The Bridge with Peter Mansbridge - Your Turn -- One Thing To Improve Health Care in Canada

Episode Date: February 29, 2024

The question this week was this: Name the one thing you would do to improve health care in Canada". You obviously care about this issue as most research shows health care is one of the top items bothering Canadians, and your letters show that you have ideas for solutions.  Lots of ideas.  Plus the Random Ranter has the issue that's on his mind this week.

And hello there, Peter Mansbridge here. You are just moments away from the latest episode of The Bridge. It's Thursday, that means your turn. This week, one of the issues that Canadians rank consistently as one of the most important ones for them, it's health care. And it's your turn. Coming right up. And hello there, Peter Mansbridge in Toronto today. And looking forward to getting to your letters. The question this week was pretty straightforward for your turn. It was, if you could name one thing that you would do to improve health care in Canada, what would that one thing be? Well, just as we found out from the last couple of months when Canadians and listeners to The Bridge put pen to paper or finger to keyboard, they certainly have answers. For your turn this week, that question about

health care. So let's get right at it. Leo Houle in Toronto starts off our letters this week, and there were many suggestions on this health care issue from across the country. The one we got most often begins with what Leo said. Here it is in my mind the one overriding issue with our health care system is a severe shortage of family doctors to me if that you know there is a dramatic the random ranter he just can't wait to get started. He's in there. He's in the random ranter studio practicing, and he just jumped again. Oh, he's going to have to wait.

He's going to have to wait for, I don't know, 20 minutes before we bring in the random ranter. That's not his fault. That was my fault. I pushed the wrong button, as I'm wont to do, as they say in the business. Let's get back to Leo's letter. In my mind, the one overriding issue with our health care system is the severe shortage of family doctors. To me, a family doctor is the gatekeeper to our health care system. The few we have triage very effectively. They know who needs more specific care and refer those in

need to the correct health care service. With a sufficient number of gatekeepers, they can avoid the chaos that permeates the health care system in every province. Our politicians stand behind their podiums and wax eloquently about the number of new students being trained as doctors, but they never mention the number who will retire or go on to something else as a result of burnout. The public never knows whether there will be a net gain or loss of family doctors. James Lawley in Gannon-Ockway, Ontario. Same theme.

Medical students are discouraged from family practice because of the financial costs deterrent. Under the current system, they are independent business people with a single customer who determines the price they will pay for services. Out of this, they have to cover their overhead and staffing costs and finance their own pension and benefits. No wonder there's a chronic shortage of family docs. What I would do is make all family physicians employees of the government

with all the associated benefits. This would encourage enrollment in the specialty of family practice and surely alleviate the chronic shortages. Matthew Skolorzyk in Vernon, B.C. The one thing I would change to improve the health care system is improve the process of turning qualified doctors into licensed doctors. According to a CBC article, there are as many as 13,000 medical doctors in Canada who are not practicing because they have not completed the two-year residency

requirements for licensing. If you're on an airplane from Vancouver to Toronto and a medical emergency occurs, the question you don't hear over the intercom, is there a doctor qualified in Canada on board? The doctors are here. Let's just put them to work. Rhonda Mulligan in Sturgeon County, Alberta. That's just north of Edmonton. We have many foreign doctors in Canada who do not speak English well enough to practice. In the past decade, I met two of these doctors living in Edmonton. One was a pediatrician from China, the other an infectious disease specialist from Mexico. The latter was taking English classes at night, hoping to hone his skills and be able to practice here in Alberta.

It occurred to me that we were not benefiting from their expertise and thought maybe the government should consider hiring a translator so that patients could benefit from their years of training. Derek Forsyth in Edmonton also has an idea for how to get more doctors focused on the admission criteria for med school. Here it is. I believe there is too much focus on academic achievement as a means of gaining admittance to medical school. There may be great general practitioners and family doctors who never had the chance to follow their passion for medicine

because they had a 3.5 GPA grade point average. Generally speaking, that's the best possible GPA is four. Okay, that's a little explainer on GPAs. Perhaps we need to take, this is back to Derek's letter, perhaps we need to take a more holistic view to admissions for those doctors that do not want to pursue a specialty but have a passion for providing excellent general care to patients in their community in order to address the growing demand for stable access to family doctors. Okay, but maybe the best answer, or the answer, isn't doctors, says Mindy Bullion in Ottawa.

