Introduction
On behalf of the approximately 500,000 members of the Canadian Union of Public Employees (CUPE), we are pleased to forward this submission to the Social Union Framework Agreement (SUFA) Third Year Review. The Agreement, signed by federal, territorial and provincial governments (except Quebec) in February 1999, was designed to create a new framework for social policy making, set up the rules for how federal and provincial governments should work together and lay out principles of equity and fairness in social programs. It also outlines rules for federal spending power and promises collaboration, accountability and transparency.
As we enter into the Third Year Review Process, it is indeed crucial to examine the effectiveness of the Agreement and its impact on social policy. While we would welcome an initiative that facilitates cooperation between the federal, provincial and territorial governments and facilitates greater social equity among Canadians, we do not believe this is possible under the current Agreement. On the contrary, the SUFA has been an obstruction to meeting the needs of Canadians. This is precisely because we have had little or no public input, no opportunity for public debate and no chance to influence the terms of the Agreement.
In order for it to be a meaningful framework agreement, we believe that the federal government must play a leadership role; funding has to be put back into the transfers for social programs and expand these programs; they must be cost-shared with commitments that the provinces must adhere to; and we must have genuine transparency, equity and accountability.
At present, this Agreement does nothing to protect against increased privatization of our social programs. In our view, any meaningful framework agreement must protect our communities from rapidly increasing privatization.
General Comments on the Framework
Enforceable Standards
A key component of any social union framework must be a commitment to pan-Canadian standards for social programs and services which will ensure the individual and collective well-being of all Canadians. The SUFA provides no such standards but instead outlines vague principles to guide the framework. There have to be enforceable pan-Canadian standards governing social programs; this is the only way we can ensure that all persons have access to social programs and services of consistent quality, no matter where they live. The SUFA must allow us to have greater social equity in and between communities across this country. The lack of such enforceable standards has resulted in a disintegration of social programs, increased fragmentation and more inequities instead of consistent quality and equitable access.
Equity seeking groups are further penalized. A system of common standards would go a long way towards ensuring their needs are met. People with disabilities already face many barriers and the SUFA does not offer any clear framework for alleviating these barriers. Mobility between the provinces and territories is not easy for people with disabilities who cannot simply move and expect the same services to be available to them. Often it is very difficult even to find out what services are available outside of a person’s own province or territory.
Aboriginal people, women, workers of colour, lesbian, gay, bisexual and trans-gender workers – all must be guaranteed equal access to the social programs we have been proud of throughout our history.
New Social Programs
We believe that another major weakness is that the development of new social programs has actually been hindered by the Social Union Framework Agreement. Evidence shows that the protection of social rights under Canada’s cost-sharing agreements is now being sacrificed to provincial demands for unfettered authority. In order for new social programs to be successful, they have to be cost-shared in a way that commits provinces to funding the actual programs as designed according to the enforceable standards mentioned above. Another factor inhibiting the introduction of new programs is the stipulation that the government will not introduce such new initiatives without the agreement of a majority of provincial governments. By allowing each provincial and territorial government to “determine the detailed program design and mix best suited to its own needs and circumstances to meet the agreed objectives”, we are destroying any chance of even minimum standards being followed by all. In short, too much power has been ceded to the provinces in this agreement.
Health Care
Although we were initially pleased to see the five principles of Medicare outlined in the Agreement, this has not been enough to protect our healthcare system against privatization. There is nothing in the SUFA that would prevent or even inhibit privatization in the healthcare system. In addition, any new programs such as home care or pharmacare would not be covered by the same five principles established for Medicare, but in fact would be left to the whims and desires of whichever provincial government is implementing such a program.
Already, we have seen major policy changes in provinces set on dismantling Canada’s public health care system. Since 1996, we have had cumulative cuts in federal health transfers to the provinces and a corresponding drive by certain provinces to de-list services, slash budgets and off-load functions to municipalities and the private sector. Under the Social Union Agreement, provinces may choose to spend money designated for services not covered by the Canada Health Act on either public, non-profit care or private, for-profit care.
Provinces Moving Towards Privatization of Health Care
In Alberta, the introduction of Bill 11 (“The Health Protection Act”) marked a critical moment for Medicare. The Bill, far from protecting Canada’s public health care system, is a blueprint for the destruction of Medicare. Privatizing the delivery of surgical health care services will erode the integrity of Canada’s public health care system with dire consequences for the entire country. The privatization of health care services also increases the exposure of the Canadian health care system to trade complaints and challenges under NAFTA and the WTO.
In Ontario, we have already seen a move to privatize home care. The provincial system favours for-profit companies and many of these companies pay low wages, offer no benefits and replace trained nurses with casual labour. The restructuring of home and community care in Ontario has opened the door to multinational companies bidding alongside non-profit providers.
In British Columbia, during the first week of October 2002, health care workers served notice to employers and government that they would not stand by and watch a reckless agenda of privatization and cuts to health services continue without resistance.
