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The Current Transcript for September 1, 2024

Host: Susan Ormiston

STORIES FROM THIS EPISODE

Prologue

[Music: Theme]

SOUNDCLIP

SPEAKER: I am a driver. I am here to earn money, not to lose money. That's what we are asking. I think every worker need security.

SUSAN ORMISTON: More than just a gig. Beginning tomorrow, new rules come into effect meant to help the 46,000 British Columbians who work through gig-based delivery and ride hail apps. In a moment, why critics fear the changes still won't lead to fair compensation. Also this morning:

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SPEAKER: School is going to be hard, but it shouldn't be hard to the point where it's just debilitating. And that's kind of the point that I got to. And that's when I realized, okay, like this is a lot harder than it should be.

SUSAN ORMISTON: Many post-secondary students rely on academic accommodations to help them manage. But educators say they're struggling to cope with the growing number of requests for things like extra time for tests or access to tutors. In 30 minutes, what schools need to do to meet the complex needs of students and instructors. And then, nearly seven million Canadians are without a family doctor. As a physician and a politician, Dr. Jane Philpott has seen the cost of this up close, but she believes there is a way out and it may not be as difficult as we think. In an hour, how to rebuild health care and how personal tragedy and her faith have shaped Dr. Jane Philpott's outlook. But we begin with making a living in the gig economy. I'm Susan Ormiston, sitting in for Matt Galloway, and this is The Current.

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Do B.C.’s new gig-worker regulations go too far, or not far enough?

Guests: Gavin McGarrigle

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GURAMAR SIDHU: I was a [unclear] contractor before I lost my contract, so I just landed up into Uber. Someone told me that you're making good money.

SO: Guramar Sidhu hoped to make a decent living when he became an Uber driver.

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GURAMAR SIDHU: The first year was okay, but after that, every other day is deteriorating. The mound we used to make about two years ago working five days a week, we are not able to make that amount working even seven days a week.

SO: It is a complaint you'll hear from most people who work for ride hailing or food delivery apps. As of tomorrow, though, those in the gig economy in British Columbia will be the first in the country to get paid a minimum wage of $20.88 an hour. It's part of a slate of new rules. But Guramar Sidhu thinks the improvements do not go far enough because the minimum wage will cover driving time, but not all the time he's spent waiting on the app for the next ride.

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GURAMAR SIDHU: We don't get too much rides now. With the saturation growing in this field, everyone is trying to make some extra money and the people who lost their jobs, they need the new jobs. Uber seems to be one of the easy-going jobs, so saturation is going up, so we at least need to get covered for that sitting time so that we can get a particular fare for the whole time so that we can even feed our family, support our families, and also make a decent living.

SO: Gavin McGarrigle is the Western regional director for the union Unifor. Hi, Gavin.

GAVIN MCGARRIGLE: Hello. Good morning.

SO: Good morning. How big a step are these changes for gig workers in B.C.?

GAVIN MCGARRIGLE: Well, certainly B.C. is ahead of all the other provinces in trying to put more money into these workers' pockets by bringing in minimum rates of pay for expenses and for the hourly minimum. But there's a lot more work to be done. So, although they're ahead of other provinces, you know, we're expecting to see more changes in the future.

SO: We're going to talk about that. But on the minimum wage, besides that part, what are the other main changes, or some of them?

GAVIN MCGARRIGLE: So, on the minimum wage, they've got that, which, as you heard, is only for engaged time and not a minimum daily pay or minimum hours. You have an expense allowance that's coming in for a personal vehicle, $0.45 per kilometre for ride hail workers and $0.35 per kilometre for delivery services work. You have worker's compensation requirements now to be registered. Some tip protection, a process to outline at least an answer when it comes to suspension and terminations and some transparency on pay. Again, it's just a starting point. But there's nothing like this in other provinces.

SO: And it sounds like significant new advantages for workers in the gig economy. Yet, you heard Girma-- and other drivers are still upset that the minimum wage only covers driving time. Not all the time they wait to accept a fair.

GAVIN MCGARRIGLE: Yeah, and they have every right to be upset over that. That's a criticism that we made as well, because, you know, there is no minimum hours of pay when you look at other areas, for people who use vehicles just in the container trucking sector in British Columbia, as an example, you know, there's minimum daily payment requirements in the hundreds of dollars because you're putting your vehicle on the road and all of the expenses to go with that. And as you heard, saturation is a real problem as well. Again, looking at container trucking, there's a licensing system that caps the total number of trucks and has strong requirements for what the employers must do. So, you know, this is really just a baby step, an important one, no doubt, and will result in more money, but lots more work that needs to be done to make this really stick.

SO: But the minimum rate for gig workers, I understand, is higher than the minimum wage for all workers in B.C. in part, so says the government to account for things like waiting time.

GAVIN MCGARRIGLE: Well, but what you don't have is protection under hours of work. You don't have protection under vacation pay. You don't have protection under statutory holiday pay. So, you know, when someone is getting minimum pay and vacation pay and stat holiday that very quickly adds up. You hear employers complain about payroll taxes all the time. So, you know, they're getting a little bit more for the engaged time. But if they're sitting out there for eight hours in the day and they only actually are engaged two and a half hours, it's only 120 per cent for two and a half hours, not the eight hours you were sitting there all day.

SO: Ontario has announced or had announced a minimum wage for gig workers back in 2022, but so far it hasn't been implemented. This is Gig Workers United President Jennifer Scott:

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JENNIFER SCOTT: The province needs to figure out how to bring in something like population from minimum wage that applies to only some of the time the workers are at work, which is kind of like the opposite of the understanding of what minimum wage is. It's meant to be a, you know, compensation for all of the time that we're at work. To give you an example, like, imagine a nurse working in a hospital, and they only get paid for the time that they spend at the bedside of a patient, but not the time that they spend doing the rest of their jobs at the hospital.

SO: So, if Ontario has struggled to make this work, why do you think B.C. pushed forward with it?

GAVIN MCGARRIGLE: I think it's a step from what the government heard in the consultations. We and many others were involved in the consultations. I think they were not prepared to go to the next step at this point. There's a important labour code review that's going on right now. One of the things that Ontario did have a number of years ago, in 2017, was actually easier ways to try to help gig workers organize, and it's the same criticism we've made here. All of the organizing laws for workers to actually access collective bargaining and negotiate a contract are based on a majority principle for 50 per cent, 55 per cent. So, in the case of ride hail workers, you know, if you have Uber drivers at the airport and they think there's only 500 drivers to organize, they don't know if there's 500 drivers, they have to hit 50 per cent of, or 5000 drivers. And no laws cover that. In Ontario, they allowed unions, once they had hit 20 per cent support, to actually apply to get a number of actual workers that they have to organize so that they can truly start to act on union behind them. And that's a huge gap that was removed in Ontario when the Doug Ford government came in. And we haven't seen that in B.C. yet either.

SO: You know, Jennifer Scott made the comparison between nurses at the bedside being paid for that and not other time. But part of the gig economy is that it's flexible. Workers can take days off or breaks in the day, so it's not exactly the same comparison.

GAVIN MCGARRIGLE: Well, there's lots of stuff that happens in employment standards where workers have flexibility. You know, we sit down and negotiate hours of work and minimum pay all the time. But when these gig employers talk about flexibility, they're talking about the flexibility not to have to pay vacation pay, not to have to pay staff pay, not to have to be subject to the full raft of employment standards. I don't hear too many workers out there that are asking for that kind of flexibility, and that's what you miss all the time when they're just listening to these gig employers who are really just looking for another way to get out of minimum standards for workers.

SO: Uber, the ridesharing app, has responded in a way to the new policies in B.C.. They say, quote, 'They are incredibly expensive and that it will drive costs to consumers up and lead to lower earning opportunities for workers.' I wonder, how do you respond to the perspective that this will be bad for consumers, that rides will go up in price?

GAVIN MCGARRIGLE: Well, I think you could take every press release from every single business group out there, and every time there's any kind of change that benefits workers, that's exactly what you hear. You hear the prices are going to come up, people are going to lose jobs. Nothing really new about it. At the end of the day, these ride delivery services, food hailing, whatever they call themselves, they're just employers looking to exploit workers and make more money by getting them exempted from various employment standards. So, we're happy to see some change, but there's a lot more work that needs to be done.

SO: Gavin, the gig economy is growing. You know, it's a whole new landscape, really, for unions, for consumers, for parents of students who are working in the gig economy. How much catching up is there to do to ensure that these types of workers are fairly compensated?

