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The Current Transcript for November 4, 2022

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

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SOUNDCLIP

Everyone deserves a family doctor, and this new option is a significant step to help make that goal a reality.

MATT GALLOWAY: 6 million Canadians who want a family doctor can't get one. The impact of that can be seen coast to coast to coast in jammed emergency departments. Now, B.C. thinks it has the answer. In 30 minutes, British Columbia's Health Minister, Adrian Dix, on paying family doctors more. And where exactly those new doctors might come from. Also this morning, COP 27, the next U.N. conference on the climate emergency kicks off this weekend in Egypt. It's been called the African cop. And African climate activists are coming with big expectations.

SOUNDCLIP

I have seen with my own eyes three young children crying at the side of a dried up river after walking 12 miles with their mother to find water.

MG: In an hour, the demands of the Global South from two young people who've lived through the impacts of climate change and why that next generation won't take no for an answer. We start, though, with the finance minister and her path through the tough economic times ahead. Good morning. I'm Matt Galloway and this is The Current.

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Finance Minister Chrystia Freeland on the rising cost of living and Canada’s economic outlook

Guests: Chrystia Freeland, Sahir Khan

MG: Well, most Canadians probably don't need an economic statement from Ottawa to tell them what they already know. Just about everything from gas to rent to food is less affordable. And a possible recession is looming. Yesterday, we got a taste of what the federal government does and doesn't plan to do about it. The finance minister, Chrystia Freeland, delivered her fall economic update to parliament and she joins us now. Minister, good morning.

CHRYSTIA FREELAND: Good morning, Matt.

MG: Let's start here. Food banks Canada says there has been a 35% increase in the number of visits to food banks in this country since March of 2019. Of course, that was before the pandemic. You pledged yesterday to make student loans interest free and rejig the Canada workers benefit so recipients will get their payments sooner. If you take a look at that use of food banks, people unable to put food on the table without some assistance. Do you think that what you are offering is enough to help the broad sections of the public who are struggling to buy groceries?

CHRYSTIA FREELAND: I think that is a great question and that is something that I think about and wrestle with every single day. And actually, my church in Toronto, around the corner from my house, has a food bank that the church sponsors every Wednesday. And I've what I'm not- I'm in Ottawa right now. I'm not in Toronto that many Wednesdays, but the times that I've been home, I've just seen that the lines are longer. And, you know, our friends who go to church, the congregation who work at the food bank, have talked to us, to me and my husband and our kids about how more people are there. So I'm just at just a personal level on my street, very aware of that and very worried and we all should be. There are concrete measures in the fall economic statement that I delivered yesterday to help precisely those people. Probably the best news is that our GST tax credit, which we are doubling, I announced yesterday. Those checks are arriving today. For a family, that's nearly $500. And Matt, if you say to me, well, that's not enough to fix everything, I will agree with you, $500 is not enough to pay for everything. But for those families you're talking about that are struggling, $500 is going to make a real difference. So is the $500 top up for people who are struggling to pay their rent? We're working really hard to get that through parliament. So is paying for dental care for kids 12 and under, and that's going to make a difference for families, too, because I think in a lot of lower income families, what happens is parents do take their kid to the dentist because you're not going to let you know, have your kid have a cavity, have the tooth fall out because you're not taking them to the dentist. But if you don't have dental coverage, that's 650 bucks has to come out of your rent or paying your groceries. You won't have to do that.

MG: Let me go back to the groceries.

CHRYSTIA FREELAND: We'll help there, Matt. And it's important.

MG: Let me go back to the grocery issue because again, this is- people face this on a daily basis. And one of the reasons why people are going to food banks is because they can't afford the food that is on the store shelves, Statcan said. The groceries are something like 11.4% more expensive than a year ago. There was a report from Dalhousie University that said that Loblaw made $1,000,000 a day in what they call excess profits in 2022. Do you think the grocery store chains are unduly profiting?

CHRYSTIA FREELAND: So I had a meeting very recently as we were putting together the fall economic statement together with my colleagues, the Minister of Industry, Francois-Philippe Champagne with the Canadian Retail Council, specifically to talk about this and to really make clear to them how important it is to our government that retailers step up and ensure that things are affordable for Canadians.

MG: Do you think those retailers are taking advantage?

CHRYSTIA FREELAND: Well, there are a couple of specific measures that we took yesterday that should help. One is action on credit cards. Credit card fees impose a real burden on small businesses and credit card fees if those are passed on to consumers, impose a real burden on consumers. What we've said is we have published draught legislation. The federal government has never done this before, saying we are going to legislate to bring those fees down unless in the next couple of months there is a deal to. Bring them down because Canadians really can't afford to pay that premium. And then the second thing we've done is introduce again for the first time a tax on share buybacks. And what we're saying to big companies, you know, including grocers, is, you know what, guys, if you have enough profits to buy back shares, we really think it would be a better idea for you to be investing in your workers, investing in bringing prices down once you [unintelligible] the money to do that.

MG: Do you think they have those profits because they're taking advantage of inflation to make more money?

CHRYSTIA FREELAND: Well, what I'm saying is let's create incentives through the tax system to encourage companies to do what I think we all want them to do, which is to be investing in bringing prices down, investing in supporting their workers more, investing in making their companies better. Better at delivering for us. That's what we need. And I really believe, you know, the tax system can be a very effective tool to encourage the right kind of behaviour from Canadian companies. That's what we've done again for the first time in Canadian history in the fall economic statement yesterday.

MG: I'll ask it again just because I think it's important, because people see the price increase. They know that they're paying a lot more and they wonder whether they're being squeezed unduly. So do you think those grocery store chains are unduly profiting in this moment?

CHRYSTIA FREELAND: What I think is and what Francois Phillipe and I said to the Council of Canadian Retailers was, we all want to see we all need to see the lowest possible prices for Canadian consumers because things are really, really tough. The government is doing what it can to support people, and we do want to see retailers doing everything they can to support Canadian consumers. And the other thing that I did say, which I really believe is we need to support hard working, essential workers at places like grocery stores, a game there. The government is doing its part with the Canada Workers Benefit, moving to an advance payment system that is going to make a huge difference in the lives of our hardest working, worst paid, most essential workers. We're now going to get to 4.2 million Canadians covered. That's one in five working Canadians. That is a really important measure. And I think the employers of Canada's low wage workers also need to do their part to support them.

