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The Current Transcript for February 13, 2024

Host: Rebecca Zandbergen

STORIES FROM THIS EPISODE

Prologue

SOUNDCLIP

SPEAKER: This audit shows a glaring disregard for basic management and contracting practices throughout ArriveCan's development and implementation.

REBECCA ZANDBERGEN: It was designed to make pandemic travel safer and more efficient, but in the end, the high price tag and lack of oversight have left a stain on the ArriveCan app and the federal government. In 45 minutes, Canada's Auditor General Karen Hogan on what she found about how this happened. Also this morning, Israel has stepped up its military campaign on the border town where more than one million displaced Palestinians are sheltering. In 30 minutes, we'll speak with an aid worker in Rafah about what people there are facing. Then:

SOUNDCLIP

DR. PETTER ATTIA: It's really a wonderful time to be completely detached from your electronics. You know, a TV or phone, the stresses of life, and you're often doing it with people you enjoy being with. So for me, that means my wife.

RZ: A sauna feels nice on a cold winter's day. But are all the wellness claims full of hot air? In an hour, we'll revisit Matt Galloway's conversation with longevity expert Dr. Peter Attia about the benefits of saunas. But we begin with the push for universal mental health care in this country. Good morning. I'm Rebecca Zandbergen in for Matt Galloway, and this is The Current.

[Music: Theme]

Why advocates say Canada needs universal mental health care

Guests: Glenn Brimacombe, Jean Blackler

RZ: When Megan Rolfe moved to Lake Louise, Alberta, she found herself isolated and alone. She already struggled with her mental health and the move made it worse and she turned to a psychologist. But without private coverage, she had to pay out of her own pocket.

SOUNDCLIP

MEGAN ROLFE: For very short sessions, it became quite expensive, anywhere from 120 dollars for a 50-minute session to close to 200. And working in hospitality, you don't really have the income to support that. It was also anywhere from a four-weeks to eight-weeks wait. I think I ended up just dealing with it a lot longer than I needed to, instead of getting the help that I could have gotten. It just, it really discouraged the motivation to even try.

RZ: Megan now has benefits at work, but they don't cover everything.

SOUNDCLIP

MEGAN ROLFE: My therapy sessions nowadays are about 200 dollars for a 15-minute session. I do have some covered at work, but it's very easy for that to get used up even in three sessions. For people who are in dire straits and need some more support, it's very difficult to be able to financially take that on and to get the help you need.

RZ: Still, Megan says having some therapy paid for is better than nothing and it's made a big difference.

SOUNDCLIP

MEGAN ROLFE: The big part of mental health is the journey. You're not going to get over it in one session or after a month of taking some medications. It is a continuous effort, but when you know that you have different people that you can work with, it makes you feel more motivated to keep going. Accessibility equals better quality of life and more encouragement to never give up on myself.

RZ: According to recent Statistics Canada data, five million Canadians have a mental health disorder and only about half of them receive any professional help. That has advocates calling for a universal, publicly funded mental health care system. Glenn Brimacombe is a health economist and the chair of public affairs for the Canadian Alliance on Mental Illness and Mental Health. He's here in the Ottawa studio with me. Good morning.

GLENN BRIMACOMBE: Good morning.

RZ: How familiar is Megan Rolfes story when you hear it?

GLENN BRIMACOMBE: Unfortunately, it's a very common story that we hear in terms of Canadians not having the ability to have full access for the full dose, so to speak, of psychotherapy or talk therapies or whatever they need in the mental health space. And it often affects individuals who are in lower income brackets or marginalized communities who have more difficulty, especially if they have to pay out of pocket in terms of getting care.

RZ: And what do we know about the number of Canadians who are living with a mental illness?

GLENN BRIMACOMBE: Well we know effectively what you said: that we have one in five that are suffering and more and more the data is pointing to one in four. We also know, coming out of COVID, that the prevalence of anxiety and depression is higher than pre-COVID rates. So, and when you see the survey data, you know, and you see that Canadians are telling us that they need better access to care, and there's more of us that need access to care.

RZ: I'm curious is part of this, though, that we have better awareness of what mental illness is, that we see these numbers go up?

GLENN BRIMACOMBE: It could be. And it wouldn't surprise me in the sense that as we talk about the destigmatisation of mental illness and mental health issues, more and more of us are talking about the importance of our own mental health. But at the same time, we're also seeking more access, better access, to care. So part of it is we need to square the circle. If we're going to create the space that we can comfortably talk about our mental health and mental illnesses, we also need to make sure that we ensure Canadians have access to care.

RZ: So your team at the Canadian Alliance on Mental Illness and Mental Health recently polled more than 3000 Canadians on how they rate mental health care in Canada. The poll had a margin of error of 1.7 per centage points, and the results were weighted based on age, gender and region to be representative of the Canadian population. So tell us, what did Canadians think of what's available to them?

GLENN BRIMACOMBE: So we asked Canadians effectively to rate their own provincial governments in terms of access to care. Their confidence in the system, their overall satisfaction and effectiveness of mental health services. And we also asked them to rate the performance of the federal government. And when you look at the survey results resoundingly, Canadians are giving their governments writ large a fail grade. An F. So clearly there is room for governments to up their game and do significantly more when it comes to improving publicly funded access to mental health care and substance use health services.

RZ: We'll talk more about what you're advocating for, but what currently is available for folks under the Canada Health Act?

GLENN BRIMACOMBE: So the Canada Health Act is more narrowly defined in the context of its relationship to physicians and hospitals. So if you can see a family physician, if you can see a psychiatrist, if you can see a psychologist that is funded within a hospital or a social worker that's within a community health centre, that is publicly funded. You have access. But again, it's very narrowly defined in terms of the scope of the legislation. What we have said as an alliance is that we need a companion piece of legislation that expands the notion of equating mental health and physical health. And we call it a Mental Health and Substance Use Health Parity Act for all. This would be a new piece of federal legislation that would attach specific envelope of funding that would go to the provinces and territories for mental health and substance use health services.

RZ: Is it difficult to get there if so, many Canadians don't have access to a family doctor? I mean, often the route for mental health care is through your family doctor first.

GLENN BRIMACOMBE: Well, this is part of the dialogue, I think that many governments, and quite frankly, the professions are having, mental health providers are having, in terms of how we organize ourselves to improve the overall delivery system within the public system. So, for example, we talk about primary health care reform. And to the medical profession's credit, they are talking a lot about improving and integrating more providers to work within family health teams. That is something that is achievable over the short term. But probably more importantly, it's also about building additional access in the sense of training more mental health care providers that can work with family physicians as much as we need to train additional family physicians.

RZ: And you talk about these envelopes of money. How then would they be disbursed? Which services would be offered, and how would that work, in your mind?

GLENN BRIMACOMBE: Well, there's different mechanisms that could be used. One size wouldn't fit all. So if the money was to be transferred by the federal government, and this is again where the alliance has called on the federal government to live up to its promise, Canada Mental Health Transfer, which it has yet to deliver on.

RZ: Just before you go on, what is that? Tell me a little bit first.