GAVIN MCGARRIGLE: Well, certainly we have to look at access to collective bargaining, because if you can't figure out 50 per cent of a certain number, you can never get access to bargaining. And that means you can never truly change. Secondly, there needs to be minimum daily pay, minimum requirements per day. The per kilometre trip rates need to be higher. And we need to talk about a certain cap. You know, your guest was completely right. When there are more and more drivers competing for rides, then what you have is people getting desperate, and that leads to undercutting and rates collapsing. We've seen that in the container trucking sector in British Columbia with massive strikes when you have too many drivers chasing too few work. And so, there's work that needs to be done in that area as well. So, it's a good thing to see something coming in. But we hope to see much more post-election from this government post-election.

SO: There's a lot of provincial elections this year. Thank you, Gavin.

GAVIN MCGARRIGLE: Yes. Thanks very much. Appreciate it.

SO: Gavin McGarrigle is the western regional director for Unifor. While workers and labour advocates have concerns about B.C.'s new regulations, some businesses are also worried. Many restaurants who rely on delivery as part of their business fear that the costs will be passed on to them or to their customers. Moshe Lander is a senior lecturer in economics at Concordia University in Montreal. Hello, Moshe.

MOSHE LANDER: Good morning.

SO: Good morning. What do you make of these changes for B.C.'s gig workers?

MOSHE LANDER: You know, I appreciate what your previous guest was saying. The workers do need some support, but it's not a costless exercise. If you're going to pay workers more, somebody has to pay for paying workers more. And that's, like you said in the intro there, it's either going to be the customers are going to see that their delivery costs have gone up, or the businesses that employ these workers are going to have their profits go down. And if you're a small business, this could be the difference between being in business or not being business at all. And so, you could be talking about unemployment as a side effect. So, I think that that's something that needs to be carefully considered as well, that protecting one group of society does have consequences for other groups in society.

SO: Yes, always. But as Gavin pointed out, that's a frequently repeated response to levelling the playing field for workers. Who do you think that a minimum wage for gig workers is going to hurt? Is it the customers, consumers, drivers, or the companies?

MOSHE LANDER: It's all of the above. It just depends on which business is employing the gig workers. So, if you're, for example, like Amazon or Walmart, for example, then you're large enough that you can force those costs onto your customers and say, we're not absorbing this. You don't like it, go somewhere else. And there's probably not a lot of options there. If you're a small business, if you try to pass it on to your customers, this is one of those razor thin margin businesses. If you're a mom-and-pop restaurant, you don't have the capacity to say, well, we're going to increase the service charge by three or four dollars on to the customers, because the customers have lots of other small mom and pop operations. And so, they're going to have to eat that, pun intended. But it's also the type of thing then that, if they're running a very small operation, they probably can't afford it. And you could see some of those mom-and-pop shops go away. You could try and force it back on to the workers and say, Hey, listen, you're going to get more money now for this. But maybe the customers themselves are going to take it out on the workers by cutting back on the tips that they get. So, it could end up being a self-defeating exercise. So, it really just depends on what the businesses, and how strong they are in being able to flex it to somebody else.

SO: Would you accept that gig workers in general need improvements on their compensation generally?

MOSHE LANDER: Yes and no. I'm going to hedge on that one. I think that the market is correct in that it's over saturating. But the way that the market would work then is that if there is this excess of supply that's driving wages down, causing workers to undercut each other, then somebody needs to come up with the bright idea that, Hey, you know what? Maybe I shouldn't be in this industry. And you would see an exodus then of workers saying, I don't want to do this anymore. It's just not worth my time. But that itself would allow wages to go up for those that remain behind. And that is the invisible hand that Adam Smith referred to 250 years ago. So, it's not a new concept. But it's one of those cases where people are not ready to leave yet. And so, they're going to try and legislate their way to more money. But as we just discussed, it is going to have consequences. If people just decide to up and find something else, you don't need necessarily collective bargaining as a solution to the problem. It's-- the market would figure it out on its own.

SO: Do you think there's worthwhile efforts to limit the number of drivers or gig workers attached to a given platform? Is that something government should be involved with?

MOSHE LANDER: Well, I think that becomes a problem then, because if we can approach that government can start legislating how many employers can exist within a certain industry, can we start having the same argument then about other industries? Now I know it already exists, for example, within lawyers and accountants and doctors, and they essentially regulate the number of people that are in their industry. But that's done at the industry level, not at the government level. The government doesn't say how many lawyers can exist. Various law societies in the various provinces decide how many people they want within their club, and that's what allows them to earn high wages relative to the rest of society. So, if you wanted to see that happen internally, where there's some decision made by, say, a union as to how many people can participate, okay. But for the government to start legislating that, that's putting a lot of confidence that the government knows how many gig workers need to exist within various industries. And are they able to be flexible enough to adapt as society changes its needs?

SO: So, B.C. is trying some things. Do you think that there are alternatives to legislation that B.C. is doing, or others that could satisfy both businesses and gig workers?

MOSHE LANDER: Well, I think from businesses standpoint, they want to keep the large pool of gig workers. It's to their advantage. That ability to have them undercut each other, keep their wages low, not have to pass that on to customers is obviously in their best interest, but the tension is that that's going to hurt gig workers. So, this is always the power play that exists between employers and employees. And so, the balance of power then is seemingly in favour of employers right now, if you're going to try and find some sort of pushback that doesn't come through legislation, it really does require that you're probably going to have to see these gig workers unionize, and create some sort of balance that way. If they were to unionize that doesn't involve any government action other than just allowing a union to be created. And then you have maybe a little bit of a fairer fight where gig workers would have the ability to strike or to walk away from the job or to regulate how they work and under what conditions. I think that would probably be a better solution, again, than relying on government legislation. And what the government is effectively doing is creating a proto union by at least mandating some basic standards. But that's the type of thing that a union would probably be more adept at implementing, because they would be more sensitive to the needs of their workers, rather than trying to balance the various interests that a government would have to consider.

SO: We heard from Uber, obviously they're not keen on changes to their business. Some suggests that Uber is offering flexibility, and that's what makes it an app like we have. Is there a risk of that changing if we are going to see unionized workers or other governments legislating gig workers?

MOSHE LANDER: For sure, it's a risk. And we've seen that, for example, with Amazon over the last few years, that when their workers try to unionize, Amazon sometimes responds by moving their distribution centres or by changing the way in which they operate to essentially avoid that. And again, that's the fundamental tension between employers and employees. But I think it's also important to realize that sometimes these apps will change as they get more entrenched and more comfortable with what their business model is. Any time you see some major disruption, it usually takes about five to ten years before this work in starts to look like something a little more normal. Think about car phones. Nobody would have envisioned the modern cell phone that we have today. If you think about legalizing marijuana, the way that it now exists within society is probably not the way that the legislators imagined when they legalized it five years ago now. So, you got to give a little bit of a run in period here. And I know that people are going to say that Uber's been around for well over a decade, but it's really only become a mainstream sort of behaviour for people in the last, say, five to ten years. So, give it a little bit of time to figure out what its business is really going to look like, how it's going to exist, if it's going to be profitable, and then maybe you start to see that, all right, they understand in order to make sure that they have a viable model, maybe they do need to pay more or be more flexible or adjust the way that workers are compensated for hours worked.

SO: In the minute we have left, Moshe, you know, I described this seemingly growing landscape of gig workers. That many of our children will be involved in that as we go forward. Is there need for reform in this space?

MOSHE LANDER: I think we've seen the the reform coming. You know, if you're of a particular generation, you would have had a job for life. And that's the way it was. And then their children would have said, wait, we don't have jobs for life. We don't have a guaranteed job. We have to switch careers. And then the next generation is saying, Well, we actually switched careers multiple times. And this is sort of the evolution of the way the labour market's been going for a century now. That the next evolution down from having multiple jobs is to working project to project. That's the fluidity of the labour market. And so, who knows what is going to come after this. But I think any attempt to try and impede that progress or that evolution is ultimately going to backfire, you just, you can't stop change. The best you could hope to do is guide it. But there too, it's one of those things that-- is the government responsible enough to know how to guide the labour market, or is that something that's best guided by employers and employees talking to each other?

SO: Of course everybody wants to make a decent living, and that's what we're facing right now, isn't it?