MG: What do you make of the fact that in Ontario there are something like 55,000 low paid workers in the education sector who had a contract rammed down their throats by the provincial government yesterday. They're going to be protesting today. There is going to be huge disruptions in the education system. What would you say to those workers?

CHRYSTIA FREELAND: Look, the prime minister has been very clear publicly and the prime minister was very clear in a conversation directly with the premier that the notwithstanding clause should not be used in this kind of flagrant, almost casual way that is really not appropriate. And it starts to really weaken the constitutional protections that are so important to Canadians when it comes to our public schools and the people who work there, especially the lowest paid people who work there. I have, you know, a very personal perspective as a mother, and I am just so grateful to the extremely hard working, extremely dedicated people who work in our schools and take care of our kids and teach them. They really matter. Their work matters. And I think they should be well paid for their work.

MG: Those low income workers are already feeling the squeeze and Pierre Polley of the Conservative leader has said that your government is making life for them, but for all Canadians more expensive. The Canada pension plan, employment insurance premiums are going to increase, as is the carbon tax at a time, as I say, when people are already feeling the pinch. Why not freeze those increases right now?

CHRYSTIA FREELAND: Well, look, you talked about three different programmes. Let me start with EI and CPP, and let me be really clear. Now is exactly not the time to vandalise those systems. Now is exactly not the time to complete contributions to those programmes which are an essential part of our social safety net. You know, the hard right always wants to cut, cut, cut. It wants to weaken, to eviscerate our social safety net. We will never do that. And, you know, Canadians are concerned right now about the economy. They're concerned about inflation. They're concerned about the slowing global economy. And I want Canadians to know that our government is totally committed to E.I. We are totally committed to the pension system, and we're not going to let anybody attack it and starve it of revenue. On the price on pollution here. You know, it's just really important to point out, as I know you know, Matt, that all the money goes back to Canadians. Eight out of ten Canadians get more money back than the price on pollution costs them. And, you know, if you live in Ontario and a family of four, you're getting 745 bucks. And I personally live in central Toronto. Our family doesn't have a car. We use the subway, we ride our bikes, we walk. And that is how a lot of Toronto families live. The price on pollution actually is helpful to people in Toronto across the country. A family in Saskatchewan. They're getting $1,000 back.

MG: The reality, though, is they'll be paying more in that immediate moment. And I guess the question is just about whether that will be squared with money that comes back to them down the road.

CHRYSTIA FREELAND: Well, actually, Matt, I think it is because those checks are now coming very, very regularly. You know, we're not talking about money coming to you ten years from now. That money the money is being returned in very regular payments into people's bank accounts or in the mail. It is a very fair system. It actually rewards lower income families the most because they are the ones who spend the least on own energy. And so, you know, the price on pollution really is not adding to the challenges that households are facing right now. And it's a very, very important measure when it comes to all of us acting on the climate, which, you know, I heard you talking about Corp at the beginning of the show. It's a really important, revenue neutral measure that actually supports lower income Canadian families the most.

MG: We're just, we're going to let you go. We have a few seconds left. One of the things that you said yesterday, and it comes at a time when people are really anxious, is you said that we will be fine. How can you be so sure, given the uncertainties in the world right now that we're going to be, in your words, fine.

CHRYSTIA FREELAND: You know, Matt, I meant it when I said it. I said that very intentionally. And I'm glad to have the chance to say again, Canada and Canadians are going to be fine. And the reason I have that confidence is we are entering this time of a challenging global economy from a position of fundamental strength. We've had a really strong recovery from the COVID recession. 400,000 more Canadians are working today than were before COVID hit. Our economy is 103% the size it was when COVID hit. This is not true for most of the other economies in the world, but we made investments during COVID. Canadians were so great and so resilient. So we're in a strong position today. And then on top of that, our federal government has been careful. We've been pursuing a compassionate set of policies. You and I talked about them a moment ago, but we've also been responsible in the budget in April, in the measures I announced yesterday, precisely because I know I need to keep my fiscal flair powder dry, because I need to know I have some reserves there so that I can say with confidence to Canadians, we are going to be fine come what may, in part because the government has the fiscal firepower to support you no matter what happens. We're going to do it.

MG: Chrystia Freeland, we'll leave it there. It's good to speak with you. Thank you very much.

CHRYSTIA FREELAND: Good to talk to you, too.

MG: Chrystia Freeland is Canada's deputy prime minister and the minister of finance. Sahir Khan has been listening and vice president of the Institute of Fiscal Studies and Democracy at the University of Ottawa. Also a former assistant parliamentary budget officer spent three years in the Privy Council office advising the Prime Minister on budget issues. Sahir. Good morning to you.

SAHIR KHAN: Good morning.

MG: How are you? I'm well. Is there anything in what you just heard that gives you confidence in where the economy for this country at a really difficult time is going?

SAHIR KHAN: Yeah, I don't disagree with the Minister's characterisation. I think there are external factors that are really driving inflation and the best thing the Federal Government can do is really not fight the Bank of Canada's monetary policy. So not to put too much money in the system and kind of fuel inflation. At the same time, focus on those that are really most vulnerable from the erosion of of of their purchasing power. So I think that is kind of that message came out really clearly in the fiscal statement. But I think that the next shoe to drop is going to be really the budget in the spring with, you know, this is a change in trajectory in some ways in the way this government has kind of spent money. It's usually had positive revenue surprises and usually spent most of it. They've kept some back here in this case. But the real test will be kind of how this balancing act kind of plays out in the budget in the spring, which is do they need to, you know, augment support for those who are really hurting? And how do they maintain the fiscal track if the economy continues to deteriorate?

MG: Spring feels like a long time away for people who can't afford groceries, who are lining up at those food banks right now. Is there enough that's been offered yesterday in the update that will help those who are immediately feeling the pinch?

SAHIR KHAN: Yeah, I think time will tell. These are very targeted measures and that money, you know, programme wise, it always takes time to get through to people. But I understand the GST checks are coming today. So I think the, the sense of urgency around getting relief to people is there. But also, you know, if we look at the economic statement that came out yesterday, the spending that happened between the last budget and the economic statement was was significant, almost $21 billion. So the government doesn't have to wait until the next budget to make a decision that it has to make adjustments. In fact, even an economic statement is about eight and a half billion. That's set aside for a provision that's really not explained very clearly in the statement that are probably measures, you know, we learnt from officials either measure likely going to be announced before the next budget. So there's room there slack kind of built into the statement that suggests that, you know, more could be cut.

