David South Consulting

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  • Private Firms Thrive As NDP ‘Reinvents’ Medicare

    Private Firms Thrive As NDP ‘Reinvents’ Medicare

    By David South

    Today’s Seniors (Canada), August 1993

    Many of today’s seniors fought for Canada’s internationally-admired public health system. But more and more people are becoming worried that the combination of health care reform, funding cutbacks and free trade is fuelling the growth of a second tier of private medical services serving the well off. 

    The provincial government sees things differently, arguing Ontarians no longer expect government to pay for everything and rather than eroding medicare, the NDP is reinventing it. 

    Whichever way one looks at it, private insurance companies, homecare providers, labs and other services designed to make money are becoming more and more involved in the health care business. 

    Operating in the territory outside the guidelines of the 1984 Canada Health Act – which sets out the principles of medicare for the federal government to enforce – the private sector has room to expand, at the same time as OHIP coverage is scaled back from more and more services. 

    Janet Maher, whose Ontario Health Coaltion (OHC) represents doctors, nurses and other health care workers, worries for the future of medicare. 

    “A number of things like accommodation services – laundry, food services – are in the grey area of the Canada Health Act,” says Maher. “So with all these fees that are being introduced, by the strict letter of the law, there is no way to stop them. But as far as we are concerned the spirit of the Act isn’t being observed.”

    In its current reforms, the government of Ontario is emphasizing paramedical professions like midwives who fall outside the CHA and aren’t covered by OHIP. The turn to community-based services means that people have to rely more on services and providers that aren’t covered under the CHA. 

    Maher says privatizing accommodation services is a recent phenomenon, the result of hospitals finding creative ways to trim their budgets. 

    “It’s a new area that hospitals are taking bids on,” she says. “The other thing around the accommodation services is that because they are not categorized, strictly speaking, as health care services, none of this is exempted in the Free Trade Agreement from U.S. competition.”

    A recent report by two British Columbia researchers tries to put together this complex puzzle. Jackie Henwood and Colleen Fuller of the 7,500-member Health Sciences Association of British Columbia recently charged that a combination of free trade and budget-slashing governments is eroding the universality of medicare and ushering in a two-tier system. 

    Fuller and Henwood identify the Free Trade Agreement as the culprit. While the health care industry created more jobs than any other sector of the Canadian economy between 1984 and 1991, they point out the job growth has been concentrated in the private sector since free trade was implemented in 1989. And they expect worse under the proposed North American Free Trade Agreement (NAFTA). 

    “NAFTA will accelerate trends towards a privatized, non-union and corporate-dominated system of health care in Canada.”

    One provision of the Free Trade Agreement has also made it possible for U.S. companies to compete against Canadian firms in health care. Chapter 14, “health-care facilities management services”, allows wide-open competition. 

    Under NAFTA, provisions will bind all levels of government to consider for-profit health care companies on both sides of the border on equal footing with public providers when bidding for services, and entitles them to compensation if they can prove to an arbitration board they’ve been wronged. 

    “That represents a substantial encroachment on the democratic right of local, provincial and federal governments to make decisions,” says Cathleen Connors, who chairs the national wing of OHC, the Canadian Health Coalition. 

    It’s this plus health care cutbacks – federal and provincial – that’s resulting in service and job cuts and bed closures in the public sector and an increase in privatization, say Henwood and Fuller. These opportunities have not gone unnoticed by private companies south of the border. 

    One such company is American Medical Security Inc. (AMS) of Green Bay Wisconsin. After hiring Canadian pollsters Angus Reid to do a survey, AMS saw a profitable market in offering American hospital insurance to frustrated Canadians awaiting surgery. Sixteen per cent of those polled said they wanted this service; that was enough for AMS. 

    “One thing that comes across loud and clear is that Canadians for the most part are happy,” says spokesperson Carrie Galbraith. “They know they are taken care of during an emergency. But they are willing to pay a little extra if they need care.”

