LGBT People and Federal Health Policy: An Invisible Population?

By Nick J. Mulé and Miriam Smith

This research was published in the June 2014 edition of Canadian Public Administration.

Three things you need to know about LGBT People and Federal Health Policy:

1. Despite major strides made on the legislative human rights front for LGBTs in Canada over the past 30 years, such progress has not extended into federal health policy for these communities.


2. LGBT people have health care issues that are often overlooked in the current system. For example, transgender people have specific medical needs in transitioning and the LGBT population suffers disproportionately from certain cancers and mental health problems, often sparked or exacerbated by prejudice, stigmatization and discrimination.  


3. Health professionals are not necessarily trained to address the specified needs of LGBTs, a situation not helped by the absence of federal health guidelines on LGBT health issues.

Three myths about LGBT People and Federal Health Policy:

Myth #1: Given the establishment of human rights based on sexual orientation and in some instances gender identity, and the higher profile and greater acceptance of LGBTs in Canadian society, they are now recognized in all sectors including health. 

The Reality: We found that Health Canada and the Public Health Agency of Canada pay very little attention to LGBT health and that their documents and websites barely mention these populations.  


Myth #2: Health Canada and the Public Health Agency of Canada have both prioritized an approach to health policy that considers social factors that affect health which by extension includes LGBTs.

The Reality: LGBTs are generally absent, yet even when sex and gender are mentioned in federal health policy, these are not taken to include LGBT people. 


Myth #3: Millions of federal dollars have been poured into the AIDS Strategy over the years addressing the health needs of LGBTs.

The Reality: This single-illness approach does not address the broad health needs of LGBTs.

Nick J. Mulé, PhD is an associate professor at the York University School of Social Work, where he teaches policy, theory and practice. His research interests include the social inclusion/exclusion of LGBTQ populations in social policy and service provision and the degree of their recognition as distinct communities in cultural, systemic, and structural contexts. He also engages in critical analysis of the LGBTQ movement and the development of queer liberation theory. A queer activist for many years, Nick is currently the founder and chairperson of Queer Ontario. In addition, he is a psychotherapist in private practice serving LGBTQ populations in Toronto.

Miriam Smith is professor in the of Social Science, York University, Toronto. Among other works, she is the author of Lesbian and Gay Rights in Canada: Social Movements and Equality-Seeking, 1971-1995(University of Toronto Press) and Political Institutions and Lesbian and Gay Rights in the United States and Canada (Routledge). Her research focuses on LGBTQ rights in law and public policy in comparative perspective as well as employment equity in the workplace. 

Do P3s constrain Canada’s capacity to address climate change?

by Joshua Newman and Anthony Perl

This research was published in Canadian Public Administration (June 2014):  "Partners in clime: Public-private partnerships and British Columbia's capacity to pursue climate policy objectives.

Public-private partnerships, also called “P3s”, allow the private sector to deliver services on behalf of the government, in areas as diverse as hospitals, highways, and prisons.

Three things to know about P3s and climate change:

1.  P3s are structured so that the private sector partner earns a profit over the life of the contract, usually in exchange for investing some capital and for taking on some portion of the risk involved in delivering the project.

2.  Climate change adaptation and mitigation efforts can be expensive in the short term. Private investors, who have considerable influence over P3 contracts, should in theory prefer to avoid onerous climate-related requirements.

3.  P3s are becoming increasingly popular, and climate change is growing as an important consideration in a variety of areas of public service delivery, especially in infrastructure development. It is possible that P3s could hamper governments’ efforts to address climate change.

We investigated the development of the Canada Line, a P3 expansion of the urban rail network in Vancouver, to determine how the participation of the private sector may have affected the government’s ability to advance its climate-related policy priorities.

Three myths about P3s and climate change:

Myth #1: Major infrastructure projects never take the environment into consideration when they are pursued through P3s.

Reality: Environmental considerations, including air quality, greenhouse gas reduction, and protection of waterways, were fundamental elements of the Canada Line P3 and were part of the criteria used to select the private sector partner.

Myth #2: P3s force governments to sign away their power to shape public service delivery.

Reality: The public sector has considerable control over how these agreements are designed and governed. In British Columbia, the provincial government used a collaborative approach to ensure that its original goals were met with minimal conflict.

Myth #3: P3s reduce the government’s capacity to implement climate change policy.

Reality: With effective leadership, the public sector can use P3s to further its climate policies. This includes the strategic use of arm’s length public agencies, tough negotiation tactics, and support for a multi-sector and multi-actor network of participants.

Joshua Newman is a research fellow in the Institute for Social Science Research at the University of Queensland in Brisbane, Australia. He holds a Ph.D. in Political Science from Simon Fraser University. His research interests include climate change, transportation, and the interaction between the public and private sectors for the delivery of public services. 