MG: To that point, Chrystia Freeland just said will be fine. Part of that, I think, is framed in the idea that this could be a mild recession. If a recession at all. Is it going to be a mild recession, do you think?

SAHIR KHAN: Yeah, I think this is a time if you know the economic cycle, everybody kind of pulls out their crystal ball and we're all trying to think about what happens. And I think the John Kenneth Galbraith had had a line once, the famous professor and economist, you know, we don't do forecasts because we know we do them because we're asked. And the reality is a government and all the kind of banks and external analysts will try to create a planning environment. So the government, having put out a scenario of a downside forecast, is useful, it's transparent, it helps us understand what the risks are, but more importantly, it helps us understand where federal finances might go. And, you know, they go from a rather kind of positive track right now ahead of, you know, budget spending that kind of gets them to a, you know, a budgetary balance, which suggests that there's room at the downside scenario kind of manifests itself. So I think the minister's right there, they've kept some powder dry. The question is, we really don't know how deep the if a recession happens, how deep it goes, we don't know. And that's actually one of the cupboard lessons, right? Like this government really had to dig deep. The provinces didn't have a lot of fiscal capacity. The feds really had to dig deep. And now they're kind of digging out of that. And that's you know, it's a difficult transition for governments to make is not a quick one.

MG: And there are also and we only have a few seconds left, but they're also in in a political balancing act in terms of, you know, the NDP wanting to follow through on big ticket spending items in the Conservatives who are calling saying that they want to see deeper budget cuts.

SAHIR KHAN: Yeah. And so this statement seems to reflect that kind of balancing act like measures were very targeted. There looks to be an improving fiscal track. The government has, you know, kind of positive revenue, surprised, spent a lot of it, kept some of it in reserve. And it sounds like that kind of compromise between, you know, keeping progressive voters and the NDP supporting this government, but also maybe kind of stealing some of the thunder from the Conservatives in terms of, you know, some reallocation and some some prudence and caution in the way this fiscal statement kind of laid out.

MG: Rocky seas ahead. Sahir Khan, good to speak with you. Thank you very much.

SAHIR KHAN: My pleasure.

MG: Sahir Khan, vice president of the Institute of Fiscal Studies and Democracy at the University of Ottawa. You're CBC News is up next. And then patients one time with their physician, they want that time to have impact and they want their problem to be solved when they walk out that door. Patients in British Columbia stand to gain more face time with family doctors under a new payment plan. Those physicians will get a pay raise as well. How one province is rethinking health care. Could this lead to more family doctors for patients who've been looking for them? I'm Matt Galloway. This is the. We're back in six minutes. Stay with us.

New payment model aims to recruit and retain family doctors in B.C.

Guest: Adrian Dix, Dr. Rita McCraken

MG: Good morning. I'm Matt Galloway and you're listening to The Current.

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MG: Still to come, the U.N. climate conference gets underway this weekend in Egypt. We'll hear from two young African climate activists about what we can learn from their continent. But first to British Columbia, where primary health care is being reshaped.

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MG: Six million Canadians don't have a family doctor. One third of those people have been trying to find one for over a year now. Those numbers come from a recent study by the Angus Reid Institute. It looked at Canada's current health care crisis. British Columbia and Atlantic Canada are by far the worst off. One in five British Columbians doesn't have a family doctor, but wants one. The provincial government there is hoping a new plan will help. Adrian Dix is BC's Minister of Health. Minister Dix, good morning.

ADRIAN DIX: Good morning, Matt.

MG: Why is it that one in five British Columbians cannot find a family doctor?

ADRIAN DIX: Well, this has been going on over about 20 years. About 20 years ago, about 300,000 people didn't have a family doctor. And when I became Minister of Health in 2017, it was almost a million then. And in B.C. we have an ageing population and people have been moving to B.C. in very large numbers. A problem not all jurisdictions have. So in one year, even during the pandemic, we gained 100,000 people from outside B.C.. So these are significant challenges and I think the work of family doctors is changing and not reflected in our current model. So in B.C. we're very focussed on what's called a fee for service model and essentially we pay doctors piecemeal for each service that they provide. And so what we've done over the last number of months is work with our family doctors on a new payment model which focuses on the work they do with patients, deals with some of their issues around overhead business costs were increasing, and younger doctors didn't see themselves reflected in the fee for service model. So we sat down with the doctors of B.C. and we did a formula for paying doctors. It focussed on complexity of patients and reflected that different people have different levels of complexity and that's important and dealt with some significant compensation issues and focussed on patients.

MG: Just if you go back though to the promises that were made again in 2010, the previous government said that every British Columbia would have access to a family doctor in five years in 2018. The outgoing premier, John Horgan, said that this problem would be addressed. The problems only gotten worse. Why has it been so difficult for the province? And again, this goes across the country, but we're talking to you in British Columbia. Why has it been so difficult for the province to wrap its arms around this?

ADRIAN DIX: Well, prior to this, I think I just say this without being too partisan. But the previous government would engage in schemes that would be two or three years long and then abandoned. So what we have here is a permanent and fundamental response. We've focussed on a couple of things. One is team based care. So we've added about 1200 people, a lot of allied health professionals, a lot of nurses, a lot of nurse practitioners, because in the future it's going to also need a team of people to support a patient. If you have type one diabetes, having access to a dietician may be as important after diagnosis as having a family physician, at least them working together. So you want to build up team based care. We've added net 600 family doctors in the last five years, but many of them haven't been focussed on what I call full service family practise, which doctors call longitudinal care. Over time, they've looked at other work in the health care system. Part of what our deal or negotiated deal with doctors is is to equalise all of that so that we're saying to everybody, this is a priority and we need a new generation of doctors to address it.

MG: What's the cost of that being, do you think, on the health care system? Are you seeing the impact of this in emergency departments, for example, where people are having to go to ADR because they don't have a family doctor and that that is, you know, clogging up the system all the way down the line.