    So far, AMS offers its plan to Ontario, B.C. and Manitoba, with Toronto its best market. Galbraith says plans are in the works to expand to all of Canada except the territories. 

    Unfortunately, like most private health plans, AMS cuts its losses by avoiding what Galbraith calls “adverse selection” – anybody with a known serious health problem need not apply. 

    Here in Ontario, private for-profit home care services take in close to half of all OHIP billings. Many clients pay out of their own pockets for additional services. 

    The Ontario health ministry doesn’t keep statistics on the extent of the private home health care sector, says spokesperson Layne Verbeek. But the Ontario Home Health Care Providers’ Association, a trade group, estimates private homecare companies now employ 20,000 and serve more than 100,000. 

    “It’s a market situation,” says Henwood. “If the services aren’t available to people within the public sector, they will go outside of it. We’ve seen this in other countries like England, where they had a public system and now have a parallel private system. If you erode a system enough that people get angry, they are going to start to look for alternatives, and the people with the greatest liberty are those with money.”

    But in a recent interview, health minister Ruth Grier was adamant this scenario wouldn’t be allowed to take place in Ontario. She strongly disagreed that medicare is being weakened due to recent changes, and said the government has actually “reaffirmed its commitment to medicare.”  

    More from Canada’s Today’s Seniors: 

    Feds Call For AIDS, Blood System Inquiry: Some Seniors Infected

    Government Urged To Limit Free Drugs For Seniors

    Health Care On The Cutting Block: Ministry Hopes For Efficiency With Search And Destroy Tactics

    New Seniors’ Group Boosts ‘Grey Power’: Grey Panthers Chapter Opens With A Canadian Touch

    Seniors Falling Through The Health Care Cost Cracks

    My background: 

    CASE STUDY 7: UNOSSC + UNDP | 2007 – 2016

    CASE STUDY 5: GOSH/ICH Child Health Portal | 2001 – 2003

    CASE STUDY 4: UN + UNDP Mongolia | 1997 – 1999

    Hannah Institute For The History Of Medicine | 1992 – 1994

    Taking Medicine To The People: Four Innovators In Community Health

    Take Two Big Doses Of Humanity And Call Me In The Morning

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    ORCID iD: https://orcid.org/0000-0001-5311-1052.

    © David South Consulting 2021

  • Rebuilding After Chinese Earthquake: Beautiful Bamboo Homes

    Rebuilding After Chinese Earthquake: Beautiful Bamboo Homes

    By David South, Development Challenges, South-South Solutions

    SOUTH-SOUTH CASE STUDY

    It has been a year since the May 12, 2008 Sichuan earthquake in China that killed more than 70,000 people.

    China’s strongest earthquake for more than half a century, with a magnitude of 8.0 (en.wikipedia.org), it devastated large parts of the province of Sichuan. More than 10 million people were made homeless, most of them poor and elderly villagers (cities were not badly damaged).

    Getting Sichuan back to normal is critical for not only the province’s people, but for all of China. Sichuan is China’s rice bowl, growing more food than any other province. But despite the abundance of food, Sichuan remains poor and has seen its working age population move away for work. If it is to have a viable future then its communities need to get back to normal as fast as possible – and its farming economy back to full production.

    The unprecedented media coverage of the disaster meant people across China saw the scenes of devastation and have since contributed large donations to help with the reconstruction. The Chinese government has pledged to spend US $151 billion on reconstruction projects.

    Finding ways to re-house people after large disasters has become an urgent issue over the last five years. From the Asian tsunami to Hurricane Katrina in the United States and multiple hurricane disasters in the Caribbean, restoring communities is critical for the health of the people and the economies they rely on. Experience has shown that temporary shelters have many drawbacks, being usually of poor quality for long-term habitation and a source of health problems.

    The temporary shelters erected for the Sichuan homeless are unsuitable for long-term housing: the 12 square metre grey boxes – two sheets of aluminium sandwiching a polystyrene core for insulation – have no heating. The occupants roast inside in the summer and freeze in the winter. They are also located away from the main source of income: the farms.

