Untitled-1Raisa Deber, PhD
Professor
Institute of Health Policy, Management and Evaluation, University of Toronto

What is the best way to pay for health care? As a professor of health policy, I am frequently asked to comment on proposals to change how health care is financed. The rationale varies, as do the goals. Extend coverage? Control costs? Encourage appropriate utilization? I frequently resorted to the policy analyst’s creed – “one size does not fit all”. Yet it seemed that it might be helpful to clarify what sizes the tailor might need to serve.

One starting point for our work was the pressure in Canada to consider using Medical Savings Accounts. This arose from the assumption that people would abuse ‘free’ care, and that the best way to attain cost control was to use economic principles. Working with colleagues in Manitoba, including co-author Les Roos, we determined that the assumptions were flawed. Average expenditures were misleading, since most people used very little health care. The top 1-5% accounted for the bulk of costs. Our work directly influenced health policy in Canada, and was cited in both the Romanow and Kirby reports. My other co-author, Kenneth Lam, did a thorough job of analyzing updated Manitoba data on the distribution of health expenditures for his PhD thesis.

Particularly, as the US debates over health reform (“Obamacare”) intensified, I was struck by the passion with which people were making similar arguments. Our findings suggested that the insistence on competitive insurance models, for example, seemed potentially harmful – escalating total costs, while not covering those most in need of care.

Our paper in Canadian Public Policy, “Four Flavours of Health Expenditure”, thus took the highly risky approach of trying to be conceptual. We divided health costs into four categories, only three of which are captured in health expenditure statistics. The first, public health, may include efforts to preserve clean air and water, as well as policies directed at ‘determinants of health’ (e.g., ensuring people have food and shelter). Indeed, several of the case studies in my new U. of T. Press book (Case Studies in Canadian Health Policy and Management) deal with such issues (e.g., contaminated water in Walkerton, Ontario). Our paper focused on the remaining three categories – routine care delivered to the population, potentially catastrophic expenditures that were not predictable in advance, and potentially catastrophic but predictable costs (e.g., pre-existing conditions). We suggested that these raised different issues, and hence that policies that could work for one category might not work for others. We concluded that universal single payer systems were most appropriate for dealing with this last category of expenditures (and had advantages for the other categories as well). We illustrated this with data from Canada, particularly Manitoba. As an experienced academic, I know it is much easier to publish straightforward data analysis than to try to use this data to make conceptual leaps, and we are grateful to CPP for publishing our paper. We hope that our paper can help policy makers ensure that the way we finance health care fits as many sizes as possible in ensuring coverage for everyone needing care at an affordable cost.

Raisa Deber, Kenneth C. K. Lam and Leslie L. Roos: Four flavours of health expenditures: Implications of the distribution of health expenditures for financing health care. Canadian Public Policy. 40(4), December 2014.

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International Sport Diplomacy in the Hockey Arena

by cmacmillan on December 4, 2014

Written by guest blogger, Marcel Jesenský.


The 2014 Olympic Winter Games in Sochi once again focused attention on the hotly contested issue of sports and politics and the potential of sport to further national prestige. After the Canadian Men’s Hockey Team’s gold-winning performance at the Sochi Games, Prime Minister Stephen Harper congratulated the team on behalf of all Canadians and stated: “Today’s exciting victory by this exceptional group of players has demonstrated once again that hockey truly is Canada’s game. The passion and dedication shown by our team throughout this gruelling competition have inspired Canadians from coast to coast to coast, and have made us all extremely proud.”

The debate over the notion that international sporting events like the Olympic Games or World Championships have a real impact on national and/or international identity continues. Politicians, sport enthusiasts, and various media sources continuously seek to measure any tangible outcomes of this sport diplomacy.

Like most Slovaks, I grew up with a sense of admiration for and interests in the fastest winter sport. Hockey has always played an important role in the sports and physical culture of Slovakia and the former Czecho-Slovakia. Slovakia gave the world many excellent players, like Stan Mikita, Vladimír Dzurilla, Peter Šťastný, Zdeno Chára and Marián Hossa, to name just a few. Sports and politics do interlock at the national and international levels. It was only when I began to study the history of diplomatic relations between Canada and Czecho-Slovakia that I discovered the fascinating events surrounding Team Canada and its sporting and diplomatic mission at the 1978 IIHF World Championship in Czecho-Slovakia.