MOSHE LANDER: That's exactly it. And it's really just a matter of, people want to make sure that they can pay the rent, pay their groceries. And after that, it's all bonus, so to speak. But, I think right now it's the scary disruption that has people more unnerved, than anything else.

SO: It sure is. Moshe, thank you very much.

MOSHE LANDER: Anytime.

SO: Moshe Lander is a senior lecturer in economics at Concordia University in Montreal. The CBC News is next. And then: extra exam time, delay deadlines, note takers and adapted assignments.

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SO: Some instructors are feeling a bit inundated by student requests for academic accommodations. Why they feel conflicted over how to manage them, keep classes fair, and make sure learning can happen for all. That's coming up in six minutes. I'm Susan Ormiston, and you're listening to The Current.

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Educators say more accommodations needed for students with complex needs

Guests: Simon Lewsen,

SO: I'm Susan Ormiston and you're listening to The Current. It's that time of year again. Back to school. Grace Eamer is heading into her third year of university at St. Francis Xavier in Antigonish, Nova Scotia. She's one of many post-secondary students who's been granted academic accommodations.

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GRACE EAMER: I was actually just recently diagnosed with ADHD. I'm unable to really pay attention throughout the entirety of classes. So, my accommodations just I have them so that it just makes it easier for me to kind of go about classes the same way as everybody else does.

SO: Her accommodations include more time on her exams and access to note takers and tutors.

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GRACE EAMER: They're there to help you. Like, school is going to be hard, but it shouldn't be hard to the point where it's just debilitating. And that's kind of the point that I got to. And that's when I realized, okay, like this is a lot harder than it should be. It was actually really, really easy for me to get them. It was just a matter of a little bit of paperwork, a meeting and contract being signed.

SO: But meeting the complex needs of all students can be a challenge for educators, and some are feeling quite conflicted and inundated with accommodation requests that are not always straightforward to navigate. Simon Lewsen is a contract lecturer at the University of Toronto. He's also a magazine journalist who wrote a piece in The Walrus magazine about the pressures of adhering to a deluge of demands from students and accessibility offices. Simon, good morning.

SIMON LEWSEN: Good morning.

SO: So, you heard Grace. How familiar you with stories like hers?

SIMON LEWSEN: Yeah, I'm very familiar with stories like hers. And hers is a success story. It's fantastic. It sounds like she got the accommodations that she needed. It sounded like accommodations were very much tailored to her individual needs. And that is sort of the example of what I'd like to see more of in higher education.

SO: She talks about ADHD. What other kinds of learning accommodation requests do you get in other instructors?

SIMON LEWSEN: So, you get a range of accommodation requests and some of them come to you, you know, in the way the Grace's did. It comes from from the Accessibility Services office in the form of a letter telling you to do something. A lot of them actually come directly from students and are not necessarily backed by the bureaucracy. And there's a range of them. Some of them are very legitimate, like Grace's, some of them feel-- you're not quite sure what to think about them, and some of them seem less legitimate. And your job as a contract instructor is to figure out what to do about each one. And I can give you an example of the sort of range of requests I get. Sometimes I'm asked, students want to get credit even though they're not attending class or to get credit for assignments they didn't do, or to get make up assignments or to submit written comments instead of actually participating in class or to not come to class, or to have class beamed out over zoom and to attend class remotely, or to get extensions on deadlines and then further extensions on those deadlines, and then even further extensions after that. So, there's a really, really broad range of accommodation requests that you get. Some of them, officialized by the university, some of them just informal between the students. I don't think a week goes by when I'm not given a request of some kind or another. And my job in that is to figure out which ones I want to grant, which ones are reasonable, which are not reasonable, and try and find some kind of balance that feels fair and also conducive to learning.

SO: How much is that your job? I mean, are you under pressure to accommodate most of these requests?

SIMON LEWSEN: I think as a general rule, instructors do feel a lot of pressure to accommodate these requests. There is a kind of culture at university that that really pushes instructors to be accommodating. And I think some instructors, some of these instructors I spoke to for my piece, are fearful that if they're not maximally accommodating, there could be repercussions. A lot of contract instructors don't have any job security, and the fear is that if they do something that gets them in trouble or gets a complaint against them, they could find that their contracts are not renewed. So, even if that fear isn't expressed directly, it is sort of lurking there in the back of a lot of people's minds.

SO: You quoted an unnamed teacher in the system who went through this process, with a complaint about accommodations. And I'm just quoting your article. 'These days,' he says, 'when I get a letter from Accessibility Services, I shut up and do what I'm told.' Is that common?

SIMON LEWSEN: Yeah, I think that is really common. I think a lot of tenured professors are afraid of disapproval of their peers. People without job security are afraid of losing their job, and people aren't sure what will happen if they push back. I think there are actually two problems that instructors are facing. One is that they want to grant requests because they want to be fair to students, and they want to make their classrooms as accommodating as possible. But some of the requests seem dubious, or some of the requests seem to undermine their learning outcomes or undermine what they're trying to do in the classroom. But there's a sort of fear that if they push back against those requests, there could be repercussions for them. And there are instances, including a very high-profile instance at New York University in which people have found that they've lost their jobs, because of complaints from students.

SO: Do you see harm in the breadth of accommodation requests for education?

SIMON LEWSEN: I don't see harm in bespoke accommodations targeted to individual students with their needs. We heard from a student earlier on in this segment, and it seemed like she got very, very bespoke accommodations, very much targeted to her needs. And what that means for her fundamentally, is that university is going to be accessible to her in a way that it just wouldn't have been otherwise. And I actually don't see any harm in that at all. I'd like to see more of that, in fact. Where I do see harm is in this trend towards a more generalized culture of leniency, the sort of pressure that's now being put on a lot of instructors to simply change the way they teach, not for individual students, but across the board. To not require participation for any students. To offer classes that are beamed online so that students don't actually have to come to class anymore. To have screens in the classroom for all students, even if you feel that screens undermine your learning environment. To not have timed assessments anymore, these kinds of things, this push towards a more generalized culture of leniency, I think is undermining what we're trying to do in education, which is we're trying to create an atmosphere where there is a little bit of stress or a little bit of friction, because it's in that atmosphere of mild stress or friction where learning happens. And I think when we take that away, we take away opportunities for learning and for growth.

SO: Do you think that's a danger right now? That we're not applying any stress?

SIMON LEWSEN: I think everybody who teachers worries about that right now. Everybody who teaches feels that they're trying to create-- what you're trying to do in the classroom effectively is you're trying to navigate a kind of sweet spot. Learning happens under situations of mild pressure, too much pressure, and you break people. And that's not helpful. You push people out and exclude people, and that's horrible. Too little pressure and you don't have that risk taking that leads-- that intellectual risk taking that leads to learning and growth. And I think everybody who teachers or most people who teach right now are fearful that we are losing that.

SO: In the minute we have left, Simon, what needs to change so that we can teach everyone in the way they need to learn?

SIMON LEWSEN: I'd like to see a much bigger investment in accessibility services so when students come requesting accommodations, they can be given the kind of attention they need and the kind of bespoke accommodations they need. Right now, I think accessibility services are picking the low hanging fruit, which is sending letters to instructors telling them to be lenient, instead of actually giving students what they need. In my piece, I talked to a student who was blind, who didn't have access to accessible textbooks. And he had to teach his instructors how to do tactile drawings for him. This is the kind of thing we're not doing for students at the same time that we are putting a lot of pressure on instructors to, you know, not have participation grades in their class. So, I'd like to see a bigger investment in accessibility services. And the other thing I'd like to see is I'd like to see instructors speaking out loud about this. I think a lot of people are frustrated about the way things are being done, but people in academia are often very scared to speak out loud about things. They're scared to feel like they're on the wrong side of sort of progressive orthodoxy. And I'd like to see more people doing what I'm doing right now and actually talk about these things, because I think these are important conversations to have, and I don't think we're ever going to get the balance right if we're not even willing to talk about it.

SO: Hopefully this conversation is part of that. Thanks, Simon.

SIMON LEWSEN: Thank you so much, Susan.

SO: Simon Lewsen is a contract lecturer who teaches writing at the University of Toronto. He's also a magazine journalist. Seanna Takacs is co-chair of the Accessibility and Inclusion Community of Practice for the Canadian Association of College and University Student Services. She's also the practice lead in accessibility services at Kwantlen Polytechnic University in Surrey. Shauna good morning.

SEANNA TAKACS: Good morning, Susan. Thank you for having me.

SO: You're welcome. What are you thinking as you listen to Simon?

