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Dave Snow: The groundbreaking Cass Review on transgender care is shifting the debate abroad. Yet it was barely reported on by Canadian media 

A counter-protester walks in front of people protesting Alberta Premier Danielle Smith's proposed youth transgender policies as she appears at an event in Ottawa on Monday, Feb. 5, 2024. Patrick Doyle/The Canadian Press.

The CBC and Canada's national media are showing their bias in the lack of coverage

Few Canadian policy issues are as polarizing as youth gender transition. Yet according to my analysis below, most Canadian media spent last month paying little to no attention to one of the most consequential reports on the topic.

The gender transition debate in Canada

In 2023, conservative governments in New Brunswick and Saskatchewan both introduced policies requiring parental consent for pronoun changes for school children, with the latter invoking the notwithstanding clause. More recently, Alberta announced it will bring in a host of policies related to youth transition, including restricting the use of hormone therapies, puberty blockers, and gender reassignment surgery. At the national level, Pierre Poilievre has publicly opposed puberty blockers for children.

Such restrictions have been rejected by major Canadian medical organizations, which remain committed to the “gender-affirming” model of care. Yet this medical consensus is being challenged at home and abroad.

Canadian investigative reports have raised questions about insufficient safeguards for hormone treatment and surgeries. Outside Canada, several European countries are actually moving away from the gender-affirming model. Then came the Cass Review.

On April 10, 2024, British pediatrician Dr. Hilary Cass released her long-awaited Independent Review of Gender Identity Services for Children and Young People. Commissioned by England’s National Health Service (NHS), the 387-page report was completed alongside independent reviews of the scientific evidence around youth gender medicine by a research team from the University of York, which were published as nine journal articles in the Archives of Disease in Childhood.

The Cass Review’s 32 recommendations call for an overhaul of how youth gender medicine is practiced in the United Kingdom. Cass found “a lack of high-quality evidence” for the gender-affirming model of care, particularly with respect to “the use of puberty blockers and masculinising/feminising hormones.” 

The review recommended “extreme caution” for providing cross-sex hormones for children and raised concerns that puberty blockers “may change the trajectory of psychosexual and gender identity development.” Going forward, the review urged that youth gender services “must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors.”

The Cass Review received significant media attention (positive and negative) in the U.S. and in Europe. It appears to have already had a serious impact in the U.K. and beyond. Both the Conservative Prime Minister Rishi Sunak and the Labour Party’s shadow health secretary praised the report, while Scotland’s NHS announced it would pause puberty blockers and cross-sex hormones for children (NHS England had already paused puberty blockers in March).

There are suggestions that Belgium and the Netherlands may soon follow suit. Alberta Premier Danielle Smith even cited the Cass Review as justification for her government’s proposed gender policies. Support for Cass was not merely confined to conservative sources, as the report was portrayed positively in the New York Times, The Atlantic, and The Guardian, as well as by the editor-in-chief of The British Medical Journal

Canadian media coverage of the Cass Review

As a major medical report on an issue where there is considerable Canadian political debate, one would have expected the Cass Review to garner considerable Canadian media attention.

To determine how the issue was covered in Canada, I conducted a content analysis of online articles from five mainstream media outlets (The Globe and Mail, National Post, Toronto Star, CBC, and CTV) from the three-week period following the Cass Review’s publication (April 10 – April 30, 2024). These five outlets published a total of 15 stories that mentioned the Cass Review. Given that three stories (all from the National Post) only briefly mentioned it in passing, and one Associated Press story was published in two outlets, this meant a total of 11 unique stories in which the Cass Review featured prominently.

Coverage was dominated by the National Post, which featured seven articles on the Cass Review over an 11-day period between April 10 and April 20. By contrast, there were only two stories featuring the Cass Review in the Toronto Star, and only one each in CBC, CTV, and the Globe. Apart from the one AP story, every article applied the Cass Review to the Canadian context, with six mentioning Alberta’s proposed gender policies. The stories were split between hard news (six) and opinion pieces (five).

Given the National Post’s longstanding focus on youth gender transition, it is not surprising that it gave the Cass Review the most coverage. The other four outlets did not give it as much attention. The only hard news piece in the Toronto Star was a wire story written by the U.S.-based Associated Press. CTV’s one mention of Cass appeared in a piece about Alberta’s proposed gender policies and was only the result of Premier Smith raising it during an interview with the outlet. Meanwhile, the lone CBC article on the review was more of a condemnation than a news report (see below). The Globe and Mail did not feature Cass in a single hard news article, though the report was mentioned in an investigative opinion piece about gender transition in Canada written 16 days after the review was published. In total, only three of the six hard news pieces quoted from the Cass Review extensively, including two lengthy pieces from National Post reporter Sharon Kirkey and one Associated Press piece (published in both the Star and Post).

While there were only five opinion pieces published about the Cass Review, they shared several notable characteristics. All five opinion pieces—three from the National Post and one each in the Toronto Star and The Globe and Mail—portrayed the review positively, including descriptions such as “landmark” and “an exhaustive and rigorous report.” All five were broadly supportive of exercising greater caution around the use of puberty blockers and cross-sex hormones for youth. The Post’s Adam Zivo called such restrictions “a wise approach that Canada should follow,” while the Globe’s Robyn Urback cited multiple studies “exploring the potential long-term effects of puberty blockers and cross-sex hormones on bone densityfertilitysexual function, and cognitive development” (links in original). Moreover, the five opinion writers demonstrated considerable knowledge of the review itself, with Cass quoted or paraphrased a total of 16, 11, eight, four, and three times, respectively.