ADRIAN DIX: That there's more complexity to it than that. We've been dealing with two public health emergencies which radically changed primary care. In March 2020, I signed an order, along with others, to establish new fee codes for virtual care. So prior to March of 2021, 97% of our appointments were in-person appointments, 97% in the year. Following that, only 30% for in-person, which is a massive change right now, about 60-40. And I don't think you can separate this from what we're dealing with right now as a health care system, which is two and a half years of pandemic. What we're seeing is more serious cases in the hospital. What we're seeing as well in our ambulance calls are more what we call purple and red calls, which, you know, for the sake of your listeners are the most serious ambulance calls when you have to get to right now. You know, and so I think that reflects the overall impact of the pandemic, which has been profound on our health care system right now in our hospitals and in our health care system. We have about 15,000 people are sick. Typically, that's 8000-9000. In B.C. we focussed in our response on people staying home when they're sick and a lot of people have been dealing all throughout this year, especially this year of Omicron. So there are a number of factors facing our health care system and. We're responding to that by changing our surgical system, which has been profound and positive. We had more surgeries last month than in any other September in history while the pandemic is going on, changing our diagnostic system to shorten wait times. My point here is that it's not one answer, it's multiple answers.

MG: And so with this new plan to increase the number of family physicians, what's the main change in the way that doctors would be paid under this new plan?

ADRIAN DIX: Right now, we have a fee for service model. These are the exact numbers of that. If you're paid $30 a visit, you do 20 visits, you know, you get $600. Right. And there's no nuance as to complexity. That's a problem because you basically are setting up a business that's solely based on volume. Our new option means that payment is based on the time with patients, the direct patient care services, both some of the indirect services, for example, someone presents with mental health issues. Finding them and the right supports and services is itself time consuming clinical, administrative and teaching the number of patient visits, the number of patients that are served in the practise. And the goal for a full time position is a practise of 1250 and the medical complexity of that patient. So if all of your patients, for example, were older and had diabetes, the expectation would be less than 1250 because by definition, the time you spend with each patient would be more.

MG: This is going to mean a significant increase in pay for family physicians.

ADRIAN DIX: Yes. What our goal was was to equalise that pay, in fact, because family physicians have to pay business overhead with what we pay, family physicians say, who work in a hospital. So what had happened in B.C. because of the way the fee for service system worked and the increasing complexity of patients, is that the family physicians were doing significantly worse than other doctors doing the same work in other parts of the health care system. So our goal was to equalise that so as to not give the signal that we weren't giving priority to full service family practise, which we are, but also to ensure that new doctors choose full service family practise as opposed to doing other things.

MG: The headline was that doctors currently making somewhere around $250,000 could see their pay raise to about $385,000. That seems fair.

ADRIAN DIX: Well, that's not apples to apples. Exactly. So one is an average and the other is the full time rate. Right. So if you're a doctor who ends up working three days a week, then you wouldn't be making the 385. And those doctors are included in the 250, if you can see what that means. But you're absolutely right, there's a significant increase in compensation.

MG: How many doctors do you want to attract to family practise in British Columbia?

ADRIAN DIX: Well, we've added, as you say, net 600 doctors since I've been minister of health. We've got family doctors. That is from a base of about 6200 to 6800. About half of them in the 3 to 4000 range are working in full service family practise. We've got in B.C., 400 doctors, men who are working and who are over 70. So it's not just an issue of of adding, it's an issue of adding and replacing. So what we've done is we've added significant number of residency spaces and undergraduate placements at the UBC Medical School, 128, in fact, which is a very large increase, maybe the largest in history. We're adding a second medical school here as a few medical school, and we're improving pathways. We've already done this significantly for nurses. That's another story for another day, but also for doctors. And so all of these actions, we believe, will increase the supply. But you can increase the supply. We've done that and not address the primary care issue unless you address these issues that primary care and family practises doctors are facing. And that's why we've taken these actions as well in concert with our doctors. And I think one of the reasons it's going to succeed is that this was a true partnership in developing this model.

MG: I guess the question, though, is just where are those doctors going to come from in the short term to address the crisis that British Columbians are facing right now?

ADRIAN DIX: So what we did in advance of this agreement was two steps. One was to deal with overhead of existing doctors, and that had a take up that was massive, close to 100%. And we made a new arrangement because what we didn't want to do while we were discussing the new payment arrangements is lose a year of new family doctors. We have the largest family residency programme in the country. Typically what's what's called a new to practise contract. We do about 20 to 30 of those in a year. We changed the arrangements on those to attract people and it was proved effective. So far about 70 have signed on and another 60 are in negotiations. That's a significant improvement. And really what we did was offer something similar to what eventually was the agreement. So there's some reason for optimism. But this agreement is foundational. We have to do a number of other things in terms of supply, in terms of support, in terms of options for doctors who are at the end of their career to continue practising in different ways. And finally, we have to build up team based care. By the end of next year will have tripled the number of nurse practitioners. And this is another less well understood. Part of the agreement so far was is it increases the capacity for doctors and family practise, doctors and nurse practitioners to work together.

MG: You're looking at other parts of the country. I mean, there's already been rumblings that doctors in Alberta who might feel as though that is not the province for them may skip west.

ADRIAN DIX: I don't think so in general. This is a national problem and the solution is not going to be provinces fighting one another or offering different things. It's working together.

MG: Or various levels of the health care system, pulling doctors, for example, from the hospital system to go into family practise.

ADRIAN DIX: That's right. You need a holistic response. So we were I worked with other provincial health ministers all the time. We certainly did so under COVID, and we'll be doing that in this case. Health ministers, provincial health ministers meeting next week. And then there's a second day when the federal minister will come to meet with us. There are lots of issues, but I think the key in Canada is for provincial jurisdictions to work together and that's certainly our goal. It's not to get into some sort of a zero sum game against provinces because that won't help any of us.

MG: Two final quick questions. One is, is there an opportunity for this to be a new model for how jurisdictions look at attracting family physicians?

ADRIAN DIX: Well, perhaps and yes, but I would say that we've also built on what other provinces have done. Ontario in the past has made reforms in its primary care system. So we were about 78% of billings were fee for service last year. Ontario was only 46%. So I think provinces can learn from one another, and I hope that other provinces will learn from this model as well.

MG: For those British Columbians right now, the many, many, many thousands of them who are searching for a family doctor and finding frustration at the other end of that search, what can you tell them about how quickly you're hoping to see results?

ADRIAN DIX: I'm saying that we're doing the work that's necessary, that this is one step in that work, and we're going to be taking other steps as well. That, I think, is very important to be modest. We've gone through in B.C. and everywhere in the world, really an extraordinary two years for health care. I'm very proud of BC's health response to the COVID 19 pandemic. I think it was amongst the best in the world and we're going to keep working to ensure that they get access to the health care they need, based care in the community with family doctors at the centre of it, and that's what we're working to do. But I think there's a tendency in these moments to say, well, now that we've dealt with the problem, well, we haven't. We've got to continue to do it step by step. And that's my commitment to people that we're going to do.