Private Clinics Endanger Medicare Principles
In late September 2002, the Canadian Health Coalition (CHC) together with the Canadian Association of Radiologists (CAR) called on the federal government to stop the violation of the five principles of medicare enshrined in the Canada Health Act (and also included in the Principles of the SUFA). The CHC and Radiologists suggest that unchecked privatization of Canada’s health-care system, particularly in Ontario, Alberta and Nova Scotia, means the number of for-profit clinics operating outside of medicare will double within the year. Five years ago there were three private MRI (Magnetic Resonance Imaging) clinics in this country and today there are 25. Five years ago, there were no private CT (Computerized Tomography) clinics (there are now 12), and no private PET clinics (and now there are two). Ontario Health Minister, Tony Clement has announced his government will allow the creation of 20 MRI and five CT clinics which could be up and running this year.
The Nova Scotia government is permitting a private for-profit clinic to operate without regulation or government approval. We believe that these moves represent a violation of the principles of the Canada Health Act and the SUFA. As well, they represent a safety and liability issue, as the delivery of medical services that are not proven to be medically indicated and without proper medical referral, is unethical and needs to be regulated.
Provinces dedicated to the privatization of health care, such as Alberta and Ontario, can agree to the five principles of the Canada Health Act as they have done under the SUFA, and at the same time direct all their spending to for-profit services. This is a fundamental barrier to the provision of equitable access to social programs and services.
Dispute Avoidance and Resolution Mechanism
As follow up to the SUFA, the federal Minister of Health and the provinces agreed in April 2002, to a “Dispute Avoidance and Resolution” mechanism to deal with disputes under the Canada Health Act. While the federal Minister of Health retains sole authority to interpret the Canada Health Act, the mechanism contains a provision to seek a third party’s recommendations to resolve a dispute. This mechanism contains no operational criteria and can be triggered only by federal, provincial or territorial governments. There is nothing in this mechanism to ensure that the principles of the Canada Health Act will be enforced or protected. In fact, it ensures that the path of least resistance can be followed in any dispute –a path that seeks to appease federal/provincial/territorial relations at the expense of enforcing the principles of the Canada Health Act.
The Need for Federal Government Protection of Health Care
The September 30 Speech from the Throne does not provide any firm direction for health care reform in the near future either. We cannot stand by and wait for the First Ministers’ meeting early in 2003, at which a comprehensive plan will be put forward and include “enhanced accountability to Canadians” and the “necessary federal long-term investments” to be detailed in the next budget. As provincial governments in British Columbia, Ontario, Nova Scotia and Alberta move rapidly toward privatized health care services, it will be too late for “enhanced accountability”. We want the federal government to step in immediately to challenge those provinces which are contravening the principles of the Canada Health Act.
Universal Child Care and Early Education
Research consistently documents why high quality child care and early education are essential for combating child and family poverty, for child development, for human capital and life-long learning and for strong communities and social inclusion. Has the SUFA been able to further these ideals and commit to the high quality child care and early education referred to in the research? Evidence suggests that it has not.
The National Children’s Agenda (NCA) and the Early Childhood Development Agreement (ECD)
After the SUFA was signed, the National Children’s Agenda (NCA) was announced. It encompassed a broad “vision” statement and was signed by the nine provinces comprising the “rest of Canada” outside Quebec in May 1999. However, while acknowledging the importance of early childhood education, words have not translated into action. In September 2000, the Early Childhood Development Agreement (ECD) emerged from the SUFA as an initiative which was designed as follows:
“to promote early childhood development, so that, to their fullest potential, children will be physically and emotionally healthy, safe and secure, ready to learn, and socially engaged and responsible
to help children reach their potential and to help families support their children within strong communities”
The four areas to be developed to meet these objectives were:
1) healthy pregnancy;
2) parenting and family supports;
3) early childhood development, learning and care;
4) community supports
The ECD Agreement saw the federal government transfer $300 million to the provinces in 2001 and a commitment to transfer $2.2 billion over five years. (This is to be compared with 1992 when the federal government spent an estimated $310 million on child care services under the Canada Assistance Plan).
The ECD commitment is much less than what families and children need and forces child care to compete for funds with a large range of programs for pregnant mothers, parents, infants and children. A plan to spend less money and spread it over four program areas does not work. It will not build a comprehensive system of early childhood education and care. We still need a national child care strategy and substantially increased federal funding to prevent the range of fragile early childhood services from being eroded even further.
It underscores the weakness of the framework agreement process when the largest province in Canada can sign the agreement and get substantial funds, yet not spend one cent on enhanced regulated child care in the province. In the Early Childhood Development Agreement: Provincial Initiatives and Spending Allocations, 2001-2002, (News release “Funding Commitments of the Government of Canada”), the report shows clearly that in provinces where the information was available every one had as its first item (the biggest spending allocation), funds spent in Regulated Child Care. Ontario did not even have it listed as a category in receipt of funds!
Although Quebec chose not to sign the Social Union Agreement, nevertheless, its model for a child care system – one that is moving towards a system of publicly-funded, high quality, not-for-profit child care - is one that Canada outside of Quebec should not ignore.
