University of Toronto – University College – Health Studies
UNI 211H1S -- Health Policy in Canada
Winter 2015
Instructor: David Langille david.langille@utoronto.ca
647-280-7747 C
Teaching Assistants: Ghazal Fazli Ghazal.fazli@utoronto.ca
and Madelaine Cahuas madeleine.cahuas@mail.utoronto.ca
Course Dates: January 5 – March 30
Class Hours: Mondays 2:00–5:00 pm
Class Location: HI-Cart (St. Hilda's College Cartwright Hall - 44 Devonshire Pl.)
Office: University College D302 Office Hours: By appointment
Course Description: This course introduces students to Canadian health policy. It examines
the policy making process; policy making in the Canadian context, and specifically the
development of Canadian health policy; and explores current debates over the social
determinants of health.
Health is increasingly contentious with Canada’s aging population, advancements in medical
technology, and government fiscal restraints. It is a challenge to achieve the best health given
the limited resources available, and to ensure that health care is fair, equal, and accessible.
The course will provide analytical tools for understanding health policy, offer an overview of
current policy issues, and explore their relationship to social inequality, gender, and race.
Course Structure: The course will cover: 1) the policymaking process in general and in the
Canadian context; 2) the Canadian health system and its development; 3) current health
reform debates and issues, and 4) how to advocate for improvements in health policy.
Course Objectives: Through readings and classroom discussions, the course will provide
students with the knowledge skills to:
1) appreciate the social, political, and economic dimensions of health policy and
policymaking;
2) critically analyse and evaluate current health policies in Canada;
3) consider emergent issues in Canadian health policy and current health reform issues;
4) build on students’ experience and skills in policy decision-making and advocacy.
Organization: Each three hour class will:
1) offer an analytic framework to understand health policy,
2) illustrate with examples of good or bad policies, and
3) discuss how we might advocate to improve health policies
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Required texts:
Bryant, Toba (2009) An Introduction to Health Policy. Toronto: Canadian Scholars Press.
ISBN 9781551303499
Fierlbeck, Katherine (2011) Health Care in Canada: A Citizen's Guide to Policy and Politics.
Toronto: University of Toronto Press. ISBN 9781442609839
Laverack, Glenn (2013) Health Activism: Foundations and Strategies. Sage: London. ISBN
9781446249659
Recommended text:
Meili, Ryan, A Healthy Society: How a Focus On Health Can Revive Canadian Democracy.
Saskatoon: Purich. ISBN: 978-1895830-637
All of these books are available for 3-hour loan from the University College Library (Course
Reserves). There are additional articles listed in the Course Outline and/or available from
Blackboard.
Note - If you have not taken UNI209, please read by Mikkonen, Juha and Dennis Raphael
(2010) Social Determinants of Health: The Canadian Facts. Toronto: York University School of
Health Policy and Management – which is available on the internet for free at
http://www.thecanadianfacts.org
GRADING SCHEME
1. Answers to Questions on the Readings – 5 x 10 = 50%
2. Essay Option (in place of 3 answers) – 25% and Outline – 5%
3. Advocacy Assignment – 30%
4. Test - 20%
Total - 100%
1. Answers to Questions on the Readings – These assignments encourage you to read
your text each week and come to class prepared for a good discussion of the material.
You are asked to prepare written answers to 5 questions, each being worth 10% of your grade.
5 answers x 10% = 60% (You can answer up to 7 questions (max!) and we will count the top
5.) Your answers have to be 450 to 700 words (roughly 2 to 3 double-spaced pages), and
must be handed in to the class/tutorial when it is due. Submit the summaries in hard copy at
the beginning of class.
We prefer typed, but will accept hand written answers. However, we will not accept them being
handed in late, as that defeats the purpose of this assignment, which is to encourage you to
read your text and be prepared to discuss the content. If you are unable to make it in, you can
submit your answer by email ONCE if it's received before 12pm.
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Your answers should thoroughly cover the content of the text, although you are welcome to go
beyond the text to draw on other material and your own ideas. (Citations are only needed for
outside material – not for your text book.) If your answer shows evidence that you have read
the material you may earn 5/10, if you give a clear answer to the question you can earn 6/10 or
7/10, and if you can offer an outstanding summation of the material(s) you can earn an “A” or 8
or 9 or even 10. Here are some tips for writing these weekly summaries:
What does an ‘A’ assignment look like?
Content

Answers all elements of the question.

