Tuesday, September 26, 2006

Smells like mean spirit - part deux.

The Globe and Mail today ran a story detailing Finance Minister Jim Flaherty's $2B in budget cuts the Conservatives intend to go ahead with even in light of a $13B budget surplus. Now I am all for cutting redundant, wastefull on ineffective programs - but let's have a look at some of the cuts.

  • $50-million: unused funding for NW Territories devolution.
    Sounds reasonable.

  • $4-million: medical-marijuana science funding
    meh - IMO this program has more to do with a vocal advocacy agenda than with meeting a health need with the most effective medical intervention

  • $78.8-million: End to program that gave GST rebates to tourists
    I guess there are not a lot of tourists in Alberta. I know in BC the Cruise Ship industry is facing fierce competition from American ports and has already been hurt by the surging Canadian dollar. This is certainly not going to help.

  • $11.7-million: Removal of unused funds for mountain pine beetle initiative
    I guess I would start with why are there "unused" funds in any program to combat an infestation that some project could wipe out most of BC's pine forests. This scourge is already spreading into the northern boreal pine forests and steadily moving into Alberta. Given that the seriousness of this problem and that in the Conservative's 2006 fiscal plan they promised an additional $500 million in funding to programs to combat pine beetle infestation, I am baffled as to why they are now cutting "unused" funding from this program. Clearly the Conservatives have no appeal to urban Canadians outside of Calgary and Edmonton - but are they abandoning rural British Columbians too?

  • $46.8-million: Smaller cabinet announced in February

  • $45-million: "Efficiencies" in Canada Mortgage and Housing Corporation

  • $4.25-million: Consolidation of foreign missions

  • $13.9-million: Cancellation of National Defence High-Frequency Surface Wave Radar Project
    Okay - this one makes no sense at all. When small leaky boats laden with Chinese refugees were appearing off the coast of BC several years back, the Conservatives were screaming about our permissive refugee evaluation programs that allowed these people to stay in Canada while their status was adjudicated. In the post 9-11 world, we are spending millions if not billions on beefing up security at airports, ports, borders, etc. Every year or so we are embarrased by foreign fishing vessels flaunting our econmic exclusion zone (EEZ) and illegally stripping our coastal waters of fish. So why are we cancelling a promising program that is already deployed in Newfoundland and Nova Scotia that if fully deployed could detect and track small ships approaching our coasts while they are still outside our EEZ?

  • $6.5-million: Elimination of funding for the Centre for Research and Information on Canada

  • $4.6-million: Cuts to museum assistance
    Conservatives don't think much of arts or culture

  • $5-million: Administrative reductions to Status of Women Canada
    or women.

  • $6-million: Operational efficiencies at the Canada Firearms Centre
    We knew this was coming but interesting timing.

  • $4.2-million: Cuts to Law Commission of Canada
  • $15-million Elimination of residual funding for softwood-lumber trade litigation
  • $4.6-million: Elimination of the RCMP drug-impaired-driving program's training budget
    meh, meh and meh

  • $5.6-million: Elimination of Court Challenges Program
    Conservatives have never liked this program, but most fail to understand why with a relatively young constitution it is important to have key test case issues litigated before the Supreme Court to establish a body of Canadian constitutional law.

Tuesday, September 19, 2006

Bad Rae Day

Bob Rae was interviewed on CKNW news talk radio in Vancouver the other day. I was driving, and missed the first part of the interview, but I think he really missed an opportunity to clearly communicate a progressive, but sensible policy on drug addiction and drug abuse. To be fair, he hit one some of the major themes - that drug addiction is a healthcare problem and needs to be addressed as such, through mental health and public health programs rather than solely treating it as a crime.

When asked if he would support a supervised safe injection site in the Greater Toronto Area, Rae was very quick to respond with an "absolutely yes". He went on to mention that "war on drugs" approach followed south of the border has not worked, and that drug use should be decriminalized. In my view his response at best missed the mark, and at worst, is vulnerable to the "soft on crime" messaging that plays so well with conservatives.

