts away, the impact on a giant share of its human and world famous animal populations will be devastating.

Since our adventure in East Africa, I have returned home to Toronto (Canada) where I continue to work and study. When settling home again following a long period of instability and regular traveling, there is an inevitable shell shock – a reflection period of sorts where one absorbs on the experiences they’ve had before they go out and really talk or write about where they’ve been and what they’ve seen. For me, this period lasted a little longer than expected and it wasn’t until fairly recently that I really became interested in communicating my story and ideas in more detail. The trigger for me, especially in regards to the welfare of the planet, was a conversation I had with Nancy Karetak-Lindell, Canada’s Member of Parliament for Nunavut. She was visiting Toronto as part of a town hall on “Northern Sovereignty” hosted by my local MP Carolyn Bennett. But it wasn’t just sovereignty that was discussed – we spoke of everything. As I had never really debated anything with someone from our Northern Territories before, this was a huge eye opener for me – it was non stop learning in hearing her perspective on current events and on the realities of life in our largest riding (inclusive of one fifth of our nations landmass!). Of all the issues, however, I was most captivated by talks on geography, and hearing her explain just how rapidly their climate and natural surroundings have changed in the past 20 years and are continuing to change; of how their culture is so immersed with their physical landscape, how there lifestyle is tied to the seasons, and how their very way of life is being redefined by our melting Arctic. Among other things, I immediately thought back to some of the places I’ve been and began to realize that this is by no means an “away” phenomenon; that it is no longer a “future” event that might one day come to pass; that it is happening here and now in our very home, and for those who still aren’t believers – it is time.

It’s as if we are caught between two worlds here in Canada. On the one hand - with 90% of our population within a short drive of the US border, many of us will probably not be terribly inconvenienced by global warming in the short term. Heck – I don’t like the cold and definitely wasn’t suffering from our record warm January ’07. Farmers won’t complain about the longer growing season, and politicians and corporations are already salivating at the prospects of the opening up of the Northwest Passage. But while this is occurring many places are already having their fears realized and some heavily populated parts of the planet could well be in crises within our lifetimes. This bubble we are living in is shrinking fast, and once the novelty of these things wear off, the dots to connect will become clear. The weather will be more sporadic, the storms more intense, and our true north will melt away; additionally, humanitarian crises engulfing so much of the rest of the world may lead to a boom in immigration and asylum seeking to spacious countries (like ours) as has never occured before. To paraphrase some recent statements by Al Gore, Stephane Dion and Tony Blair: We no longer lack scientific clarity on the reality of global warming, and there are no shortages of practical steps we as humans can now take. We know exactly the types of things that we can do to help prevent the Armageddon scenarios that have been prophesied – but we are lacking political will, and for this tide to turn in a democracy, it must be demanded by the people. On this issue, we are no longer living in a time where our grandchildren will be able to makeup for our mistakes. We are living in a time of consequence.

Aerial photograph of two Maldivian islands, taken by Ron Gluckman

Looking back on the Ice Fields from Uhuru Peak, Mt Kilimanjaro, taken by me

Kyoto has targets, even if benefits unachievable

While its exciting that climate change and environmental issues in general have reached the upper echelons of political decision making in Canada, how exactly we capitalize on such massive public appetite for action is of critical importance. Like so many other *big issues* of the day which have been replaced in the national spotlight by other emergent issues, the time may soon come for this to be replaced by another. As such, this window we are currently in for what seems to be limitless action & planning should not be squandered.

In this first of several blogs on the environment debate, I'd like to quickly give both praise and criticism to the policies of the Conservative Harper Government. It doesn't matter whether or not the recent green-spending spree is a reaction to public opinion instead of something they actually want to do. It doesn't matter whether or not they are re-packaging previous government plans that have been shelved. Irrespective of the fact that they need to get tough on industrial emissions or recognize the value of Kyoto – what matters is that this administration is now finally doing some good things, and they deserve credit for what they are accomplishing. From being far from a priority a year ago, the CPC has come a tremendous way on this and are now approving billions of dollars in alternative energy investments, green tax incentives for individual households, money for the provinces and territories to develop clean air and other green initiatives, not to mention a crackdown on smog and dangerous chemicals. To take the public criticism, to acknowledge they got it wrong the first time, and to come around and prioritize this issue the way he has, Prime Minister Harper has exceeded all initial expectations of him on the environment. While I disagree with most CPC policies, and while I'll fall in line with Al Gore & Stephane Dion in saying that climate change is the *challenge of our time* and much much more in fact needs to be done - a start is (finally) under way here in Canada and we should give credit for the good steps that are being taken.