In the course of my research, I was struck by the way in which hockey, diplomacy and politics interacted at the 1978 IIHF World Championship. The Department of External Affairs (DEA) in Ottawa was fully aware that Canada’s image in Czecho-Slovakia was intimately if not almost exclusively, identified with hockey. Ottawa sent Senator Sidney L. Buckwold to represent the Government of Canada and make courtesy calls on Czecho-Slovak officials. The DEA meticulously briefed Team Canada prior to its departure for Europe. Finally, Canadian embassies in Sweden and Czecho-Slovakia lent support to Team Canada and monitored its public relations success, working full-time on the world hockey tournament portfolio.

My interest in analyzing “sport diplomacy” and the 1978 IIHF World Championship owes a large debt to my earlier academic training and my career in diplomacy. My diplomatic experience made me understand that the efforts of the Canadian diplomatic staff in Ottawa, Moscow and Prague to alter Canada’s image in the world in the 1970s was novel and modern in many respects. Team Canada was a clever diplomatic orchestration by the DEA – despite its official “hands-off” attitude – as well as part of a larger context of a steadily growing government interest in amateur sport in Canada. I believe that the way in which the DEA managed this “charm offensive” in Europe in 1978 was innovative and gave it greater credibility to participate in the sport diplomacy than many realized.

Marcel Jesenský


Marcel Jesenský’s article, “Win Friends or Make Enemies: Team Canada’s 1978 Diplomatic Mission to Czechoslovakia” appears in the latest edition of the Canadian Journal of History/Annales canadienne d’histoire. Read it today by clicking here: http://utpjournalsreview.com/index.php/CJOH/article/view/13002

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Jocelyn WentlandDo people really ‘get’ the difference between casual sex relationships based on labels alone? The short answer: yes.

The long answer: the answer is still yes, but let me tell you why this is such a cool research question to answer.

When I started my PhD, I planned on examining women’s reasons for engaging in casual sex as this would be a direct extension of my previous graduate work. But the closer I looked at the existing casual sex research literature, the more apparent it became that I couldn’t look at women’s reasons for engaging in casual sex at all because of one critical reason: researchers can’t really agree on what casual sex is.

So I went back to the drawing table and planned out my dissertation. First step: let’s talk to young adults and get them to tell us what the different labels used to describe casual sex are. This seemed like a better idea versus us researchers creating our own definitions (that have not been endorsed by the people who are arguably more theoretically and practically versed with these relationships than we are). That article was published previously in The Canadian Journal of Human Sexuality (20: 3/2011).

The next step: let’s check if young adults agree with these preliminary definitions. Turns out they do. A lot.

The present study surveyed 885 participants (75% of the sample was under the age of 30 yrs) and it turns out that a large majority of participants can identify the relationship definitions provided (even when the definitions are presented to the participants simultaneously, which to date, has not been done). Specifically, 96%, 92%, 81%, and 85% of participants identified the definitions for One Night Stand, Booty Call, Fuck Buddy, and Friends with Benefits, respectively.

And some pretty cool patterns of results emerged from this study. First – and not terribly surprisingly – sexual intercourse experience was necessary to be able to discern between these relationship labels. Second, women were ‘better’ at identifying the various relationships labels, which makes sense since the costs of casual sex are higher for women versus men. Third, previous casual sex experience did not impact people’s ability to identify the relationship labels, suggesting that for young adults, these relationships are pervasive in terms of how they are represented in popular media and on various social media platforms.

Why does this study matter? This study suggests that not only can people differentiate these relationships from one another, but it also highlights the importance for researchers to ensure that they use the terminology that accurately reflects their participants’ conceptualizations of these modern sexual relationships.

Casual sexual relationships: Identifying definitions for one night stands, booty calls, fuck buddies, and friends with benefits” is open access and can be found in Canadian Journal of Human Sexuality 23.3.

