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Canada's top doctor calls for 'structural change' to address COVID-19 inequities – CTV News

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OTTAWA —
Canada’s Chief Public Health Officer Dr. Theresa Tam is calling for “structural change” across health, social, and economic sectors in the wake of COVID-19, in a new report highlighting the successes and shortfalls in the country’s pandemic response to date.

“I do see COVID-19 as a catalyst for collaboration between health, social, and economic sectors, and I have observed at the federal level, but also from local levels, and provincial levels,” she told reporters during a press conference discussing the report.

Tam said that while there are examples of decisions taken that begin to address some of these shortcomings—such as increasing affordable housing availability and financial supports for low-income and precarious workers—these policies should be extended past the emergency phase of the pandemic.

“What I’m really, really keen to see is that this continues… The report is calling for this to be a more sustained approach,” she said. “Why can’t we have those governance structures beyond the crisis and into recovery?”

In the Public Health Agency’s annual report made public on Wednesday, Tam offers new insights and statistics related to Canada’s battle against the novel coronavirus over the last several months and the “serious threat” the virus continues to pose. 

For example, in Canada:

  • 80 per cent of COVID-19-related deaths have been residents of long-term care facilities;
  • 19 per cent of national cases are among health-care workers; and
  • 92 per cent of hospitalized COVID-19 patients had at least one underlying health condition.

The annual report is entitled “From Risk to Resilience: An Equity Approach to COVID-19,” and it gives an overview of COVID-19’s consequences so far, such as the disproportionate health impacts experienced by workers who provide essential services, racialized populations, people living with disabilities or mental illnesses, and women. 

It also includes recommendations on how to improve the country’s pandemic preparedness, response, and recovery. 

The report says the “structural change” should include improving employment conditions and conditions inside long-term care homes, increasing access to housing, as well as enhancing Canadians’ ability to access social and health services both in-person and online. 

Tam said she hopes that in future pandemic planning, “it can’t just be health and public health making it known that all other departments and different sectors, and different aspects of societies need to be part of the response. We need to sort of build it in explicitly so that, you know, future pandemics and health crises have those other supports come into play immediately.”

As Tam argues, Canadians’ health depends on their social and economic well-being and the severity of COVID-19 illness may be influenced by their access to these kinds of supports. 

“No one is protected until everyone is protected,” says Tam in the report. 

Tam’s overall recommendations are distilled into three calls:

  • Sustaining governance at all levels for “structural change” in health, social, and economic sectors. The report notes that the health of people in Canada was not equal before COVID-19, but that the pandemic has exposed and exacerbated existing shortcomings. Tam suggests that more data needs to be collected and used to inform policy decisions to eliminate inequities and mitigate some potential long-term pandemic impacts;
  • Harnessing “the power of social cohesion” to control and minimize the virus’ spread. She suggests this can be done by leaders sharing evidence and information to provide Canadians with confidence in taking public health precautions such as mask-wearing; and
  • Strengthening public health capacity. Tam says that more work is needed to ensure Canada’s public health system is able to handle case surges while having the capacity to deal with non-COVID-19 health issues, including re-evaluating “what sustained investments and the future of public health would look like.”

GLOBAL COMPARISONS 

The report also goes over the timeline from the first confirmed case in Canada and when community transmission began, to the various rolling restrictions and travel advisories imposed. 

From a global perspective, according to the report, Canada ranked 79th out of 210 countries with respect to total cases per million inhabitants, and 26th for total deaths per million, as of Aug. 22. The outbreaks in Canadian long-term care homes are cited as a driving factor in why Canada is so high on the list of countries when it comes to deaths. 

“Pandemic preparedness did not extend into these settings leaving residents vulnerable to the introduction, spread and impact of a novel virus,” the report states. 

Further, analysis of international travel-related cases between January and March found that 35 per cent of cases entered Canada from the United States, 10 per cent from the U.K. and France, and 1.4 per cent from China. Once travel restrictions were imposed, 91 per cent of reported cases by August originated in Canada.

COMMUNICATION STRUGGLES 

The report notes that in the absence of an effective treatment or vaccine, individual and collective public health measures need to be taken to control the pandemic. However, “accurate, timely and clear communication” has been a challenge. 