MG: People will be watching. This is really important, and I'm glad to talk to you about it. Adrian Dix, thank you very much.

ADRIAN DIX: Hey, thank you so much, Matt.

MG: Adrian Dix is British Columbia's minister of health. Dr. Rita McCraken is a family physician in Vancouver, also assistant professor at UBC's Faculty of Medicine. Dr. McCracken, good morning to you.

DR. RITA MCCRAKEN: Good morning.

MG: Do you think the new plan laid out in your province will help the millions of people or close to a million people, I suppose, who are looking for a family physician there?

DR. RITA MCCRAKEN: Well, I think that this new plan is really bringing a ray of sunshine, particularly to the family doctors who are right now providing the type of service that people who live in British Columbia need for primary care. So that means that those people who are already lucky enough to be attached to a family doctor or have a relationship with a primary care clinic where they can go for, you know, life's regular health issues, both mental health, physical health and sometimes help in obtaining social needs like housing security and food security. So for those people who are already attached, this deal is really going to help their doctors be reinvigorated and stay in business. I think that we I'm less optimistic about how this particular new payment model is going to attach to those people who don't have a family doctor.

MG: Let me go back to the doctors perspective. Part of this in a huge part of this is about pay. Pay will increase. The pay model will change. What is that going to mean for doctors like yourself?

DR. RITA MCCRAKEN: You know, I think. People go into medicine because they're very interested in the idea of working with other human beings on improving their health. The large majority of people don't go in it to get rich. And so, you know, I think that if you were to ask any Canadian in any job, do you think you need a raise right now? I'm pretty sure that everybody would say yes. And so I think that, you know, family doctors are human beings. We are not heroes, actually. We are human beings. And in addition, as Minister Dix outlined, the last three years have been really, really challenging. People who work in health care are extremely exhausted. And so some extreme remuneration is coming at a nice time in order to feel a little bit more rewarded. And then the other big problem that we have with primary care all across Canada is that in general, our system is really rooted in what was established in 1962 when Medicare was first started by Tommy Douglas in Saskatchewan. You know, it ruled out over the next couple of decades to be supportive of primary care, but it has not really evolved very much the infrastructure of how we provide that care. And so this new payment model is the beginning of a nod to what we need to do to modernise primary care in order to ensure that everyone who lives in Canada has access.

MG: In the future. You said you also aren't convinced that this new model will give those British Columbians who are looking for a family doctor that that it resolution. In part, it's interesting because the minister has said that that change in the payment model could perhaps attract more people into family medicine. So why is that not going to lead to more people finding that family physician?

DR. RITA MCCRAKEN: Right. So a payment model for doctors is not a primary care system and that's the big problem. So imagine if we were to fund a public school system entirely by just paying teachers and saying to the teachers, hey, go set up your own school, buy your own equipment, get your own aid programme, manage your own staff, we'll pay you. And then we just want you to use your income to set up the schools. You can see immediately that we would have challenges with. Well, what if the right number of teachers didn't want to live in rural areas or in certain parts of urban areas? What if teachers were not including students who had some extra challenges around learning because they just had to look after everybody else so that that infrastructure of the school is currently lacking largely in British Columbia. Some other provinces, for example, Nova Scotia and Ontario have made some investment in that infrastructure for primary care, where governments are directly funding the clinics and then the physician remuneration. The pay that the doctors get is a separate deal.

MG: Because they so clinic they don't work for themselves.

DR. RITA MCCRAKEN: You know, the physicians will still be perceived as independent contractors. But the clinic hires the physician and they bring their payment with them.

MG: Right. Okay.

DR. RITA MCCRAKEN: It's similar in, you know, in B.C. here, the teachers just initiated a new deal. So it's not each school negotiating the deal for the teachers, but each school is hiring the teachers that they're going to have working there. So very similar that's working in a few models in Ontario and Nova Scotia has been dramatically increasing the number of clinics that are using that direct funding approach.

MG: So when the minister talks about team based care and that can mean, you know, family health teams, that can mean a greater role for nurse practitioners. In the perfect scenario, if you had the magic wand and you were able to wave it. What would you want governments to consider to build that system to deal with the family doctor shortage?

DR. RITA MCCRAKEN: So we'd need to have both things happening. We'd need to have a great job for family doctors, as well as other primary care practitioners like nurse practitioners, advanced practise nurses. So they would have a really attractive job that they want to go to that, you know, people are graduating from high school and studying for to become. But then we also have that infrastructure so that communities have a clinic or a group of clinics. If you were to move, you know, right now, if you move in Canada and you have to leave your family doctor, the idea of finding a new one, anywhere you go, you're asking everybody, you know, could you see you could you ask your family doctor? Imagine you had to do that for education. So we need to be seeing that same kind of direct funding of the infrastructure. And that's going to allow us as well to start having teams that are able to increase capacity. You know, I think family doctors are great and we do a wonderful job. But as I said, we are human beings. We need to take vacations. We need to be sick, sometimes. Sometimes we have babies and we 100% of us are going to die. And so we need to make sure that we don't have service delivery tied to one human being, that instead we are creating these units of service delivery where people are going to not, you know, if their doctor gets sick or has a baby, that they're not going to be left in the lurch. And building that padding into our infrastructure is really essential.

MG: Let me ask you, in the couple of minutes that we have left, two questions, which is one, this is seems obvious in some ways, but from your perspective, it's important. Why is it essential that we get this right?

DR. RITA MCCRAKEN: So primary care shows us that a population stays more healthy and it reduces health care costs overall. So if we don't get this right, we the lives of people who live in Canada could be cut short. And it's possible with how bad things are right now, that we are going to see a change in our life expectancy. And so this is really a life or death matter in getting this access figured out. We have great health benefits in general. Our single payer system is absolutely the way to go. It is been proven everywhere that it's the most efficient way to deliver services. And so if we don't get this right, we are going to see a further widening of health between the haves and the have nots. And we are going to see our country get sicker.

MG: And so then finally, very briefly, again, there are 6 million Canadians who don't have a family doctor. People have been trying for a long time to find those family doctors. What's the word of advice you would give those Canadians?