    The dilemma is how to build new, long-term houses that will not cost too much. Inflation has increased the costs of conventional building materials: bricks, cement and steel.

    But the use of traditional building materials and home designs offers an alternative. By drawing on the abundant bamboo and wood in Sichuan and by building to traditional designs, cheaper but sturdy and beautiful homes can be built.

    An average home now costs around 80,000 yuan (US $11,688). The Chinese government estimates the price is now 820 yuan per square meter for a new home: bamboo homes cost between 300 and 400 yuan per square meter. Government compensation is between 16,000 yuan (US $2,337) and 23,000 yuan (US $3,360) per family. The bamboo houses range in size from 75 to 200 square metres, and in cost from 22,500 yuan to 80,000 yuan for a very large home.

    In Daping village, Pengzhou Town, original homes destroyed by the earthquake sit at the edge of a forested hill. Their frames are more or less intact, but the walls and roofs have collapsed. The new houses replacing them are large, two stories high and have solid grey clay tile roofs. The beauty of the designs stands out and sits in stark contrast to the temporary shelters and concrete buildings.

    “There are 43 houses and two public buildings being rebuilt in this project,” says team member Hu Rong Rong of the Green Building Research Centre of Xi’an University of Architecture and Technology. “The design and the main building material are based on the ecological and sustainable habitat idea. The place (Sichuan) is rich in bamboo and wood. These natural materials are cheap and friendly to the environment. In some buildings we use light steel which can be also recycled.”

    The new homes are built to earthquake resistance standards. Led by Professor LiuJiaping, a team of 15 people from the research centre and two from a design institute developed the home designs and supervised the training of local people. They were joined by 10 people from an NGO called Global Village of Beijing, who managed the project to completion.

    “All the designs were discussed with the local people,” continues Hu. “We trained a local construction team, which means the local people would build their own houses by themselves. Both our research center and the local people were involved in developing the home design.

    “To get the trust from the local people is a challenge in the project. We resolved it by showing our respect to the local people. Before we started our design we discussed with the local people many times to know what kind of house they like. We built the first house to make them believe us.”

    Hu believes it is possible to replicate the homes across Sichuan.

    “The design is suitable for other villages in Sichuan which have a similar climate and culture with this village. To rebuild sustainable houses after a disaster we should know well about the local life, environment and culture – try to find the useful technique which was used in their traditional houses and upgrade the traditional house to meet the need of their modern life.”

    Others have not been as lucky as these villagers. In the village of Yuan Bao, Chen Jingzhong, 66, has had to build a makeshift shack: “They wanted to get us to build our own houses but they didn’t give us enough money,” Chen told the Telegraph Magazine. “All we could afford was this shack, which we built ourselves, with our own hands and without any help from anyone.”

    Published: May 2009

    Resources

    Architecture for Humanity: By tapping a network of more than 40,000 professionals willing to lend time and expertise to help those who would not otherwise be able to afford their services, they bring design, construction and development services where they are most critically needed. Website: www.architectureforhumanity.org

    Chinese Red Cross: The Red Cross Society of China is accepting donations for disaster reconstruction and is coordinating rebuilding efforts in Sichuan Website: http://www.redcross.org.cn/ywzd/

    Gerd Niemoeller has developed flat pack, cardboard homes that can be deployed quickly after a disaster and can become permanent homes.Website: http://tinyurl.com/6t6jtf and the company
    Website: http://www.wall.de/en/home

    Global Greenhouse Warming is a website that tracks extreme weather events around the world: drought, flooding, severe storms, severe winter, tropical cyclone, wildfires, and extreme heat waves.Website: www.global-greenhouse-warming.com