Tam notes that there have been “a number” of issues on this front, such as Canadians being exposed to a vast amount and varying quality of information and the confusion spawning from the frequently-moving goal posts when it comes to public health advice due to the evolving science. 

“Information needs to be tailored and locally contextualized, while at the same time balanced with consistent key messaging being shared across the country,” the report states. 

Tam is advising that as long as the virus is uncontrolled, public health officials and governments need to be transparent and provide regular updates on COVID-19 and up-to-date guidance. 

It’s a part of Tam’s mandate to provide Health Minister Patty Hajdu with a report on the state of public health in Canada annually, which then is tabled in Parliament.

The report is based on Canadian data available from January to the end of August, and notes that because the virus and evidence around it continues to rapidly evolve, “the report was written with the knowledge that the story of this pandemic is continuing to change every day.”

TIMELINE OF KEY MILESTONES

  • December 31, 2019: PHAC was notified of a pneumonia-like illness of unknown cause originating in Wuhan, China.
  • January 22, 2020: Canada implements novel coronavirus screening requirements for travellers returning from China. Residents are asked additional screening questions to determine if they have visited the city of Wuhan, China.
  • January 25, 2020: First presumptive confirmed case of 2019-nCoV related to travel to Wuhan, China confirmed in Ontario.
  • February 20, 2020: First COVID-19 case in Canada from travel outside mainland China, from Iran, reported in British Columbia.
  • February 23, 2020: First recorded COVID-19 case in Canada linked to community transmission.
  • February 24, 2020: Alberta records first COVID-19 case in Canada linked to travel to the U.S.
  • March 7, 2020: First COVID-19 outbreak at a long-term care home in Vancouver, British Columbia involving 79 cases.
  • March 11, 2020: Canada surpasses 100 reported COVID-19 cases.
  • March 12-22, 2020: Physical distancing measures are implemented across the country. All provinces and territories declare a state of emergency and/or public health emergency. Non-essential businesses close or have significantly reduced capacity; gatherings are restricted; schools close; advisory issued for those who can, to work from home.
  • March 13, 2020: The Government of Canada recommends avoiding non-essential travel outside of Canada,
  • March 16, 2020: Government of Canada advises all travellers entering Canada to self-isolate for 14 days.
  • March 18–19, 2020: Additional international travel advisories and border restrictions are implemented: Entry to Canada by air is prohibited to all foreign nationals (except those from the United States); Canada and the United States agree to temporarily restrict non-essential travel across the Canada-US border; International flights are redirected to only 4 airports.
  • March 28, 2020: First reported outbreak among temporary foreign workers in an agricultural setting, involving 23 people.
  • April 7, 2020: Council of Chief Medical Officers of Health issue a statement supportive of wearing non-medical masks as an additional layer of protection for other people in close proximity.
  • April 14, 2020: Largest known COVID-19 outbreak reported at homeless shelter in Toronto, Ontario, involving 164 cases.
  • April 15, 2020: Lockdown in response to largest known outbreak at a correctional facility in Laval, Quebec involving 162 cases.
  • April 17, 2020: First reported COVID-19 outbreak in an isolated northern community in Saskatchewan, affecting 117 residents.
  • April 24, 2020: New Brunswick is the first province to ease physical distancing restrictions.
  • May 6, 2020: Alberta reports a COVID-19 outbreak at a meat processing plant, which becomes the largest outbreak at a single location in Canada (by the end of August) with 1,560 people confirmed.
  • June 17, 2020: First COVID-19 outbreak in a religious-cultural community declared in Saskatchewan, involving 285 people.   

Timeline source: Public Health Agency of Canada. 

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Arizona voters guarantee the right to abortion in the state constitution

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PHOENIX (AP) — Arizona voters have approved a constitutional amendment guaranteeing abortion access up to fetal viability, typically after 21 weeks — a major win for advocates of the measure in the presidential battleground state who have been seeking to expand access beyond the current 15-week limit.

Arizona was one of nine states with abortion on the ballot. Democrats have centered abortion rights in their campaigns since the U.S. Supreme Court overturned Roe v. Wade in 2022. Abortion-rights supporters prevailed in all seven abortion ballot questions in 2022 and 2023, including in conservative-leaning states.