GLENN BRIMACOMBE: So the Canada Mental Health Transfer was a part of the Liberal government's promise in the last election that they would provide 4.5 billion dollar over five years, and it would grow over time. To the credit of the other two major national political parties, the conservatives and the NDP, they also had very robust proposals in terms of policy as to what they wanted to do in this space, as well. But what we haven't seen to date is the current government live up to the promise of actually delivering a specific envelope that would go to the provinces for the area of improving access to mental health and substance use health. You will know that there's a ten-year accord in place and that there are bilateral agreements. But again, the moneys are very modest in terms of what we have seen with the four that have been publicly released that are going to mental health and substance use health. That's why we have argued very strongly for a protected envelope of funding for mental health and substance use health. And that envelope could be attached to that new piece of legislation that we've been fighting for that equates mental health, substance use health, with physical health.

RZ: We did contact the office of Ya'ara Saks, the federal minister of mental health and addictions. The office sent a statement that read, in part, that, quote, "since 2015, we have made historic investments to support the mental health of Canadians, including five billion dollars starting in 2017, to the provinces and territories to increase the availability of mental health care. Almost 600 million for a distinctions-based mental health and wellness strategy for Indigenous peoples and 140 million to support veterans." And the statement goes on to say that the government has invested 25 billion dollars over ten years on four priorities, one of which is mental health and substance use, which I think you just touched on. But why is all of that not enough?

GLENN BRIMACOMBE: In our view, it's a very good starting point. It's far from an end point. Governments really need to significantly up their game in terms of investing in mental health and substance use health. Based on the data that we have, roughly five to seven per cent of each provincial territorial health budget is focused on mental health and substance use health. CAMI, the alliance, recommends that that should be a minimum 12 per cent of each provincial health budget should be focused on mental health and substance use health, which is closer to where many G7 countries are in terms of investing dollars.

RZ: And so how much in total do you think all of this would cost the federal government?

GLENN BRIMACOMBE: It would cost more than what they're currently putting into place. At a minimum, what we would want to see the federal government is invest a minimum, again, of roughly 5.2 billion dollars to get the ball rolling in terms of beginning to improve funding and then subsequent improvements in access. But it also means at the same time, this is not just a federal government responsibility. It also means the provincial governments need to significantly invest and improve access to care. And saying that, it's important to recognize it's not like the provinces right now are standing still. There are a number of different elements, pilot projects and pieces that they're putting in place. They are responding. Our view is they're not responding nearly fast enough and scaling up delivery models fast enough.

RZ: So, Ottawa is spending at least five billion dollars, but, you know, and you know this as well as I do, the federal government is currently rolling out a publicly funded 13-billion-dollar dental program. It's also promised pharma care legislation. That's estimated to cost federal and provincial governments more than 11 billion dollars in the first year. So how do we add to the load an extra five billion?

GLENN BRIMACOMBE: That's a very good question and one that decision makers will ultimately make. But what we can tell you, based on the survey data that's out there, is that Canadians are saying to governments that investments in mental health and substance use health rank higher than dental care and pharmacare. So it's up to governments to reflect those respective priorities in terms of the public dollars that they invest in different programs.

RZ: So, you're suggesting we should put this mental health care program ahead of dental care?

GLENN BRIMACOMBE: It's a higher priority in the context of the way that it cuts across and impacts every Canadian. Mental health has a significant impact, not only in terms of improving one's mental health, but think of it in terms of the social dividends and the economic dividends that it pays Canadians by just, in terms of getting them, for example, back to work quicker, more effectively, more productively.

RZ: We just have about a minute left. But I want to talk, just briefly, about that. What are the dividends? If you invest up front for mental health, what do you get back in return?

GLENN BRIMACOMBE: So there are studies out there, and one particularly in Ontario that was recently released, that said, for every dollar that we invest in improving access to psychotherapies, publicly-funded psychotherapies, we save two dollars. So the investment is, in terms of, if we get people treated quicker, improved health outcomes, hopefully back to a functional status, whatever that may be, in terms of either being a worker, a sister, a mother, a family member. So there are these notions of, if you put the dollars in upfront, there are different ways in which we accrue savings back to society.

RZ: Okay. Glenn Brimacombe, we will leave it there. Thank you for joining us this morning.

GLENN BRIMACOMBE: Thank you.

RZ: Glenn Brimacombe is the chair of public affairs for the Canadian Alliance on Mental Illness and Mental Health, and the director of policy and public affairs with the Canadian Psychological Association. And he was in studio with me in Ottawa. Well, last fall, Nova Scotia took a step toward universal mental health care. The province amended legislation to allow for publicly funded services using private mental health practitioners. As part of this, the province recently rolled out a pilot program to test out ways to expand coverage. Jean Blackler is the president of the Nova Scotia chapter of the Canadian Counselling and Psychotherapy Association. Jean, good morning.

JEAN BLACKLER: Good morning, Rebecca. Thank you for having me. RZ: So tell us, what does your organization make of the Nova Scotia government's plan?

JEAN BLACKLER: We're thrilled with that. We are at the table to discuss how that plan should be rolled out. They're being very prudent in being careful and to have the right plan in order to accommodate all the needs of Nova Scotians, regardless of economic status.

RZ: And describe how it will work, the pilot.

JEAN BLACKLER: Well, the current pilot that's being rolled out is with psychologists, and what they're doing is applying all of the current and incremental changes to the MSI plan to determine whether or not it's feasible as it is or it needs more tweaking. And what they're doing is asking psychologists to assess, help with the backlog of assessment requirements for people with ADHD and those with autism. So we're getting some feedback on how that's going to roll out. And we're going to look forward to soon being able to do that with registered counselling therapists.

RZ: Jean, tell me, in Nova Scotia specifically what you're seeing with mental health. Why is it so important to find some kind of solution to help people who may not have access at this point?

JEAN BLACKLER: It is very difficult for people who do not have family doctors, as Glenn was saying. It's very, very difficult for people to self-navigate when they're in a mental health crisis. So what we want to do is have it at the grassroots level, available to people who can walk in the door of a registered counselling therapist, see their office sign and know that they're welcome. And that economic barriers are not going to be a challenge for them. When we look at Nova Scotians who are economically challenged, the last thing they need right now is to have to pay for their own mental health care. They need to put food on the table. They need housing opportunities, and they need transportation to get to and from work. So when you look at Maslow's theory of hierarchy, those are grassroots needs. And one of those needs that will impact their wellbeing is access to mental health.

RZ: And what kind of feedback are you getting both from participants and also those who are now billing the government, I would think, for the services they're providing.

JEAN BLACKLER: Well, I can't speak for psychologists because I'm a registered counselling therapist. However, we do know that there are many, many, many people that come into my office and offices like mine in private practice who are paying out of their pocket. And so we really need to look at who those people are that can pay because their insurance companies have, they've maxed out their available funds out of those arenas. And we see that the people who can afford it are still stretching their own dollars. And we need to understand that there are many, many, many people who are not even able to do that. So it's really important for the government to step up and provide that service. And they are starting to do that. We are seeing a huge amount of progress with the government. We are providing information to them on what expectations we have because they are asking us, you know, how can they guarantee quality services. And we're able to say, well, we have a Nova Scotia College of Counselling Therapists that regulate registered counselling therapists in Nova Scotia. And we're saying that we have a code of ethics and a standards of practice, and we're monitoring that. Tthe college's goal is to protect the public. And we're able to do that.