    The Building and Social Housing Foundation: An independent research organization promoting sustainable development and innovation in housing through collaborative research and knowledge transfer. Website: www.bshf.org

    https://davidsouthconsulting.org/2021/09/01/disaster-recovery-ten-years-after-the-gujarat-india-experience/

    https://davidsouthconsulting.org/2021/11/12/energy-efficient-wooden-houses-are-also-earthquake-safe/

    https://davidsouthconsulting.org/2021/09/01/haiti-earthquake-prompts-tech-aid/

    https://davidsouthconsulting.org/2021/02/12/rammed-earth-houses-china-shows-how-to-improve-and-respect-traditional-homes/

    https://davidsouthconsulting.org/2022/09/26/3d-home-printing-landmark-10-houses-in-a-day/

    Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.

    https://davidsouthconsulting.org/2021/03/05/southern-innovator-issue-4/

    Creative Commons License

    This work is licensed under a
    Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

    ORCID iD: https://orcid.org/0000-0001-5311-1052.

    © David South Consulting 2023

  • Rammed-Earth Houses: China Shows how to Improve and Respect Traditional Homes

    Rammed-Earth Houses: China Shows how to Improve and Respect Traditional Homes

    By David South, Development Challenges, South-South Solutions

    (Havana, Cuba), November 2008

    SOUTH-SOUTH CASE STUDY

    The pace of change across the South has been blistering. Over the past decade, the overall population has moved from being primarily rural to majority urban. In the process, rural communities have suffered, as they have seen their young and ambitious leave in droves seeking a better life in cities.

    More than 200 million Chinese farmers have moved to cities in recent years. It’s easy to see why. Chinese farms are tiny, with the average rural household farming just 0.6 hectares. And incomes are low compared to the cost of living: average annual income was just US$606 in 2007, a third of city salaries.

    But it is possible to improve the quality of life in rural areas and in turn boost economic fortunes.

    In China, projects that upgrade homes to modern standards while respecting traditional designs and architecture are breathing new life into rural communities. A return to the age-old technique of using earth as the principal building material is saving energy and keeping house costs low.

    The tradition of packing earth to build a wall dates back to some of the earliest stretches of the Great Wall of China in 220 BC.

    Currently it is estimated that half the world’s population-approximately 3 billion people on six continents – lives or works in buildings constructed of earth.

    This traditional building technique is being used in the reconstruction effort to build new homes after the May 12, 2008 earthquake in Sichuan Province. The earthquake left millions of people homeless in the country’s worst natural disaster in 30 years, and has made low-cost but efficient house building critical.

    In western China, villages have been entirely rebuilt from scratch. The application of research and science to the traditional designs – roofs in the pagoda style, with buildings arranged around courtyards – enabled the development of homes that are energy efficient to run, and are more hygienic and earthquake safe. In Yongren County of Yunnan Province, over 7,000 mountain dwellers were moved to better farming land and over 2,000 homes were built in the new village of BaLaWu. Over 30 of the homes were built using rammed earth by the Xi-an team. 

    “The original homes had very low living quality,” said team member Hu Rong Rong of the Green Building Research Centre of Xi’an University of Architecture and Technology (http://www.xauat.edu.cn/jdeg/about.html), which oversees building of the new homes. “The architecture layout of the indoor space and courtyard was not reasonable. In the courtyard the areas for living, raising livestock, storing and processing crops were mixed up. The indoor environment was not comfortable. It was cold in the houses during winter and hot during summer. Most of the rooms lacked natural lighting and were dark in the daytime.

    “In the poor areas, many people still live in earth houses because of the low cost. However, most of the earth houses have low living quality.

    “After we finished the project, through our design, the living quality was improved very much. The dwellers were satisfied with their new houses.”

    Land reform in China has brought more hope to the country’s 750 million rural poor, many of whom live on less than US$1 a day. It is hoped that giving the rural poor more control over their lives will bring an improvement in agricultural production, food security and economic prosperity. Reforms also mean the poor have more secure land rights.

    Hu said gaining the trust and buy-in of the villagers was critical to the success of the project.

    “We built the first home as a demonstration. After we finished, the villagers could experience the advantages of the new home. Most of them decided to use our design and they could choose the one they liked from several proposals.”