Now I may give them props for the recent string of green investments, but when it comes to Kyoto the CPC's position entirely misses the point. Since when should we be afraid to set ambitious goals that may or may not be out of our reach? Some of the greatest discoveries and collective human achievements have been a result of visions that looked far beyond the limits/capacities of their time. In his "Race Against Time" lecture series, UN Envoy for AIDS in Africa, Stephen Lewis, gives a very relevant assessment of another international framework which did not meet it's targets - that of WHO's 3x5 initiative. In 2003 UNAIDS and the World Health Organization rallied governments into a highly ambitious campaign to get 3 million people living with AIDS in developing and transition economies on to antiretroviral treatment therapy by 2005. While this goal was far from being met (1.3mil on ARV's by end '05) and some considered it a failure, the campaign has triggered tremendous momentum for treatment efforts. In his words:

"... what we now have, in country after country, is the single-minded pursuit of keeping people alive. When historians look back, there is no doubt in my mind that the 'three by five' campaign will be seen as a turning point. Everyone is now talking of 'universal access' to treatment, prevention and care by 2010. That would never have happened without the 'three by five' initiative."

It is from this type of perspective that I feel we must be looking at the potential value of something like Kyoto, because whether or not it is practically possible to achieve its targets is not really what this is about. Sure if we are able to that would be wonderful, but beyond that it's really about setting an ambitious goal and getting to work on it. Greenhouse Gas (GHG) emissions don't respect international borders. Melting of the polar ice caps affect far more than the arctic countries. Rising water levels affect far more places than our shores. "Made in Canada" solutions are great and we need plenty of them, but that doesn't mean we must develop them at the expense of international obligation - they should be part of it. Unfortunately even the most well intended international treaties are only able to take flight if major industrial nations such as Canada sign on, and as a major GHG emitter we have a responsibility to give this one a chance. The Kyoto Protocol will be viewed as a success if it energizes people and governments the world over to view their actions in the context of a liveable planet. It will be viewed as a success if emerging industrial powerhouses such as China & India start viewing alternative energy solutions as a priority to ultimately replacing their reliance on Coal & Oil. And if agressive action should validate environmentalist claims that it will also bring in economic value - the momentum that would ensue would be beyond anything we can right now comprehend.

If there was ever a truly global problem that required a truly global solution, this is it. I'll be the first to admit that the Kyoto framework isn't perfect - but when it comes to climate change, we are at one of those turning points where history will look back on what we have accomplished and what we could have accomplished with everything that we know about climate science and polluting behaviour. So even if we cannot reduce GHGs to 6% below 1990 levels by 2012, if we can at least do our part and provide some leadership here so that global momentum for sustainable action really takes off - it'll not just be better for the planet, but for Canada too. Even if the human survival argument doesn't play well with people - economic prosperity should. The collective green market/industry is just starting to blossom and it is only a matter of time before it is regarded as one of the premier global industries. Whether this happens sooner or later is uncertain, but it is inevitable - and the rewards to Canadians will be astronomical if we can come out in front on this. But if we and other industrial nations don't work to at least try to make this happen under a framework for international cooperation - we will be breaking Kyoto's back before even letting its potential be realized.

View of Earth taken in October 1997 by NASA's Apollo 17 Crew.

Strange Diplomacy

Originally posted 13 February 2007:

So a big story in the international news this week has been the six nation deal reached between North Korea, USA, China, South Korea, Japan and Russia for the North to disarm their nuclear & atomic weapons research and development program. Laced with heavy energy-packed, incentive-based compensations for North Korea, and although it doesn't involved dismantling any of the nuclear weapons Pyongyang already has developed - the deal is being promoted as a multilateral diplomatic success and an important step in diffusing hostilities in the region.