RZ: You know, in the fall, the Association of Psychologists of Nova Scotia told CBC there was actually little capacity among those in private practice to take on more work, even if they could bill the public system. How much capacity is there right now?

JEAN BLACKLER: For registered counselling therapists, if you recall a conversation with John Hubert, who is the registrar of the Nova Scotia College of Counselling Therapists, he has indicated that in the last three years, the number of registered counselling therapists has doubled. It was 350 and it's now around 730. And we are turning out qualified individuals from a number of universities within Nova Scotia and across Canada who reside in Nova Scotia to be able to pick up clients who are entering the system, because we anticipate there are going to be a number of them. But we also have a succession plan. And so that regeneration of counselling therapists available to serve the public is growing. And we're growing at an exponential rate.

RZ: Do you think this pilot and expanding this pilot at some point is the silver bullet? I mean, is it the solution to what Nova Scotia and regions across Canada are struggling with?

JEAN BLACKLER: I think that it is an absolute necessity in order to make a difference. Is it the be all and end all? Perhaps not. We do have, like Glenn was saying, a number of other health care challenges going on at the same time. However, we need to start somewhere, and we need to start thinking outside the box. And we need to start utilizing an industry, as in counselling therapy, who is already connected to many providers within many social service and health care systems within Nova Scotia. We deal with a number of different departments already, so the foundation is already there, and now what they're doing is they're opening the door for another group of people to add service availability to Nova Scotians. And it is a great start.

RZ: And Jean, can Nova Scotians afford it?

JEAN BLACKLER: Meaning, does the provincial government have enough money? Is that what you're asking?

RZ: Yeah. To pay this pilot program. To pay for people to have access.

JEAN BLACKLER: So, if we look at the research that's recently been done, it's indicative of the fact that if you enter the system early and get early intervention, the likelihood of a catastrophic event occurring at a later time, which would probably take more resources to resolve, in five years, we'll be able to do an assessment to determine whether or not early intervention and greater access earlier on will reduce the costs in other social systems.

RZ: Okay, Jean. We will leave it there. Thank you for making time for us this morning.

JEAN BLACKLER: I appreciate your time, Rebecca. Thank you.

RZ: Jean Blackler is the president of the Nova Scotia chapter of the Canadian Counselling and Psychotherapy Association. Now over to you. What's your perspective on universal mental health care in Canada? How have you or your family been affected by the cost of mental health care? Write to us at thecurrent@cbc.ca. The CBC News is next. And then:

SOUNDCLIP

SPEAKER: We didn't find records to accurately show how much was spent on what, who did the work or how and why contracting decisions were made. And that paper trail should have existed.

RZ: The saga of the controversial ArriveCan app continues. The federal Auditor General released a scathing report yesterday. She'll join me to talk about what she found and the eye-wateringly high estimate cost of the app. I'm Rebecca Zandbergen, and you're listening to The Current.

Palestinians in Rafah brace for Israeli incursion

Guests: Yousef Hammash

RZ: I'm Rebecca Zandbergen sitting in for Matt Galloway. And you're listening to The Current.

SOUNDCLIP

SPEAKER: Victory is within reach. We're going to do it. We're going to get the remaining Hamas terrorist battalions in Rafah, which is the last bastion. But we're going to do it. And in this I agree with the Americans. We're going to do it while providing safe passage for the civilian population so they can leave.

RZ: Not if, but when. Despite concerns raised by the international community and the pleas of people living in Gaza, Israeli Prime Minister Benjamin Netanyahu says an invasion of Rafah is imminent. The city's population has swelled to 1.4 million since the war started, after the Israeli military ordered people to evacuate their homes elsewhere in the Gaza Strip. Yousef Hammash and his family are among those who fled south to Rafah looking for safety. He is an advocacy officer for the Norwegian Refugee Council. Hello.

YOUSEF HAMMASH: Hello Rebecca.

RZ: Yousef, tell us what your night was like and the morning.

YOUSEF HAMMASH: Last night was a bit acceptable comparing to the previous night when the Israelis start this massive operation. And in Rafah, that's continuous bombardment since midnight up to the early morning. And the attack targeted more than [unclear] several other areas. But yeah, and that was a huge concern for us, because everyone's hoping that this military offensive is not going to take place in Rafah. And that was an indication that they are going to expand it. Actually, we didn't have any clue about what was going on because the bombing was everywhere, and our understanding was that they are starting officially in Rafah. And then last night we had a bit calmer night than the previous one. Still bombing around Rafah. But more and more the intensity is more intense in Khan Yunis. But Khan Younis [unclear] has somehow connected to each other. There is no distance between both of them.

RZ: As you've mentioned, there were heavy airstrikes on the weekend with Israeli forces. They rescued two hostages. At least 60 people in Rafah were killed. What was it like while you were there and that was all happening?

YOUSEF HAMMASH: All of that started suddenly and after the middle of the night. Around 1:00 a.m. and all what we are hearing is massive explosions and like almost an earthquake, that the land was shaking. But unfortunately, we didn't know what's going on around us because lack of connectivity and we didn't have electricity or connection to understand what's going on around us. And it was very intense up to that. I wasn't able to get my head out of the window to see what's going on and where is this targeting? Because it literally was everywhere, all across Rafah. And then in the morning you understood that there was an operation, and they were rescue two hostages and all of that. But at the beginning we didn't understand any of that. And that was what make us think that they already started that offensive in Rafah.

RZ: You have two small children. If you yourself and everyone there doesn't understand what's happening, what do you tell your kids?

YOUSEF HAMMASH: Unfortunately, what my children and the children in Gaza, which have more than half of the population are children, are going through horrific, terrifying experience and circumstances dealing with what's going on around us. And we ran out of justifications in front of our children about what's around us and what's going on and why we are here. And everyone in Rafah at least have been displaced and forced to flee up to five times, at least. And from an area to the other just looking for the sense of safety, because there is no safe place in all over Gaza. But when we have been displaced in Rafah, the main reason for that was to have just a sense of safety. And when we lost it, since they start to talk about expanding their military operation in Rafah, even that little sense of safety that we have fleeing from a place to the other to have it, we lost it. And I imagine as adults, we are, we don't have the mental stability to deal with the situation around us. So imagine how it's going to be a situation for our children. They are paying the highest price, unfortunately.

RZ: And so how do you react when you hear Benjamin Netanyahu say there will be safe passage for civilians to leave Rafah?