Child Care as a Test for the SUFA
In an article entitled “Is this as good as it gets? Childcare as a test case for assessing the Social Union Framework Agreement” (in Canadian Review of Social Policy No. 47, Spring 2001), Martha Friendly, of the Childcare Resource and Research Unit at the University of Toronto, looked back to the groundbreaking 1986 Status of Women Canada’s Report of the Task Force on Child Care. The Task Force’s key recommendation was a universal system of child care – co-funded by federal and provincial governments with affordable parent fees, designed and managed by the provinces under national standards – to serve all children and families by 2001. Her task was to gauge whether the shifts in roles and responsibilities that culminated in the 1999 Social Union Framework Agreement (SUFA) have shaped a political environment in which it seems less possible to achieve a child care system now than it did then.
The Framework Agreement’s seven clauses include a number of points by which she judged whether the SUFA model works for child care. She found the following:
Under Principles, the provincial choice mechanism upon which the ECD agreement is based seems to work against “ensur(ing) access for all Canadians, wherever they live or move in Canada, to essential social programs and services of readily comparable quality”.
Under Mechanisms for use of the federal spending power, direct transfers to the local level (government or community groups) for child care do not appear to have received any serious consideration (although it is technically possible).
Under Public Participation, the limited civic engagement that has occurred does not constitute the SUFA’s promised “effective mechanisms for Canadians to participate in developing social priorities and reviewing outcomes”. In fact, Friendly suggests, “policy-making for children has been carried out in behind-closed doors intergovernmental processes that not only exclude ordinary Canadians, but also that the traditional more public legislative processes of Parliament have essentially been rendered impotent”.
In summing up the effectiveness of the SUFA, using child care as the lens, Friendly concludes that the 1999 Agreement (and its offspring, NCA and the ECD) does not ensure that promises to families and children will be fulfilled.
Social Assistance
In the Principles section of the SUFA, governments are committed to “provide appropriate assistance to those in need”. We have lost the three conditions set by the federal government under CAP for cost-sharing arrangements:
Eligibility for assistance had to be solely based on a test that “takes into account the budgetary requirements and the income and resources available to (that) person to meet those requirements”, and no other condition (e.g. work-for-welfare);
An appeal system had to be published as part of the jurisdiction’s social assistance legislation, and appeal information conveyed to all applicants;
No residency requirement in Canada or in a particular province or territory could be imposed as a condition of eligibility for social assistance applicants.
As we review how social assistance has operated in the past three years, “appropriate assistance” is far from the reality and experience in our communities. Similarly, when we look at the principle which commits governments to “ensure adequate, affordable, stable and sustainable funding for social policies and programs”, we believe that the SUFA has failed.
Since its inception in the fiscal year 1996-97 billions of dollars have been cut from the Canada Health and Social Transfer (CHST), which provides bulk funding for health care, education, social assistance and some social services. This is despite the $23 billion in health and early childhood development funding announced in September 2000. During the period from 1993-94 to 2001-02, $25.2 billion has been eliminated from the CHST. This means that, adjusted for inflation, the real cash cut to the CHST for the period is in excess of $32 billion. Funding cuts have hit social services and social assistance the hardest. The federal government could remedy this by substantially increasing CHST funding to the provinces and earmarking specific amounts to each of the three areas – education, health care and social services.
Ontario’s Punitive Social Assistance Measures
We see the weakness of the Social Union Framework Agreement in language allowing each provincial and territorial government to “determine the detailed program design and mix best suited to its own needs and circumstances to meet the agreed objectives” (The SUFA section on Federal spending power – Improving social programs for Canadians). During the last seven years, we have been forced to stand by and watch the devastation of social assistance in Ontario. The “get tough” philosophy of the Ontario government has seen the reduction by 21.6% in social assistance rates and “work for welfare” under the Social Assistance Reform Act; decreased funding to community services including counselling, child welfare and childcare; a new education formula that endangers open access to school facilities and community services such as childcare; the repeal of rent controls along with the cancellation of 17,000 social housing units and the downloading of housing responsibilities to the municipalities.
The Social Assistance Reform Act “provides temporary financial assistance to those most in need while they satisfy obligations to become and to stay employed”. It is more commonly known as Workfare. Since the introduction of the punitive measures against social assistance recipients in Ontario, families on social assistance have faced declining benefits and fewer supports. The 21.6% cut to social assistance in 1995 is now the equivalent of a 27.5% cut due to the rising costs of living. This means that an estimated 436,000 children on social assistance are living in families with incomes 50-60% below the poverty line. In 1989, about 1 in 10 children in Ontario was poor; by 1998, almost 1 in 5 children was poor. More than one-third of children with disabilities in Ontario live with a poor family. (Campaign 2000, Child Poverty in Ontario, Report Card 2000)
Women and Poverty
As far back as April 1999, the United Nations Human Rights Committee expressed its concern about high rates of poverty among Canadian women and about the harmful impact on women of cuts to social programs. This gender imbalance was not addressed in the SUFA and has not been addressed since. Social programs and social assistance rates must be restored in order to improve the conditions for women and their families in Ontario. To do this, however, there have to be pan-Canadian standards in place and these standards have to be enforced, otherwise the inequities in provision of social assistance will continue to exist. When 56% of single parent families headed by women are poor, it is time that we recognized this gender discrimination in our guiding principles for social assistance.