Arizona for Abortion Access, the coalition leading the state campaign, gathered well over the 383,923 signatures required to put it on the ballot, and the secretary of state’s office verified that enough were valid. The coalition far outpaced the opposition campaign, It Goes Too Far, in fundraising. The opposing campaign argued the measure was too far-reaching and cited its own polling in saying a majority of Arizonans support the 15-week limit. The measure allows post-viability abortions if they are necessary to protect the life or physical or mental health of the mother.

Access to abortion has been a cloudy issue in Arizona. In April, the state Supreme Court cleared the way for the enforcement of a long-dormant 1864 law banning nearly all abortions. The state Legislature swiftly repealed it.

Voters in Arizona are divided on abortion. Maddy Pennell, a junior at Arizona State University, said the possibility of a near-total abortion ban made her “depressed” and strengthened her desire to vote for the abortion ballot measure.

“I feel very strongly about having access to abortion,” she said.

Kyle Lee, an independent Arizona voter, does not support the abortion ballot measure.

“All abortion is pretty much, in my opinion, murder from beginning to end,” Lee said.

The Civil War-era ban also shaped the contours of tight legislative races. State Sen. Shawnna Bolick and state Rep. Matt Gress are among the handful of vulnerable Republican incumbents in competitive districts who crossed party lines to give the repeal vote the final push — a vote that will be tested as both parties vie for control of the narrowly GOP-held state Legislature.

Both of the Phoenix-area lawmakers were rebuked by some of their Republican colleagues for siding with Democrats. Gress made a motion on the House floor to initiate the repeal of the 1864 law. Bolick, explaining her repeal vote to her Senate colleagues, gave a 20-minute floor speech describing her three difficult pregnancies.

While Gress was first elected to his seat in 2022, Bolick is facing voters for the first time. She was appointed by the Maricopa County Board of Supervisors to fill a seat vacancy in 2023. She has not emphasized her role in the repeal vote as she has campaigned, instead playing up traditional conservative issues — one of her signs reads “Bolick Backs the Blue.”

Voters rejected a measure to eliminate retention elections for state Superior Court judges and Supreme Court justices.

The measure was put on the ballot by Republican legislators hoping to protect two conservative justices up for a routine retention vote who favored allowing the Civil War-era ban to be enforced — Shawnna Bolick’s husband, Supreme Court Justice Clint Bolick, and Justice Kathryn Hackett King. Since the measure did not pass, both are still vulnerable to voter ouster, though those races hadn’t been decided by early Wednesday morning.

Under the existing system, voters decide every four to six years whether judges and justices should remain on the bench. The proposed measure would have allowed the judges and justices to stay on the bench without a popular vote unless one is triggered by felony convictions, crimes involving fraud and dishonesty, personal bankruptcy or mortgage foreclosure.

The Canadian Press. All rights reserved.

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Voters back Nebraska’s ban on abortions after 12 weeks of pregnancy and reject a competing measure

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OMAHA, Neb. (AP) — Nebraska voters supported a measure Tuesday that enshrines the state’s current ban on abortions after the 12th week of pregnancy in the state constitution, and they rejected a competing measure that sought to expand abortion rights. Nebraska was the first state to have competing abortion amendments on the same ballot since the U.S. Supreme Court overturned Roe v. Wade in 2022, ending the nationwide right to abortion and allowing states to decide for themselves. The dueling measures were among a record number of petition-initiated measures on Nebraska’s ballot Tuesday.

What were the competing abortion measures?

A majority of voters supported a measure enshrining the state’s current ban on abortion after the first 12 weeks of pregnancy in the state constitution. The measure will also allow for further restrictions. Last year, the Legislature passed the 12-week ban, which includes exceptions for cases of rape and incest and to protect the life of the pregnant woman.

Voters rejected the other abortion measure. If they had passed it by a larger number of “for” votes than the 12-week measure, it would have amended the constitution to guarantee the right to have an abortion until viability — the standard under Roe that is the point at which a fetus might survive outside the womb. Some babies can survive with medical help after 21 weeks of gestation.

Abortion was on the ballot in several other states, as well. Coming into the election, voters in all seven states that had decided on abortion-related ballot measures since the reversal of Roe had favored abortion rights, including in some conservative states.