YOUSEF HAMMASH: The question is that--where? All over Gaza is, it's a land of rubble. And 60 per cent of the houses, housing units were destroyed in Gaza. I mean, the remaining 40 per cent remained in Rafah. So it's a land of rubble. There is no access for the northern part in Gaza City, the only area available now is the middle area because Khan Yunis, there is a military operation underground. The middle area is already stuffed with people. More than half a million or more. They exceed the number of that because since few days we are seeing a lot of families, thousands of families evacuating currently from Rafah to the middle area, mostly families who are already originally from the middle area, but people like me and the majority of the people here from the northern part of Gaza and Gaza City. And Khan Yunis recently we don't have that option, and there's not enough space in the middle area to have all that amount of people. Even in Rafah, as a city, there is not enough space for all that amount of people who are currently displaced in Rafah. And so literally everything is destroyed and all over Gaza. There is no infrastructure or no access for water. Even here and Rafah, we have the same issue that you are dealing with and for families, since weeks trying to adapt themselves during the circumstances that we are going through, at least just to cover their basic needs, which is having access for a water, or at least using a bathroom or managing the basic needs for the children. But now that option that we have here in Rafah we will lose it. And if you look to the northern part of Gaza and Gaza City, there is literally a famine there. People used to eat animal food and even animal food is not available anymore. So what are the options that have been put in place in front of us as people who are displaced in Rafah? We don't have an option. It's unrealistic that we are going to be displaced from a place to the other, because there is not enough space for anyone.

RZ: Yousef, I want to talk a little bit more about what life is like right now. You talk about trying to feed your family. How do you do that right now?

YOUSEF HAMMASH: The situation is chaotic in Rafah. When we go every day to find our basic needs, we don't go with a wish list. Whatever we find, we buy. Unfortunately, even if you have some affordability, the prices are crazy expensive. And I don't think 10 per cent of the population here have the financial ability to buy their needs. So mainly families here in Rafah are relying on the humanitarian aid. And unfortunately, all of what we can get through Rafah is barely covering 10 per cent of the need. So, it's very challenging. You need a few hours every day from your day, either you stand in line to have drinking water, or stand in line to get some food, or looking, searching around, finding a medicine, for example, which is very rare now. It's really, it's almost an impossible mission on a daily basis to cover the daily needs. Add to that the horror that we are going through mentally because we do need to know what's going to happen next, whatever. What is the option that we have as people in Rafah? We are blocked in that small piece of land. From one side, we have the Israeli tanks for their military operation in Khan Yunis and the other side we have the Egyptian border. And we are locked in between trying to survive on a daily basis.

RZ: What do you feel aid organizations can do right now? Is there anything anyone can do on the ground right now to help this impossible situation?

YOUSEF HAMMASH: We have, we spent huge efforts and that's a huge concern, actually. We spent huge efforts all over the last few weeks to establish and start to operate, to serve people in need in Rafah. Because the need is huge. It's massive. But we are trying and we will keep trying. But the main issue for here, they are starting an offensive in Rafah. The only access point that we have for all the entire Gaza Strip is Rafah crossing or Kerem Shalom. Both are in Rafah, which is the only access for aid. What are going to happen for the aid that it's barely covering tables? And if an offensive started in Rafah, how we are going to provide aid for families here. We were demanding to increase the number, the amount of trucks that are allowed on a daily basis. Now, for example, the average now is 150 a day and we are demanding and asking for at least 1000 trucks per day to start recovery process for families who are in need. Unfortunately, even these 152 truck through Rafah crossing or Kerem Shalom are at risk if there is a military operation will start.

RZ: Yousef, we have to go here shortly. But before we do, I just, I know you've done dozens of interviews just like this one. Why are you doing so many interviews? It must be exhausting.

YOUSEF HAMMASH: Yeah and to be honest, it's part of, I used to work as a journalist before I was working, I start work as a humanitarian. But also for me, I'm really interested and to the world, the Western world, to know exactly what's going on. Because the only hope for us is the people outside. We lost faith and we tried everything. UN Consultant, world leaders, international community, ICJ, everything. So I think the only hope for us is the people. And that's what gave me a responsibility to start to keep telling and informing what's going on here. So we start, we keep, we still have that glimmer of hope from the people outside that they will advocate and stand with us stopping this madness.

RZ: Okay. Yousef, take care. Thank you for joining us.

YOUSEF HAMMASH: Thank you so much. Thank you so much.

RZ: Yousef Hammash is advocacy officer for the Norwegian Refugee Council. He is in Rafah with his family.

[Music: Instrumental]

Scathing report on ArriveCan app

Guests: Karen Hogan

RZ: I'm Rebecca Zandbergen sitting in for Matt Galloway. And you are listening to The Current.

SOUNDCLIP

DOMINIC LEBLANC: Under no circumstance would we pretend that because the whole world was facing this global pandemic, that the contracting rules that need to be robust to handle taxpayers’ money can somehow be disregarded.

RZ: Federal Public Safety Minister Dominic LeBlanc responding to a scathing new report from the federal Auditor General into how the government developed and implemented the ArriveCan app. That was the app designed in the early days of the pandemic to give Canadians who were travelling in and out of the country a way to register their health information with the government. And while LeBlanc now says the proper rules and procedures should have been followed, Auditor General Karen Hogan found that the reality was quite the opposite. Auditor General Karen Hogan joins me now. Good morning.

KAREN HOGAN: Good morning.

RZ: So, let's start with the money. What are the biggest issues you've uncovered in terms of what was spent on this app?

KAREN HOGAN: Well, I think overall we just found a glaring disregard for some of the most basic practices when it came to maintaining good financial records, project management and contracting practices. But when we look at the financial records, we found that the Canada Border Services Agency didn't have complete and accurate financial records. And as such, we weren't able to determine the exact cost of the application. But we estimated that it is around 59.5 million dollars.

RZ: You told MPs and reporters yesterday you were deeply concerned about what your investigation did not find. Tell us what you meant by that.

KAREN HOGAN: Well, normally I would expect that when a procurement takes place in the federal public service, that there would be a robust file that demonstrates some of the most basic things, like why you would choose a vendor, why they have the skills and competencies to carry out the work. And we found very little evidence to support some of those basic decisions. That missing or that lack of evidence went on to things around project management. We would have expected to see a budget in place. And it's hard to manage a project when you don't have a budget. And we didn't find a budget here. And then even financial records, you know, basic information around what an individual worked on, what project, was missing. So it was unclear if the invoice should, was related to ArriveCan or to another IT project that the Canada Border Services Agency was doing.

RZ: Hm. And the shoddy record keeping, is that a straight line to why this project ballooned to nearly 60 million dollars?

KAREN HOGAN: I think there would be a few reasons to say why the government didn't achieve the best value for taxpayer money that was spent. I would say that some of it was a long-term dependency or heavy reliance on external resources. They're more costly than if the application could have been developed or maintained, even after some time, by public servants. There was really no support for consistently requiring from external vendors the highest level of IT experience. And that high level of experience, like ten years or more, comes at a higher price tag. We even saw contract extensions where dollar values were increased, but the work didn't increase. And so all of those contributed to the ArriveCan application just costing, you know, the government paying more than they should have for the application.

RZ: Talk to me a little bit about the biggest contractor on this, GC Strategies. What did you learn about them?

KAREN HOGAN: So early on in the pandemic, GC Strategies was the contractor that was awarded the initial contract for around two million dollars to start the development of the application. And the contract was a non-competitive contract. And while that's allowed in the federal public service, it really should come with heavy documentation around: why choose that vendor? And we were unable to determine who made the decision to award the contract to GC Strategies, but also why they had the skills and competencies to deliver on that project. Then after time passed, when the government decided to move from these non-competitive contracts to a competitive contract, we found evidence that GC Strategies was involved in setting some of the selection criteria for the vendor, and those criteria were so restrictive and narrow that it limited competition and GC Strategies was then the only vendor to respond to this public call for proposals, and then was awarded the competitive contract. And that kind of involvement from a vendor in a competitive process should not happen.