SEANNA TAKACS: I have lots of thoughts. I think there is a climate, where education, post-secondary education is changing and shifting, and for a number of reasons. And along with that shift comes a real misunderstanding. And I see this in a lot of different ways, a real misunderstanding over what academic accommodation actually means. We have academic accommodations in the sense of what we do in accessibility services, where we take a student's medical documentation, we figure out the functional limitations that they have in an academic setting, and we design accommodation plans based on that. And one of the constraints in that process is to actually avoid a fundamental alteration of the course. That's contrasted with, let's say, what I think Simon was alluding to is, you know, academic adjustment or modification. So, that's where we get into, you know, real fundamental changes around course delivery, course expectations, grading changes in person classes versus, you know, being converted to zoom, those sorts of things. And they do need to be treated quite differently.

SO: Why do you think the accommodations have become fraught? I mean, it is a case that people are talking about them a lot.

SEANNA TAKACS: There are a number of reasons. You know, I think we have a much stronger awareness of questions of equity and diversity, which is good news. You know, we're more mindful about inclusion and different pathways to inclusion. I think a lot of what happened in post-secondary, around COVID really helped people see, you know, we can make these sorts of changes. We can move online quickly. We can pivot really quickly. And then once the post-pandemic sort of world, suddenly a lot of those measures were taken back. I think it is leaving instructors and professors on kind of mushy ground, you know, is it based on disability? Am I, should I be modifying my class, to what extent? And a lot of the work that I do with faculty is around making those those kinds of distinctions.

SO: And can you briefly explain the approach that you use, the universal design for learning? What's an example of how that might look?

SEANNA TAKACS: Universal design for learning is a curriculum design framework. So, the idea is instead of focusing on the disabilities or the barriers that individual students might face, we sort of take a systems approach and we look at design components. So, as an example, typically an accommodation would be audio recording of lectures which would benefit a student with, you know, particular types of disabilities. What UDL tells us to do is to say, well, you know, let's examine the barriers that are present in particular classes, in particular activities, and examine whether audio recording could be something that would benefit everyone in the class? And we find when we start to implement some of these measures, and there are a bunch of different measures, a bunch of different ways that you can design pedagogy to be more inclusive, we start to see that a lot of different people really benefit from these sorts of measures in a lot of different ways.

SO: You know, there are so many different challenges and disabilities in teaching and learning. But in your experience, have you come up with sort of the overarching thing that students with special accommodations need?

SEANNA TAKACS: Oh, that's a really good question. I don't think there is one particular thing. I mean, we would love to have that sort of silver bullet. I think that would be amazing for everyone. But, you know, what we find is it's really a concern of, you know, some pedagogical measures like really looking at pacing. You know, providing more challenge. In a lot of cases. Some students have requests, you know, they really wish that their instruction would move faster. Assistive technology is really important. We're learning the benefits of captioning. So, when I work with faculty, I really suggest that they examine each class sort of as a unit rather than going person by person. Really look at the class as a unit. What does the class need? What are the barriers that the class is experiencing? What measures could be implemented from a design standpoint, from a proactive standpoint that would really support students?

SO: And Simon talked a bit about instructors or students who believe that accommodations aren't fairly applied, that they perhaps take away a level playing field, or they dismiss parts of learning a material. How would you respond to that?

SEANNA TAKACS: I think that that's a problem that can be sorted out with much better training. There isn't a lot of work that goes into onboarding new faculty, and that varies from institution to institution. But by and large, there isn't very much strong accessibility onboarding when faculty start at the institution. I really do think that with better training around access and accessibility, the duty to accommodate, course modifications, I really think that we'll see some of these problems mitigated. And I mean, what really came across in The Walrus article was just this sort of confusion. And I do hear that from faculty. That they're not sure what to do. They're not sure what counts as a modification. They're not sure, you know, what it means to honour some aspects of accommodation plans.

SO: Would you say that accommodations have been stretched too far or that we are missing some students?

SEANNA TAKACS: I think when it comes to accommodating with students with disabilities, I think we're missing students. And I think Simon had written about a couple of examples in the article that were really salient. You know, when we run into alternate format texts, for example, when we have to use tactile resources, that's really, really challenging. And there are people with highly specialized knowledge that, you know, need to mobilize that knowledge. We need to know more of that. It has to become knowledge that's more generalized across institutions generally.

SO: It's a huge subject. We're out of time. Seanna, thank you so much.

SEANNA TAKACS: Thank you so much, Susan.

SO: Seanna Takacs is co-chair of the accessibility and inclusion community of practice for the Canadian Association of College and University Student Services. She's also the practice lead in accessibility service at Kwantlen Polytechnic University in Surrey, B.C.

SO: I'm Susan Ormiston and this is The Current. It is always such a pleasure to guest host The Current. Great team, great scope. In the past week, I've talked to an astronaut, a republican congressman from Georgia, and two Paralympians, just as an example. The Current's new season starts tomorrow with a similar breadth of stories. And your host, Matt Galloway, will be back. And he's joining me now to tell us a little bit about what you'll be hearing in the coming weeks. Hi, Matt.

MATT GALLOWAY: Hi, Susan. Good morning. How are you?

SO: I'm great. You're on the East Coast, about to start this epic road trip. What's the first stop?

MATT GALLOWAY: Well, we're going to come to you from P.E.I. on Tuesday, and there's any number of reasons to be on the island. It's a glorious place in the midst of what's been a crazy tourism season. We're here to talk about a number of things, including the fact that there is a new medical school that's opening up on P.E.I. Like just about everywhere else, certainly in the country, particularly in Atlantic Canada, there is a huge shortage of primary care physicians. Something like 36,000 people on the island are waiting for primary care. And so, this new school is meant to address that. You'd think this would be a good idea. You'd think that people would welcome this with open arms, but it's actually been weirdly controversial. In part because there are concerns that the doctors who are already overworked, will be further overworked because they're going to have to be teaching in addition to doing their usual doctoring work. So, the group that represents those doctors has said there should be a pause on this whole idea until things are worked out. We will talk about that coming up tomorrow. You can't come to P.E.I. and not talk about Anne of Green Gables.

SO: You can't. And I really want to know if you have your red pigtail wig on right now, your Anne wig.

MATT GALLOWAY: I, for full disclosure, and to perhaps prevent incriminating myself in future, I will refuse to answer that question. I've had it on in past. This is 150th anniversary of Lucy Maud Montgomery's birth. So, there's this new exhibition that's celebrating her. But there's also this new book of stories that reimagine Anne as a cyborg and as a blood sucking vampire. There are Anne purists, and I can imagine they're not particularly pleased about that. So, we'll talk about that. And we'll also talk to a comedian from the island. Patrick Ledwell. He talks about life in a small province and says that P.E.I. stands for 'privacy ends immediately.' Anybody who lives in the small town knows what he's talking about. We'll hear from Patrick about that tomorrow.

SO: Perfect. You know, you're in my old stomping grounds. I used to work in the Maritimes for about five years. And you're going on to New Brunswick, I think. What stories you covering there?

MATT GALLOWAY: Love it out here. New Brunswick is fascinating because, I mean, this is back to school time. Most kids are heading back to school. Some have already gone back to school. There are many people who are moving to Atlantic Canada. And in New Brunswick, that has meant that schools aren't keeping pace. It's really difficult-- I heard you talking about teachers and the teacher shortage across the country. This is about the school shortage and the fact that there aren't enough classrooms and not enough school sizes for people who are arriving here. Have a listen to : Anika Spence and her children, Mykha, Grey, who's 12, and Jhana-Jade Campbell, who's five. They are part of that influx. They moved from Ontario to New Brunswick. They're at a welcome centre in Moncton that's been set up by the school district to help the influx of new students get oriented.

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ANIKA SPENCE: So, Mykha is heading into grade seven. He's really, really intelligent. So, I'm really looking for a good fit for him. And he's not so social, so I kind of want to encourage that as well. So, it would be really good if he found other kids that are like minded. Jhana, she is turning five on the 13th of September. She's really excited. She had one year in JK, so she's going to continue in kindergarten here. Really social.

JHANA-JADE CAMPBELL: I'm excited that I'm gonna turn five soon.

REPORTER: Yeah. You are. You going to have a party?

JHANA-JADE CAMPBELL: Yeah!