    Poverty is a big problem in the villages. Incomes are very low, at 2000 RMB per year (US $290). Hu said “families were given a house-building allowance of 8000 RMB (US $1,160) to meet the cost of building materials – and the land was free for them to use.”

    “The villagers built the houses by self-help. We helped them to design and build the houses for free,” Hu said.

    The houses are pioneering in using natural sources to provide light, heat, waste disposal and gas for cooking and heating.

    “We used natural material like earth as a main building material to get good thermal mass and also to reduce CO2 emission,” Hu said.

    “We designed a simple family sewage-purge-pool and marsh-gas-well system to reduce pollution and get energy from wastes.”

    Using rammed earth has a long history in China. Across Western China, there are many buildings constructed with rammed earth. And using earth has many advantages when resources are scarce or expensive: “Earth buildings avoid deforestation and pollution, and can achieve low energy costs throughout their lifetime,” said Hu.

    “With living standards increasing, more and more people would like to use burned bricks and concrete to build new houses, which will consume more energy and bring pollution,” said Hu.

    But like any technology, the application of modern science and environmental knowledge to the traditional designs, can reap huge improvements in the quality of the homes and comfort levels. And win people back to the benefits of rammed earth dwellings.

    “Building with earth materials can be a way of helping with sustainable management of the earth’s resources,” said Hu.

    And Hu is adamant the new, environmentally designed homes respect the wisdom of traditional design.

    “The new earth house design should consider the local culture. It should be proved that both the house style and the construction technique can be accepted by the users.”

    Published: December 2008

    Resources

    • The Rural Development Institute focuses on land rights for the poor and has a series of articles on China’s land reforms. Website: www.rdiland.org
    • Rural DeveIopment Institute has recently been given an award from the World Bank’s Development Marketplace competition to create Legal Aid and Education Centres in China’s countryside. Website:www.rdiland.org/PDF/092808_WorldBankComp.pdf
    • A blog gives more details on the Chinese rammed earth project. 
      Website:www.51xuewen.com
    • Earth Architecture, a book and blog on the practice of building with earth, including contemporary designs and projects. 
      Website: www.eartharchitecture.org

    https://davidsouthconsulting.org/2022/05/23/debt-free-homes-for-the-poor/

    https://davidsouthconsulting.org/2021/11/12/energy-efficient-wooden-houses-are-also-earthquake-safe/

    https://davidsouthconsulting.org/2022/10/26/making-bamboo-houses-easier-to-build/

    https://davidsouthconsulting.org/2021/02/12/rebuilding-after-chinese-earthquake-beautiful-bamboo-homes/

    https://davidsouthconsulting.org/2022/05/23/solar-bottle-bulbs-light-up-dark-homes/

    https://davidsouthconsulting.org/2022/09/26/3d-home-printing-landmark-10-houses-in-a-day/

    https://davidsouthconsulting.org/2022/11/17/tiny-homes-to-meet-global-housing-crisis/

    Sponsored by BSHF. BSHF is now called World Habitat and it aims to seek out and share the best solutions to housing problems from around the world.

    https://davidsouthconsulting.org/2021/03/05/southern-innovator-issue-4/

    Creative Commons License

    This work is licensed under a
    Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

    ORCID iD: https://orcid.org/0000-0001-5311-1052.

    © David South Consulting 2023

  • Turning Street Children into Entrepreneurs

    Turning Street Children into Entrepreneurs

    By David South, Development Challenges, South-South Solutions

    SOUTH-SOUTH CASE STUDY

    The UN estimates that 500 million people around the world are homeless, and UNICEF estimates India alone has 11 million homeless children on its streets (though it is difficult to pin down the figure). In order to survive another day, these children will work in one way or another. While there are many campaigns to ban children from working, and charities dedicated to getting them off the streets and into shelter, the raw fact remains: many of these children slip through the cracks and remain vulnerable, poor and neglected.