I think that an expanded use of nurse practitioners would be a tremendous benefit on many levels. My husband and I have been seeing one for well over 10 years now, and not once has she needed to refer us to see a GP with whom she works. She's able to order tests and make referrals to specialists. Okay, we got a similar note from David Abramson, or sorry, Adamson. In Virginia Beach, Virginia, my primary care physician retired a few years ago and I wasn't able to find a replacement. I ended up going to a physician's assistant. I realize we don't have PAs in Canada, but we do have nurse practitioners. We need to increase the number of nurse practitioners, let them prescribe medication, order tests, and refer to a physician when necessary. I have no issues with my PA and find the quality of care every bit as good as my primary care physician was.

The Canadian health care system needs improvement, but it's way better than people give it credit for. It's way more affordable and has better outcomes than here in the U.S. Albert Versteeg in Grimsby, Ontario. I just spent 12 days in the Hamilton Health Sciences Centre after bypass surgery. What I would change and advocate for is single rooms with single bathrooms. I decline to call them private rooms with private bathrooms, since that has an elitist ring to the Canadian mind. P.S. The service provided from the surgical staff to the cleaning staff was excellent.

I could not have asked for a better service. Sheila Booker. Sheila's in Mexico at the moment. She lives in Ninette, Manitoba, 200K west of Winnipeg on the north shore of Pelican Lake. Remember that? I would get rid of all regional health authorities. CEOs have six-figure incomes to run the RHAs. That money could and should be going into the system,

not into the pockets of administrators. Prateek Sarma in Mississauga. As a person with multiple long-term medical conditions who's lived in eight countries on four continents, I often consider the strengths and weaknesses of our system. Make no mistake, I'm very proud of what we do have, but there are clear signs of the system falling apart and easy solutions not being implemented.

The one thing I would change in our health care system is to have the federal government bulk purchase all medicine, medical equipment, et cetera, and then sell it to provincial governments at or near cost. Provinces would purchase medicine at a lower cost for their citizens and insurance companies could pass the savings on to their clients. Josette Sassoon in Toronto. We urgently need more doctors and nurses, especially in geriatrics.

Running around from one doctor to another and having many prescriptions lands our seniors in trouble and then requiring all kinds of specialized attention. Morris Joseph. With our aging population, many seniors are being over-medicated. That can lead to falls and other severe adverse effects requiring emergency visits and hospitalizations. All patients over 65 taking six or more medications should be required to have their medications reassessed annually by a geriatrician. Only a geriatrician knows enough about a senior's

metabolism to be able to streamline drug regimens with input from the patient's GP and pharmacist. I think that's really important. I think Morris is on to something there. Ron Fisher in Moncton. I would take away the billing cap on GPs. Let them work as many hours as they want, taking care of as many patients as they can. There were several letters about the role of private care in our system.

This is a debate that, as you well know, has been going on for years. Al Short in Coldstream, B.C, that's in the Okanagan. I would propose we allow private health care along with public health care. My belief is that this would increase access and create competition, resulting in improved system efficiency. I don't see any new ideas being introduced in the current system. All I hear are calls for more and more money, which we don't have, and doesn't seem to help. T.C. Shang in Vancouver. Many years ago, when my father was spending the winter in Hong Kong, he was diagnosed with an enlarged prostate.