InSite is not about decriminalization. Let me be clear. Use of scheduled drugs is still illegal in Vancouver. InSite has an Ministerial Exemption under Section 56 of the Controlled Drugs and Substances Act that allows the administration of scheduled drugs for scientific and research purposes. These drugs are not decriminalized nor is production, sales or distribution of drugs decriminalized.

More importantly, InSite does not operate as an isolated program divorced from other healthcare and social services programs. Supervised injection, is one instance of a fairly broad harm reduction program (others include needle exchange programs, distribution of bleach kits, condoms, and education on transmission of infectious diseases, etc.) in Vancouver, that is a component of the City's "Four Pillars" approach to reducing drug related crime and harm in the city. Harm reduction is one pillar, the other three pillars are treatment, prevention and law enforcement.

The important messaging about InSite is not decriminalization. In fact, law enforcement is one of the four pillars. While many Canadians might support decriminalization of marijuana, I doubt that many would support the decriminalization of heroine, methamphetamine, barbituates, cocaine, etc. Safe injection is about harm reduction not decriminalization.

The progressive response to the question "would you support a safe injection site in Toronto" should be:
Supervised, safe injection as a method of harm reduction can be an effective component in the reduction of drug addiction, crime and the associated social and public health problems if it is combined with treatment, prevention and law enforcement. Outside of an integrated approach such as Vancouver's "Four Pillars" approach, an isolated safe injection site in Toronto is not advised.

Friday, September 08, 2006

What are we doing in Afghanistan?

I support our mission in Afghanistan, at least for now. I question if it is being planned and executed effectively.

Canada has proudly led the NATO mission in Afghanistan from its inception. The conditions that existed three years ago which compelled our government to commit Canadian troops and aid to this struggling nation by all accounts have not improved measurably. While I am too lazy to look up the official objectives of the UN stabilization force in Afghanistan and the specific objectives of the Canadian contingent, they probably include stabilizing the fedgling democracy, suppressing the insurgent forces of the Taliban, training the Afghan army and providing reconstruction aid to the nation.

Unfortunately, most of these objectives are only articulated at the beginning of each new deployment of our armed forces to the region. As each new wave of soldiers embarcs for Afghanistan, the military and civilian leadership and television talking heads provide the obligatory speeches about winning the hearts and minds of Afghans, rebuilding schools and generally improving the every day living conditions of the "ordinary" Afghans. However within days, all we hear about are the military operations - each with its "code name", the predictions of impending victory against the "enemy" and the inevitible casualty reports. When was the last time you heard a news story on reconstruction?

There are two possible explanations for this. Either the reconstruction efforts are proceeding all the while, they just are not exciting enough to attract the attention of the "liberal" press, or within weeks, the sole focus of each new contingent of soldiers becomes the counter-insurgency effort. While there are those who will argue each of these viewpoints, several things are becomming apparent. If military convoys in armoured vehicals can not safely traverse many of the nation's rural roads except with air support, it appears the counter-insurgency mission is at best making extremely slow progress against an embedded, organic insurgency. The Afghan government is little more than a mirage in many vast regions of the country, and the Afghan army is invisible in the field. The poppy economy is still the primary source of income for many rural Afghans. Where efforts to eradicate poppy fields have succeeded, a sustainable replacement has not been found or taken hold. It appears that outside of a few isolated urban centres, the lives of most Arghanis have not been measureably improved after 3 years.

This leaves me asking several questions. These are not rhetorical, but I have no easy answers.

Have we made the right committment to Afghanistan? Clearly you can't provide aid or reconstruction without security, but it appears that our presence in Afghanistan is primariliy military focused (or maybe that is all we hear about). Is the perfect modern soldier anything more or less than a highly professional, disciplined, efficient, human killing machine? I don't say this to denigrate our soldiers, they are among the best all volunteer professional forces in the world, but a rifle is a weapon not a tool.

Should the mission continue if there is little or no hope of acheiving our objectives? I find it difficult to even describe let alone predict what an acceptible outcome would look like. But if, recognizing that our efforts may be futile, we pull out, are we willing to accept the inevitibility of a failed state from which terrorist attacks will once again be planned and executed? Another grizzly alternative is that the "civilized world", what ever that is, may have to indefinitely administer Afghanistan and continually repress the extreme elements that nurture terrorism.