DR. RITA MCCRAKEN: The word of advice I would give is get vaccinated and also write a letter to your provincial member of parliament and your federal member of Parliament and tell them your story. And tell them that you want access to primary care and you want them to be making investments that are evidence based and that are going to provide care for you now and for your kids in the future.

MG: There's a lot to think about here. And as you said, this is this is essential work. We will be talking more about this next week. In the meantime, I'm really glad to have you on the programme this morning. Thank you very much.

DR. RITA MCCRAKEN: Thank you so much.

MG: Dr. Rita McCraken is a family physician in Vancouver, also an assistant professor at UBC's Faculty of Medicine. Next week, as I mentioned, we'll look at the calls to expand the roles of nurse practitioners to help ease the crisis in primary care. In the meantime, we would love to hear from you if you are a family physician. What would make your life and your job easier? Do you? Are you listening to what's happening in British Columbia and inspired by that thinking that that's the way forward? And if you're a patient, if you're somebody who has been looking for a family doctor, what has that been like for you? Get in touch. You can email us thecurrent@cbc.ca. Coming up after your regional update.

SOUNDCLIP

Our rivers are running dry, our harvests are failing, our storehouses stand empty, our animals and people are dying.

MG: The next U.N. climate conference COP 27, starts on Sunday with a focus on Africa. With increasing droughts, floods and storms, climate activists on the continent say something needs to change. We will hear from two of those young activists coming up. My name is Matt Galloway. This is The Current. Back in 90 seconds, Secretary.

The young African climate activists demanding change at COP27

Guests: Nyombi Morris, Abigael Kima

MG: Hello again. I'm Matt Galloway. You're listening to The Current.

SOUNDCLIP

CROWD: [Chanting] We are unstoppable. Another world is possible.

VOICE 1: Please provide a shelter for us. We get, we get fruits from some trees. We get. We get oxygen from trees.

VOICE 2: Who is ready to plant a tree today?

CHILD 1: me.

VOICE 2: Are you all ready to plant trees?

CHILDREN: Yes.

MG: That's a group of Ugandan schoolkids taking part in a special education programme on climate change. The young man leading those kids is Nyombi Morris. He is founder of the non-profit Earth Volunteers and one of the African climate activists who will be taking part in COP 27, the U.N. Climate Change Conference, which starts this weekend in Egypt. Nyombi Morris joins me now from Kampala, Uganda. Naomi, good morning.

NYOMBI MORRIS: Hi, Matt.

MG: Tell us about going to cop. Why is it important for you to be there in Egypt for this conference now?

NYOMBI MORRIS: As you say, today we are hosting this conference and even the day it was announced that it would be in Africa, everyone was so, so happy because for so many years we have been talking about Global South being left out. At the same time, we have been talking about Global North for exploiting us. So this time around we are going to cope. Because me personally, I'm a climate migrant and I would like to share my story to what happened to my family. And also I would like to demand for compensation. I'm not the only victim and the number is more than 100,000 people who are said to be displaced in some regions. Some are already in camps today, and others are said to be displaced. So for me, my main focus is on how are we going to make sure that the people who are being displaced by floods or landslides or who are who are dying due to starvation, and how are they going to survive in 2020? Because today we are already seeing this happening. So I'm looking forward to to go to talk about the loss and damage and also talk about the exploitation of the global north.

MG: Tell me about your own story. What happened? This was you were ten years old and there was flash flooding around your family's home.

NYOMBI MORRIS: Yes. Back in 2008, there was a flash flooding in eastern Uganda, a district where over 400 people were displaced. And amongst the 400 people dead was my family. We lost their home. And when the government declared climate emergency in the area, some people were sent in two camps. But me and my son, we decided to go to Kampala, where I only knew one person, our grandma. Now things began to become so hard because yes, even these poor sent into camps who are not compensated, even us were not compensated. So we had nowhere to stay when we went to Kampala. Everything became extremely difficult to an extent that we had to rent. One is called suburbs, one of the suburbs here in [unintelligible]. And it also happened that the area was so much vulnerable to climate change to an extent that we continue to be in floods, even that side. So standing hasn't been easy, but along the way I was supported by some individuals. I've been studying on scholarship with the support of my mum. And here we are. I'm here today and I try my best to make sure that no kid is left behind. Because me, I'm lucky. Maybe I got a sponsorship when I was studying. But there are some kids on street today. There are some people who are still stuck in camps. We have more than six climate refugee camps in Kampala. So all these kids need access to education. We are not saying that we are not to in flooding today, but we can do something better so that people don't suffer.

MG: How did that experience lead you to become an activist when it comes to climate change?

NYOMBI MORRIS: Yes, I realised that many times when they talk about, let's say, gender equality, they don't talk about how they can create that they can make it possible. I realised that many, many young people are out here with the historical background that is linked to climate and they cannot speak. So for me I decided to talk about climate change, but also educate them and empower them with knowledge to start leading to. Because climate change in Uganda is disproportionately affecting women and girls and these are the same people they want them to be leaders of today. And because climate curriculum is not yet in school. This is my role to make sure that I don't see anyone left behind. If we are to lead, let us lead today.

MG: Do you need to be careful in your country about speaking out around climate change? Are there dangers that that you might face for being an activist?

NYOMBI MORRIS: Yeah. For so many times I looked up into me at the time I talked about one of the forests here in Uganda is [unintelliglbe] forest in 2020. It was almost being given out to sugar cane company. And when we stood up, I was amongst the few people who had a very big platform by then. And yes, instead of listening to us, they ended up suspending or banning my Twitter account for one month. Now, this was just the beginning to what happened in 2021 last year, in March, as I was on the street protesting for climate change. Oh, my God. They sent- It was maybe two or just by luck that they happened to find me on street because we were from elections that didn't go well because the opposition said they won. And the incumbent were like, No way you lost, and we won. So they thought that people wouldn't street. Now, when they saw me on street protesting, holding placard with my young brother, they just arrested us and they confiscated our phones. They interrogated me asking me who was financing me. You know, they thought I work with people from the Western world. But yeah, I tried to explain to them. Up to now they keep an eye on me. And to get my Twitter account back, one of the journalists approached me and is the one who contacted Twitter to get back. Otherwise, my government had refused and I believe they are the one behind it. So being an activist in Uganda is not something easy that they look at us as criminals, also as people who are trying to challenge the development. But we are asking what kind of development are talking about? Do we have a new project that is running from Uganda and to go to Tanzania, the East Africa pipeline, this pipeline, according to them, they said they are going to provide young people with jobs. But ever since it started, you know, young people, we are seeing getting employed. So we are asking, why are you looking at the short term goals? But again, we never we speak , they be like, Who are you representing? Are you representing Uganda? Or when you talk about climate activism, you are representing some people's agenda? So it is very so hard, but we are more than ready to face anything.