The Impact on Communities
Deep cuts in federal transfers have had a far-reaching impact on families who rely on social assistance for housing, food and income support, as provincial and local governments reduce spending on these essential programs. Social services have been cut drastically – everything from child care and child welfare programs to support for people with developmental and physical disabilities.
We need strong and enforceable standards for income assistance including earmarked funding especially for social assistance. We also need a Special Needs Fund to improve the quality of life for persons with disabilities. People with disabilities are too often an ignored segment of our population, especially children with disabilities. A 1994 study showed that approximately 21% of Canadian children aged 6 to 11 have some form of disability. However, a Canadian Council on Social Development survey of community based agencies has discovered that children and youth with special needs are not being properly served due to such factors as inadequate levels of funding for agency services and families’ lack of financial resources. Measures announced in the 2001 Budget to assist persons with disabilities are only a first step; much more needs to be done.
The Need to Eradicate Poverty
There is nothing in our Social Union Framework Agreement which commits federal, provincial or territorial governments outside of Quebec to eradicating poverty in Canada. 1997/ 98 statistics showed staggering poverty rates (17.5% or 1 in 6 Canadians living in poverty; 1 in 5 Canadian children living in poverty). First Nations People and persons with disabilities are more likely to live in poverty compared to the population as a whole. In a recent report entitled “Hunger Count 2002: Eating their words – Government Failure on Food Security”, the Canadian Association of Food Banks stated that since 1996 when the federal government pledged to reduce hunger and poverty, food bank use has increased by more than 12%. During March of this year 747,665 people received emergency groceries from a food bank and 40.8% of food bank recipients were children.
Unless we have enforceable pan-Canadian standards in place and effective measures to combat poverty, including security for income support and social services, we will continue to have one of the worst child poverty rates among the 16 highly industrialized nations.
Additional Comments on the Agreement
Inter-provincial Mobility
As outlined in the SUFA, “unfettered mobility is a core feature of what it means to be Canadian” and the government is trying to ensure that “All Canadians should be able to take advantage of social programs on the same terms as their neighbours, regardless of how long they have lived in a particular province or territory”. However, there has been a lack of progress in the accreditation of skills and training and of skills transportability from province to province or territory. As well, regarding issues such as training and child care, all Canadians cannot take advantage of social programs on the same terms as their neighbours. We have seen increased fragmentation of access to social programs in communities across this country, instead of a cohesive vision.
Post-secondary Education
For those involved with public post-secondary education, they can now look forward to private training institutions in Ontario, institutions which will have unfettered rights to impose exorbitant fees. In our view, Ontario’s law permitting private universities is by far the biggest and most destructive step down the road to privatizing post-secondary education. There are no standards, no regulations and no reporting process. CUPE has called for a national Post Secondary Education Act, which will prohibit the establishment of private, for-profit institutions.
Public investment in post-secondary education has been eroded and we have a major crisis of under funding in the sector. The reduction of $7 billion in cash transfers for post-secondary education, heath and social assistance since 1996, has had a detrimental effect on accessibility, equity and quality in our post-secondary education system. We want to see funding restored to this sector so that students and their families do not bear the burden of skyrocketing tuition. Recent figures show that student fees accounted for almost one-fifth of universities’ total revenue last year compared to 12% a decade earlier.
Conclusion
CUPE believes that for there to be a meaningful social union framework, the following steps must be taken:
The federal government must play a leadership role once again and provide the national vision necessary to go forward;
The federal government has to put the funding back into the system. It must increase transfers for social programs – health, social assistance and post-secondary education – and expand the range of these programs to include child care, home care, pharmacare and long term care;
There has to be cost-sharing, with federal government funding first and then the provinces must be required to commit to these same programs;
We must have transparency, accountability and equity in this framework;
We want to see solid guarantees for equitable access and quality programs;
We want to see a commitment to a gender-based analysis within the framework document as was formerly proposed;
We cannot have programs put on hold while we wait for the majority of provinces to agree – barriers must be removed;
There have to be genuine efforts to involve Canadians in setting priorities for social programs and to involve them in the SUFA Review process in a meaningful way-no behind close door negotiations;
The details of the dispute resolution process must be transparent and accountable.
Looking back at the last three years of the SUFA, evidence suggests that we have seen a disintegration of national programs and greater difficulties in establishing new programs. The next Three Year Review should engage the public in a meaningful way by actively seeking input and arranging forums for public debate and discussion. There should be a concrete progress report on whether the federal, provincial and territorial governments have achieved the goals of the SUFA to ensure greater equity and fairness in social programs and promote collaboration, accountability and transparency. CUPE calls on the governments – federal and provincial - to increase spending on programs and guarantee accessible, equitable and quality programs in all communities. We also call on the government to halt any moves towards privatization of our social programs; these moves will lead to fragmentation and disintegration of our communities. Only with these changes can we facilitate greater social equity among all Canadians.