RZ: I know this is outside of your purview here, but the CBSA and the RCMP are now investigating aspects of these relationships between officials and contractors. I mean, is there, was there anything potentially going on that was illegal, do you think?

KAREN HOGAN: I think when it comes to determining if a criminal offence occurred, if something was illegal, the RCMP is really the authority for that. So I will leave that to them. The Canada Border Services Agency, however, did launch an internal investigation into the conduct and ethics of some of their employees. We made the deliberate decision not to duplicate that work. It started in 2022, and it is still ongoing. I'm going to watch it very closely to see what the results might be and decide if we need to do more work after we see that internal investigation.

RZ: And how problematic do you think it is that the bureaucracy relies on outside contractors for these sort of technical experts to put something like this together? I mean, have we not seen something like this before with the Phoenix pay system?

KAREN HOGAN: Well, I think here, when you look at what was going on in March of 2020, it's hard for lots of us to put ourselves back to that position. But, the Canada Border Services Agency and the Public Health Agency of Canada had done an assessment that the public service didn't have the skills, but also didn't have the capacity at that time to develop the application. So it was reasonable to turn to a third party, an external source, in order to put that application into place very quickly. What I would have expected, however, is that over time that that reliance on them would have diminished and that there would have been some plan to either transition parts of maybe the operation and maintenance of the application, or the skills to the public service. And we just didn't see that happening. There was a continued reliance all the way until March of 2023.

RZ: Yes. The response from the CBSA was, quote, "the CBSA was working as quickly as possible to replace a paper process that was not meeting public health needs and was also impacting the border with significant wait times that disrupted the essential flow of people and goods." So your concern really is not the development of this app, it was the way in which an outside contractor maintained it.

KAREN HOGAN: Yeah, our concern was that there was no plan to sort of transition away from that reliance on the external resources. And, you know, you talked about what the app did at the beginning of the pandemic. And I would tell you there was some value there. And I would point back to a 2021 audit report we did on border measures, and we found that the ArriveCan at the time improved the quality of the information that the government was collecting around travellers and the timeliness and ability to follow up to ensure that people were quarantining properly. When it was paper based, it took almost 28 days for the public health agency to receive the paper. Really hard to follow up on a 14-day quarantine when you have no information until 28 days. So, there was some value. But the enduring value now is that the Canada Border Services Agency has been using the application to automate the custom and immigration form. But in the end, this was really not the best value that the government could have achieved for taxpayer money.

RZ: You found that many rules and procedures were not followed. They were ignored, it would seem. So what are you recommending to make sure these sorts of things, these failures don't happen again?

KAREN HOGAN: Well, in this audit, a lot of our recommendations are actually really basic. Basically following, I would say common sense. Basically, following the rules and guidelines that already existed. And I don't typically like to do that. I like that our recommendations be really about improving service delivery and outcomes for Canadians. But because there was such a glaring disregard for some of the most basic practices here, we felt it was important to make some obvious recommendations. We also did recommend that, you know, the Canada Border Services Agency should ensure that vendors are not involved in competitive processes because that is just a practice that shouldn't happen.

RZ: Okay. Karen Hogan, thank you for speaking with us this morning.

KAREN HOGAN: Thank you for having me.

RZ: Karen Hogan is Canada's auditor general. I'm Rebecca Zandbergen and you're listening to The Current. Joining me now from Winnipeg is the person who normally hosts this program, Matt Galloway. Good morning.

MATT GALLOWAY: Rebecca, good morning.

RZ: Matt, what have you been up to in Winnipeg?

MATT GALLOWAY: Looking for winter. It's not here. It's just a very little bit of snow and it's not particularly cold. And that, I think, might be shocking for Canadians who call it 'Winterpeg' and etc. But it's also shocking for people who live here because this is a city that really embraces winter. People love the fact that you can get out and do things in a different way when it's cold and when there's a ton of snow, and that's not the case this year. Part of it is people are worried about climate change. People are worried about the impact of El Niño. We went down to The Forks, where the rivers meet, at hive of activity on a Sunday afternoon. Tons of people in this market eating and drinking and shopping and wandering around. But outside you're talking to people about sort of what they're doing in the absence of winter. There's a little skating rink that's there, but there's this beautiful river that should be frozen where people are out skating and they're not. And so we talked to some people about how they're reacting to this, but also what they're doing to pivot to other things. And one of the people we spoke with is a woman named Liz Wreford who is a landscape architect and a winter lover. Have a listen:

SOUNDCLIP

MATT GALLOWAY: So at the beginning of February, what should you be doing in the depths of winter? You just rolled your eyes when I asked you.

LIZ WREFORD: Not this! It's so crazy. It's so disappointing this year. Usually, it's a bright blue sky and the river is full of people and there's, like, all of this amazing stuff all the way along the river. The warming huts are out. I actually tell people to come to Winnipeg in February because it's like a magical, kind of exotic place that we live, I think.

MATT GALLOWAY: And this year?

LIZ WREFORD: This year, it's a little disappointing. We're waiting, waiting, waiting. It was snowing today. And, you know, we're all hoping that everything starts to open up in the next week. But that only means we have about maybe three or four weeks to actually do all this stuff that we've been waiting to do all year.

MATT GALLOWAY: I mean, how do you react when--it's the beginning of February--we should be out doing these things and we can't?

LIZ WREFORD: I mean, it probably is a taste of what's to come. It's an El Niño year, so it's very warm. Last year it was very cold. It was almost too cold to do all of these things. So I don't know, talk to us next February maybe. We'll see if it's a pattern. I hope it isn't, but we need to do some thinking, probably. The city and the people have invested a lot in winter infrastructure over the last few years. During COVID it exploded. Communities were building these amazing things along the rivers, and I think people just started to appreciate that we have this open public space on the rivers every winter that just appears and there's not really any rules. No one really owns it. And it's so unique to a city to have that. And this year we're all kind of sad about that.

MATT GALLOWAY: You can kind of hear it in her voice that she's sad. Now, one of the things we should mention, Liz is also the inventor of a sport. The sport is crokicurl, which is a mixture of crokinole, for people who don't know, kind of wooden boards, an octagon, and you use your fingers to flick these things into the centre of the board to try and get into the hole. But you knock out other people's pieces. It's a mixture of crokinole and curling.

RZ: So it's big, I would take it. Much bigger than the board.

MATT GALLOWAY: I was disappointed that we couldn't play crokicurl, but I will come back to do just that.

RZ: All right. Now you are doing a special live show in Winnipeg tonight. What do you have planned?