Shows advanced understanding of the material and an ability to articulate this
understanding clearly and succinctly.

Uses own words to explain the concepts from the text. This is particularly critical when
providing definitions - the more you are able to use your own words rather than relying
on quotes, the more obvious it is that you understand the concepts.

Provides a context for the discussion.

Integrates your learning from previous weeks and show a developing understanding of
the field of health policy.

Expresses some unique thoughts on the material or uses outside sources or examples
to enhance the paper. Always identify any personal opinion as such and provide
justification for why you hold that opinion. Fully explain the examples that you raise and
how they are relevant.
Structure

The summary is well structured with the use of paragraphs and a brief introduction and
conclusion.

There is a clear and logical flow with good transitions between ideas.

Minimal grammatical / spelling errors and appropriate academic writing style.
2. Essay Option - You have the chance to explore an area of your own interest in an essay
rather than answer three of the smaller assignments.
You will be required to submit an outline and annotated bibliography beforehand, worth 5%.
It will be due in class on Feb 9. The outline should include a 150 word description of your topic
and how you will approach it, and identify and describe at least 5 sources of material, with a
couple of sentences to make clear why each source is relevant or useful for your paper. The
essay itself will be due on March 15, and is worth 25%. It should be 2500-3500 words, or
roughly 10-15 pages double-spaced.
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3. Advocacy Assignment – The Health Advocacy Project calls on you to resist the siren call of
science. There are those who study public policy as a science, but they are largely irrelevant to
the public policy debates that actually determine public policy. Sadly, public policy is not
determined by rational scientific methods, nor by imitating best practices from around the world,
but by the naked exercise of power, often in the pursuit of profit. Therefore, our best hope as
citizens and students of health policy is that we are able to mobilize our democratic power and
act collectively to control state institutions in the public interest -- to make them instrument of
popular rule.
If you accept this premise, you need the skills to become political activists and community
organizers, rather than be high priests of public policy. That's the best way to improve the
social determinants of health – to seek excellence in citizenship, in public service and
collective action.
The assignments vary from year to year depending on the political timetable and the policy
agenda. Students have options for either individual or group projects.
Advocacy Assignment Proposal -- Whichever of the options you chose below, you need to
get started early in the term. Please submit a one page (roughly 250 words) proposal that
clarifies which option you have chosen, the specific topic you are addressing, who you are
working with, your own role or goal and those of your group members (if you are working with
a group). This proposal is worth 5% of your grade, and is due on January 26.
Group Project – Personal Journal -- If you work on a group project we need some objective
criteria to assess how much you contributed to your project and what you learned in the
process. Please present us with a journal that offers:

A summary description of what your group accomplished (150 words) – you are
welcome to cut and paste from any documents you generated.

What you did for the project, step by step, i.e. time spent organizing, writing,
researching, contacting people.

A critical assessment of what you and your group accomplished or did not accomplish
(at least 150 words)