MATT GALLOWAY: School's like a party when you're five years old. There's an election looming. And this is-- people say this is the largest ever population increase in the history of New Brunswick. And this will create a huge new base of new voters. And the question is whether those voters will be upset with the fact that their kids can't find school. And will they vote against the government. A CBC story called this an X factor, in the election. So, we'll talk about that as well.

SO: Wow. That's busy. And then you're going on to Montreal. So, who will we be hearing from?

MATT GALLOWAY: Long drive from New Brunswick to Montreal. When we get there, we will speak with a couple of people. Yoshua Bengio. He's one of the godfathers of artificial intelligence. He's a Montrealer. And like some of those people who were around at the very beginning of this technology, he is deeply worried about what he has helped unleash. The timelines that he talks about for AI getting smarter than us, and maybe trying to figure out how it doesn't need us, are kind of terrifying. He talks about this in years, not in decades. But he says that Canada can play a leading role in helping to tame AI. We will talk to Yoshua Bengio about that. We'll speak with Anthony Housefather father, Liberal MP. He has been somebody who, there's a lot to talk to him about. He's been outspoken about the rise of anti-Semitism in Canada. There are questions as to whether he would stay in the Liberal Party because of that. There are also questions about who's staying in the Liberal Party right now with the party plunging in the polls. And I mean, there was a caucus retreat in Halifax not so long ago. They're not even whispers anymore about whether Justin Trudeau should stay on as leader. We will talk to Anthony host father about that in Montréal.

SO: Yeah, we forget that there's a lot of elections going on in this country as well this fall. Matt, you have been busy. Not just in the East Coast, but you were also in Haida Gwaii a few weeks ago. And I know you were really taken with some of the stories you heard there.

MATT GALLOWAY: What an unbelievable place. Eight hundred kilometres north of Vancouver, kind of the edge of Canada. This is a remarkable place that has gone through remarkable changes in the last little while. People might know it as, in past, the Queen Charlotte Islands, now known as Haida Gwaii, that name change is part of the overall change that's happened there. The Haida, from the B.C. government, have now title over the entire territory. So, we were asking, what does this mean, what happens next? And what does it mean for the people who are there? The population is kind of split between Haida and non-Haida residents. We spoke with a number of people about this, including somebody named Jaalen Edenshaw. He is the son of somebody who has been fighting for this title recognition for more than 40 years. He's a fascinating guy. He's carving a totem pole in his father's honour. We spoke with him, his daughter and his father while he was carving the totem pole, in the carving shed. And before that, we actually went out onto the land in Haida Gwaii to talk about what this decision means. I've done radio from a lot of really interesting places. This was ridiculous. We bushwhacked into an old growth forest surrounded by these 300-year-old cedars, to see the remnants of a canoe from the 1800s that was carved by Haida and then abandoned when the population was decimated by smallpox. Have a listen to Jaalen talk about the land and what the land means to that idea of being Haida.

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JAALEN EDENSHAW: Things are going to be different now in this the new landscape of a government recognizing Haida title. But, you know, up until now, we've had to use our culture and things like this old canoe and the monumental cedear and the medicinal plants to protect these areas. And the argument being that we need these things to exist as a people. And it's true. Right? This, our culture, who we are, comes from Haida Gwaii. From the land. So you know, this is exactly who we are right here.

SO: Matt, I can't wait to hear that bushwhacking. You know, there's a lot of other stories you're bringing this fall. You have some really fascinating interviews, too.

MATT GALLOWAY: Heading to Winnipeg to talk to Marie Sinclair, former senator and chair of the Truth and Reconciliation Commission. He has a new memoir. We'll speak with him on stage in Winnipeg in September. Of course, there's the U.S. election. There are other great Canadian stories. There's-- Malcolm Gladwell has a new book coming out. We're going to talk to him. We're going to speak with the great former Toronto Raptor DeMar DeRozan. There's no shortage of stories to tell. We always talk about The Current being a place where, you know Canadians can explain themselves to each other on the radio. And hopefully there will be a lot of that done face-to-face over the course of the next few months.

SO: Thanks, Matt. I hope I've done a little bit of that this week, and we're anxious to have you back and hear about all these fascinating stories. Enjoy your road trip.

MATT GALLOWAY: Thank you, Susan.

SO: Matt Galloway is, of course, the host of The Current, and he's back with you in the host chair tomorrow from Charlottetown, P.E.I. Coming up after your regional update, almost seven million Canadians can't find a family doctor.

[Music: Theme].

SO: Dr. Jane Philpott has seen the cost of that close up as a family physician and is the former federal minister of health. Her new book is Health For All: A Doctor's Prescription for a Healthier Canada that's coming up in 90 seconds. I'm Susan Ormiston, and you're listening to The Current.

A legal right to a family doctor?

Guests: Dr. Jane Philpott

SO: I'm Susan Ormiston and you're listening to The Current. The Canadian health care system- --once our pride and joy-- is struggling in ways it never has before. People are without family doctors, waiting in overcrowded emergency rooms, struggling to find mental health support. Dr. Jane Philpott believes there is a way out and it may not be as difficult as we think. She is, of course, a former federal Liberal cabinet minister who served as Minister of Health from 2015 to 2017. She's now dean of the Faculty of Health Sciences and director of the School of Medicine at Queen's University. And her book is called Health For All: A Doctor's Prescription for a Healthier Canada. Matt Galloway spoke with Dr. Jane Philpott back in April. Here's that conversation:

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MG: This is a fantastic book.

DR. JANE PHILPOTT: Thank you so much.

MG: It says that you are concerned, you write this, that you're concerned about the well-being of Canada. If my doctor said that they were concerned about the well-being of me, of my well-being, I might start to get my affairs in order. I think I would be concerned. How did we get to this point?

DR. JANE PHILPOTT: There are many factors that got us to the point we are at, and I should first start by saying that what we have in Canada now is not nothing, but it's not enough. We have an incredible legacy of having built a system where everyone in the country has health insurance for care by doctors and care in hospitals, and I believe that we were resting on our laurels in that regard, and thinking that we had something amazing, that it was the best in the world. And over time, we have not done the maintenance necessary to be able to modernize our approach to health care. And we've, through the pandemic, cracked the system open and it's now in a state of disrepair.

MG: You say that the system is broken, and that people are losing faith in it. What is most concerning to you? What's the most concerning part of that broken system?

DR. JANE PHILPOTT: The most concerning part of that broken system is that there are probably about seven million people in the country who neither have a family doctor nor any other access to primary care. That's the front door to the health system. And there's no front door available for about a quarter of our population. And what are they left to do? They're on their own. No one is screening them for cancer. No one is maintaining their chronic illnesses, and no one is caring for their mental wellbeing. It's truly shameful that we've allowed it to get to this point.

MG: You say that family doctors are kind of a species at risk. Why do you use that phrase?

DR. JANE PHILPOTT: Well, family medicine is an extraordinary speciality. I've been a family doctor for almost 40 years now. I love to call myself a family doctor. I think it's like a huge privilege to be able to do that. But fewer and fewer of our medical school graduates are choosing family medicine. We've reached the point now that just a little under 30 per cent of them want to be a family doctor. They see how hard it is. They see that the conditions of work are not great. And even among those who graduate from our family medicine programs, very few of them go into what we call comprehensive family practice, where they cover everything, and you can go to see them with any need that you might have. They're going into very specialized or focused areas of practice. And that has really left us short of access to the care that Canadians need.

MG: I mean, you're the director of a school of medicine. Do those students who are making their way through to become doctors, do they say to you why they would not want to go into family practice? This used to be something that people, it was the, you know, the corner, the pillar stone of a community in some ways.

DR. JANE PHILPOTT: Well, I would say it's still the cornerstone of the community. The problem is that not every community has that cornerstone accessible anymore. I have conversations about this with medical students on a regular basis, and they acknowledge how hard it is. They acknowledge the importance of primary care, but they're also concerned about their own wellbeing and what they see when they look at the models that are in front of them, the family doctors that are burned out, that are leaving comprehensive practice, that are finding that they can't get a break, it's not particularly appealing to them. They recognize that we haven't actually got a system built in this country, and so they choose what is actually an easier path to go into a specialized area where we've built the supports around them. And we need to create the conditions of work so that people will find the profession and the speciality appealing again.

MG: So, you propose a model where everybody has a primary care home. What does that look like?

