Life in Canada

Canada ranks last among 11 OECD countries in a new survey in terms of how quickly people can get in to see their regular family physicians, showing "where a person lives does matter," says the Health Council of Canada. In Nova Scotia we do not have a health "Bill of Rights" we are really poorly served.

The finding was published in the council's final bulletin, based on data from the 2013 Commonwealth Fund International Health Policy Survey of the General Public.

The council, an independent national agency, has been reporting on health-care renewal since its creation in 2003.

The report, titled "Where You Live Matters: Canadian views on health care quality," focuses on differences across the provinces, comparisons among the 11 OECD countries that took part in the survey between March and June 2013, and changes in Canada’s performance over the past decade.

Hypochondriacs, not wait times ruining Canadian health care, say many CBCNews.ca readers

"What we find is that Canada is really not keeping pace with a lot of these other countries," Mark Dobrow, the group's director of analysis and reporting, said in an interview.

"The highest performing province might be looking pretty good in Canada, but be the worst performing if you compared it to all the other countries in the survey."

More than a third of Canadians in a new report said their regular doctor did not seem informed about care they had received in the emergency department, a finding that has not improved since 2004. (Paul Chiasson/Canadian Press)

For example, 50 per cent of respondents in Ontario said that on the whole, the health-care system works pretty well, compared with 23 per cent in Quebec.

The report notes that improvement in reducing wait times has been modest and is often lacking, and concerns Canadians. Only 31 to 46 per cent of Canadians, depending on the province, could get an appointment the same day or the next day, not including emergency department visits.

Since patients who don't have a primary care provider go to the emergency department, the two waits are related, Dobrow said.

Brantford, Ont., resident Richard Kinsella said he had trouble finding a family doctor when he moved to the city east of Hamilton 15 months ago. Kinsella said people in Brantford commonly turn to the emergency department.

"The emergency, I've been twice, and I was there waiting over six hours."
Dr. Nandini Sathi

Family physician Dr. Nandini Sathi's practice is now able to see more patients within 48 hours of when they call. (CBC)

People in the U.S. have quicker access to their family doctors, with 48 per cent of those polled saying they could get a same-day or next-day appointment, ranking second last among the 11 countries.

Germany was listed as first in how quickly residents saw their doctors, at 76 per cent, followed by New Zealand at 72 per cent.
Many Canadians don't have a regular doctor

Dobrow said the report raises important questions about the wide variations among provinces in areas such as access to after-hours care, emergency department wait times, affordability of care, co-ordination among care providers, and uptake of screening programs.

"Do we have the rights goals for our system? Are we looking at better health, better care, better value for all Canadians?" he said.

In September, the council suggested that provinces pay attention to issues such as leadership, having the right types of policies, and legislation and capacity building. For example, overall resources in primary care could be increased by expanding scopes of practice of some health professionals and improving their interdisciplinary training.

At Toronto's Wellpoint Clinic, the physicians changed to an "open access" system, meaning patients no longer make appointments weeks in advance. Exceptions include people who need to prebook wheelchair transit services or a physical checkup.

"As physicians, we were worried that we would become inundated with patients on a daily basis," said family physician Dr. Nandini Sathi. "In fact, what's happened it's opened up a little bit more time throughout the day for patients who need to be seen."

Previously, a non-urgent patient may have had to wait up to 10 days or sometimes longer if a doctor was on vacation. "Now it really is 48 hours," Sathi said. More urgent care slots are also available.

The other findings in the report include:

Between three per cent and 15 per cent of Canadians, depending on the province, do not have a regular doctor or clinic.
Accessing medical care after hours without resorting to emergency care is difficult for 62 per cent of Canadians, ranging from 56 per cent in B.C. to 76 per cent in Newfoundland and Labrador. In contrast, the U.K. cut its problem in half over the same time period.
61 per cent of Canadians rate their health as very good or excellent.
36 per cent of Canadians take two or more prescription drugs, among the highest use of prescription drugs of the 11 countries surveyed.
21 per cent of Canadians skipped dental care in the past year due to cost.
37 per cent of Canadians said their regular doctor did not seem informed about care they had received in the emergency department, a finding that has not improved since 2004.
20 per cent of Canadians hospitalized overnight left without written instructions about what they should do and what symptoms to watch for at home.
Between 23 per cent and 49 per cent of Canadians age 50 or older have never had a test to screen for bowel or colon cancer.

"We still use hospital emergency departments for too much of our primary care. And we show largely disappointing performance compared to other high-income countries, some of which have made impressive progress," the report’s authors concluded.

Commenting on the findings, Health Minister Rona Ambrose's office said, "Our government is delivering the tools the provinces and territories need to deliver health care in their jurisdictions," and reduce health wait times.

The other countries included in the survey are: Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom and United States.

HALIFAX -- Nova Scotia's bridges are corroding and crumbling to the point where 391 of those inspected were listed as having serious damage including missing concrete, says a provincial database.

Chief highway engineer Bruce Fitzner says the decline of bridges has reached the point where the government might consider closing smaller crossings that aren't frequently used.

Using the freedom-of-information law, The Canadian Press obtained 3,021 inspection reports done on bridges in 2012, the last year where records are complete. It is sad that a law has to be used to get such critical information and shows that authorities just do no care about the public they serve.