Opeiu491/fm
S:ResearchWPTEXTECONOMYSocial Union Framework Agreement.doc
On behalf of the approximately 500,000 members of the Canadian Union of Public Employees (CUPE), we are pleased to forward this submission to the Social Union Framework Agreement (SUFA) Third Year Review. The Agreement, signed by federal, territorial and provincial governments (except Quebec) in February 1999, was designed to create a new framework for social policy making, set up the rules for how federal and provincial governments should work together and lay out principles of equity and fairness in social programs. It also outlines rules for federal spending power and promises collaboration, accountability and transparency.
As we enter into the Third Year Review Process, it is indeed crucial to examine the effectiveness of the Agreement and its impact on social policy. While we would welcome an initiative that facilitates cooperation between the federal, provincial and territorial governments and facilitates greater social equity among Canadians, we do not believe this is possible under the current Agreement. On the contrary, the SUFA has been an obstruction to meeting the needs of Canadians. This is precisely because we have had little or no public input, no opportunity for public debate and no chance to influence the terms of the Agreement.
In order for it to be a meaningful framework agreement, we believe that the federal government must play a leadership role; funding has to be put back into the transfers for social programs and expand these programs; they must be cost-shared with commitments that the provinces must adhere to; and we must have genuine transparency, equity and accountability.
At present, this Agreement does nothing to protect against increased privatization of our social programs. In our view, any meaningful framework agreement must protect our communities from rapidly increasing privatization.
General Comments on the Framework
Enforceable Standards
A key component of any social union framework must be a commitment to pan-Canadian standards for social programs and services which will ensure the individual and collective well-being of all Canadians. The SUFA provides no such standards but instead outlines vague principles to guide the framework. There have to be enforceable pan-Canadian standards governing social programs; this is the only way we can ensure that all persons have access to social programs and services of consistent quality, no matter where they live. The SUFA must allow us to have greater social equity in and between communities across this country. The lack of such enforceable standards has resulted in a disintegration of social programs, increased fragmentation and more inequities instead of consistent quality and equitable access.
Equity seeking groups are further penalized. A system of common standards would go a long way towards ensuring their needs are met. People with disabilities already face many barriers and the SUFA does not offer any clear framework for alleviating these barriers. Mobility between the provinces and territories is not easy for people with disabilities who cannot simply move and expect the same services to be available to them. Often it is very difficult even to find out what services are available outside of a person’s own province or territory.
Aboriginal people, women, workers of colour, lesbian, gay, bisexual and trans-gender workers – all must be guaranteed equal access to the social programs we have been proud of throughout our history.
New Social Programs
We believe that another major weakness is that the development of new social programs has actually been hindered by the Social Union Framework Agreement. Evidence shows that the protection of social rights under Canada’s cost-sharing agreements is now being sacrificed to provincial demands for unfettered authority. In order for new social programs to be successful, they have to be cost-shared in a way that commits provinces to funding the actual programs as designed according to the enforceable standards mentioned above. Another factor inhibiting the introduction of new programs is the stipulation that the government will not introduce such new initiatives without the agreement of a majority of provincial governments. By allowing each provincial and territorial government to “determine the detailed program design and mix best suited to its own needs and circumstances to meet the agreed objectives”, we are destroying any chance of even minimum standards being followed by all. In short, too much power has been ceded to the provinces in this agreement.
Health Care
Although we were initially pleased to see the five principles of Medicare outlined in the Agreement, this has not been enough to protect our healthcare system against privatization. There is nothing in the SUFA that would prevent or even inhibit privatization in the healthcare system. In addition, any new programs such as home care or pharmacare would not be covered by the same five principles established for Medicare, but in fact would be left to the whims and desires of whichever provincial government is implementing such a program.
Already, we have seen major policy changes in provinces set on dismantling Canada’s public health care system. Since 1996, we have had cumulative cuts in federal health transfers to the provinces and a corresponding drive by certain provinces to de-list services, slash budgets and off-load functions to municipalities and the private sector. Under the Social Union Agreement, provinces may choose to spend money designated for services not covered by the Canada Health Act on either public, non-profit care or private, for-profit care.
Provinces Moving Towards Privatization of Health Care
In Alberta, the introduction of Bill 11 (“The Health Protection Act”) marked a critical moment for Medicare. The Bill, far from protecting Canada’s public health care system, is a blueprint for the destruction of Medicare. Privatizing the delivery of surgical health care services will erode the integrity of Canada’s public health care system with dire consequences for the entire country. The privatization of health care services also increases the exposure of the Canadian health care system to trade complaints and challenges under NAFTA and the WTO.
In Ontario, we have already seen a move to privatize home care. The provincial system favours for-profit companies and many of these companies pay low wages, offer no benefits and replace trained nurses with casual labour. The restructuring of home and community care in Ontario has opened the door to multinational companies bidding alongside non-profit providers.
In British Columbia, during the first week of October 2002, health care workers served notice to employers and government that they would not stand by and watch a reckless agenda of privatization and cuts to health services continue without resistance.