What you learned from participating in the project (150 words).
Your report should be roughly 4 pages (1000 words) plus appendices if necessary or
appropriate. It need not be formally written. It will be due on Monday, March 23.
Alternatively, you can work individually or in groups to survey the health policy community
in Ontario, i.e. to investigate one of the many interest groups or organizations that is trying to
shape health policy in this province in order to know their policy priorities, their power base,
their communication methods and the overall effectiveness.
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In this case, you have two options:
1. Choose one of the social determinants of health, and identify the policy community
involved ie, describe the key actors and groups of actors who make policy decisions in this
area eg, the government agencies, elected officials, corporations, non-governmental
organizations, academic experts and policy consultants. List them, and where possible, write
a few sentences to describe them. You are encouraged to assess the balance of forces, ie.
which actors wield the most influence, and why do they have more influence than others?
2. Compare and contrast two organizations involved in health policy in Ontario in
order to determine which wields the most influence, and why does it have more
influence than the other. These could be organizations working on the same issue or from
widely different areas of the policy community. You will have to:
a) Describe the organizations - in terms of the number of employees, their annual budget,
who they represent, their goals, objectives and main activities.
b) Find out what policies they advocate and how they do so. Were they active in the last
election, and if so, how?
c) How do they communicate their positions, before and after the election eg. are they
meeting with the Premier, the Minister of Health, the opposition leaders or their health
critics, or with their local candidates. What print materials have they produced? What
materials are they sending to their members, or to the media? What use are they making of
their website or other social media? Offer some analysis of the material that you gather.
Whether you chose Option 1 or Option 2, be as concrete and specific as possible in
your analysis of who has the most power and why. This may require you to speak with
actors in the policy community -- it will be difficult to find all the answers in the library or on the
internet. Treat such interviews as you would any other source -- offer a citation in the text and
identify them in your bibliography -- name, title, place, date -- and whether you communicated
in person, or via telephone or email.
Your answer should be about 2000-2500 words (8-10 pages), and should be written in
essay format. It will be due on Monday, March 23.
4. Test – The test will be based on the questions that will be "answered" in class and tutorials
over the course of the term, roughly 4 per class x 11 classes. Ten of these questions will
appear on the test, of which you will have to answer 2, each of which is worth 10 marks = 20%
It will be held on the final class of the term, March 30.
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Some Research Questions – I encourage you to engage the big questions about power,
politics and health.
I am particularly interested in how corporate priorities are undermining the health of
Canadians; and more specifically, how health policy is being shaped by corporate priorities;
and how the delivery of health care is being affected by corporate needs.
In my article -- “Follow the Money: How Business and Politics Define Our Health,” in Social
Determinants of Health: Canadian Perspectives, Second Edition, edited by Dennis Raphael – I
examined how corporate priorities affect the social determinants of health at a relatively
abstract structural level (in terms of the neo-liberal assault on the welfare state) and more
concretely, how business influences our fiscal priorities (and it is at this macro-economic level
that most of the damage is still being done).
We need to take a more detailed look at the specific mechanisms whereby these economic
interests are able to affect public policy. The recent debate over health care reform in the US
show just how dysfunctional that democracy has become in the face of corporate power.
Canadians may gloat over the relative efficiency of our Parliamentary system and our public
health care, but there has been an ongoing assault on public health in Canada via multiple
mechanisms that undermine health outcomes in order to enhance corporate profits
It is important to identify all of these outrages against our public health. The battle is not being
fought just in the corporate boardrooms and around the Cabinet table in Ottawa – they are
battling for the hearts and minds of the Canadian public. If we are to convince the Canadian
voters to support public health care we have to expose how corporate priorities are infecting
our whole system at every level. For example:

How Big Pharma affects patents and drug prices, research funding, doctors prescribing
practices, hospital hiring and firing;

How health insurance and workers compensation schemes affect our legal system, how
they are trying to intimidate doctors;

How diagnostic testing has been privatized or contracted out;