An analysis of the data from those reports, shows 13 per cent of the bridges inspected were in poor or worse shape. The database is based on preliminary and advanced inspections of the bridges.

Bridges in poor condition were those that had advanced section loss, pieces of concrete falling off and structure that was worn away by water and sediment, the database says. Those considered in serious shape -- a worse ranking than poor -- had various forms of erosion and crumbling that affected primary structural components.

Fitzner said smaller bridges could be closed by the Transportation Department.

"We talk about the long-term deficit. It has to be addressed at some point or infrastructure comes out of service," he said in an interview.

"It's a huge challenge."

The percentage of bridges in poor or worse condition grew gradually from just under 11 per cent in 2010, while those listed in good or better shape fell from 54.6 per cent to 53.3 per cent over three years, the database says.

Just under half of the province's 4,310 bridges are more than 50 years old, Fitzner said.

He said the bridges remain safe, in part because when they are too deteriorated they are either closed or a new maximum weight is posted. Fifty-three bridges are on a five-year replacement or repair list, he added.

The database does not say how many bridges have been closed.

Fitzner said tight budgets mean many of those listed as poor or worse will have to wait for repairs as the province's salty air takes its toll.

"You start losing the metal to oxidation," he said. "If you have a very rigorous painting program you keep that section loss from happening, and in a lot of cases we aren't doing that as much as we should be doing it."

Partial results released for last year show that 3,950 bridge inspection reports were done, but 527 of those are incomplete, the database says. Of those that are complete, 344 were ranked poor or worse.

The problems detected affect all sorts of bridges, from those in tiny, out-of-the way areas to busy overpasses in Halifax.

The Prospect Road Overpass on the outskirts of the city was listed in serious condition. Damage to the bridge includes the loss of structure in its steel girders, the main horizontal supports.

Inspection reports in 2012 and 2013 for that overpass also say the bridge bearings, which are sandwiched between beams and the foundations, were deteriorating to the point where pieces had broken off.

The bridge is on schedule for repairs in four years, and there are quarterly inspections to ensure it doesn't deteriorate further.

Highway 7, located along the province's windy and scenic Eastern Shore, has a dozen bridges that were in poor or serious condition, the database says.

"Timber abutments are rotten," says an inspection report dated Aug. 14, 2012, on the Gaetz Brook Bridge, one of the bridges cited along that stretch of road. The Spry Bay Bridge, east of the Gaetz Brook Bridge, was found to have "severe widespread crushing of abutment and pier members" in an inspection report dated April 3, 2012.

"All of them are deteriorating at roughly the same rate and they're all coming up due for a major rehabilitation or replacement," Will Crocker, the province's chief bridge engineer, said in an interview.

On the Trans-Canada Highway between Halifax and Truro, an overpass at Nine Mile River is listed as having "heavy pitting and section loss on girders," with a note saying, "superstructure needs repairs."

Crocker said the Transportation Department will keep monitoring the bridges and, in some cases, the work will be timed to coincide with highway upgrades.

In some counties, inspectors occasionally add handwritten notes on the state of decline of the bridges, many of them small and on quiet roads.

"Bad shape," an inspector says about the Campbell Meadow Bridge in Kings County. "On the project list for last two or three years!"

In Cape Breton, the Crowdis Bridge over the Margaree River was closed due to its deteriorated condition. After pressure from community leaders who were worried about being cut off from emergency services, the Transportation Department agreed to replace it.

However, Fitzner said such agreements to fix one bridge could mean communities have to accept that other small bridges can't remain open.

"We ultimately need to look at the amount of infrastructure we have," he said. "At some point in the future does it make sense to have three or four crossings over a river if one or two of them would suffice?"

Fitzner said the province is also hoping that Ottawa's $14-billion infrastructure program -- the Building Canada Fund in last year's budget -- will add to budgets for roads and bridges.

In the meantime, he estimates the province is about $100 million a year short of what's needed to keep its highways and crossings in good condition.

"It's going to remain a challenge just because of the financial position of the province," he said.

I have real issues with the insanely thorough and ever-expanding spying being perpetrated against the average citizens of the world. Consider:

The NSA stores metadata from half a billion telephone calls, emails, and text messages in Germany alone every month.

In direct violation of the law, France has been revealed to have been intercepting and storing most of that nation’s internal Internet and phone communications for years. The NSA is said to have obtained over 70 million phone records on French citizens in a single 30 day period.

The “Fairview” program is being used by the NSA to spy on the communications of Brazilian citizens.

Direct access to monitor communications lines has been given to the British spy agency GCHQ (Government Communications Headquarters) by Verizon, Vodaphone, and BT.

The NSA has cracked numerous forms of encryption used by private citizens and is planting back doors into consumer products with the help of the tech industry, often through the use of malware and outright theft of keys.

Most major smartphones are now able to be tapped into by the NSA. These devices contain a world of information on many of us, from our personal correspondence to where we happen to be at any moment. We help make this form of surveillance possible because we want the convenience offered by this technology.

Google and Yahoo have had their unencrypted data center communications intercepted by the NSA, allowing almost full access to whatever these companies store in “the cloud” on our behalf.

I could go on; there are many more revelations, but the point has been made. Everyone is affected at some point. And everyone should feel violated.

While we share in the outrage, we don’t share in the surprise.