MG: You sound it. Stay on the line with us now because I want to bring another activist into our conversation. Abigael Kima is a climate activist from Kenya, also the host of a podcast. The podcast is called Hali Hewa. It's the Swahili term for climate. Abigael, hello to you.

ABIGAEL KIMA: Hello. How are you?

MG: I'm well. You're listening to Naomi talk about his own experience. When you hear that, how does that compare with other young climate activists on the continent that you know?

ABIGAEL KIMA: I think we pretty much have similar experiences. And unlike Nyombi, I wouldn't say I have experienced half the things we have gone through. But I guess I'm really struck by the fact that being an activist is actually a security threat from his country. And I don't think anyone would wish to experience what he has experienced, you know, getting silenced by the government, taking away the one platform where you can openly speak about your activism and use it for good, which is educating the public about the climate crisis. So I'm inspired by the fact that didn't stop you from from doing what you do. So I'm really inspired.

MG: He talked about the own his own know experience and how that shaped him to become an activist. How have you seen climate change impact your own life? You've seen this firsthand, right?

ABIGAEL KIMA: Oh, yes, I have. So I come from a community of farmers and I was able to go through school because of farming. And where I come from, which is a rural part of Kenya called Iten, is at the moment schools accept bags of maize or bags of beans as a supplement for tuition fees. So if a parent is not able to raise like actual money, you can actually take food to school and have that as your child's tuition fees. So that is the kind of environment I grew up in. And then the changing weather patterns have had drastic impacts on our livelihoods because for example, we used to plant two seasons of maize, but because of climate change, you can only plant one. And what was shocking for me this year was the fact that we had to we had water rationing from the month of January to around April, which is something that has never happened before in that you only get running water from the tap in the morning. And being that we practise agriculture, it means water. It's such an important resource. And from the farm that I grew up in because of deforestation and also because of climate change, we had a stream that cut across our farm which is completely dry now, which means you have to now put more effort in irrigating the farms. So I have seen how climate change is, taking livelihoods of food yields going down drastically. And, you know, that is also impacting on parents who are not able to take their children to school because, you know, the same amount of money you are making out of selling your produce is not the same. And with inflation, it's not even getting any better. Yeah.

MG: You went - and that's drastic - you went to an area in the country that had been even harder hit. Tell me about this county where there hadn't been rain, what, in two years?

ABIGAEL KIMA: Oh, yes. Honestly, that's an experience that will stay with me for a long time because some of the things I saw and experienced are just beyond devastating because we were driving down roads littered with animal carcases and we went to families that are completely devastated by the loss of their livestock because it's a community that is dependent on pastoralism as a source of income and having families lose, had 50 cattle to just one remaining with one cattle because of the drought is, it's beyond devastating for them. And I think another thing that really struck me was going into this homestead and realising that families eat in shifts because there's no food. So if you eat today, you actually can't eat tomorrow. And even when there is food, it's not enough for a family of about nine people. And another image that I'll never forget is that of a young girl, probably six years or seven years old, with her friend fetching water from a very dirty water. And because it's extremely filled with filth and they're pushing it home excitedly, and the jerrycan they're using to carry is probably double their weight. And these are kids are supposed to be in school. These kids are supposed to be learning, supposed to be enjoying life. But now the situation has had them, you know, in this stage where they have to travel for long distance just to get water, which some of us get directly from wire taps. And I yeah, I was really struck by that experience and, and it was just a clear picture of what loss and damage is. And because you can't tell these families to adapt to lack of food or adapt to lack of water, they like they need they need something to be done and they deserve better because they're human beings.

MG: These are stories that you're telling through the podcast and why? Why a podcast? What do you think you can do and who do you think you can reach through that medium that you wouldn't be able to do otherwise?

ABIGAEL KIMA: The reason why I went with the podcast was the fact that I, I went to COP26 as I am from Africa and being my first COP I felt kind of lost because you know, copy is a lot is overwhelming and sometimes you without any sense of direction you'll just be lost in the crowd. And I remember feeling very burdened because I felt like I wasn't doing enough to represent the voices of the communities where I come from. And at this point is when I started sharing bits and pieces about what is happening and why it's important and sort of relating it in in our own lives, for example, speaking from a farmer's perspective and those good feedback. And so when I came back, the interaction I've had with climate change has always been through statistics and numbers through say the IPCC reports are very big policy reports and I think I felt like something that was missing was the human aspect of climate change, because it's affecting real people with real experiences, with real stories. And so my aim was to actually bring these stories to places where it matters, to rooms where decision making happens. So that beyond the numbers, the statistics also remember that climate change, like putting a face to the climate crisis and seeing that indeed real people are facing this issue. For example, nobody has talked about losing their homes. This is a story that otherwise we didn't know if we didn't have such conversations. And I think you just I would really love to touch policy makers and decision makers from a human point and from a human heart. Because if this is a real person going through this experience, then you must really try and do something about it because you really do not have time.

MG: Nyombi If you're able to reach those decision makers, as Abigael says, and tell them the human stories of the impacts of climate change, what do you think is possible?

NYOMBI MORRIS: One, I think is they should start thinking about what is happening now, because now we have come with the stories, but what next? So for me, my demand is to start with the smallest story. Say climate change can be solved in just one day. Yes. But again, what are those tips and what we what have we achieved so far? Because today we are talking about building resilience. But again, these countries where, when they are resilient to happen, they do not have enough resources. So I will ask them if possible. If you cannot upload a hundred billion, it's okay. What do you have in the pocket? Give us that. Because what might happen tomorrow? We are not sure it will be the same as today because for the first time we saw over 33 million people in Pakistan displaced. And again, we are seeing the same thing happening in [unintelligible]. We saw the same in Nigeria. So we cannot push for something bigger. We want to start with what is available. So my mission is for them to accept to is what is available. If the plans are in place, then what is left? Implementation.