Who is behind the Nebraska abortion measures?

The 12-week ban measure was bankrolled by some of Nebraska’s wealthiest people, including Republican Sen. Pete Ricketts, who previously served as governor and donated more than $1.1 million. His mother, Marlene Ricketts, gave $4 million to the cause. Members of the Peed family, which owns publishing company Sandhills Global, also gave $1 million.

The effort was organized under the name Protect Women and Children and was heavily backed by religious organizations, including the Nebraska Catholic Conference, a lobbying group that has organized rallies, phone banks and community townhalls to drum up support for the measure.

The effort to enshrine viability as the standard was called Protect Our Rights Nebraska and had the backing of several medical, advocacy and social justice groups. Planned Parenthood donated nearly $1 million to the cause, with the American Civil Liberties Union, I Be Black Girl, Nebraska Appleseed and the Women’s Fund of Omaha also contributing significantly to the roughly $3.7 million raised by Protect Our Rights.

What other initiatives were on Nebraska’s ballot?

Nebraska voters approved two measures Tuesday that will create a system for the use and manufacture of medical marijuana, if the measures survive an ongoing legal challenge.

The measures legalize the possession and use of medical marijuana, and allow for the manufacture, distribution and delivery of the drug. One would let patients and caregivers possess up to 5 ounces (142 grams) of marijuana if recommended by a doctor. The other would create the Nebraska Medical Cannabis Commission, which would oversee the private groups that would manufacture and dispense the drug.

Those initiatives were challenged over allegations that the petition campaign that put them on the ballot broke election rules. Nebraska’s attorney general said supporters of the measures may have submitted several thousand invalid signatures, and one man has been charged in connection with 164 allegedly fraudulent signatures. That means a judge could still invalidate the measures.

Voters also opted Tuesday to repeal a new conservative-backed law that allocates millions of dollars in taxpayer money to fund private school tuition.

Finally, they approved a measure that will require all Nebraska employers to provide at least 40 hours of paid sick leave to their employees.

The Canadian Press. All rights reserved.

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Abortion rights advocates win in 7 states and clear way to overturn Missouri ban but lose in 3

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WASHINGTON (AP) — Voters in Missouri cleared the way to undo one of the nation’s most restrictive abortion bans in one of seven victories for abortion rights advocates, while Florida, Nebraska and South Dakota defeated similar constitutional amendments, leaving bans in place.

Abortion rights amendments also passed in Arizona, Colorado, Maryland and Montana. Nevada voters also approved an amendment, but they’ll need to pass it again it 2026 for it to take effect. Another that bans discrimination on the basis of “pregnancy outcomes” prevailed in New York.

The results include firsts for the abortion landscape, which underwent a seismic shift in 2022 when the U.S. Supreme Court overturned Roe v. Wade, a ruling that ended a nationwide right to abortion and cleared the way for bans to take effect in most Republican-controlled states.

They also came in the same election that Republican Donald Trump won the presidency. Among his inconsistent positions on abortion has been an insistence that it’s an issue best left to the states. Still, the president can have a major impact on abortion policy through executive action.

In the meantime, Missouri is positioned to be the first state where a vote will undo a ban on abortion at all stages of pregnancy, with an amendment that would allow lawmakers to restrict abortions only past the point of a fetus’ viability — usually considered after 21 weeks, although there’s no exact defined time frame.

But the ban, and other restrictive laws, are not automatically repealed. Advocates now have to ask courts to overturn laws to square with the new amendment.

“Today, Missourians made history and sent a clear message: decisions around pregnancy, including abortion, birth control, and miscarriage care are personal and private and should be left up to patients and their families, not politicians,” Rachel Sweet, campaign manager of Missourians for Constitutional Freedom, said in a statement.

Roughly half of Missouri’s voters said abortion should be legal in all or most cases, according to AP VoteCast, a survey of more than 2,200 of the state’s voters. But only about 1 in 10 said abortion should be illegal in all cases; nearly 4 in 10 said abortion should be illegal in most cases.

Bans remain in place in three states after votes

Florida, Nebraska and South Dakota became the first states since Roe was overturned where abortion opponents prevailed on a ballot measure. Most voters supported the Florida measure, but it fell short of the required 60% to pass constitutional amendments in the state. Most states require a simple majority.