Private Clinics Endanger Medicare Principles
In late September 2002, the Canadian Health Coalition (CHC) together with the Canadian Association of Radiologists (CAR) called on the federal government to stop the violation of the five principles of medicare enshrined in the Canada Health Act (and also included in the Principles of the SUFA). The CHC and Radiologists suggest that unchecked privatization of Canada’s health-care system, particularly in Ontario, Alberta and Nova Scotia, means the number of for-profit clinics operating outside of medicare will double within the year. Five years ago there were three private MRI (Magnetic Resonance Imaging) clinics in this country and today there are 25. Five years ago, there were no private CT (Computerized Tomography) clinics (there are now 12), and no private PET clinics (and now there are two). Ontario Health Minister, Tony Clement has announced his government will allow the creation of 20 MRI and five CT clinics which could be up and running this year.
The Nova Scotia government is permitting a private for-profit clinic to operate without regulation or government approval. We believe that these moves represent a violation of the principles of the Canada Health Act and the SUFA. As well, they represent a safety and liability issue, as the delivery of medical services that are not proven to be medically indicated and without proper medical referral, is unethical and needs to be regulated.
Provinces dedicated to the privatization of health care, such as Alberta and Ontario, can agree to the five principles of the Canada Health Act as they have done under the SUFA, and at the same time direct all their spending to for-profit services. This is a fundamental barrier to the provision of equitable access to social programs and services.
Dispute Avoidance and Resolution Mechanism
As follow up to the SUFA, the federal Minister of Health and the provinces agreed in April 2002, to a “Dispute Avoidance and Resolution” mechanism to deal with disputes under the Canada Health Act. While the federal Minister of Health retains sole authority to interpret the Canada Health Act, the mechanism contains a provision to seek a third party’s recommendations to resolve a dispute. This mechanism contains no operational criteria and can be triggered only by federal, provincial or territorial governments. There is nothing in this mechanism to ensure that the principles of the Canada Health Act will be enforced or protected. In fact, it ensures that the path of least resistance can be followed in any dispute –a path that seeks to appease federal/provincial/territorial relations at the expense of enforcing the principles of the Canada Health Act.
The Need for Federal Government Protection of Health Care
The September 30 Speech from the Throne does not provide any firm direction for health care reform in the near future either. We cannot stand by and wait for the First Ministers’ meeting early in 2003, at which a comprehensive plan will be put forward and include “enhanced accountability to Canadians” and the “necessary federal long-term investments” to be detailed in the next budget. As provincial governments in British Columbia, Ontario, Nova Scotia and Alberta move rapidly toward privatized health care services, it will be too late for “enhanced accountability”. We want the federal government to step in immediately to challenge those provinces which are contravening the principles of the Canada Health Act.
Universal Child Care and Early Education
Research consistently documents why high quality child care and early education are essential for combating child and family poverty, for child development, for human capital and life-long learning and for strong communities and social inclusion. Has the SUFA been able to further these ideals and commit to the high quality child care and early education referred to in the research? Evidence suggests that it has not.
The National Children’s Agenda (NCA) and the Early Childhood Development Agreement (ECD)
After the SUFA was signed, the National Children’s Agenda (NCA) was announced. It encompassed a broad “vision” statement and was signed by the nine provinces comprising the “rest of Canada” outside Quebec in May 1999. However, while acknowledging the importance of early childhood education, words have not translated into action. In September 2000, the Early Childhood Development Agreement (ECD) emerged from the SUFA as an initiative which was designed as follows:
“to promote early childhood development, so that, to their fullest potential, children will be physically and emotionally healthy, safe and secure, ready to learn, and socially engaged and responsible
to help children reach their potential and to help families support their children within strong communities”
The four areas to be developed to meet these objectives were:
1) healthy pregnancy;
2) parenting and family supports;
3) early childhood development, learning and care;
4) community supports
The ECD Agreement saw the federal government transfer $300 million to the provinces in 2001 and a commitment to transfer $2.2 billion over five years. (This is to be compared with 1992 when the federal government spent an estimated $310 million on child care services under the Canada Assistance Plan).
The ECD commitment is much less than what families and children need and forces child care to compete for funds with a large range of programs for pregnant mothers, parents, infants and children. A plan to spend less money and spread it over four program areas does not work. It will not build a comprehensive system of early childhood education and care. We still need a national child care strategy and substantially increased federal funding to prevent the range of fragile early childhood services from being eroded even further.
It underscores the weakness of the framework agreement process when the largest province in Canada can sign the agreement and get substantial funds, yet not spend one cent on enhanced regulated child care in the province. In the Early Childhood Development Agreement: Provincial Initiatives and Spending Allocations, 2001-2002, (News release “Funding Commitments of the Government of Canada”), the report shows clearly that in provinces where the information was available every one had as its first item (the biggest spending allocation), funds spent in Regulated Child Care. Ontario did not even have it listed as a category in receipt of funds!
Although Quebec chose not to sign the Social Union Agreement, nevertheless, its model for a child care system – one that is moving towards a system of publicly-funded, high quality, not-for-profit child care - is one that Canada outside of Quebec should not ignore.