MATT GALLOWAY: There is a really interesting energy in the city. You talk to people, and they speak about the sense of change and possibility in Winnipeg, and we wanted to do a show with the people who are leading that. So we're doing the show in front of a sold out crowd at the West End Cultural Centre, and we'll talk about that sense of possibility. Downtown, the Hudson's Bay building, for example, right near the famous intersection of Portage and Main, it's going to be turned into this Indigenous hub with housing and other support services, and a lot of other things put into this massive structure that has been empty for the last couple of years. And we'll talk about how what's happening here could be, people believe, kind of a roadmap for reconciliation for the rest of the country. We have live music as part of this event. The great singer songwriter William Prince is going to be performing throughout the show. He is amazing and I can't wait to be sitting next to him as he sings songs that might make me cry. We're going to talk about food as well. There's an amazing initiative that's happening here where these people put together kind of a repurposed food truck and drove it around the province to learn the stories behind the food of Manitoba. And we will hear about those stories. And at some point in time, I will eat what is known as a 'fat boy,' which is a burger that is topped with chilli. And that's all in the interest of journalism, not anything beyond that. And there are lots of other things as well that are going to be part of this event that you will hear on CBC Radio on Wednesday.

RZ: Yeah, and I understand you did have a last-minute addition to the show. The Premier of Manitoba, Wab Kinew. What will you ask him about?

MATT GALLOWAY: I mean, part of it is about that promise--to talk to him about how he feels the city has changed in many ways. People see him as part of that promise. When he was elected in the fall, they looked at him as somebody who might lead some of that change. But now the hard work really begins. There are big expectations, and when you have to make tough decisions, what does that do in terms of those expectations that people put on you? It'll be interesting to hear from him, as well. And then, he used to be a rapper, so maybe we'll get him to perform with William Prince as well. I'm not sure.

RZ: All right, Matt, have fun over there.

MATT GALLOWAY: Thank you very much.

RZ: Matt Galloway is the host of The Current. That special live show is happening tonight in Winnipeg. Now, unfortunately, all the tickets are booked, but you will be able to hear it on The Current tomorrow morning. Coming up after your regional update: how good are saunas for you, really?

SOUNDCLIP

DR. PETER ATTIA: When individuals using sauna at least four times a week, at least 20 minutes per session, there is on the order of a 30 per cent reduction in the risk of cardiovascular disease and on the order of a 60 per cent reduction in Alzheimers.

RZ: Longevity researcher Dr. Peter Attia used to be a sauna sceptic, but a second look at the research lured him back into the heat. That's coming up in 90 seconds. I'm Rebecca Zandbergen and you are listening to The Current.

[Music: Instrumental]

The culture and health benefits of saunas

Guests: Anna Hints, Peter Attia

RZ: I'm Rebecca Zandbergen, and you're listening to The Current.

[Music: 'Well Founded' Theme]

RZ: Well Founded is a new series here on The Current. Looking at wellness, what works, what doesn't, and what's backed by evidence. Well, our relationship with sauna seems to be getting steamier. TikTok and Instagram are full of sauna champions, who believe sitting in a sweltering room is the secret to living longer and living better. This morning we're going to hear about both, but first we're going for a sauna. And to do that, we need some wood on that fire.

[Sound: Wood chopping]

RZ: Valtteri Rantala is chopping wood for his business, The Finnish Sauna. It started in 2019 as a mobile sauna on a trailer. He towed it from beaches to yards and even to back alleys across Vancouver. He's since expanded the project. But the core of sharing Finnish sauna culture has stayed the same.

SOUNDCLIP

VALTTERI RANTALA: The heat has a slightly, not even slightly, but it has a humbling, softening and present awakening characters to it. So it cultivates a space where you want to share and listen and be in whatever comes up. So I love Sana for storytelling, for listening stories, for singing or just being in silence and listening the fire crackle and then see what comes up.

[Sound: water splashing, hot steam]

VALTTERI RANTALA: In Finnish we call it löyly. I think it's very similar in Estonian. aAnd we call the, the löyly is a good way to put your intentions, ask from, ask for the spirit of löyly for kind of like healing, soothing or whatever you want to let go. So it is kind of a good way to set intentions and make it into a spiritual health or whatever awakening meaningful experience for yourself.

[Sound: steam]

VALTTERI RANTALA: The memories are coming back now because I go back home and I have eight nieces and nephews there, which are from two months to 11 years. So you can see the whole, all the chapters and the different steps in the sauna life. When they first start, in a little top in the floor. When they become a bit more, like four or five, you start like going to the bottom bench. Five, six, you go in the, you try the top bench. And I think my memories would be, yeah, somewhere around four or five with Mom and Dad and just like just, you know, going for it and being like overwhelmed and then rolling in the snowbanks after. And we would make a hole in the lake in the, with the ice, which would be like three feet thick and then have little stairs to go down the ice and have cold dips in.

[Sound: Stove door creaking]

VALTTERI RANTALA: Some of the best saunas that you go in Finland and northern Europe can be 100, 150 years old. When you go into a hundred-year-old sauna, you know that how much life it has seen and how many sweats, how many stories. So there is a depth to the space that is different than a brand new, shinier sauna. So I would say sauna is like wine. It will just get better over time, as long as you properly maintain it.

RZ: But Finland shouldn't get all the credit. Estonia also has a vibrant sauna culture. Anna Hints is an Estonian filmmaker. Her new documentary is called Smoke Sauna Sisterhood. It documents the intimate conversation of women over several years in a smoke sauna. Her film is Estonia's nominee for the upcoming Academy Awards. Matt Galloway spoke with her in January and here is that conversation:

MG: I have a friend, a colleague who is Estonian, and she says there's a sign near her sauna that says a sauna is a poor man's doctor.

ANNA HINTS: [laughs]

MG: What does the sauna broadly mean to Estonian culture? What's its place in Estonian culture?

ANNA HINTS: It is a sacred place, especially smoke saunas. Smoke sauna is like old type of sauna that has no chimney. And, um, it dates back to Pre-Christian times. Uh, when people go to church, we go to smoke sauna and we take off our clothes. Uh, not just physical clothes, but also emotional clothes. And we enter there into kind of cosmic womb where you can share absolutely everything. And, uh, it is, um, I can say, the best doctor, like best mental and physical doctor. And, uh, something that is so deeply in our culture or, like, people need that. Like, you need to get the sauna need when you haven't been to sauna or you haven't been to smoke sauna. You get this kind of itching in your body. At least I get. [laughs]

MG: Can you explain how that works? You said there's no chimney?

ANNA HINTS: Yes.

MG: So the smoke just comes back into the room or what happens?

ANNA HINTS: Uh, so there is no chimney. It means that you have to heat it beforehand. So you have to take time. Uh, 6 to 8 hours, depending on the temperature that is outside. And then you heat it, and then you let it stay for some time, and then you let the smoke out, and then you enter. So, and you cannot be inside smoke sauna and put fire or hear the fire, because then smoke would come and you would die basically.

MG: Hm.

ANNA HINTS: So it works, um, it works, uh, differently. And really you have to take time to be in smoke sauna. You cannot do it in rush. And, uh, because there is no chimney, uh, the walls are dark and it's this kind of tarty smell, and really, it has no electricity. And you enter into this darkness that has only one or two, maximum two small windows and, uh, natural light or kind of light. And you feel like you are inside kind of timeless space. And, um, and it really is, it's also a place where you can meet your ancestors. Like, we have special time in late autumn when we believe our ancestors and spirits come to see us, and then we make special smoke sauna for them. And, uh, there's this. Yeah. This smell and this, uh, this, um, different type of leil. Different type of this, um, heat that comes from smoke sauna. And it stays, uh, long time warm. And women used to give birth in, uh, smoke saunas. Also wash the dead and, um, heal for centuries. So it's significantly, uh, special for women.