He got surgery in three days, paying $2,000, the same fee for a Hong Kong permanent resident. Under the current Canadian medical system, he'd have to wait in line for years for treatment. I'd like to see specialist care opened up to some private care in Canada. Allowing people who can pay for it will shorten the wait for everyone. The government can get some guidelines, such as mandating these specialists to take patients in the public line, or only allowing specialists who have practiced for 10 years to set up privately. I understand that the Canadian medical system is about fairness,

but having my father or anyone else suffer unreasonably long for treatment isn't something I consider fair. Eric Dumichel in Ottawa. We should allow more private clinical practice. My wife and I spent eight hours in emergency yesterday for her to get an x-ray and assessment for her injured foot. I would have gladly paid several hundred dollars privately if I had the option. I'm not wealthy, but I can't afford that much. In fact, being in Ottawa, we're looking at options to get future care in Ogdensburg, New York.

That's an hour away. Or Messina, New York. That's 90 minutes away. Let the wealthy pay more for private health care when they choose and thereby free up public health resources. Yes, it's two-tier. But two-tier health care already exists with the wealthy getting care outside of Canada when they need it. Paulette Brody in Toronto. The most important fix would be to add private care.

The Scandinavian countries, as well as Europe and most of the rest of the world, have both private and public care. Canada and Cuba do not. Are we the only ones who are right? Here's a short story about what our family is facing. My granddaughter, age 17, suffers from a rare rib syndrome. She underwent an operation in August with a long, painful recovery. Unfortunately, her symptoms returned in December and she is scheduled for a second operation in March of this year. Her surgeon wanted an immediate MRI and although she was on an urgent list, the MRI could not be done until April. We tried to get it done at private radiology clinics, but the government would not allow it. She's not well enough to make the trip to Buffalo

where she could have the MRI within 24 hours. The surgeon will go ahead with the surgery because she's too much in pain to wait any longer. I and my entire family are heartbroken. Peter Natt in fredericton the health care system should be converted from a universal single player system single payer i think he means system to a system in which everyone is insured for all health care related services and not just basic health as is currently the case. Insurance and service can be provided by public and private organizations. Doug Hubbell in Guelph,

The one thing that I would do to improve health care in Canada is privatize it. Privatize everything. Clearly, the universal public administered system is not working. This would allow entrepreneurial doctors to open clinics and improve everyone's access to services. This may even encourage Canadian doctors that have left for the U.S. to return to Canada. There was quite a push on allowing some private care back into the system.

However, there was an on-the-other-hand approach to this as well. Joan Roshan Full, I'm sorry, Joan, I'm not sure on the pronunciation of your letter, but she's writing from Sudbury. She writes that she's a former registered nurse who retired in 2021 following a 40-year career during which she worked in Alberta, Manitoba, Saskatchewan, and Ontario in acute care, home care, palliative care, and long-term care. Can I just add that those who work in palliative care and long-term care. Can I just add that those who work in palliative care and long-term care,

my God, you are amazing people. I've seen you working because of friends and relatives who've been in palliative care, and I just, amazing. Anyway, getting to Joan's point, stop using public dollars to fund private for-profit health care organizations. Historic and extensive research shows this rapidly spreading occurrence wastes taxes by diverting dollars from fully funding public health care in favor of funding for profit entities.

We had several letters that argue that the health care system is fixing symptoms, not causes. Cole Christie writes this from Calgary. Supply and demand. Until supply can increase, let's reduce the demand for our already strained health care resources. Phys ed in schools should not just be 12 years of basketball, badminton, and volleyball technique, as it was in my rural Alberta school. It should include classroom teachings as well.

On nutrition, the science behind carbs, protein, fats, and sugars, the mechanisms for weight loss and weight gain, muscle mass and aging, vitamins and supplements, weight training form, endurance exercise, disease and prevention, and an overall emphasis on the role that exercise and nutrition play in health, happiness, and overall quality of life. We need to set people up for success from the start. How many hospital visits and tax dollars could be saved if people ate right and properly maintained and used the most important machine we'll possess in our lives, our own human bodies?

