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Veronica Green: Ontario’s health care system is failing women

Commentary

It is well documented that women are not well-represented in health care research and that there are systemic biases that affect a woman’s access to both health care and health care-related information. 

A perfect example is cardiac health. 

Did you know that heart disease kills more women than men

Heart disease is a leading cause of death for women in Ontario each year, yet a study by Women’s College Hospital reveals that only 35 percent of clinical trial subjects in cardiovascular research are women. What’s more, many cardiovascular drugs have been on the market for years but have only been tested on men. 

It’s not a quantifiable bias to point to but anecdotally I cannot think of a scene in a movie or television show where the powerful female CEO crumbles to the floor, suffering from a heart attack, induced by a heated argument. 

It will therefore likely come as a surprise that women are more likely than men to suffer a heart attack and not know it.

To oversimplify, women are dying because they have been excluded from the research to create a treatment for a known disease. This is all because women do not make good “test subjects”—their hormones fluctuate too much. Heart disease goes under-detected in women because doctors do not recognize the risk factors and symptoms unique to this sex

These inequities are not new. In fact, medicine has a long and shocking history of absorbing socially constructed gender divisions. Elinor Celeghorn’s recent best-selling book, Unwell Women, Misdiagnosis and Myth in a Man-made World documents this trajectory. She begins in the third century BCE when Aristotle described the female body as the inverse of the male body, with genitalia “turn’d outside in”. Since then, the male body has been seen as superior and women defined by their uterus—an anatomical deficiency that defines the purpose of their existence. She chronicles that by the 16th century, women progressed from defective to demonic as King Henry VIII passed the Witchcraft Act. In the 18th century, medicine had been professionalized and defined by the works of educated men and the societal confines in which they write. She marks the 19th century as a time that popularized hysteria; made famous were the delusions and diseases provoked by the uterus. 

The word uterus, by no coincidence, in Greek is hystera. 

In the last 200 years, campaigners and politicians have rightly advocated for women’s representation and access to health care. It cannot be disputed that vast inroads have been made. But it is difficult to claim triumph knowing that, until the 1990s, women were not included in most health care studies. This means that the majority of prescription drugs and treatment protocols have been disproportionately studied on men and not designed to help women. 

The icing on this uneven cake is a lack of public education. 

In Ontario, health care education for young women effectively stops in Grade 12. Most often, women are confronted with harsh medical realities by happenstance. 

I have a friend who only learned of the presence of her hereditary cancer because she was pregnant and having tests done. Another found out they had perimenopause after a trip to the dermatologist to treat new acne. A third was diagnosed with endometriosis, a chronic and painful disorder, because the cramps she thought were IBS sent her to the emergency room. 

Did you know that once you turn 50 you’re supposed to get a mammogram every two years? That you can experience perimenopause at 30? That you can check your ovarian reserve?

If my tone comes off as alarmist or harsh, I am glad. As I get older, I have spent a disproportionate amount of time researching and engaging with health care resources trying to find the appropriate responses to my body’s changes. 

While I am struck by how much time and money one can spend just to learn the most simple facts about their health, it is how I arrive at the conclusion that women’s health is intimately connected to our economy. And more specifically, our province’s post-COVID-19 economic recovery.

It is a fact that the COVID-19 pandemic has disproportionately affected women’s employment around the world. 

While women make up 39 percent of global employment, they account for more than half of all pandemic-related job losses.

There is an opportunity for Ontario to lead a cross-ministry initiative to educate women to take control of their health and in turn empower their role in the workforce. The Ontario government’s interventions to address economic participation can also address these societal aspects of gender equality. 

First, the government can invest in maternal health, mental health, and access to care. Ontario currently spends more subsidizing electricity rates than it does on cancer screening, cancer treatment, mental health services—including for children and youth—and midwifery services combined.