    Most street children suffer from malnutrition, hunger, health problems, and abuse. They make ends meet by working various jobs or by stealing. While they have dreams, there is no mechanism for them to save for the future. It is a live-for-now existence that, if they survive to adulthood, means they will probably remain homeless and vulnerable.

    Street and working children have money: it is a natural consequence of having to be resourceful to survive. But what they don’t have is access to banking services or trustworthy financial advice that can help them to gain wealth and move out of poverty and into a brighter future.

    The Children’s Development Bank in India is one initiative that seeks to turn these neglected children into the next generation of entrepreneurs. The bank works on banking and co-operative principles, where savers are members and joint owners of the bank. Any child can save money with the bank and earn interest, as well as take out loans if they are over 15 years old. It was started in 2001 and was inspired by the Youth Bank in the UK. Interest made by the bank is shared by its members, as with many co-operative banks and credit unions.

    The bank is managed jointly by children and adults. The children have a say in how the bank is run and on what conditions it should lend money. They also keep an eye on borrowers to prevent them from running off without repaying loans.

    For these vulnerable children, it has many advantages: they can put money aside without fear of it being stolen or lost, save for important things like clothes, or pay for their education.

    A key part of the bank’s mandate is helping the children build entrepreneurial skills for business. Mentors help the children choose a business model, select an occupation with minimal risk and more benefits, get training and solve business problems.

    The bank has branches in India, Afghanistan, and Sri Lanka.

    Ten-year-old Deepak Prahlad, a street child in Delhi, dreams of being a doctor.

    “I know what it takes to be a doctor. I need to study hard and need to save a lot of money,” he told the Hindustan Times. For now, he works as a rag picker but has started saving 30 to 40 rupees a day in the Children’s Development Bank. The bank has 1,300 members in the city. It pays 3.5 per cent interest on savings accounts.

    “Some of them want to fly very high,” said Rita Panicker, who helped set up the bank in 2001. “We have been working with street children for the past two decades. Some of these children are very talented and have entrepreneur qualities. One of the biggest problems facing these children was that they did not have a safe place to keep their hard-earned money. In fact, it was the children who came up with the idea of the children’s bank. It started with 20 members in 2001 – and now it has 1,300 members in Delhi.”

    Sudesh, a 15-year-old manager who looks after the bank’s current accounts, said: “We are extremely careful about whom to offer loans since we do not want to see our members’ savings lost because of bad loans. The skills I have learnt here are going to stand me in good stead in life.” Managers are chosen every six months by the children and they compete for the job.

    Published: November 2007

    Resources

    • Making Cents International: “It inspires youth, practitioners, policy makers and funders to more effectively share and develop parnerships, programmes and policies that support youth entrepreneurs.”
    Southern Innovator Issue 2 focused on youth and entrepreneurship. https://g.co/kgs/6kZAg4

    https://davidsouthconsulting.org/2022/12/18/the-disabled-in-the-south-can-make-money-restore-dignity/

    https://davidsouthconsulting.org/2021/10/28/ending-gang-violence-while-cleaning-the-streets-in-haiti/

    https://davidsouthconsulting.org/2023/01/16/hip-driven-pump-brings-water-to-parched-fields/

    https://davidsouthconsulting.org/2022/05/02/landmark-study-finds-simple-toys-key-to-boosting-educational-development-and-meeting-mdgs/

    https://davidsouthconsulting.org/2021/03/05/southern-innovator-issue-2/

    https://davidsouthconsulting.org/2020/12/09/study-finds-simple-toys-key-to-boosting-educational-development-january-2007/

    https://davidsouthconsulting.org/2022/10/27/tapping-the-power-of-child-play/

    https://davidsouthconsulting.org/2022/07/19/traffic-signs-bring-safety-to-the-streets/

    Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator. 

    Creative Commons License

    This work is licensed under a
    Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

    ORCID iD: https://orcid.org/0000-0001-5311-1052.

    © David South Consulting 2023