All right, cool. Don Seymour don you forgot to tell us where you're running from but we're going to let you slip through the system anyway don't do this for everyone if i could change one thing in our health system, it would be to put more resources into the system upstream rather than downstream. A significant part of our health funding is directed to hospitals and doctors, which are the most expensive parts of health services. I believe robust community-based health services, including mental health and addiction, combined with community-based health education and promotion, could be the panacea our health system desperately needs.

You cannot treat a polluted lake without treating the rivers and streams that run into the lake. The same should apply to our health system. Rashad Degama Rose in Milton, Ontario. We must reduce the number of people with preventable conditions who visit health professionals for help. I mean diseases caused by excessive alcohol and sugar consumption, lack of exercise, poor attention to mental health. In my opinion, the folks who are born with health conditions should be prioritized above all.

A few realistic ideas I can think of to achieve this goal are promoting physical activity through active modes of transportation, healthier diets by reducing alcohol consumption, processed foods in grocery stores and fast food restaurants, and promoting mental health by making mental health care more accessible for all Canadians. We've got a letter from Gary Aslanian, who's written before. I think he works at the World Health Organization in Geneva. He's definitely in Geneva. We need to get away from what's called Medically Necessary in Canada Health Act

and expand it to prevention. By the time things are medically necessary, it's too late and too expensive. I realize it is not an easy task, but health systems in the country have to stop being systems only for sick people and start preventing things in healthy people. Unless this is done, there will never be enough resources, financial or human, to care for all people that needed it in a timely and quality manner.

Only by preventing things from happening can we help fix the system? Kate Wilson in Toronto. I worked in health care for about 42 years as a registered nurse, educator, and manager. It was an honor, and I'm so glad to be retired now. The one thing I would do is place more priority and resources on individual health literacy, education, and prevention community service than acute care hospital medicine. Let's keep people as knowledgeable, healthy, and at home as much as possible. Better for individuals and taxpayers.

Walter Hardy in Lloydminster, Alberta. I would allow general practitioners, family doctors, to requisition tests such as MRIs rather than the patient having to be referred to a specialist first. Wait times to first see the specialist and then wait for the test are too long and could be shortened by eliminating the requirement of a referral to a specialist. Sharon McKenzie, she's a retired nurse in one of my hometowns in Stratford, Ontario.

I would change the way nurses are trained. We've observed that the old style of nursing seems to be out the window and that punishing 12-hour shifts have driven experienced nurses away. The young probably do their best, but student nurses and doctors are not trained as in the old hospital schools, on the job from the first day, and they graduate without the true immersive experience. Brian Vickerman in Brantford, Ontario. To improve health care, I would make some changes to taxes. One, remove the HST from vitamins and supplements. Two, provide a tax credit for gyms, recreational sports, etc.

A large part of the burden on the health care system is due to lifestyle choices. We need to encourage exercise and nutritious diets. Anthony Preston in Calgary. I'd overhaul the Canadian income tax system and make it more equitable, broadening the tax base, increasing progressivity, taxing capital gains more equitably, addressing corporate tax avoidance, introducing wealth taxes, and enhancing tax enforcement would create a windfall. The combined changes could potentially add between $23 billion and $45 billion annually to government revenue. That's a lot of money.

Elizabeth Prosser in Bracebridge, Ontario. That's a couple hours north of Toronto. I think it's the Muskoka region. Make each level of government in every province and territory. Give taxpayers a comprehensive and understandable breakdown of how our tax dollars are allocated and spent. We need to know if our money is being used wisely to deal with staff shortages,

wait times, and the myriad of other problems facing our health care system. Accountability. Spencer Stinson in Blenheim, Ontario. That's southwestern Ontario, but I guess about an hour east of Windsor. We've heavily taxed tobacco and alcohol, which I totally agree with, says Spencer, to help offset the known health care issues these will likely cause in the future. I think it's ludicrous that we haven't put something like this around sugary drinks and snacks that are outright terrible for us and might be as bad as tobacco and alcohol long term. I'd have no problem if a $1.50 candy bar went to $5 due to taxes. In parallel, let's reward consumers for making healthier choices. The price of fresh healthy food has skyrocketed, but unhealthy processed foods have remained cheap.