Anthony Perl is Professor of Urban Studies and Political Science at Simon Fraser University in Vancouver, British Columbia, Canada.  Before joining SFU, Anthony worked at the University of Calgary, the City University of New York, and Universite Lumiere in Lyon, France.  He received his undergraduate honours degree in Government from Harvard University, followed by an MA and a Ph.D. in Political Science from the University of Toronto.  He is the author of numerous scholarly articles on environmental, transportation and urban policy research as well as five books.

How do we close the "mind gap" to address complex problems in public policy?

by Ted Casby

The complex problems that we face today, including (and especially) those that confront public policy makers, are not well suited to our default ways of thinking about the world. Income disparity between rich and poor, urban planning for higher population densities, terrorism, global warming – these are the kinds of challenges that demand greater cognitive sophistication.

Three things to know about today's complex problems:

1. They are different than the kind of straightforward problems we routinely solve in our daily lives. And different than the challenges that dominated the lives of hundreds of generations of our ancestors.

2. The cues we need to decipher complex problems are buried below the surface of immediately available information. And the feedback we get from interacting with them is delayed and ambiguous.

3. Complexity arises from multiple causal factors interacting in intricate ways. So the key to addressing complex problems is uncovering the dynamic of these interactions.

Three myths about complex problems:

Myth #1:  "Blinking" gives us an edge in tackling complexity, as per Malcolm Gladwell's interpretation of how effective our intuitions are.

The Reality: Blinking, aka intuition, works only in the case where we have developed reliable expertise. It serves a crucial purpose in our everyday lives and is an important base from which to tackle complex problems. But our intuitions are often misleading when it comes to tackling situations that feel familiar, but are fundamentally different from other problems.

Myth #2:  To know something is to access a truth about the world.

The Reality:  Knowing is a feeling, described best by neurologist Robert Burton. It is the feeling of calm confidence that we have figured something out. But it is a psychological state that is entirely based on the subconscious trigger that our interpretation of the world is both internally consistent and consistent with everything else we have already stored in our memory banks. 

Myth #3:  Two heads are better than one.

The Reality:  Cognitive diversity is absolutely crucial to tackling complexity, as demonstrated by decision scientist Scott E. Page. However, groups of people are prone to unique vulnerabilities, such as groupthink. The benefits of cognitive diversity only accrue when discussion is facilitated by team leaders who know how to foster the kind of constructive dissent that deepens conversation, expands understanding and extends creativity.

Ted Cadsby, MFA, CFA, ICD.D (http://tedcadsby.com/) is a corporate director, consultant, author and speaker on complexity and decision making. He was formerly an executive vice president of CIBC leading 18,000 employees. His newest book is Closing the Mind Gap: Making Smarter Decisions in a Hypercomplex World (BPS, 2014).

Why create policy for assisted reproductive technology?

by: Dave Snow

While assisted reproductive technologies provide new reproductive opportunities for many, some fear that, unchecked, they have the potential to exploit women and commodify human life. Public policy is designed to prevent these negative outcomes.

Three things to know about Canadian assisted reproductive technology policy:

1.   Eleven years after a 1993 Royal Commission recommended national legislation, in 2004 the federal government passed the Assisted Human Reproduction Act, which created a number of criminal prohibitions and a national regulatory agency.

2.  In 2010, the Supreme Court of Canada struck down most non-criminal aspects of this legislation for violating provincial jurisdiction over health care.

3.  As a result, the Canadian policy status quo for assisted reproductive technologies is a patchwork of provincial, medical-professional, and some federal criminal policy.

Three myths about assisted reproductive technology policy in Canada:

Myth #1: The federal government lost all its regulatory authority in the 2010 Supreme Court decision.

The Reality: While the federal government lost its licensing authority and some regulatory power, the Court upheld its ability to create several regulations in this field, including those related to the reimbursement of expenditures for ova donation and surrogacy. Health Canada’s subsequent failure to create regulations does not stem from a lack of legal authority.

Myth #2: Assisted reproductive technologies are completely unregulated in Canada.

The Reality: Most provinces have created policy regarding surrogacy and the legal parentage of children born through assisted reproduction. Moreover, Quebec (and soon Ontario) has tied funding for in vitro fertilization to rules regarding embryo transfer. Finally, several federal criminal prohibitions remain in place.

Myth #3: Provinces are incapable of governing assisted reproductive technologies.

The Reality: Although few provinces have introduced legislation, Quebec’s experience demonstrates that provinces have the capacity, if not necessarily the will, to legislate.

Dave Snow is a Killam Postdoctoral Fellow in the Faculty of Medicine at Dalhousie University, where he studies health policy and Canadian politics. Follow him on Twitter @aDaveSnow.