At any rate, our mission in Afghanistan must be continually examined and debated without the proponents of debate being labelled as terrorist lovers or lunatics. The human costs of our mission, on both sides, are too high to continue doggedly down the same track without debate.

Insight on InSite

First of all, I would like to give Health Minister Tony Clement some half hearted applause for his half hearted decision to extend for one year the exemption under Section 56 of the Controlled Drugs and Substances Act for the Vancouver INSITE safe injection site. Maybe I’ll just use one hand. Did you hear that?

For weeks, the Stephen Harper and Tony Clement have been coy on the future of Vancouver’s innovative but controversial experiment in harm reduction as a component of a a “Four Pillars” approach to reducing illicit drug abuse and drug related crime in the downtown core. Under mounting pressure from the current and three former Vancouver mayors, the Premier of BC, the entire population and public health professional and academic communities, the entire Vancouver social services community, Vancouver’s chief of police, virtually all of the public sector unions, national and international HIV/AIDS and epidemiology experts … virtually every expert in the fields of public policy, healthcare, social services, public health, epidemiology and substance abuse, Harper punted, renewing the exemption and funding for the site for one more year, when researchers have asked for three more years to complete the ongoing research.

Given the fact that virtually everyone who knows anything about the related fields has spoken out in support of the site, why did Harper wait until the 11th hour and then only renew the site’s license for one additional year? It is probably due to the fact that people who live in Canada’s urban centres are not Harper’s constituents. The Conservatives did not elect a single MP in a major urban centre outside of Calgary and Edmonton. So while Harpers constituents don’t have to deal with the impact of drug abuse, overdoses, the spread of infectious diseases and the related prostitution and property crime that result from drug addiction, his constituents DO have strong opinions on so called “vices” such as drug use and prostitution. For the most part their opinions could be distilled down to “throw them all in jail”. Publicly, Harper has said that the deliberation was needed to review the research. The evidence on the results of the site is pretty clear. More likely, Harper needed to assess the political impact of doing the right thing. Harper needs to appeal to his base – suburban and rural conservative. To do so he has to come across as tough on crime, regardless of whether or not his policies result in a dozens junkies and prostitutes dying or the spread of HIV and Hepatitis B. Inner city junkies and prostitutes probably don’t vote conservative.

The research on INSITE is pretty clear. It was publicly funded under grants from the Canadian Institutes for Health Research (CIHR), has been peer reviewed and published in some of the most respected and rigorous academic journals including The New England Journal of Medicine, the British Medical Journal and the Canadian Medical Association Journal. This represents the platinum standard in academic research. For a review of the results, please look here. But this is not clear enough for Mr. Harper. We have heard musings of needed more independent and arms length research.In fact, this is exactly what (heard on CKNW radio in Vancouver) the head of the BC RCMP (the only law enforcement agency that does not support the site) has said. More independent and arms length research? What he really means is that the Fraser Institute (whose work is neither peer reviewed or subject to independent editorial review) or some other third rate, right wing propaganda machine has not weighed in yet.

To be honest, I was initially sceptical about the INSITE program. On the surface it seems to be enabling drug use. But to really understand the safe injection site, you have to view it in the context in which it was designed. It is only one component, in a comprehensive “Four Pillars” approach to reducing drug related problems in Vancouver. Outside of such a comprehensive approach, I probably wouldn’t support it. Vancouver has been at the forefront of including harm reduction - reducing the spread of deadly communicable diseases, preventing drug overdose deaths, increasing substance users' contact with health care services and drug treatment programs, and reducing consumption of drugs in the street into its policies around drug prevention. The other three pillars are Prevention, Treatment and Enforcement. For more information on Vancouver’s Four Pillars program, look here.

But all of this information was available to Stephen Harper before the last election when he said he was “not committed” to the InSite program and would be opposed to using tax payers money to fund it. So rather than allowing the best scientific evidence direct his government’s policies on drug abuse, Mr. Harper seems to be falling back on the failed “war on drugs” policies of the 1980’s and 1990’s.