People can't afford to eat healthy. In addition to taxing more unhealthy foods, let's provide huge subsidies on the other side if people choose healthy things. Okay. I think it's break time. We've got lots more letters to come. They're good, eh?

Aren't they good? People are really thinking through this. All right. Let's take a quick break. We'll be right back after this. And welcome back. You're listening to The Bridge, the Thursday episode. That's your turn.

We're on the issue of health care in Canada, what you do to make it better. We've had letters from all across the country, and we'll continue to have that in our second half. Plus, plus, the random ranter. You heard him at the beginning of the hour. He was warming up and wanted in early, but we put him on pause, and he's ready to go when we get to him in a few moments' time. You're listening on SiriusXM, channel 167, Canada Talks, or on your favorite podcast, and he's ready to go when we get to him in a few moments' time. You're listening on Sirius XM, channel 167, Canada Talks, or on your favorite podcast platform.

Corey Fortier. Corey's writing from Ottawa. I've spent the better part of my professional life asking the question you're asking this week and proposing solutions from my perspective as a manager at a health care association and later as a pediatric hospital manager. I would change about 80 things, but I'll share my top priority. Design care models that formally recognize patient partners

and essential caregivers as members of the care team. Health care is stretched too thin, and no one has more skin in the game than patients and their care partners. Health care talks a big game about meeting its quadruple aim of improving patient experience, reducing costs, advancing population health, and improving the provider experience. I know of no other low-effort, high-reward change that could make the needle further to achieving that goal. Move the needle. Jennifer Loss in Saskatoon. Doctors, nurses, and support staff are trying to serve their communities and make a living, often while working outrageous hours and not being able to spend time with their own families and friends due to the outrageous environments, shortages, and conditions they're working under.

Patients needing care are feeling vulnerable because they are trying to get better under those same shortages and conditions. Norm Busolaro in Port Sydney, Ontario. That's near Huntsville. My wife recently retired from Sunnybrook Hospital in Toronto after 34 years as an ICU intensive care unit registered nurse. Her tight-knit group of fellow nurses have always had an abundance of complaints and suggestions for health care improvement. Summarizing into one thing is a challenge, but here it goes. For many years, there was a push to run our hospitals and health care systems like a private business. Do more with less, was the

mantra. Then the pandemic hit. Our frontline workers were already facing increased workloads, skimpy medical supplies, nurses poached by private agencies, doctors lured to private clinics, and all manners of qualified professionals moving to higher-paid jobs in the U.S. Already stressful working conditions and staff retention problems could not address the pandemic influx, resulting in ER closures, high burnout rates and cost overruns by filling gaps from private agencies. Sadly, this continues today. Paying our frontline doctors and nurses competitive salaries and reducing their workloads will immediately lower the drain to the U.S. and to for-profit organizations.

It will also attract more young people to the profession and put pressure to fast-track qualified individuals to fill these spots. Eric Peterson, writing from southern Thailand. I'd stop appointing political favorites, buddies, or hacks to lead the health care system. Too many senior places on the health dockets across this land are politicians or political appointees. What on earth do they know if they haven't been part of the system in the first place? When you end up in a hospital, the people who know the most about everything are the nurses, not the doctors or the big paycheck directors. You wouldn't

want them in charge of your recovery for a heart bypass. I've been there, like many others. I'd like to see an older woman, probably, who has worked her way through the realities of the system get the director's job. Marilyn Wallace in Fanny Bay, BC. My family doctor has a unique way to manage his patients that I wish every Canadian had access to. Appointments can be made only on the day you call. But there is a strong promise, almost a guarantee, that you will always get an appointment on that day. In the 10 years that I have been under his care, there has been only one time that I couldn't get an appointment. I went the next day instead.