Second, there can be long-term education campaigns to encourage preventative services in shots and screening services. A public target for increased preventative screenings communicated to Ontario’s women via a public advertisement campaign or a mailed info package to every household is both good politics and good policy.

Third, there might even be the opportunity to nudge the private sector to adopt family-friendly policies and fertility planning services. After all, these types of investments in the female workforce are cheaper than retraining and replacing over and over.

After a trying history, it is time for medicine, our health system, and the government to put women’s health and their role in our economy first.

With provincial elections just around the corner, these are platform planks that can be easily communicated by candidates, handy to have when knocking on doors. A premier that stands behind a women’s access to information to empower her healthcare and in turn support our economy? That’s a campaign everyone can get behind. 

Matt Spoke: Canada needs less ‘innovation theatre’ and more productive growth

Commentary

Canada doesn’t need more startups.

Bear with me for a minute. After all, I’m a startup founder in Canada. I’ve raised tens of millions of dollars building two companies and have employed over 100 people during that time. 

But like most tech startup founders, I didn’t set out to build a startup. The goal is bigger, more aspirational, and ultimately what our policies should be working to incentivize. 

I’m building a company that aspires to change the world in a small or big way. To do that, my company can’t stay a startup for long. In fact, what I’m ultimately building is a massive company. It just so happens that “startup” is step one. 

The statistics suggest that I’ll likely fail. But the fact that I’m trying—alongside so many others like me —means some of us will succeed.

From the perspective of policy focused on encouraging innovation and economic growth, the purpose of this process needs to be to change the odds so that we as a country create more winners and fewer losers, as compared to our competition (the U.S., China, Europe, wherever).

“Startups”, as we’ve come to call them, have become a little bit of a romanticized notion in Ottawa. Politicians love the imagery of 20-something-year-olds in hoodies crowding into government-subsidized incubators to build startups. The problem is that we’ve created a policy environment that incentivizes what you might call “innovation theatre”.

The goal is not measured in the number of companies that go on to dominate their markets globally. It’s not measured in impact on GDP growth. It’s not even measured in employment. It’s measured in optics. 

How many entrepreneurs have been supported through the laundry list of government funding programs? How diversely do they represent Canada’s regions? What demographic do they fall into? 

In optimizing for these vanity metrics, we’ve fallen behind other countries in our ability to create world-changing businesses, started by world-leading Canadian entrepreneurs. 

“Startups” are NOT small businesses.

There is a missing distinction that politicians too often don’t understand. Every political party spends a disproportionate amount of time and energy focused on what they broadly call “small businesses”. 

And although I don’t like the way we often use the term in Canada, startups are NOT small businesses. They are huge businesses finding their footing in a new market, optimizing their odds of winning, and ultimately growing to be big drivers of wealth and productivity. 

The unpopular reality that Robert Atkinson does a good job describing in his recent Dialogue with The Hub is that small businesses generally slow down productivity. In fact, the bigger a business is (all else being equal), the more productive it necessarily is. It earns higher margins, pays better wages, contributes more in taxes, captures more market share, and innovates.

Until we understand that distinction, we will continue to primarily prioritize policies that encourage more small businesses, more startup theatre, and fewer global winners.

As any entrepreneur would likely agree, we’re not sitting on the sidelines waiting for our government to figure out the right policies to help us win. But as with any economic policy, we are influenced in our decisions by the things that are permitted, encouraged, and celebrated, as well as those that are restricted, discouraged, and frowned upon. 

In some cases, despite bad policies, a Shopify will spring up from Canada and go on to create a market and win. And today, Shopify is the most valuable company in Canada, and one of the largest contributors to our national productivity and economic growth. 

There is no government program that led to its success, nor any that could have stopped such a world-class team from building what they built.

But what we can and should expect from our government is a recognition of the importance of new innovative companies that start off as startups, but ultimately aspire to become massive, successful companies. 

We should assume that our most valuable companies in 10 years will not be the same brands that hold those titles today. The question then becomes how do we make that true.