"I've been here for five hours," a patient shouted at the end of my shift and they were not alone. Working in an emergency room, I see the individuals behind the overcrowding statistics and the conditions to which patients and healthcare providers are subjected -- long waits, being short staffed, assessing and treating patients in the waiting room, admitting people to a hallway. I recently saw someone with a bleed in their brain who left the hospital because they couldn't stand having to sleep in the hallway. Last week a man died in an E.R. waiting room in Montreal, while Alberta, E.R. doctors are also sounding the alarm.
Ten years ago, the Canadian Association of Emergency Physicians identified E.R. overcrowding as "a national problem" and "a chronic state in many departments." They diagnosed this as symptom of the broader healthcare system: "increased waiting times for transfer to an inpatient bed has become the most important cause of Emergency Department overcrowding. Over the past five years, hospital beds in Canada have been reduced by almost 40 per cent nationally." According to the Canadian Health Coalition, there were 64,000 hospital bed cuts between 1988 and 2002 and this has not visibly changed for the better since then. This is not because healthcare is unsustainable but because it is underfunded, at both federal and provincial levels.
Where's the bailout for healthcare?
What's more frustrating is that this unacceptable situation persists despite available resources. Prime Minister Stephen Harper did not create this situation, but he (along with provincial governments) is choosing to ignore it. Instead of spending $1 billion on health, he spent it on the biggest mass arrest in Canadian history. Instead of building much needed hospitals, he is spending $9 billion to build prisons, despite a falling crime rate, and $18 billion to build fighter jets when most Canadians are opposed to the war. Instead of bailout out healthcare, he is bailing out corporations with $47 billion in corporate tax cuts.
E.R. overcrowding from underfunding is the most visible way in which the government is neglecting our health. But in a broader sense, patterns have emerged over the years of a government agenda that does not just ignore health, but actively undermines it. In the field of health, H.A.R.P.E.R. has come to stand for:
Humanitarian aid politicization
The Harper government has repeatedly undermined health in Palestine -- making Canada the first to cut humanitarian aid to the Palestinian Authority, the first to cut funding to UNRWA that provides healthcare to refugee camps, and the first to criminalize George Galloway for delivering ambulances, food, and medicine, to the people of Gaza. It's no wonder this bias cost Canada a UN Security Council seat for the first time. In addition, the government militarized aid to Haiti, while practically ignoring the catastrophic floods in Pakistan. The cost of G20 security could have twice covered the $460 million that the UN requested -- and has still not received -- for health security in Pakistan.
While 25 million people have died of AIDS worldwide and 40 million live with HIV, Harper refused to attend the 2006 International AIDS Conference in Toronto, preferring to tour military bases in the arctic. As UN envoy Stephen Lewis said at the time:
"In a very real way, it's a slap in the face to the international community of activists and scientists and researchers and advocates and agencies all gathered to deal with the single greatest problem on the planet... it's just profoundly inappropriate and I think it's a measure of the government's commitment to (fighting) the disease."
This year, Harper renewed this inappropriate commitment by quietly joining others in underfunding the Global Fund to Fight AIDS, TB and malaria. As Dr. Jennifer Cohn, MSF HIV/AIDS Policy Advisor said a few weeks ago:
"Today marks a sad turning point in the fight against AIDS, TB, and malaria: world leaders have officially under-financed the Global Fund. This decision will result in the death of millions of people from otherwise treatable diseases."
The cost of new fighter jets -- built to destroy life -- could cover twice over the $8 billion shortfall required to save lives.
Reproductive health prejudice
Conservative MPs introduced two anti-choice bills in 2006 and one in 2008. This year the Harper government is imposing its anti-choice agenda on women in the developing world with a "maternal health plan" that specifically excludes abortion services. According to the Lancet, one the world's leading medical journals:
"This omission is no accident but a conscious decision by Canada's Conservative government not to support groups that undertake abortions in developing countries. This stance must change. Seventy thousand women die from unsafe abortions worldwide every year... Canada and the other G8 nations could show real leadership with a final maternal health plan that is based on sound scientific evidence and not prejudice."
The Harper government has been complicit in traumatizing detentions of Canadians: delaying repatriation, not apologizing for torture, and maintaining "security certificates." The government has also been complicit in abuses overseas -- transferring Afghan detainees to torture and deporting Iraq War resisters to jail for refusing to participate in war crimes. Harper justifies these policies by claiming to support our troops, but he has silenced those advocating for their healthcare -- from Veterans' Ombudsman Col. Strogan, to veteran advocate Capt. Sean Bruyea -- while ignoring military families who oppose the extension of the mission.
While climate change leads to 300,000 deaths a year, Harper abandoned Canada's Kyoto obligations and has supported tar sands that lead to global pollution and local cancer epidemics for First Nations communities. When Greenpeace dropped banners on Parliament to raise awareness of the health impact of climate change, the government responded by arming Parliamentary guards with machine guns.
The Harper government is trying to criminalize those fleeing war crimes. It issued Operational Bulletin 202 to criminalize U.S. Iraq War resisters, which the former chair of Canada's Immigration and Refugee Board Peter Showler described as "fundamentally wrong-headed and a violation of the UN Refugee Convention." The government claims war resisters interfere with other refugees, but last year Harper was silent over the genocide against Tamils and this year has tried to criminalize the resulting refugees who fled the chaos in their homeland. The Canadian Council for refugees has responded by stressing that "people who are forced to flee for their lives need to be offered asylum and a warm welcome, not punished."
Prescription for health
Fortunately, Canadians are rejecting this bad medicine: campaigning for Medicare and the redirection of military spending, organizing an aid boat to Gaza, exposing Harper's prejudice concerning abortion and AIDS funding, demanding the repatriation of Omar Khadr and an end to security certificates, mobilizing to support the troops by bringing them home and taking care of their health, demanding sanctuary for war resisters, organizing to stop the tar sands, and opposing the criminalization of refugees. This is truly a prescription for health. As I share patient frustration trying to provide individual healthcare in an overcrowded E.R., I'm comforted by all the work others are doing outside the hospital to protect and strengthen our collective health.
Dr. J is an Ontario-based emergency physician. You can read his blog here.