How vitamins are being pushed to an unwitting public;
How private ownership of clinics, especially by doctors, threatens the values that
underlie our system.
Once we’ve demonstrated the high degree of corporate influence, and their impact on the
system, past, present and future, the next challenge will be to convince the public that they can
influence change. We can chronicle concrete examples of political education and democratic
influence, and get students "learning by doing".
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RECOMMENED READINGS
Recommended – on Politics and the Canadian Political System
Brodie, Janine and Sandra Rein. (2008) Critical Concepts: An Introduction to Politics. 4th edition. Toronto:
Prentice Hall.
Brodie, Janine and Linda Trimble (eds) (2003). Reinventing Canada: Politics of the 21st Century. Toronto:
Prentice Hall.
Recommended – on Public Policy in Canada
Miljan, Lydia (2008). Public Policy in Canada: An Introduction, 5th ed. Toronto: Oxford.
Dobuzinskis, Laurent, Michael Howlett and David Laycock. (2007) Policy Analysis in Canada: The State of the
Art. Toronto: University of Toronto Press.
Howlett, Michael, M. Ramesh and Anthony Perl (2009) Studying Public Policy
Policy Cycles and Policy Subsystems, Third Edition. Toronto: Oxford University Press.
Recommended – on Health Policy
Armstrong, Pat & Hugh (2008) Health Care. Halifax: Fernwood.
ISBN 13:978-1-55266-246-5
Armstrong, Pat and Hugh Armstrong. (2003) Wasting Away: The Undermining of Canadian Health Care. 2nd
edition. Toronto: Oxford University Press.
Armstrong, P., Armstrong, H. and Coburn, D. (eds.). (2001). Unhealthy Times; Political Economy Perspectives on
Health and Care in Canada. Toronto: Oxford University Press.
Barlow, Maude. (2002) Profit is Not the Cure: A Citizen’s Guide to Saving Medicare. Toronto: McClelland and
Stewart.
Beach, Charles, Richard Chaykowski, Sam Shortt, France St-Hilaire, and Arthur Sweetman (eds). Health
Services Restructuring in Canada. Montreal and Kingston: McGill – Queen’s University Press.
Blake, Raymond and Jeffery Kesler (eds). (2006) Social Policy or Patchwork Quilt: The Development of Social
Policy in Canada. Peterborough: Broadview.
Burke, Mike and Susan Silver. “Universal Health Care: Current Challenges to Normative Legacies” in Anne
Westhues (ed). (2006) Canadian Social Policy: Issues and Perspectives, 4th edition.
Chappell, Neena L. and Margaret J. Penning. Understanding Health, Health Care, and Health Policy In Canada:
Sociological Perspectives. Toronto: Oxford University Press, 2009.
Clavier, Carole and and Evelyne de Leeuw (eds.) (2013) Health Promotion and the Policy Process. London:
Oxford.
Commission on the Future of Health Care in Canada. Building on Values: The Future of Health Care in Canada –
Final Report. Commissioner: Roy J. Romanow.
http://www.hc-sc.gc.ca/english/pdf/romanow/pdfs/HCC_Final_Report.pdf
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Doern, Bruce (ed). (2006) How Ottawa Spends, 2006-2007: In from the Cold - the Tory Rise and the Liberal
Demise. Montreal and Kingston: McGill-Queen's University Press.
Duckett, Stephen and Adrian Peetoom.(2013) Canadian Medicare. Montreal & Kingston: McGill-Queens.
Forest, Pierre-Gerlier, Gregory P. Marchildon and Tom McIntosh. (2004) The Romanow Papers – a three volume
set. Toronto: University of Toronto Press.
Gustafson, Diana L. (2000) Care and Consequences: The Impact of Health Care Reform. Halifax: Fernwood,
Grieshaber-Otto, J. & Sinclair, S. (2004) Bad Medicine: Trade Treaties, Privatization and Health Care Reform in
Canada. Ottawa: CCPA.
Health Council of Canada. (2010) Stepping It Up: Moving the Focus from Health Care in Canada to a Healthier
Canada. Toronto.
Houston, Stuart and Merle Massie. (2013) 36 Steps on the Road to Medicare: How Saskatchewan led the way.
Montreal & Kingston: McGill-Queens.
Johnson Redden, Candace. (2002) Health Care, Entitlement and Citizenship. Toronto: University of Toronto
Press.
National Forum on Health. (1997). Canadian Health Action: Building on the Legacy: Volume II – synthesis reports
and issue papers http://www.hc-sc.gc.ca/english/care/health_forum/
Rachlis, Michael. (2004) Prescription for Excellence: How Innovation is Saving Canada's Health Care System.
Toronto: Harper Collins. Available for downloading at www.michaelrachlis.com/product.pfe.php