And it should be. But while I'm not one to normally criticize an agreement designed to reduce the profileration of these weapons of mass destruction, one of the US concessions struck me as somewhat odd. In part of the agreement that involves the USA and North Korea working towards normalizing their diplomatic relations with each other, the USA has agreed to take steps to remove North Korea from its list of terror-sponsoring states. Now it's not hard to see how this must be a necessary part of improving diplomatic ties between the two countries, but removing North Korea from the list of terror-sponsoring states for this reason has nothing to do with them actually not sponsoring terrorist activities!! Please anyone correct me if my logic is off here - but in a post-911 world where the USA of all countries appears fanatically obsessed with terror related issues, it seems quite strange to me that this would be a concession that they would agree to.

Anyways, the agreement is still conditional for another 60 days while the UN's weapon inspectors do their thing & the teeth of this deal and committment of participants really show itself ... after then we'll get a clearer picture of how things will unfold. Moving on to how this might affect things in other parts of the world - regardless of the specific details of the agreement, however, the Bush Administration has shown the world that they are capable of engaging in diplomatic pressure to stop a nuclear R&D program in a country named as one of their adversaries. If North Korea holds up their end of the bargain for the foreseeable future and this deal proves to actually be successfull in its objectives, I wonder how much pressure President Bush & Co will increasingly be under to shift their seemingly hostile policy toward Iran's declared nuclear energy program to a more moderate and engaging one.

--This photo of delegates to the six nation talks was taken by Michael Reynolds & Andrew Wong for the International Herald Tribune.

Public money & Separate schools in Ontario

Publicly funded religious (mostly Catholic) schools in Canada are called "separate schools," or as Wikipedia would define them, as publicly funded schools with religious education embedded in its curriculum. While most religion oriented schools in Canada no longer receive public funds, my home province of Ontario is an unfortunate exception to this where the Catholic school system receives complete funding from public money. My objection to this has nothing to do with Catholocism, and everything to do with equality and the removal of government sponsored discrimination based on religion.

I would not be nearly as uptight about this if other faiths got their fare share of the pie - but they do not. While several private Muslim, Jewish, and schools of other Christian denominations exist, they all have to fund their operations through the collection of tuition/membership/user fees and alumni donations. In this multicultural, multi-ethnic, multi-religious melting pot of a social experiment we have in Canada where equal opportunity is supposedly what we're promoting - Catholic schools should not be given an easier ride than the others. The United Nations has my back on this one too, as their Human Rights Committee has repeatedly chastised Ontario's Ministry of Education for religous discrimination by funding Catholic separate schools but not other separate schools. For those legal/UN charter buffs, it's the equality provision in Article 26 of the International Covenant on Civil & Poilitical Rights which we are violating - a covenant which we as a nation have ratified many years ago.

So why hasn't anything been done about this?

Well popular support isn't really an issue, as several Ontario news polls over the years have shown respondents overwhelmingly favouring a single public school system. The real problem is that the authority for funding Catholic schools goes back to the British North America Act (1867) and to change it would require an ammendment to our constitution - which is a bloody annoying, difficult and lengthy process. As such, I don't believe there has ever been serious effort to ammend it. Some lawmakers are vehemently opposed to opening up the constitution for, well, anything - but there are issues for which it is both wise & where the government leading the charge won't pay a heavy political price. I'm pretty sure this is one of those issues, and I would love to see a proper referendum occur on this in Ontario (similar to Newfoundland's of 1997).

So what would I like to see happen? At the root of it all - just something fair. I'm not die hard in saying that public money shouldn't go towards religous education - but favouring one is plain wrong and if we're gonna do it we gotta open the door for sharing the wealth. One creative alternative option could be to do as British Columbia (BC) has done, where public money still supports some separate schools - just in a more equitable manner. BC has developed a strict set of provincial curriculum & behaviour standards for religious schools, and those who meet said standards are eligible to receive government funds for up to 50% of their operational costs. In addition to Catholic schools, BC also has Muslim, Christian, Hindu, Sikh, and Jewish schools who receive public funds under this policy. Even though I would personally prefer tax dollars financing one public school system for Ontario as that which exists in most provinces - fairness is what's ultimately important here and I would not oppose something like what exists in BC as it is both fair and non-discriminatory.