The idea is that if you are sick enough to need a doctor, you've probably cancelled any commitments and will obviously benefit from timely care. Patients are more likely to wait out small concerns because they know that if the symptoms worsen, medical help will be available. All right. Rebecca Sideras in Montreal. I'd create a platform or portal that enables individuals to access any documentation, scans, or reports from appointments and checkups. It's hard to gain access to most doctors due to long waiting lists,

so this could help empower us by centralizing our information. For example, the long time between appointments has resulted in me personally forgetting the findings of a previous assessment done, resulting in my feeling helpless and in the dark about my healthcare experience. Bill Barnhold in Prince George, B.C. If we truly have a national health care plan, then the federal government should run it, not the provinces. The amount of duplicate government positions must be staggering.

One plan for every Canadian across the country, the same for all. The federal government should own it and the provinces should oversee it. The amount of money that would save, that would save, could go back into the system to pay for doctors, nurses, rooms, or medications. That would be a start. Percy Phillips from Portage Prairie, Manitoba. To improve the health care system, treat patients as valued customers. In business, there's incentive to treat customers well, to get repeat business and establish relationships that are vital. The current way health care is structured, patients are not customers, and patient-oriented care is a slogan, but entirely missing in practice.

Doug McDougald. He's in Stratford. Two letters from Stratford this week. I'm a livestock veterinarian, and our practice oversees the health of six million animals. I, with my brother, have also been the primary caregiver and advocate for our patients the last few years. They both died a year ago last fall and have seen the health care system up close.

There was a low point where I suggested to my parents' family doctor that we veterinarians kept better records for our 6 million patients than he did for his 1,200 and that we actually communicate with 21st century tools, including effective telemedicine. Our health system needs centralized medical records with modern communications tools. This would break down the silos by having every person in Canada with a centralized medical record that all providers access and add to. This means public health pharmacies, physiotherapists, specialists,

hospitals, emergency wards, specialists, hospitals, emergency wards, etc. It's ridiculous that Canada does not have this. And believe it or not, doctors, pharmacies, and others can still communicate by fax. Who uses a fax machine any longer? It's all archaic and shows lack of leadership and vision by healthcare and government. Well, while we're on the subject of faxes, Ryan Dolan in Toronto writes, it may be a stretch to claim this would materially improve Canada's health care system, but I certainly know something that could improve the public perception of it. The fact that most doctors and pharmacies still use fax machines to exchange critical patient information is an abomination. The mere mention

of the word fax evokes the grating sound of dial-up internet circa last century, busy signals, and the image of being clunky big clunky machines that require more paper. When a pharmacist recently told me that she would fax my prescription renewal to my doctor again. I politely asked if she had any way of telling if the original fax was picked up on the other end. She said no. I suggested that we should maybe mail a letter to my doctor's house instead. I think she picked up on this sarcasm. As we left the store, my intelligent, world-absorbing nine-year-old daughter asked me, Daddy, what does fax mean? Seems that in the private sector sector you adapt or fall behind,

whereas the public sector you don't adapt and fall behind. God, I could tell you a funny story about a fax. Remember when that Swiss airplane crashed off the East Coast near Peggy's Cove? I went out there that afternoon with Fred Parker, my director, and we did the national from the shore at Peggy's Cove. And we had to move material and information back and forth to Toronto. And the only way we could do it then in those years of the 90s

was to get a fax. Well, I didn't have a fax with me so somebody went into halifax and bought a fax machine we brought it out there and we were using we'd sort of ask these people if we could use their home as a kind of an office you know their small kind of cottage home at peggy's and they said absolutely you can do it's set up of fax in their house and then when we had to leave we couldn't lug a fax with us back onto the plane so we left the fax there for them we gifted them a fax machine I've often wondered what happened to them um okay we better move along here we're never going to get to the random ranter and he will be he will be ranting

if that happens ontario health care providers send an estimated 152 million faxes each year by the way the government's promising to phase out faxes in health over a five-year timeline okay marty zilstra in maple ridge bc i just saw an article about a tragic story the young mother lost her life to cancer due to the lack of mri machines in canada and it prompted me to answer your question of the week according to the national post canada placed 25th out of 29 similarly developed countries with 10.3 mri per million population, well below the average of 18.3 per million, and far behind leaders such as Japan, Korea, Germany, all had more than 30 per million.