DR. JANE PHILPOTT: So, when you use the term primary care home, sometimes people get a bit confused. They don't think of health care as a home. They think of long-term care homes. But that's not what we mean when we say a home. We use the term home in the sense that this is a place where you belong. This is a place where everybody knows your name. And we use the term primary care home because it's not just about family doctors, it's actually about an interdisciplinary team. There are many people that deliver primary care. They may be nurse practitioners or nurses. They may be social workers or dietitians. They are all part of a team. And we can not only create better access by sharing the work out across that whole team, but we can actually sometimes provide better care, you know? Dieticians provide better nutritional advice than I ever did as a family doctor. And so, this is a way that we can actually build a support in a community that can be the heart and soul of our health care system. And that should be in every community, I use the example in the book that it's just like every community has a public school where we can be guaranteed that our children have access to education. We should have the same thing for access to primary care.

MG: Tell me more about that and the school parallel, because you say that if we had a system where--what only 80 per cent of the kids were in school, that they were only guaranteed education, that we would say that that's unacceptable. [DR. PHILPOTT: Exactly.] You see a similar line that we could draw to access to primary care.

DR. JANE PHILPOTT: Well, I love this metaphor because people can grab hold of it easily. So, you know, I always think about when my family and I moved back from West Africa to Canada in the late 1990s, and I didn't think for a minute about whether my kids would be able to get access to a school. And it's still the case that you can move to any neighbourhood, any city or town, rural part of this country and you know your children will be able to go to publicly funded elementary and secondary schools. We actually have taken that incredible system for granted. But you move to another city, and there is no guarantee you're going to be able to find a family doctor. In fact, people beg and they wait on lists and they drive, you know, hundreds of kilometres.

MG: You're in Kingston. There was a line up. How long was the line up?

DR. JANE PHILPOTT: Oh, there was an extraordinary line up of people waiting for care, and they've been waiting on wait lists for years. If we had let this happen in our public education system, people would be marching in the streets saying, it's unconscionable. So, why have we let this happen in our health care system?

MG: Why have we let it happen in our health care system?

DR. JANE PHILPOTT: Well, I think, as I said, it's a case of neglect. It's a case of sort of thinking that we had something that we didn't really have. You know, I think people have not believed that it's possible to do this. There's, always worries that we can't afford it, when in fact, the reality is that countries that have strong systems of primary care actually pay less per capita for health care, and they get better outcomes than we do.

MG: When you talk about--and people might know the phrase family health teams, we've talked about this in our program. I'm lucky enough to be part of a family health team. You talk about this being open seven days a week, 12 hours a day. And when you talk about cost, how much would it cost to create family health teams for people across this country so that they have access to that kind of care?

DR. JANE PHILPOTT: So, we've done the calculations in Kingston because we've been advocating, we would like to be a city in Kingston where every single person has a primary care home, and we've calculated what it would cost to have the overheads that you need, plus the people, which are always the most expensive part, for the doctors, the nurse practitioners, the OTs, PTs, etc. that it needs. And it actually works out to about $500 per person per year of public funds that it would cost to be able to provide that wraparound service in a neighbourhood. You know, that adds up to a lot when you're talking about the entire country, but it's a whole lot less than we spend on things like hospitals. And we need to focus our attention on primary care. We spend actually about six per cent of our health care dollars right now in primary care. That's actually a very small amount.

MG: How do you think that doctors, family doctors now would react to a big overhaul of the primary care system? Because, as you've said, primary care is not just the family doctor. It's looking at a suite of services that can be provided by a range of people. How do you think that doctors would react to that?

DR. JANE PHILPOTT: So of course, we've had these conversations. In fact, I spent most of my day yesterday talking to a bunch of family doctors about how we could do better. And there's always a little bit of angst. You know, family doctors and other doctors in this country have had a lot of autonomy. And the autonomy of physicians is something that we cherish. But I think people are so disturbed now about the lack of access to care that they are prepared to look at different models. And so, for example, we've asked graduating resident doctors whether they would consider going into a salaried system as opposed to a fee for service system. And in fact, more than half of our resident physicians now say they actually would like that. They would be willing to give up a bit of autonomy if it actually meant they had some structure, if it meant that they would get a holiday and be able to not have to be checking their labs and filling out forms on weekends and late into the evening every single day. So, there's a bit more openness, I would say now to doing something different. And that's, this is one of the reasons why it's the time to fix things now.

MG: A few days ago, the Prime Minister, Justin Trudeau, was sitting in your seat on this program. I asked him what he thought it would take to get the health care system in this country back to one that Canadians would take pride in. Have a listen to what Justin Trudeau said:

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JUSTIN TRUDEAU: Well, first of all, getting a better understanding of what's working, what's not. We can't just throw money at the problem. I absolutely agree. That money needs to be spent in intelligent ways, and the best way to do that is to actually have accountability and transparency, not to the federal government by the provinces, but to citizens in the actual results pushing forward. And that's where the federal government is stepping in. We're not going to tell provinces how to deliver health care. The Constitution says they need to do that themselves, but we can make sure that they are measuring and demonstrating the improvements that Canadians deserve, including how many people are getting access to family doctors.

MG: What do you think of what he has to say?

DR. JANE PHILPOTT: Well, I was happy to hear him say that it's about what Canadians want. I think that's a really important starting place. And we know that Canadians want to have access to primary care. You know, I think that he raised this issue about who's responsibility, is it? And that's always a bit of a quick answer as to, you know, how this, why this isn't happening. The federal government points to the provinces. The provinces point to the federal government. My sense is that what Canadians want is for all orders of government to get together and find the solutions, agree upon what the standards should be, and to be able to, I would say, legislate that standard, to legislate a right to primary care and to recognize that we can afford to do this and make a commitment to make it happen within a given period of time.

MG: The legislation that you call for is the Canada Primary Care Act. How would that work?

DR. JANE PHILPOTT: So, I came up with this idea partly, you know, on reflecting since I've left government. I've had a lot of time to think about how governments work and to see what, you know, what are the levers that you have within government. The Canada Health Act is one of our most iconic pieces of legislation. It's almost 40 years old, on April the 9th. Which is a big deal. It's not perfect. It's not perhaps as expansive as it should be, but it's actually a pretty simple piece of law that says, here are the principles. The federal government is going to give money to the provinces, and here's what we expect in return. I think we could use a similar tool for a Canada Primary Care Act that would say, here are the expectations. Every single person will have access to a publicly funded primary care professional team that will work together to serve the needs of every community. And if you lay out those standards and law, you agree that the federal government will make contributions to the provinces, and you'll find a mechanism by which there will be some accountability in the system. This is what we see in other countries that have done this well. And I point to some of those in the book, where there are places in the world that have more than 95 per cent, a place like Norway has had this, more than 99 per cent of their country that has access to primary care. And they have grounded that in federal legislation where people know their rights and they have a mechanism to say that their rights are not being met.

MG: But you just heard the Prime Minister say that this is an issue of jurisdiction in the Constitution. He's not going to tell provinces and territories what to do when it comes to health care. That's the barrier that we often hear is that health care, funded federally, is under provincial jurisdiction. In the book you write, there is nothing stopping the federal government from implementing universal access to primary care right now. Are you serious?

DR. JANE PHILPOTT: I'm serious.

MG: That there's nothing preventing the Prime Minister who is sitting there and his cabinet from saying, this is what we think Canadians need, we're going to do it.

DR. JANE PHILPOTT: The only thing that's stopping us from making this happen is the political will to make it happen. So, it is possible. There is all the technology. And the legislation, the argument around jurisdiction is one that Canadians need to challenge and say, actually health is a shared jurisdiction.

MG: And so, when the premiers raise hell and say, how dare you tell us what to do with the money that--we've seen this already when it comes to the agreements that have been signed across the country. People don't want strings attached. What should be said to those premiers?

DR. JANE PHILPOTT: So, it's not about what politicians want, it's about what Canadians want. And what Canadians want is that for their elected officials to get together, to come to consensus, to collaborate and cooperate and figure this out. That's what we have seen happen over the years. And, you know, in the beginnings of access to universal health insurance, it was about collaborating. It was about Saskatchewan coming up with a model where we would have insurance for hospitals and then insurance for doctors. And other provinces saying, what a great idea, let's actually make it happen. And the federal government coming together and saying, this is such a great idea, we're going to put it in our federal laws. And that is what we need to happen now in the world of primary care. I argue in the book that we should have; we should ask for a First Ministers meeting focussed on making this happen. This is not about pitting one order of government against another. That is not how you solve problems in this country. You solve problems by sitting down together and saying, we're here to serve Canadians. That's our job. Here's a solution. It's an affordable solution. Who's going to chip in what resources to be able to make it happen? And how are we going to deliver for Canadians?