MG: Abigael, what do you want people here in Canada to understand about the impact of climate change on the continent? Nyombi talked about I mean, the numbers in Pakistan throw some million people being displaced. That's the population of the country that I'm in right now. What do you what do you want people here to know about what what you're seeing and what you're going through?

ABIGAEL KIMA: Honestly, what I want them to know is that climate change is not just a concern for us. We are living through the impacts of climate change. It's affecting our day to day lives. And we really do not have time to wait because more than ever, communities need a solution. More than ever we need and more than ever, we need a sanitation fund more than ever. We want solidarity from from the rich nations to see that. Indeed. I mean, we say this a lot. It's probably becoming a cliche, but we are only responsible for about 4% of the global emissions. And now I just want people to know that it's not just a concept for us. We are living through it and we need solidarity so that everyone can live a happy life, a safe life, and not have us constantly trying to recover from climate disasters and, you know, never having time for that.

MG: Why do you think that solidarity hasn't been seen yet? I mean, you mentioned going to COP26. There were huge promises made. And one of the things that we've talked about in the wake of that is that many of those promises, as alluring and attractive as they were, haven't been followed up on. So why is it that that so little progress has been made in helping countries in Africa and other countries that might be in the global south beyond the continent, to deal with the impacts of climate change that they're feeling right now?

ABIGAEL KIMA: I think I'd say, number one, the lack of taking responsibility. And then number two, just the inaction, I mean, the slow implementation of this all of this promises, because, for example, we do have, yes, the climate finance and the climate fund. But how long would it actually take someone from a community success is funds the processes are too hectic that too [unintelligible]. And for me what I, I have more hoping in [unintelligible] because I see what they can do and if you look at some point this meeting's edges are slowly becoming irrelevant if we can't actually act on what we promised a number of years ago because we keep meeting every other time, make promises, make big announcements on media, and then when we come back home, there's nothing happening. So I'm just- I don't know I don't know what to say, but I feel it's the lack of taking responsibility and also seeing that this is serious because maybe it hasn't. Maybe the impacts of climate change have not hit home, but it's happening to us and we are living through it. And there's something that needs to be done about.

MG: Nyombi, you're both young people. Do you feel that the young people have less patience, if I can put it that way, for slow progress than a different generation? Again, you're both seeing this, but you're going to be inheriting the world that we leave behind.

NYOMBI MORRIS: Yeah. Young and [unintelligible] they're not just talking about this because they read about it. No. Most of them are worried of what might happen in the future because they are witnessing everything now. And whenever there is conferences, these leaders come with beautiful speeches and they end up being nothing. I remember at COP26, I was in the hall desperately livestreaming the UK as the hosting country for COP26 was the first country in January to approve new fossil fuel projects. I was surprised because this conversation was brought under one roof, like with Fossil cannot go anywhere. And yes, we do. Everyone was happy that the competition was a step back. At the same time, these are the same country that are saying, again, we have to be in a conference to talk about fossil. Why when you acknowledge less time. So young people are worried that leaders are lying to us. And the same time it is very hard for us to go far. If these people are not taking that responsibility. So we need to push them and we are not ready to keep quiet. Otherwise, if we keep quiet, people are going to continue to suffer. Today we know, if you read some news somewhere, you will have known that Uganda lost over 900 people between June and July this year due to starvation when there was a locust infestation in 2020. These people in eastern north eastern Uganda, Karamoja, we are not helped to recover from losing our food. Now, this year, they have been struggling and we have lost more than 900. So it is time to put a big focus on adaptation and also find new way of working with farmers, because these are the people who are going to save us in the years to come. So countries like Canada, they should start raising the money and also completely phase out all the mining projects they are financing.

MG: You're both activists on different part of the continent. What would you say to each other? Naomi, do you have a word of inspiration or or support for the work that Abigail is doing?

NYOMBI MORRIS: Yeah, for me, one one thing I can say is that we need everyone is voice and we need everyone's mode of communication. And I'm so happy that she's hosting a podcast that is their way of sensitisation, like sensitising the entire group. You never know who is listening. You never know who is supporting you, but never stop pushing. You know, it's like it is not easy, but we always have to try. You never know. So I like that mode of communication and I'm so happy to hear from her.

ABIGAEL KIMA: Nyombi, you inspire me. You have quite a story and I just want to give you your flowers now because you're doing something that most people cannot do. You're very confident. You're brilliant. And despite the challenges that you've experienced, you kept going. And I just want to applaud you and see that you're doing and encourage you to keep going because you're doing this for so many other people who otherwise would not have the same platform or opportunities. As you said, do not stop. Keep going. We are cheering you on.

MG: You both are doing really, really important work. Thank you both for talking to us.

NYOMBI MORRIS: Most welcome.

ABIGAEL KIMA: Thank you so much.

MG: Abigael Kima is a climate activist in Kenya. She's also host of the podcast, Hali Hewa, Swahili Term for Climate. Naomi Morris is Ugandan climate activist and the founder of the non-profit Earth Volunteers. This weekend, our good friends at What on Earth on CBC Radio One will have a special show on COP 27. Laura Lynch speaking with key players who are pushing for a radical way of reform to help the nations that are most at risk, nations like we've just been talking about now, that's what on Earth, Sunday at 11 a.m., 1130 in Newfoundland. You can catch that programme on CBC Radio one on the CBC Listen app or wherever you get your podcasts. That's The Current for this Friday. q's up next on CBC Radio. Before we go, have you seen this new Heritage Minute release this week? Features the life and accomplishments of Jackie Shane, honorary Canadian born in Nashville, found her community in the R&B scene in Toronto of the 1960s, breaking ground as one of the first commercially successful transgender singers as an extraordinary voice. Here's part of that tribute. I'm Matt Galloway. Thanks for listening to The Current and have a great weekend.

SOUNDCLIP

Long way from Nashville. And Mama tell you there is Vaughan, Montreal, Boston, Los Angeles and Toronto. That's my chosen home. So when I'm walking down Yonge Street, I see some funny people. I'll have the nerve to point the finger at me and grin and smile and whisper. My song was number two on local radio. So 10,000 in Toronto alone. Turned down at Sullivan because they asked me to remove my makeup. I wouldn't do American Bandstand because of the segregation policies. I was just being me. I never tried to explain myself to anyone. And besides, none of that time were rejected. Because I know I look good. Here you come.

[Song]

Friday November 4, 2022 Full Transcript

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