MG: All the, all the way through life, as you said. From birth to death.

ANNA HINTS: Yes, yes, yes. Yeah. You give birth there and then, uh, later, your body's being washed there with cold water, uh, before a funeral.

MG: What is that heat? You said it's a different kind of heat. What does that heat feel like when you're in that space?

ANNA HINTS: Mhm. Uh, it feels uh, it really goes deep into your body and cells. And it is this kind of heat where that at the same time it's not like, you're not feeling exhausted. Because sometimes saunas can be very sharp. It's not sharp. It's like it gets to your bones. But at the same time it is like embrace, you know. It's and, um, and how it is, uh, how it functions is that with the heat, you start to sweat and then, um, with time, deeper, deeper layers of physical dirt start to come up to the surface, but also emotional dirt starts to come up to the surface. And, uh, then you let it out. And, uh, I've never experienced this kind of listening to each other, like, smoke, sauna. Like, uh, every story, every experience has the birth right there. And you just hear each other out. It's this kind of safety. You feel very safe there and, uh, very, like, protected and embraced. And what is nice is that that warmth comes with you also outside to this world that is, you know, as we know, a lot of challenges and not nice things also in the world. But then you have that heat that stays with you.

MG: When were you first introduced to this? When did you I mean, as I said, it goes right through life. What's your earliest memory of that?

ANNA HINTS: Yeah. You start to go to smoke sauna already when you're in the mother's womb. But a very significant moment that I remember is when I was 11 and my grandfather had just died and his body was in the house, and we went to smoke sauna before funeral. Uh, one day before a funeral. It was my granny, my aunt, my niece. And their granny revealed that grandfather had actually cheated on her, not just once, but several times. And she released, like, all the emotions connected with that. And uh, there was, I remember frustration and anger, but also a lot of shame and, you know, like how difficult it was at the time and for kids. And she released all that. Also like, [growls], you know, like really vocally releasing all the emotions. And one smoke sauna session lasts several hours. So you're there, you go out, you come back, you're there. And once we put clothes on and we fully went out, I felt that Granny had made peace with Grandfather.

MG: Wow.

ANNA HINTS: So that next day we could bury Grandfather in peace. And this was the time when like next layer or next door of smoke sauna opened to me. And I realized that okay, on this earth there is a safe space where absolutely all your emotions, all your experiences can be shared, can be heard. And when we give voice to our story and when we give space to other stories, there is like huge, huge healing power in that. And so, and also now I think this was at the time when I was like initiated to the sisterhood, to these kind of sharings. So I was 11 at the time.

MG: This is the thing that you see throughout--your film is beautiful. Um, and that's...

ANNA HINTS: Thank you.

MG: That's the kind of emotion and the scenes that we see throughout the film. Where there are women who are talking about cancer and miscarriage and sexuality and violence, and these are hard things to talk about, but they're there also laughing. And there's moments of joy. And I mean, it sounds obvious, but you're in the sauna and you don't have your clothes on. You're naked, but you're not just naked physically if you know what I mean. There's something else that is brought up as you said it, in that space. How do you, what do you think is going on that those conversations are different than outside of that space?

ANNA HINTS: Mhm. There is the permission to, um, for everyone to be totally vulnerable. And, uh, there is this kind of, um, I mean, many things. First of all, there is the darkness, there is the heat, but there's also the centuries-long tradition that gives you that permission. Um, and, you know, I've thought about that when I started to make the film that I made, uh, seven years, I thought that the most important is the courage to share the uncomfortable. And by uncomfortable, I mean all these experiences, and, you know that we are usually hiding outside in the world or, you know, we're ashamed to talk about. But there you have that permission. Um, but then when I made the film, I realized that maybe the most important is the courage to hear the uncomfortable. We are looking for connection, but we are often thinking that there should be like an easy way or like, okay, can we connect without being vulnerable? And I'm like, no, there is no other way. It is through that vulnerability. And you learn, uh, to be okay with that. You learn to be okay with the uncomfortable. You learn how to be okay with the vulnerable. And you, uh, after that, you, uh, start to feel more and more alive. And my granny said that you know, when we have traumas, then they are like frozen water inside us. But, um, and sometimes we can find ourselves in deep, dark winter, just ice fields. But it's so important to remember that ice has the power to flow again. We just need warmth and safety and then we can melt our traumas. So with that thought, I say a lot of love to everyone.

MG: Your granny was right.

ANNA HINTS: Thank you.

MG: Yeah. Thank you. Anna.

ANNA HINTS: Thank you.

MG: Anna Hints' film, Smoke Sauna Sisterhood will be playing in Toronto at the Ted Rogers Hot Docs Cinema beginning on the 26th of January. Well, it turns out that saunas aren't just culturally important. Researchers are finding evidence that they can help both your heart and your mind. Dr. Peter Attia is a Toronto-born medical doctor who specializes in lengthening lifespan. His latest book is Outlive: The Science and Art of Longevity. He's in Austin, Texas. Dr. Attia, good morning.

DR. PETER ATTIA Yeah. Thank you.

MG: Are you a sauna person?

DR. PETER ATTIA I am, yes. Very much so.

MG: Tell me about that. Because that changed, right? You used to. I remember reading somewhere that you used to believe that, you know, they felt great, but that was kind of it. What did you learn that led you to become, as I say, a sauna person?

DR. PETER ATTIA Maybe about ten years ago, my view and looking at literature was, now this was, there were a lot of what were called healthy user biases. So people of higher socioeconomic status, people who were healthier, tended to use sauna. But I repeated the analysis, or I should be more clear. I had my team repeat the analysis in 2020, uh, late 2019. And I actually came to a different conclusion based on the strength of the data, that in fact, there probably was causality there. And if that's the case, then it would imply that using sauna, at least within the parameters that the research suggested, might actually reduce the risk of chronic disease.

MG: Tell me more about that and what you learned and what we know about the actual, the health benefits, of using a sauna. From medical literature, from research that's been done.