All of that said, how I would fix health care is very simple. Buy more MRIs. Hire more technicians to run them. My sister died in 2016 to similar circumstances and early diagnosis was not available to her for similar reasons. Austin Ziegler in Toronto. My one thing would be to set standards for virtual health care and require that provinces provide equitable funding for them. Virtual health care offers more equitable access across a variety of dimensions. People with mobility issues can be seen more readily. People in rural Canada can see professionals

and specialists that may be hours from where they live. The Indigenous peoples of Canada will have more improved access to providers that has been long denied. The pandemic proved that in-person visits are not required for many conditions and virtual care can increase access to many people so that emergency rooms do not become people's substitute for a lack of primary care physicians. Luke Petralekas. Luke has the last letter of the week. He's in Toronto.

The one thing I would do for our health care system is this. Provide better education about matters of health to everyone. We all need to have a robust general understanding of human biology, reproduction, infections, addiction, and a disease and its prevention. We need to learn how treatments with vaccines, medicines, and therapies work so we can make more informed choices. The goal is to have a population that can communicate better and more efficiently with health professionals about what ails us and not be fooled by charlatans. We will be better able to discern when to seek medical care,

saving precious dollars both through early treatment and avoiding unnecessary visits. Well, there you go. As I said at the beginning of this program, there were lots of ideas from you. And some conflicted with some of your fellow Canadians who listened to the bridge and had other ideas on directions to go. But all of them generating thought, provoking different ideas.

And good for you once again uh you know i feel so fortunate to share these feelings uh with all of you about what you see is important on various issues and certainly this one is important to all Canadians. I'm going to think about these letters and pick one to get this week's copy of a signed book of mine, and I'll let you know about that after we listen to the guy who makes Thursdays fun to listen to as well and important to listen to. Some weeks the random ranter's rants are at a certain level of interest and seriousness. And other weeks they're really important. Well, they're all important to get us thinking this one's very important i think certainly been something that i've thought about for a long time i'll tell you why after we hear the rant here it comes here's the random ranter for this week. There is a dramatic over-representation of Indigenous people in the

criminal justice system. And I don't know how you can describe it any other way, because while Indigenous people represent about 5% of the population, they make up about 37% of the total prison population. This is a problem that's been long in the making, and a problem that continues to get worse every year. Now, as a white guy, I'm a bit reluctant to even broach this subject, but I really feel like someone has to, because it's yet another tragedy being suffered by Indigenous people, and no one is really talking about it. It's like it's just something that's accepted, something that we've all grown complacent to or worse, willfully blind to. But it's not right. I mean, this is an old truth that the justice system has been wrestling

with for decades and it needs to be reconciled. As a society, we can't afford the cost of consigning yet more Indigenous youth to the justice system. It's just wrong. And the justice system itself has recognized this. I mean, all the way back in 1999, the Supreme Court of Canada passed down their Gladue ruling, which required judges to consider the circumstances of Indigenous criminal offenders when it came to sentencing. The thought was that the problem was systemic and that lighter or alternative sentences would help reverse the problem. At that time,

Indigenous people represented 3% of the population and 17% of the prison population. And they called that a crisis. Well, fast forward 25 years and the problem has only grown magnitudes worse. Now, I'm not saying Gladue is wrong or even a failure. I'm just saying it hasn't worked the way they thought it would. It's like it's too little too late. If the problem is systemic, then to me the only solution would be to figure out a way to keep Indigenous youth out of the system entirely. Instead of putting a ton of effort at reforming people once they enter the system, we should be applying that effort to other areas like education and healthcare. But we don't.