Michael Gullo and Heather Exner-Pirot: Finally, we all agree Canada must get more major projects built


“Getting major projects built means more jobs, in more regions across Canada, and more opportunities for the next generation of workers. Canada’s regulatory system must be efficient and quicker—it shouldn’t take over a decade to open a new mine and secure our critical minerals supply chains.”

These are not our words, though they could be. They come verbatim from Budget 2024. After almost nine years in office, the federal government is recognizing that slow, opaque, and duplicative regulatory processes are not good for anyone and they need to be fixed. We couldn’t agree more. But the first thing that needs fixing is the government’s credibility on the issue.  

The government’s messaging is evolving on account of a shift in public opinion and a growing sense of frustration that Canada is a difficult place to build major projects. In Budget 2023, the government committed to releasing a concrete plan by the end of 2023 to improve regulatory and permitting processes. That plan was never released by the end of 2023, and the responsibility was punted to a new Ministerial Working Group on Regulatory Efficiency for Clean Growth Projects, led not by usual suspects Environment Minister Steven Guilbeault or Energy and Resources Minister Jonathan Wilkinson, but rather Labour Minister Seamus O’Regan, who has arguably been one of the stronger voices for energy and resource development at the cabinet table. 

Perhaps recognizing the doubters, O’Regan posted on his social media that while “it sounds like just another government committee…this one has teeth.” Whether that will be proven true remains to be seen, but its early work as revealed in Budget 2024 is worth noting.

The government is establishing a Clean Growth Office to “reduce interdepartmental inefficiencies,” “prevent fixation on well-studied and low-risk impacts,” and “reduce redundant studies”; setting targets of five years for completing federal impact assessment and permitting, two years for non-federal projects, and three years for nuclear projects; building a federal permitting dashboard to increase transparency and accountability; and issuing a cabinet directive to drive culture change. 

These initiatives suggest that the government would like to see the wheels of its own bureaucracy turn faster. A risk-averse public sector, unbothered by the mounting regulatory and fiscal costs borne by proponents, has indeed been a big part of the problem, and it’s encouraging to see it acknowledged. 

But the implementation is still lacking.

The main lever that the government controls at a political rather than operational level is the Impact Assessment Act (IAA), also referred to as Bill C-69. The Liberals introduced this sweeping environmental legislation in 2019, despite a chorus of companies warning of its economy-stifling consequences, which have since been borne out. A majority of the provinces, led by Alberta, challenged it on the grounds that it impinges on their jurisdiction. The Supreme Court of Canada largely agreed in a decision in October 2023. 

This forced the federal government to undertake amendments to the IAA to ensure it complies with the Constitution. But it also presented a genuine opportunity to bridge the gap between itself and the provinces and territories and improve the efficiency of the assessment process. Ministerial working groups, permitting targets, and dashboards are fine; but the IAA is where the rubber hits the road in terms of attracting investment and moving major projects along. 

The opportunity has been missed. The amendments proposed for the IAA, announced in April, have been tacked on to the Budget 2024 implementation bill which, by fate or karma, is also numbered C-69. Based on an initial review, it appears the government has done the minimum possible to address the Supreme Court’s concerns, adding qualifiers to its areas of authority, but failing to correct the legislation’s negative impacts on the pace, cost, and efficiency of project approvals. 

The amendments are likely to face challenges again from some provinces, and in the event that a different government is elected in 2025, they will no doubt undergo wholesale revision. Meanwhile, companies and the investor community will continue to wait for clarity and, until they receive it, many will keep their money on the sidelines, or spend it in other countries. Canada can’t wait and should be bold and more intentional in its effort to grow market share and respond to a world thirsty for more Canadian-made energy, food, and critical minerals.  

Minister of Labour Seamus O’Regan speaks to reporters before heading to a caucus meeting on Parliament Hill in Ottawa, on Wednesday, May 10, 2023. Spencer Colby/The Canadian Press.

The business community often says policy uncertainty is a major deterrent to investing in major projects in Canada. In fact, it seems the opposite is the real problem—there is a certainty that the regulatory and permitting process in Canada will be painful and costly and plagued by domestic politicking. In this respect, the amendments provided in C-69 version 2.0 do little to instill confidence that rules for approving and permitting projects in Canada are clearer and better off than what was initially proposed when the Impact Assessment Act came into force in 2019.  

We are seeing improvement in the government’s rhetoric around getting projects built because we are seeing rising expectations in the broader Canadian public to see these changes happen. For example, a recent Nanos Research poll found that two-thirds of Canadians support building new export facilities for natural gas, suggesting that Canadians want to see their country’s influence in the world grow through increased energy production and trade.

The only metric that matters is getting more projects built faster. And the track record right now is not good. The number of energy and natural resource major projects completed in Canada dropped by 37 percent between 2015 (88 projects) and 2023 (56 projects). The ones that get done, like the Trans Mountain expansion pipeline or Site C hydroelectric dam, are often beset by cost overruns and delays. Critical minerals production is down, in many commodities by double digits since 2018. The average time to get from discovery to production for new mines in Canada is now 18 years. 

As we’ve written in the past, much can be done to advance the principle of “one project and one assessment,” ie. reducing the duplication and redundancy inherent in our regulatory system. For starters, the federal government can use its Regional Energy and Resource Tables as places to work proactively with the provinces and territories to develop equivalency agreements over project approvals and restrict its role to permitting in areas of federal jurisdiction. Another option is to fast-track projects where consent and equity and/or benefit agreements with First Nations are already in place.

Because we are now reaching crisis levels, both in economic and supply chain terms, the federal government is taking the issue more seriously than it ever has before in its nine-year tenure. To show that it’s not too little too late, it will need proponents and investors to believe that government ambition can translate into implementation. Rather than saying what they will do, they should start doing what they say.