MG: You were at that cabinet table. Did you ever propose something like this, a Primary Care Act?

DR. JANE PHILPOTT: I didn't propose it during the time that I was there. We had a lot of things on our plate when I was there, but I did see how things do work together when things work well.

MG: I just wonder whether it's easier to propose something like that when you're not...

DR. JANE PHILPOTT: Absolutely, absolutely. And so, you know, what I'm proposing is a theoretical solution. I use a quote in the book where we talk about the fact that, you know, doctors are doing medicine and politics is nothing but medicine writ large. It's a quote from the late Rudolf Virchow. And it says that, you know, doctors and people like me can propose theoretical solutions. It's the politicians that actually implement the practical solutions. I'm hoping that by sharing this and by having some sense of what works inside government. And I give lots of examples in the book about things that have worked and why it worked and why it works when people collaborate together. This will give hopefully some credence to my suggestion that it actually could work as a possibility. And more than anything else, I, my desire is that this will bring hope to Canadians to say, yes, there actually is a solution out there. Because there's a sense of despair in health professions. There's a sense of despair in the public. And what we need is to be able to say, actually, here's something that could work, and would you please sit down together and make it happen.

MG: That requires political will. This is a top issue for Canadians. It's, I don't know that it's a top issue for politicians. The prime Minister was here. I don't know that he expected me to ask him about health care, for example. You'll hear a lot of money thrown around when it comes to housing. Those are big issues. Housing and cost of living, what have you. Is fixing health care a winning issue for politicians? Do you think?

DR. JANE PHILPOTT: Such an interesting question, Matt. You know what, I believe that it is. It absolutely matters to Canadians. You know, I often look at polls that talk about what Canadians care about. And, you know, issues around affordability and housing are always very close to the top of the list. Health care is always in the top three to five, and sometimes it's at the very top of the list as to what matters most to Canadians. So, like you, Matt, I'm actually shocked that politicians don't talk about it more. Perhaps they're afraid of it. Perhaps they think it's something that they can't fix in a short period of time. And, you know, another election cycle will roll around before they've been able to demonstrate progress. But we should be asking them, what are your solutions? And we should be asking provincial politicians that and federal politicians. And we should not catch them without an answer.

MG: Or take a look at what happened in Nova Scotia and in Manitoba, where two elections, many people will be flipped based around the issue of health care.

DR. JANE PHILPOTT: That's, that made me really happy to see that in those two cases. And of course, people will be watching closely to see how well they can deliver on that. But I think that was a remarkable demonstration of the fact that, yes, you can run on a platform of health care. I'm really surprised when we're facing a federal election next year that we're not hearing any federal leaders saying that they have ideas. I hope a few of them will read my book, or their policy development teams will read the book and they'll say, Oh, actually, here's something that we could do. We would like to be the government that if you elect us, we will actually make sure that everyone in this country has access to a primary care home. So, the plan is laid out for them, and I hope somebody will pick it up.

MG: You say the stars are aligned to deliver the biggest disruption in health care since we introduced Medicare. You really believe that now is the time and that, to your point, it may not be that difficult.

DR. JANE PHILPOTT: I believe the stars are aligned because the appetite is so huge. Because it matters so much to people. And, you know, you, people have conversations in their homes about, you know, things like affordability. Whether, you know, the cost of groceries, which are becoming absurd and unattainable. But they also talk about health care. It's a dinner table conversation. You know, people, as soon as anybody finds out that I'm a family doctor, the first thing they say is, well, can you help me get a family doctor? And it used to be that, you know, there were a few people that would ask that now, but everyone asks me that. People that normally can use their power and influence can't even use power and influence to be able to access primary care. So, this is something that really matters to Canadians. We should absolutely, you know, jump on this opportunity. There is a solution. It's an affordable one. It's what Canadians want. Wouldn't this be an amazing legacy to be able to leave for future generations?

MG: So, we have to pause for news. But stick around because there's more that I want to talk to you about including your own religious faith and the story of how family tragedy has driven your work. So, stay with us. After the CBC news I'm going to continue my conversation with Dr. Jane Philpott, Medical School Dean, family doctor, former health minister,

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MG: and most recently the author of a brand-new book: Health for All: A Doctor's Prescription for a Healthier Canada. We're back in six minutes. My name is Matt Galloway, and this is The Current. Stick around.

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MG: Hello, I'm Matt Galloway and you're listening to The Current. We're continuing our conversation now with Dr. Jane Philpott. She has seen health care from a lot of different angles. From decades as a family doctor, from her stint providing medical aid in West Africa and from her time as health minister in Justin Trudeau's cabinet. Jane Philpott's new book is called Health for All: A Doctor's Prescription for a Healthier Canada, and she's with me in studio. This is a book about changing the health care system, as we were saying, but it's also a book about how you got to the place that you are in now and how you think about the health care system. And there's a lot of personal stuff that's in this book as well. You write about the stint that you had with your husband working in Niger, and a journey in a car when your daughter Emily got sick. And this is a really hard story. People might know a little bit of the details of it, but there were things in the story, as you told it, that I had never heard before. Can you describe what happened in that car?

DR. JANE PHILPOTT: So, as you said, my husband and I and our family lived in Niger, the Republic of Niger, for nine years in the 1990s. It was essentially where we started our careers. It's one of the poorest countries in the world. I loved living there. I loved raising our young children there, but it also is the place where we experienced the worst day of our lives. At that point, we had two little girls. One was two and a half and one was eight months old, and we were studying the house of language. We were living about two hours away from the hospital where we had normally been based. And our daughter, Emily, the older one, developed a terrible rash that was a sign of something called meningococcemia. It's one of the most rapidly fatal infectious diseases on the planet. And I tell the story in the book of how she, unfortunately, died as we were trying to get her to the hospital. It was exceptionally difficult. It still brings tears to my eyes when I think about it, but it changed me in a way that no other single day of my life has ever changed me.

MG: I mean, it sounds obvious, but how so? You were in the car. You're sitting in the backseat with her. She dies in your arms. How does that--and it seems obvious, as I say. But how does that shape who you are now and the work that you have done over the course of your life?

DR. JANE PHILPOTT: I would say the way that it changed me the most was not the actual day that she died, but it was what I came to understand in the days that followed. And I describe in the book that a couple of days after Emily died and we'd had the funeral, my husband and I walked out of the trailer that we were staying in one morning, and there was a line-up of people from the village that had come to greet us. And these were the people of Galmi village, people living in rural parts of Niger, some of whom we knew and had worked with, and others who we'd never met before. And one by one they came to greet us, and they spoke words of compassion. They encouraged us to be patient. And what I realized in that, and in the further conversations I had with the people around us was that we were not special. That there was nothing exceptional about what had happened to us. And in fact, what we were getting was just a tiny taste of what the reality is for people that live in Niger. At that time in the country, 27 per cent of children did not live to see their fifth birthday. And I knew so many women who had lost more than one child. And it, I knew the world was unfair before that, but it hit me like a storm, and I thought, wow, what kind of a world is this where 27 per cent of babies don't get to have their fifth birthday? We've got to find a way to care for one another better. We've got to find a way that people that live in that incredible country of Niger have better access to health care, that they have better access to food and all of the other things that children need to thrive. And if I could do something in the rest of my life to try to make the world more fair, to try to give people better chances to be healthy, that that's what I wanted to commit every day to. And I've never forgotten that.

MG: In that storm, one of the things that you held onto was faith. What did faith mean to you?

DR. JANE PHILPOTT: Faith has meant everything to me in terms of having hope. I talk in the book about the importance of having hope and what it means about our wellness and recognizing that there is actually more than just the material world around us. We've become such a secular society. We've become so focused on the things that we can touch and prove. But there's something about our souls that gets lost in all of that. There's something about recognizing that there are big spiritual forces around us, and that, you know, this time that we have on earth is meant to be infused with a sense of the miraculous. A sense of the profound. And, for me, faith, and a belief that there is more to life than what I can see and touch and prove is part of what gives me the hope to go on.

MG: You've never really spoken about that before. Right? About your Christian faith before. Why is that? Why? I mean, politics is politics. And we'll talk maybe a bit more about that later. But why haven't you spoken about that before?

DR. JANE PHILPOTT: It's a great question, Matt. I think I was afraid to.

