Search

The COVID-19 pandemic offered Canadians a glimpse of the digital healthcare system we could have here if we are willing to clear away the traditional roadblocks that stand in the way. However, as the pandemic slowly recedes, the opportunity to keep moving forward, with a health-care system that fully embraces digital, will likely require the federal government asserting itself as a leader in a policy area that falls within provincial jurisdiction, despite the controversy and contention that federal intervention would arouse. The pandemic's urgent demands on the health system forced jurisdictions to clear many barriers that have impeded digital-health innovation until now. Within weeks of the onset of the pandemic, virtual care exploded to previously unimaginable levels, with health-related telephone and video calls rapidly rising from less than two per cent of all ambulatory visits at the beginning of 2020, to as high as 70 per cent by mid-May the same year. The bureaucracy around procurement, privacy and security was reduced, while digital-health innovators were given the opportunity to take a larger role in the health system. Digital health care is much more than just a doctor making a Zoom call, however. Seizing the momentum to realize broader change will require a national approach. This should include several policies, many requiring federal leadership, such as enshrining digital care within the definition of "medically necessary" care, insured under the Canada Health Act. Digital health also includes giving patients ownership of their personal health data, while ensuring data interoperability across Canada. The current, fragmented, provincial approach to health care is a drag on innovation, creating barriers to the efficient procurement of technologies, interoperability and data sharing. Our heavily siloed system disadvantages not only the health-care system and patients, but Canadian digital-health companies who, because they are unable to scale up in Canada, will find it hard to compete in the growing global digital-health industry. The federal government can show leadership by innovating with digital health policy for those citizens that fall under its health-care purview, such as Indigenous Canadians and members of the Canadian Armed Forces. Ensuring that Canadians everywhere realize the benefits of digital health care, however, will require Ottawa taking a more active role in breaking down barriers between provinces and territories, making it clear that our slow-to-innovate health-care silos are no longer sustainable in a digital world. [ABSTRACT FROM AUTHOR]

Urban sustainability is a priority for cities, challenging public administrators to coordinate action on environmental policy, economic development and social policy. Multilevel governance is now a popular theoretical framework but research must illuminate the constraints on local administrators. This case study reviews efforts of public administrators in the City of Ottawa and Canada's national capital region to implement sustainability policies with collaborative governance, but new governance relationships are constrained by traditional intergovernmental relations. Case study research illuminates the challenges of multilevel governance for local governments and provides insights on the pursuit of sustainability with environmental programs, land use, and urban and development by Crown corporations. [ABSTRACT FROM AUTHOR]

The maintenance of Canadian federalism, and Canada itself, depends on workable relationships between its constituent parts that are able to secure political agreement through accommodation. This argument is developed by examining the dispute between Newfoundland and Ottawa over the control of offshore oil and gas from the late 1950s to 1985, which also became a subtext for the pursuit of economic security, justice, and equality for the province. Energy policy, including the offshore, was often a key issue in the fractious intergovernmental relations in Canada in this period, and this article argues for the inclusion of political actors as an important force in shaping politics and political decisions. While it does not ignore partisan divisions and issues of constitutionalism, the article makes the case that political stability in Canada also depends on relationships. As such, the article offers a unique opportunity to reframe our understanding of interstate federalism and redirect the discussion of politics and federalism away from constitutionalism and judicial review to the role of politicians and personal relations in federal-provincial governance. [ABSTRACT FROM AUTHOR]