We don't address poverty, we don't address addiction, and we don't address the lack of opportunity until it comes time for sentencing, and then all that stuff suddenly matters. That just doesn't make sense to me, because we have it within our ability to do more to alleviate all those circumstances before a crime is ever committed, before the victim of the system becomes a criminal. And once they're a criminal, well, to me, a crime is a crime. I believe prevention is a safer bet than reform. How much concern can we afford for perpetrators when it comes at the expense of victims. And that's really my one criticism of Gladue and bail reform and the justice system in general. I'm a big believer that crime should

have repercussions for the criminal because we know they have repercussions for the victims. Whether it's a property crime or a violent offense, there needs to be commensurate repercussions because if you don't respect the law, you at least need to fear it. But right now, there is no fear, there is no deterrent, and it seemingly takes a lot before there are even repercussions. The Random Ranter for this week. Let me just say this. When I was a young reporter out of Manitoba

in the early 1970s, I can't remember what the actual story was about. But it involved me going to two provincial institutions. One was a provincial jail in Headingley, Manitoba. And the other was a federal institution at Headingley, Manitoba, and the other was a federal

institution at Stony Mountain, Manitoba. And among the many things that struck me on those visits, and I've been in and out of various prisons, part of stories that I've had to do over the years in different parts of the country, but the thing that struck me immediately on that visit was the high percentage, extremely high percentage, of Indigenous peoples who were incarcerated. And every time I hear a story like this, like what the rancher just said, reading that report in the late 90s, the Gladue report.

God, this is not getting any better. The rancher's right. Okay, time for the winning letter on this week's, well, winning sounds like a fine, you know, it's just me. There are a lot of great comments here about the one thing you do and this week for the first time I'm going to pick two

because I really like these two first one was from Spencer Stinson in Blenheim we've heavily taxed tobacco and alcohol which I totally agree with to help offset the known health care issues these will likely cause in the future. I think it's ludicrous that we haven't put something like this around sugary drinks and snacks that are outright terrible for us and might be as bad as tobacco and alcohol long-term.

I'd have no problem if a $1.50 candy bar went to $5 due to taxes. In parallel, let's reward consumers for making healthier choices. The price of fresh, healthy food has skyrocketed, but unhealthy processed foods have remained cheap. People can't afford to eat healthy. In addition to taxing more unhealthy foods, let's provide huge subsidies on the other side if people choose healthy things. Makes sense to me.

And the second letter this week, and this is unusual, right? This is the first time we've picked more than one. Cole Christie in Calgary. Supply and demand. Until supply can increase, let's reduce the demand for our already strained health care resources. Phys ed and school should not be just 12 years of basketball, badminton, and volleyball technique, as it was in my rural Alberta school.

It should include classroom teachings as well on nutrition, the science behind carbs, protein, fats, sugars, the mechanisms for weight loss and weight gain, muscle mass and aging, vitamins and supplements, weight training form, endurance, exercise, disease and prevention, and an overall emphasis on the role that exercise and nutrition play in health, happiness and overall quality of life. We need to set people up for success from the start. How many hospital visits and tax dollars could be saved if people ate right and properly maintained and used the most important machine

we'll possess in our lives, our human bodies? Thank you all for your letters this week. And to Spencer in Blenheim and Cole in Calgary, email me with your postal address, and I'll send you a signed copy of one of my books. And I hope you enjoy them. Listen, thanks for everything this week. Again, as usual, love hearing from you.

And I'll work on a question for next week. Tomorrow, good talk. Chantel's away. She's on a short holiday. She'll be away for a couple weeks. Susan Delacorte from the Toronto Star fills in along with Bruce Anderson tomorrow on good talk. And this has been a heavy-duty week. Big stuff out of Ottawa.

New legislation, pharmacare stuff drops today. We had the online harms bill earlier in the week, so obviously we'll talk about that and we'll talk about any number of other things that have been happening in our national political scene.

I look forward to that. I'm Peter Mansbridge. Thanks so much for listening. Talk to you again in 24 hours.