DR. PETER ATTIA Well, I think, you know, it's always easiest to stop with the findings. And then what's a little harder to parse out sometimes is the why. But the findings would suggest an unambiguous association between sauna use at about the following frequency. So in, you know, in individuals using sauna at least four times a week, at least 20 minutes per session, at least 179 to 180 degrees Fahrenheit. And I apologize that my Canadianness, has, I've forgotten what that is in Celsius, but I'm guessing it's about 80 degrees Celsius maybe, you know, plus or minus. So we're obviously talking about a very hot sauna here. Uh, at least 20 minutes, at least four times a week. And if an individual does that, the association is clear that there is, you know, on the order of a 30 per cent reduction in the risk of cardiovascular disease and on the order of a 60 per cent reduction in Alzheimer's disease. So then the next order question is, well, okay, um, what would be the mechanism for that if we were to believe that there's causality there? And I think here it gets a little harder to work out. Um, but I would actually attribute three benefits, two of which are kind of technical, but one of which I think is interesting and not necessarily as technical. So on the technical level, I think we're seeing, uh, an improvement in cardiovascular function. So there's this concept called hormesis, or stress, where little bits of stress are very beneficial when we respond to them and recover from them. So the obvious example of this is exercise, right? Everything you do while you're exercising is actually stressful to the body, right? Your heart rate goes up, your blood pressure goes up. None of those things would be good for long periods of time, but it's when your body responds and recovers from those things that good things happen. Similarly, when you're in a sauna, your heart rate goes up, your blood pressure goes up. Uh, your body's working very hard to rid itself of the extra heat. And that hermetic stress, because it's just given in small doses, produces a positive effect during the recovery. The other thing that seems unique to sauna is something called heat shock proteins, which, as their name suggests, are proteins that are produced when the body is under a lot of heat. And those heat shock proteins you can think of as little sort of, I don't know, garbage disposal cleaning crews that walk around the body cleaning up cellular debris, cells that are potentially, you know, on the down that are maybe going to become cancerous or things of that nature. But I actually want to emphasize a third benefit to sauna that I wouldn't have fully appreciated until I started becoming a regular user.

MG: Hm.

DR. PETER ATTIA: Which is, um, sort of the pro-social effects of sauna. Right. So you're, it's really a wonderful time to be completely detached from your electronics, you know, a TV, your phone, the stresses of life. And you're often doing it with people you enjoy being with. So for me, that means my wife. My wife and I are always in the sauna together, and it's a great time for us to talk, and we just tend to do it in the evening. So it's kind of part of the wind-down ritual to produce a far better night of sleep. And I don't think you can discount the health benefits of that.

MG: You mentioned earlier that there was the possibility of minimizing risk of Alzheimer's. What more do we know about that?

DR. PETER ATTIA: Well, again, at this point it is just a very, very strong association. But again, um, you know, I don't think it's an accident that the two chronic diseases that seem to have an improvement of risk are cardiovascular disease and Alzheimer's disease. Because those two diseases, more than any two chronic diseases, uh, tend to travel together. And the old adage that what's good for the heart is good for the brain, uh, is almost universally true. And so I think what's happening is that the same factors that are improving circulation, reducing inflammation, you know, utilizing these heat shock proteins, as we talked about, they're having all these favourable effects on the heart. And I think we're also seeing them have the same effects on the brain. And of course, Alzheimer's disease is a pretty complex disease. There's many paths to get there. Um, you know, there are some that seem a little bit more genetically predetermined. There are some that seem a little more, uh, tied to the same types of risks of cardiovascular disease. And it might be that we're seeing just a subset of that disease respond favourably here.

MG: It's interesting in talking to you about this at a time when we're seeing stats that show that life expectancy in countries like Canada and the United States is trending downward in recent years. What do you make of that? Why is that happening?

DR. PETER ATTIA: Well, I can't speak to Canada because I don't, I'm not as familiar with the stats, but I can speak to the United States, and it wouldn't surprise me if they're very similar. In the United States you're absolutely correct. The past four years have seen a reduction in lifespan. There's two things going on there. One which is transient. So you have to sort of strip out the COVID deaths from that because that was obviously seen across the globe. Um, but even when you strip out deaths from COVID, the US is still on a decline of life expectancy, and it's actually being driven by what we would call deaths of despair. So these are deaths attributed to alcohol use, accidental overdose and suicides. And, in particular, it's the former two that are driving it the most. So alcohol-related deaths and accidental overdose is more than suicide or deliberate self-death. And so, um, again, we can speak to what that's about and what might be at the root of that. Is it a crisis of meaning? Uh, despair? Other factors? Isolation? I think there's probably a lot of things that factor into that. But it is worth noting that that trend began before COVID. So something was going on even pre-COVID and potentially COVID exacerbated that, certainly in terms of, uh, isolation it did.

MG: In the face of that, your book Outlive has become a sensation. What do you think people are looking for?

DR. PETER ATTIA: That's a great question. I suspect that one of the reasons the book has been as successful as it's been, which has actually been a very, you know, big surprise, but I think it's actually been an equal emphasis on healthspan to lifespan. So I think, you know, people might look at the title of the book and say, well, you know, this is a book about living longer, you know, okay, that's interesting, but who cares? But really, I think the book is more about living better. And if you really focus on how to live better, so how to be more physically robust, how to be able to play with your grandkids later in life, how to be able to stay cognitively sharp, and perhaps most importantly, how to be emotionally healthy, then you're going to live a better life full stop. And by the way, as a bonus, you're probably going to live five or seven years longer along the way. But I think it's this focus on health span, where you get some of the lifespan benefits for free that might be what's resonating with people. Because I don't think anybody out there in a sane state of mind would say, yeah, I'd like to live longer and prolong suffering. Right? Nobody's really interested in lifespan without health span.

MG: What is a better way to think about who we want to be and what we want to be as the new year starts?

DR. PETER ATTIA: I think one of the things to do is not tether it to the new year, per se. Um, I find it very difficult when I'm working with my patients to make or to help them or guide them into making sustainable behavioural changes. You know, the good news is that behavioural changes, whether it be, you know, exercise probably more than anything else, but certainly, nutrition, sleep, et cetera, these things have a much greater impact on both the length and quality of your life than people realize. They're far more potent tools than the suite of pharmacopeia that we learn about in medical school. Um, that's the good news. The bad news is they're actually harder to comply with. Right? It's, you know, it's hard enough for most people to just take their pill for blood pressure. There's about 60 per cent compliance in something as simple as that. When it comes to these behaviour changes, it's obviously much less. But to me, the first step begins with a very clear understanding of your goals. Um, and I think they can't be abstract, right? It can't be, yeah, I want to be healthy. Or, I want to live longer. It has to be, no, picture exactly what you want to be doing in that last decade of your life. Something I write about and call the marginal decade.

MG: Uh-huh.

DR. PETER ATTIA And if you can picture what you want to happen in the marginal decade, who do you want to be with? What do you want to be doing? And I mean that very specifically, right? Like, do you want to be able to sit on the floor with children? Do you want to be able to stand up on your own? Do you want to be able to walk up a flight of stairs carrying a bag of groceries? If you can go through that exercise very tangibly, then all of a sudden, the exercise you have to do 40 years sooner becomes far less abstract. Because it's in service of a very specific goal.

MG: I'm really glad to talk to you about this, Doctor Attia. Thank you very much.

DR. PETER ATTIA: Yeah. Thank you so much for having me.

RZ: Dr. Peter Attia's latest book is Outlive: The Science and Art of Longevity. And that's our program for today. Stay tuned to radio one for Q. We were just hearing about how saunas are having a bit of a moment, and while we can't send steam directly through your speakers, we can bring you a bit of that sauna feeling. Now everyone wants to hear something slightly different when surrounded by that hot fog. Many prefer silence, but some sauna fans feel called to a track by the indie band Bastille, and here is their collaboration with the composer Hans Zimmer, 'Pompei.' I'm Rebecca Zandbergen. Thanks for listening to The Current.

[Music: 'Pompei' by Bastille]

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Tuesday February 13, 2024 Full Transcript

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