It's not about TUITION fees

And so the debate rages on about what to do about post secondary education. With the Ontario government lifting the university tuition freeze for the province, and an endless amount of student protests on the go - I have to state my objection to the cost of tuition being the constant centerpiece of the debate. The greater issue concerning post secondary education is much more about access to it, and less so about the actual cost of tuition. Without dramatically changing the government-university relationship in ways I cannot see possible, for an Ontario university to stay at the top of their game in delivering high quality education; to be a leader in their fields of specialty; to develop new and innovative programs to prepare students for new industries/types of employment; and to continue to attract some of the brightest intellectuals - it will cost them a great deal of investment on their part and tuition prices should remain high to accomodate for this (unless people are willing to accept a decent up-front tax hike or cuts elsewhere - which I'll bet that they won't).

Having said that, something needs to be done about the cost of a university education for students from low income families and others struggling in this area - for this I see greater value in a restructuring of government loan programs. The most fundamental issue about any reform to be made is that anybody who desires a university education and who has worked hard to get accepted into a program should be able to receive said educational opportunity.

The second issue, while being more difficult to address, is that of financial cost and how the decision to attend university should not be influenced by the possibility of having to carry an exceptionally intimidating debt upon graduation. The cost of a first rate post secondary education must no longer serve as a deterrent to a promising young scholar's ability to enroll and achieve their dreams if the careers they seek demand such an education. During my time abroad I've had some interesting discussions with some Australian friends about university financing and was quite fascinated with some of the ideas coming out of their end. I cannot remember which jurisdiction (federal or one of their provinces) was under discussion, but the basic tenets of the student loan system that was described to me were something along the lines of:
1. If you cannot afford to attend the university you have been accepted to, the government will foot the bill under loan-conditions
2. Unlike with the OSAP-Mafia, repayment of the loan only begins when you start working - and not by a specific time frame after graduation
3. The rate at which a loan is paid back is proportional to salary such that if you land a higher paying job you pay more of the loan back until it's gone, and if you land a lower paying job you pay it back at a lower rate
4. Payback is automatic upon employment; a portion will come right off your paycheque just like another tax, and as you pay it off the amount you pay will reduce until there is nothing left to pay
5. If one cannot find work after graduation they do not pay the loan back until they commence employment

I do not know enough about economics or the finances of this stuff to really judge/sell the practicality of this idea just yet for Ontario. But on the surface, a post secondary government loan system such as this appears to have several positive attributes such as:
1. It addresses the problem of financial access to educational opportunities;
2. As a loan the province still gets their financial investment back (with interest) in addition to having a more educated population;
3. As graduates no longer have to fear seemingly insurmountable debt payments - the related pressure of landing a high paying job right away also fades as they know their debt will slowly be wiped clean as soon as they start working and not before then when they may not be in a suitable financial position to manage debt.

On accountability & Swiss democracy

With the sponsorship scandal & Gomery inquiry helping bring down the Martin-lead Liberal government, and with Harper’s crew successfully bringing government accountability reform into their previous campaign – it might be said that Afghanistan (& Green issues lately) aside, the past couple of years in Canadian politics has been largely influenced by accountability issues. But with the passing of the Conservative Accountability Act and the recent NDP uncovering of a corporate contribution loophole in said Act - it’s as if the debate is dominated by ethical conduct, transparency, lobbying and how political campaigns are financed.

These are all worthy issues for reform and I am very glad efforts these things are all part of the debate - my concern with all of this, however, is what happens when the public is genuinely pissed off with their government; when they have been elected fairly and have not broken any ethical or transparency rules but are passing legislation that the public at large is in heavy disagreement with? It’s impossible to predict from a campaign the full spectrum of activities any government will proceed with in the course of their term in power – and though highly unlikely in Canada (since seriously negative public opinion usually leads to a modification of policies on their own), if a government were to actually proceed with passing legislation that genuinely angered a decent majority of citizens - as a representative of the people, are there any options that can be developed for the angered public to take beyond simply waiting for the next election to remove them from power?

While I would never advocate imposing much of Swiss law onto Canada, after spending a couple of years in Geneva I did come to admire some aspects of how they practice democracy. Though it can be an excruciatingly slow process at times, their system of referendums is quite interesting …If government has passed something drastic that is not well received, concerned citizens can form a petition which if verified to contain ‘x’ number of names – an automatic referendum is scheduled on the issue where the public can vote to uphold or strike down whichever aspect of the legislation is under criticism (it can only be stricken if a certain quota of voters is met). When I asked Toronto MP Carolyn Bennett about this in her weekly web chat, her response was rightfully that although it is democracy practiced at a high level, the world of Swiss referendums is inefficient and can take a very long time (up to 4 years!!) to complete. While I completely agree with her here, I’ll also be the first to acknowledge that there must be ways in which we could adopt a modified version of legally-binding referendums that respects the basic tenets of the Swiss style into a more timely and practically relevant process.