The result was a political win for Gov. Ron DeSantis, a Republican with a national profile, who had steered state GOP funds to the cause. His administration has weighed in, too, with a campaign against the measure, investigators questioning people who signed petitions to add it to the ballot and threats to TV stations that aired one commercial supporting it.

Marjorie Dannenfelser, president of the national anti-abortion group SBA Pro-Life America, said in a statement that the result is “a momentous victory for life in Florida and for our entire country,” praising DeSantis for leading the charge against the measure.

The defeat makes permanent a shift in the Southern abortion landscape that began when the state’s six-week ban took effect in May. That removed Florida as a destination for abortion for many women from nearby states with deeper bans and also led to far more women from the state traveling to obtain abortion. The nearest states with looser restrictions are North Carolina and Virginia — hundreds of miles away.

“The reality is because of Florida’s constitution a minority of Florida voters have decided Amendment 4 will not be adopted,” said Lauren Brenzel, campaign director for the Yes on 4 Campaign said while wiping away tears. “The reality is a majority of Floridians just voted to end Florida’s abortion ban.”

In South Dakota, another state with a ban on abortion throughout pregnancy with some exceptions, the defeat of an abortion measure was more decisive. It would have allowed some regulations related to the health of the woman after 12 weeks. Because of that wrinkle, most national abortion-rights groups did not support it.

Voters in Nebraska adopted a measure that allows more abortion restrictions and enshrines the state’s current 12-week ban and rejected a competing measure that would have ensured abortion rights.

Other states guaranteed abortion rights

Arizona’s amendment will mean replacing the current law that bans abortion after the first 15 weeks of pregnancy. The new measure ensures abortion access until viability. A ballot measure there gained momentum after a state Supreme Court ruling in April found that the state could enforce a strict abortion ban adopted in 1864. Some GOP lawmakers joined with Democrats to repeal the law before it could be enforced.

In Maryland, the abortion rights amendment is a legal change that won’t make an immediate difference to abortion access in a state that already allows it.

It’s a similar situation in Montana, where abortion is already legal until viability.

The Colorado measure exceeded the 55% of support required to pass. Besides enshrining access, it also undoes an earlier amendment that barred using state and local government funding for abortion, opening the possibility of state Medicaid and government employee insurance plans covering care.

A New York equal rights law that abortion rights group say will bolster abortion rights also passed. It doesn’t contain the word “abortion” but rather bans discrimination on the basis of “pregnancy outcomes, and reproductive healthcare and autonomy.” Sasha Ahuja, campaign director of New Yorkers for Equal Rights, called the result “a monumental victory for all New Yorkers” and a vote against opponents who she says used misleading parental rights and anti-trans messages to thwart the measure.

The results end a win streak for abortion-rights advocates

Until Tuesday, abortion rights advocates had prevailed on all seven measures that have appeared on statewide ballots since the fall of Roe.

The abortion rights campaigns have a big fundraising advantage this year. Their opponents’ efforts are focused on portraying the amendments as too extreme rather than abortion as immoral.

Currently, 13 states are enforcing bans at all stages of pregnancy, with some exceptions. Four more bar abortion in most cases after about six weeks of pregnancy — before women often realize they’re pregnant. Despite the bans, the number of monthly abortions in the U.S. has risen slightly, because of the growing use of abortion pills and organized efforts to help women travel for abortion. Still, advocates say the bans have reduced access, especially for lower-income and minority residents of the states with bans.

The issue is resonating with voters. About one-fourth said abortion policy was the single most important factor for their vote, according to AP VoteCast, a sweeping survey of more than 110,000 voters nationwide. Close to half said it was an important factor, but not the most important. Just over 1 in 10 said it was a minor factor.

The outcomes of ballot initiatives that sought to overturn strict abortion bans in Florida and Missouri were very important to a majority of voters in the states. More than half of Florida voters identified the result of the amendment as very important, while roughly 6 in 10 of Missouri’s voters said the same, the survey found.

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Associated Press reporters Hannah Fingerhut and Amanda Seitz contributed to this article.

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This article has been corrected to reflect in the ‘other states’ section that Montana, not Missouri, currently allows abortion until viability.

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