Child Care as a Test for the SUFA
In an article entitled “Is this as good as it gets? Childcare as a test case for assessing the Social Union Framework Agreement” (in Canadian Review of Social Policy No. 47, Spring 2001), Martha Friendly, of the Childcare Resource and Research Unit at the University of Toronto, looked back to the groundbreaking 1986 Status of Women Canada’s Report of the Task Force on Child Care. The Task Force’s key recommendation was a universal system of child care – co-funded by federal and provincial governments with affordable parent fees, designed and managed by the provinces under national standards – to serve all children and families by 2001. Her task was to gauge whether the shifts in roles and responsibilities that culminated in the 1999 Social Union Framework Agreement (SUFA) have shaped a political environment in which it seems less possible to achieve a child care system now than it did then.
The Framework Agreement’s seven clauses include a number of points by which she judged whether the SUFA model works for child care. She found the following:
Under Principles, the provincial choice mechanism upon which the ECD agreement is based seems to work against “ensur(ing) access for all Canadians, wherever they live or move in Canada, to essential social programs and services of readily comparable quality”.
Under Mechanisms for use of the federal spending power, direct transfers to the local level (government or community groups) for child care do not appear to have received any serious consideration (although it is technically possible).
Under Public Participation, the limited civic engagement that has occurred does not constitute the SUFA’s promised “effective mechanisms for Canadians to participate in developing social priorities and reviewing outcomes”. In fact, Friendly suggests, “policy-making for children has been carried out in behind-closed doors intergovernmental processes that not only exclude ordinary Canadians, but also that the traditional more public legislative processes of Parliament have essentially been rendered impotent”.
In summing up the effectiveness of the SUFA, using child care as the lens, Friendly concludes that the 1999 Agreement (and its offspring, NCA and the ECD) does not ensure that promises to families and children will be fulfilled.
Social Assistance
In the Principles section of the SUFA, governments are committed to “provide appropriate assistance to those in need”. We have lost the three conditions set by the federal government under CAP for cost-sharing arrangements:
Eligibility for assistance had to be solely based on a test that “takes into account the budgetary requirements and the income and resources available to (that) person to meet those requirements”, and no other condition (e.g. work-for-welfare);
An appeal system had to be published as part of the jurisdiction’s social assistance legislation, and appeal information conveyed to all applicants;
No residency requirement in Canada or in a particular province or territory could be imposed as a condition of eligibility for social assistance applicants.
As we review how social assistance has operated in the past three years, “appropriate assistance” is far from the reality and experience in our communities. Similarly, when we look at the principle which commits governments to “ensure adequate, affordable, stable and sustainable funding for social policies and programs”, we believe that the SUFA has failed.
Since its inception in the fiscal year 1996-97 billions of dollars have been cut from the Canada Health and Social Transfer (CHST), which provides bulk funding for health care, education, social assistance and some social services. This is despite the $23 billion in health and early childhood development funding announced in September 2000. During the period from 1993-94 to 2001-02, $25.2 billion has been eliminated from the CHST. This means that, adjusted for inflation, the real cash cut to the CHST for the period is in excess of $32 billion. Funding cuts have hit social services and social assistance the hardest. The federal government could remedy this by substantially increasing CHST funding to the provinces and earmarking specific amounts to each of the three areas – education, health care and social services.
Ontario’s Punitive Social Assistance Measures
We see the weakness of the Social Union Framework Agreement in language allowing each provincial and territorial government to “determine the detailed program design and mix best suited to its own needs and circumstances to meet the agreed objectives” (The SUFA section on Federal spending power – Improving social programs for Canadians). During the last seven years, we have been forced to stand by and watch the devastation of social assistance in Ontario. The “get tough” philosophy of the Ontario government has seen the reduction by 21.6% in social assistance rates and “work for welfare” under the Social Assistance Reform Act; decreased funding to community services including counselling, child welfare and childcare; a new education formula that endangers open access to school facilities and community services such as childcare; the repeal of rent controls along with the cancellation of 17,000 social housing units and the downloading of housing responsibilities to the municipalities.
The Social Assistance Reform Act “provides temporary financial assistance to those most in need while they satisfy obligations to become and to stay employed”. It is more commonly known as Workfare. Since the introduction of the punitive measures against social assistance recipients in Ontario, families on social assistance have faced declining benefits and fewer supports. The 21.6% cut to social assistance in 1995 is now the equivalent of a 27.5% cut due to the rising costs of living. This means that an estimated 436,000 children on social assistance are living in families with incomes 50-60% below the poverty line. In 1989, about 1 in 10 children in Ontario was poor; by 1998, almost 1 in 5 children was poor. More than one-third of children with disabilities in Ontario live with a poor family. (Campaign 2000, Child Poverty in Ontario, Report Card 2000)
Women and Poverty
As far back as April 1999, the United Nations Human Rights Committee expressed its concern about high rates of poverty among Canadian women and about the harmful impact on women of cuts to social programs. This gender imbalance was not addressed in the SUFA and has not been addressed since. Social programs and social assistance rates must be restored in order to improve the conditions for women and their families in Ontario. To do this, however, there have to be pan-Canadian standards in place and these standards have to be enforced, otherwise the inequities in provision of social assistance will continue to exist. When 56% of single parent families headed by women are poor, it is time that we recognized this gender discrimination in our guiding principles for social assistance.