MG: Afraid of what?

DR. JANE PHILPOTT: Afraid that people would think that I was trying to manipulate them. You know, people attach faith to religion, and they attach religion to some sort of, you know, desire to try to convince other people to become part of your religion. And I think Christians probably have that in or are accused of that more than others. That they're proselytizing somehow if they talk about their faith. And so, for me, especially as a politician, I didn't want anyone to think that I would ever use my faith as a way to change what I did, that I would serve people only if they were part of my same faith. And of course, that's not what either doctors should do, or politicians should do. And so, it seemed safer to just make it a personal thing and keep it quiet. And yet it's so much a part of who I am that as I wrote this book and as I thought about what drives me and what motivates me, I needed to tell people who I am so that they could understand why health for all matters so much to me.

MG: You say that you believe in the power of prayer with your whole heart and mind. What does that mean?

DR. JANE PHILPOTT: I do. I believe that there is a higher power. Lots of people do. People call that higher power by all kinds of different names. And I believe that there is someone, maybe you could call that someone a creator, who put this whole world together. This whole, the galaxies. And that I have the ability to be able to communicate with that higher power, the creator. And to be able to tell someone what's on my heart, what matters to me, how I would like to see the world unfold. And sometimes those prayers are answered and sometimes they're not. But I have seen the miracles of prayer. I describe the miracle of our daughter Bethany surviving meningococcemia. And I say in the book that she survived in part because of the miracles of antibiotics. But I also believe that one of the reasons she survived is because thousands of people were praying for her life.

MG: Is that hard to explain to people who don't believe?

DR. JANE PHILPOTT: It's really hard to explain to people.

MG: As a doctor.

DR. JANE PHILPOTT: It is hard as a doctor. And I think, as I say, we've sort of pitied the sense of, you either are a scientist or you're a person of faith. [MG: Yeah.] as if they, as if they can't both be held together. And we've done ourselves a disservice by separating those things. And so, I start to step into some of that conversation in the book to say that, can't we actually talk about the deepest values of our lives? What we believe and what we don't believe, what we question, what our doubts are? All of those important conversations about being human have somehow been separated from talking about stuff like health and health care. And in fact, our wellness does depend on things like hope and belonging and meaning and purpose. And I talk about those in the book because, you know, we can have the best health care system in the world, but if people aren't well on the inside in their souls, or if our society's soul is crushed, then actually we aren't living fully and we're not living well.

MG: How do you see that play out at a time now when we, it feels like we are, I mean, there's a report that came out about incivility. People not talking to each other, not listening to each other. When it feels like people are polarized and pitted against each other. How do you see what you're talking about fitting into that time?

DR. JANE PHILPOTT: My sense is that we have, our muscles perhaps you could say, to be able to have hard conversations about heartfelt issues, have, those muscles have atrophied. Because we haven't been exercising them over the last several decades. In our wonderfully pluralistic, multicultural society we felt safe to be secular, and we haven't figured out how we can talk about things like faith, where you and I might have different ideas about what that is, and we might even disagree on some things, but that I can respect you for having a different idea. I can, in fact, learn from you. And because we haven't been exercising those muscles well enough, it has left us in this world of incivility where we treat each other terribly and we say awful things about each other. And that does not make for a healthy country.

MG: What happens when politicians do that? What's the role of our leaders, do you think, in creating that environment or creating those conditions for people to say, as you said, awful things about each other?

DR. JANE PHILPOTT: [Sighs] I think...

MG: That's a big sigh.

DR. JANE PHILPOTT: It's a big sigh because, oh my gosh, we have to learn to care about each other! And politicians have to care about each other, and they have to treat each other as human beings, and they have to treat the people around them as human beings. They have to, you know, when I hear, you know, politicians speaking with complete disdain for one another, when they respond to journalists and other human beings with such disrespect, I think, wow, that's not the kind of leaders we need in this country.

MG: You're kind of asked to do that, though, right? Like, look at... [DR. PHILPOTT: You are. Yes! That's thoughtful.] So, there's a story in the book about you in the House of Commons and what the House of Commons has become in question period. When you are directed in some ways to respond. Well, you describe it...

DR. JANE PHILPOTT: [Laughs] So, I talk about this in the book and, you know, this is one of the most shocking things about going into politics, was the fact that you are, you know, for the first time in my life, I found myself in a place where other people wanted me to fail. That was a shocking realization. But then, even worse than that was that part of my job was to try to make other people fail. And I thought, what an absurd arrangement we have that we elect 338 people to go to Ottawa to represent their community, to make this a great, strong country, and then they tear each other apart. You know, I, people, I'm sure, will call me naive for some of the things that I said in that part of the book. But I fundamentally believe that we can find a way to disagree with one another without actually trying to make other people fail. And so, the incident you're referring to is where, you know, a couple of my wonderful young staff people came to me and said, you know, the Prime Minister's office says that you need to be more political in your answers. You need to be nastier. You need to use these lines like, you know, for ten years under the previous government, the blah, blah, blah. And I said that's not who I am, and I won't be somebody different than who I am, and I won't tear people down because that's not going to help anyone. I'm here to build this country up, to build other people up. I actually want the people that represent a riding that happen to be in a different political party, I want them to do well because I want their community to do well, because I want the whole country to do well. And we've got to figure out a way to bring politics back to that place of respect.

MG: You say that politicians should be more like doctors and admit their mistakes and apologize.

DR. JANE PHILPOTT: I do, yes. I, so, I had a lot of fun with that. I have a whole chapter. It's actually one of the longer chapters in the book that talks about the things that I learned as a doctor that helped me in politics. And I had fun kind of thinking about some of those clinical skills and what, how they might transform politics.

MG: You asked the Prime Minister to admit that he'd made a mistake.

DR. JANE PHILPOTT: I did, yes.

MG: And this was with regard to the Jody Wilson-Raybould story.

DR. JANE PHILPOTT: Yes. So, I talk about the fact that one of the things I think doctors are trained to do well, and, you know, airline pilots are given the same kind of training, is that you can't deny mistakes. You actually have to admit when you've made a mistake. And in fact, one of the ways that we get better is by recognizing our mistakes, taking ownership for them, looking at who might have been hurt, apologizing to those who might have been hurt, analyzing how that mistake possibly happened and what you can do to prevent it happening again. It's a tremendous formula and we actually practice it in medical school. We practice people disclosing to a patient that a harm has happened to them. And yes, I did have this conversation on a couple of occasions with the Prime Minister when I felt that he had made a mistake. And I had hoped that, you know, perhaps that same formula could be used. But we can't. It's not something that's part of politics now, except in rare circumstances.

MG: So, would you ever go back into politics? You say in the book-- there's a line. It leaps right out: I don't know if I'll ever go if I'll ever end up in politics again. That's a pretty big door to leave open.

DR. JANE PHILPOTT: So, I would say I think about it as a door. The book makes it really clear that what I care about right now and what I want to spend every single day of my working life doing, is trying to help make sure that this country is as healthy as possible, that we can build a world with health for all, that we can build a country with universal access to primary care. Right now, I get to do that at Queen's University. And I love my job. If a door ever opened that it seemed possible that politics could be part of my life again, I'd have a look at it. But right now, that door doesn't seem to be open. So, I'm going to keep doing what I'm enjoying at Queen's University.

MG: And you're optimistic about that work? Again, that seems to run through this book. That when we hear about six and a half, seven million people without a family doctor, it seems like one of those too big to solve problems. It's not to you.

DR. JANE PHILPOTT: It's not because I've seen other countries do it. It's not that I'm just imagining this. There is hard evidence that it works, that there are several other countries in the world that do better than we do. And let's do it together. I really want the book to give people that hope, that belief that there is a solution. And as people come together and we build that national vision, that it will build the political will to deliver.

MG: I'm really glad to talk to you about this. Thank you for coming in.

DR. JANE PHILPOTT: Thank you so much for having me.

SO: Dr. Jane Philpott is a former federal health minister. She's now dean of the Faculty of Health Sciences and director of the School of Medicine at Queen's University. Her book is called Health For All: A Doctor's Prescription for a Healthier Canada. Matt Galloway spoke with her in April. That's our program for this Labour Day. Stay tuned to radio one for Q.

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SO: Coming up tomorrow, Matt Galloway will be back. He's on the road this week travelling across the east coast. First stop is Charlottetown. Tune in for that tomorrow. I'm Susan Ormiston. Thanks for listening to The Current.

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