Panitch, Leo and Colin Leys. (2009) Morbid Symptoms: Health under capitalism. Socialist Register 2010. Halifax:
Fernwood.
Raphael, Dennis. (2008) Social Determinants of Health: Canadian Perspectives. 2nd Edition. Toronto: Canadian
Scholars Press.
Raphael, Dennis. (2007) Poverty and Policy in Canada: Implications for Health and Quality of Life. Toronto:
Canadian Scholars Press.
Raphael, Dennis, Toba Bryant and Marcia Rioux. eds. (2006) Staying Alive: Critical Perspectives on Health,
Illness, and Health Care. Toronto: Canadian Scholars Press.
Sullivan, T. Baranek, P.N. (2002). First Do No Harm: Making Sense of Canadian Health Reform. Vancouver: UBC
Press.
Walt, Gillian. (1994) Health Policy: Politics and Processes. London: Zed.
On Health Advocacy:
Laverack, Glenn. (2013) Health activism: foundations and strategies. London: Sage 2013.
Other sources of material:
CHSRF Myth Busters are available at www.chsrf.ca/mythbusters/index e.php .
Policy Options articles are on the website of the Institute for Research on Public Policy: www.irpp.org/po
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University of Toronto – University College – Health Studies
UNI 211H1F - Introduction to Health Policy - Winter 2014
DRAFT SCHEDULE – SUBJECT TO REVISION AS WE ADD GUESTS
Class Meeting Topic and Required Readings
January 5
Introduction to the Course & Introductions of the Class
Film – Sicko, by Michael Moore
January 12
Introduction to Politics and Public Policy
With guest Natalie Mehra, Coordinator, Ontario Health Coalition
Read: Brodie, Janine and Sandra Rein. (2008) Critical Concepts: An Introduction
to Politics. 4th ed. Chapter 1 and skim Ch 2.
You are encouraged to read one additional chapter -- either Ch 3 on the
Liberalism, Ch 4 on Democracy, or Ch 5 on Radical Politics
and
Laverack, Glenn (2013) Health Activism: Foundations and Strategies. Chapter 1
– Foundations of Health Activism
January 19
Health Policy and Policy Studies
Read: Bryant, Ch 1 and 2
and Laverack, Chapter 4 – Strategies to influence healthy public policy
Recommended: Brodie, Janine and Linda Trimble (eds) (2003). Reinventing
Canada: Politics of the 21st Century. - Chs 4 and 6
January 26
Theories of Public Policy and Policy Change
Read Bryant chs 3 and 4
and Laverack, Chapter 5
February 2
Influencing Policy - from the Outside
Read Bryant ch 5
Read Langille ch 20 from Raphael’s, Social Determinants of Health in Canada
(on Blackboard)
Also see Bryant Ch 11 on “Globalization and Free Trade”
February 9
Health Care in Canada
Read Bryant ch 6
and skim Laverack, Chapter 6 & 7
9
February 16
READING WEEK
February 23
Reform of Health Care
With guest Michael Rachlis MD [TBC]
Read Bryant ch 7 and Fierlbeck ch 1
Read Michael Rachlis, “Canadians are ready for an adult
conversation on Medicare” Originally published in the
Toronto Star, Oct 14, 2012. Revised Dec 5, 2013
March 2
Private vs Public – Is there a role for the market?
Read Bryant ch 8
Read Sutherland, Medical Laboratories and the Public-Private Debate,
Introduction to False positive: private profit in Canada's health care,
Halifax:Fernwood, 2011
Read Fierlbeck ch 9
March 9
An International Perspective on Health Policy
[TBC} With guest Dennis Raphael, Professor of Health Policy
and Management, York U and author of Tackling health
inequalities: Lessons from International experiences; Poverty in
Canada: Implications for health and quality of life; Social
determinants of health: Canadian perspectives, etc….
Read Bryant ch 9
Recommended: Fierlbeck ch 10, 11
March 16
Mental Health Policy
[TBC] With guest Steve Lurie, Executive Director of the Canadian Mental Health
Association - Toronto Branch and Adjunct Professor at the University of Toronto
Faculty of Social Work.
Read Fierlbeck ch 8
Read Mental Health Commission of Canada, Changing Directions, Changing
Lives
Read Mental Health Commission of Canada, Making the Case for Investing in
Mental Health in Canada
Read Ontario Ministry of Health and Long Term Care, “Open Minds, Healthy
Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy”
March 23
Drugs and Drug Policy
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[TBC] With guest Dr. Nancy Olivieri
Read Fierlbeck ch 7
March 30
Test – in class
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