The Impact on Communities
Deep cuts in federal transfers have had a far-reaching impact on families who rely on social assistance for housing, food and income support, as provincial and local governments reduce spending on these essential programs. Social services have been cut drastically – everything from child care and child welfare programs to support for people with developmental and physical disabilities.
We need strong and enforceable standards for income assistance including earmarked funding especially for social assistance. We also need a Special Needs Fund to improve the quality of life for persons with disabilities. People with disabilities are too often an ignored segment of our population, especially children with disabilities. A 1994 study showed that approximately 21% of Canadian children aged 6 to 11 have some form of disability. However, a Canadian Council on Social Development survey of community based agencies has discovered that children and youth with special needs are not being properly served due to such factors as inadequate levels of funding for agency services and families’ lack of financial resources. Measures announced in the 2001 Budget to assist persons with disabilities are only a first step; much more needs to be done.
The Need to Eradicate Poverty
There is nothing in our Social Union Framework Agreement which commits federal, provincial or territorial governments outside of Quebec to eradicating poverty in Canada. 1997/ 98 statistics showed staggering poverty rates (17.5% or 1 in 6 Canadians living in poverty; 1 in 5 Canadian children living in poverty). First Nations People and persons with disabilities are more likely to live in poverty compared to the population as a whole. In a recent report entitled “Hunger Count 2002: Eating their words – Government Failure on Food Security”, the Canadian Association of Food Banks stated that since 1996 when the federal government pledged to reduce hunger and poverty, food bank use has increased by more than 12%. During March of this year 747,665 people received emergency groceries from a food bank and 40.8% of food bank recipients were children.
Unless we have enforceable pan-Canadian standards in place and effective measures to combat poverty, including security for income support and social services, we will continue to have one of the worst child poverty rates among the 16 highly industrialized nations.
Additional Comments on the Agreement
Inter-provincial Mobility
As outlined in the SUFA, “unfettered mobility is a core feature of what it means to be Canadian” and the government is trying to ensure that “All Canadians should be able to take advantage of social programs on the same terms as their neighbours, regardless of how long they have lived in a particular province or territory”. However, there has been a lack of progress in the accreditation of skills and training and of skills transportability from province to province or territory. As well, regarding issues such as training and child care, all Canadians cannot take advantage of social programs on the same terms as their neighbours. We have seen increased fragmentation of access to social programs in communities across this country, instead of a cohesive vision.
Post-secondary Education
For those involved with public post-secondary education, they can now look forward to private training institutions in Ontario, institutions which will have unfettered rights to impose exorbitant fees. In our view, Ontario’s law permitting private universities is by far the biggest and most destructive step down the road to privatizing post-secondary education. There are no standards, no regulations and no reporting process. CUPE has called for a national Post Secondary Education Act, which will prohibit the establishment of private, for-profit institutions.
Public investment in post-secondary education has been eroded and we have a major crisis of under funding in the sector. The reduction of $7 billion in cash transfers for post-secondary education, heath and social assistance since 1996, has had a detrimental effect on accessibility, equity and quality in our post-secondary education system. We want to see funding restored to this sector so that students and their families do not bear the burden of skyrocketing tuition. Recent figures show that student fees accounted for almost one-fifth of universities’ total revenue last year compared to 12% a decade earlier.
Conclusion
CUPE believes that for there to be a meaningful social union framework, the following steps must be taken:
The federal government must play a leadership role once again and provide the national vision necessary to go forward;
The federal government has to put the funding back into the system. It must increase transfers for social programs – health, social assistance and post-secondary education – and expand the range of these programs to include child care, home care, pharmacare and long term care;
There has to be cost-sharing, with federal government funding first and then the provinces must be required to commit to these same programs;
We must have transparency, accountability and equity in this framework;
We want to see solid guarantees for equitable access and quality programs;
We want to see a commitment to a gender-based analysis within the framework document as was formerly proposed;
We cannot have programs put on hold while we wait for the majority of provinces to agree – barriers must be removed;
There have to be genuine efforts to involve Canadians in setting priorities for social programs and to involve them in the SUFA Review process in a meaningful way-no behind close door negotiations;
The details of the dispute resolution process must be transparent and accountable.
Looking back at the last three years of the SUFA, evidence suggests that we have seen a disintegration of national programs and greater difficulties in establishing new programs. The next Three Year Review should engage the public in a meaningful way by actively seeking input and arranging forums for public debate and discussion. There should be a concrete progress report on whether the federal, provincial and territorial governments have achieved the goals of the SUFA to ensure greater equity and fairness in social programs and promote collaboration, accountability and transparency. CUPE calls on the governments – federal and provincial - to increase spending on programs and guarantee accessible, equitable and quality programs in all communities. We also call on the government to halt any moves towards privatization of our social programs; these moves will lead to fragmentation and disintegration of our communities. Only with these changes can we facilitate greater social equity among all Canadians.
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