One would hope that the combination of drastic majority-government action & negative public opinion would never get this far in Canada (poor PR often leads to policy modifications on its own). If it did however, in giving the public the possibility of veto power, it would likely force governments to better educate the general public so that they can at least better understand the reasons behind a seemingly controversial and complicated piece of legislation.

Cheers

--Bryan--

Ps – FYI, the Swiss voting populace is fairly conservative on referendum voting, only approving about 1/10th of the referendums placed before them; much more common is an acceptance of a modified version of the criticized initiative that has been rewritten by government - a happy medium if you must.

Response to China's anti-satellite missle test

Originally posted 22 Jan 2007

With all of the political news in the past week the story of China's recent space missle test has been pushed to the backpages, but the significance of this issue should not be underestimated. In successfully being able to disrupt and/or destroy low orbit satellites, China has proven its an important step closer in bridging the gap in military and intelligence technologies. While I am never a fan of military buildups, I have to disagree with so many of the critics out there calling for the world to Unite and alienate China on this and other space related technologies. I am multilateralist through and through who feels it is counterproductive to global peace to alienate China as an enemy in any sort of way.

Regardless of what China does or is spending on defence right now, the US is still far and away the only global military power - something which will not be compromised anytime soon as they are spending multiples more. When analysing the situation from China's perspective, however, this anti-satellite technology is not just an offensive capability, but it is foremost a potent deterrent should anyone try to take them on as most advanced weaponries and intelligence operations are highly dependent on communications provided by such satellites. What they have recently displayed is a capability the US has demonstrated long ago, and they probably view diplomatic outcries of thier "hostility" as hypocritical as it is not fair for another power to have such technology (and it be globally accepted) and not them. Arms races in general are very scary things, and there are many of them going on in Asia right now of concern ... South/Central Asia is probably the most dynamic and evolving region on Earth, with an exploding population, important energy resources, and several nuclear powers in or nearby. Whether or not we feel China has apparent external military threats, they themselves believe they have many such threats and that is important to understanding why they are building up so aggressively. Such threats include but are not limited to:
- Enormous Japanese spending on Naval & Air force capabilities
- A rising North Korean nuclear status
- the US arms support of Taiwan
- The rivalry between India & Pakistan; China is fighting to keep ahead of India for regional political supremacy
- The instability of many former USSR states

It is not in China's best interests to engage in war against anybody and they know this. They cannot match the US militarily and they know this - but they are a major player in an exceptionally hostile region of the world and want to have their basis covered for any scenario that could unfold. I believe this weapons test is much more about defense than any potentially offensive action. There is a wonderful book that I can't speak highly enough of by Zbigniew Brzezinski, co founder of the Trilateral Commission and former National Security Advisor to President Carter - it is called "The Choice: Global Domination or Global Leadership" and looks from the perspective of US foreign policy what its strategic priorities should be if we are to work to creat enduring peace and prosperity in the world. Aside from an excellent analysis of most world regions, it makes an excellent case for multilateralism, for engaging in our preceived opponents/rivals to facilitate a much more cooperative and thus stable world where the economic/social/communication links between citizens/states become the foremost deterrent against the invasion of anyone.

Anyways, regarding China, it's not a containment strategy we need - alienating them and publicly gathering the allies to take agressive action against them will be the tipping point in putting more than half the world's population into chaos in a region that already has many potentially serious hostilities brewing. If peace is really our end game, then we (lead by the US) have to continue to engage China in a regional strategy for Asia that involves them being a leader in the process alongside their powerful neighbours (at least India/Pakistan, Russia, Japan). China has tremendous amounts of foreign assets, therefore economic sanctions cannot work without everybody suffering. It is in nobody's interest to engage in military action on this scale - everybody loses. Diplomacy is the only way - it must be smart, sensitive to the perspectives of the other side, and engaging of all parties involved.