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By guest contributor Camellia Webb-Gannon, Research Fellow, University of Western Sydney

Despite occupying the western half of the island of New Guinea, located upon Australia’s doorstep,” West Papua is frequently referred to as far-flung, isolated, remote, and exotic. It has gained this reputation due to the cloak of secrecy within which it is draped by the Indonesian government, which bans foreign journalists and NGOs from entering the territory, and also because of its remarkably rugged terrain, which poses challenges for prospective travelers.

Camellia Webb-Gannon at Sydney Protest
When I give public lectures and when I speak privately about West Papua and the conflict that has dogged its people and lands for five decades, the question I am commonly presented with is Why West Papua?, the implication being that West Papua’s location and under-reported conflict is an eccentric choice for a researcher. While many anthropologists or conflict analysts choose to study a particular geographical area as a case study to further their disciplinary or theoretical work, I entered academia specifically as a means to learn more about, and advocate, for West Papua.

I grew up in Papua New Guinea with an ethnomusicologist father and developed an appreciation for things Melanesian from an early age. When my work in international development and HIV prevention took me to East Timor in the mid 2000s, I was struck by the similarities between East Timor’s and West Papua’s history of occupation, the difference being that West Papua had yet to emerge as an independent state. At the 2005 Pan-Pacific HIV/AIDS Conference in Auckland, New Zealand, I was struck by the absence of HIV in West Papua—a very real concern—as a conference topic. Despite disproportionately affecting and infecting West Papua’s Melanesian population, HIV was considered by conference organizers to be an Asian epidemic. Meeting West Papuan activist Dolly Zonggonau at this conference piqued my interest in other structural injustices impacting West Papuans. I resolved to pursue PhD studies on the challenges facing West Papua’s independence movement in the hope that my research skills would be useful for increasing knowledge about paths to peace with justice for West Papuans.

Being a professional academic activist is a privilege, particularly when so many West Papuan life-long activists with distinguished educations face threats of violence or worse when peacefully expressing their desire for merdeka, or freedom. My article for Anthropoligica, ‘Merdeka in West Papua: Peace, Justice, and Political Independence,’ is an attempt to use my privileged academic position to disseminate West Papuan leaders’ ideas about what merdeka means to them, and what a future shaped by merdeka might look like. It draws on interviews with three generations of West Papuans living in dispersion in seven countries, and argues that merdeka for West Papuans implies a state of governance characterized by peace with justice, with political independence as its baseline. The argument has two prongs. It argues from a top-down, international human rights law perspective that self-determination is a human right, and that peace with justice necessitates the fulfillment of fundamental human rights. It also argues from a bottom up, grassroots ethnographic perspective that West Papuans believe that peace with justice necessitates independence, and that they cannot realize collective or individual self-actualization until they are in a position where they have the choice to determine their own political future.

A compelling theoretical and ethnographic case can be put forward, but does it have any utility for advocacy purposes? This is something I have been reflecting on lately, as the recent election of a relatively democratically-minded OLYMPUS DIGITAL CAMERAIndonesian president, Joko Widodo, ironically makes the likelihood of political independence painfully remote. (If the tyrannical General Prabowo Subianto had been the victor, West Papuans’ pleas for international assistance would arguably have reached a more receptive international community). If, under Widodo West Papua becomes comparatively more open—political prisoners might be granted amnesty, for example, or the provinces might be accessible to international press, which would be welcome improvements, certainly—would this detract from the integrity of West Papuans’ right to self-determination? Or, even if conditions do not improve for West Papuans, but the apparent futility of pursuing West Papuans’ right to choose self-governance continues to grow, should international supporters of their right to self-determination desist and instead focus on campaigning for more achievable, limited human rights for West Papuans?

Such questions prompt me to ponder the utility of radical research; when I posed them recently to a friend and experienced West Papua human rights advocate, he reminded me that one should not grow weary of standing up for what is right, simply because one is in an apparently ever shrinking minority regarding the issue. Human rights should not be treated according to the whims of fashion, taken up or abandoned based on preference or convenience. All that is necessary for evil to triumph—for human rights to become obsolete—is for concerned people to do nothing, to paraphrase Burke. And miracles do occur, as the case of East Timor testifies. It is of course important not to be single-focused; strategic wisdom dictates that the more achievable gains be sought after as West Papuans walk their long walk to freedom. As the article articulates, it is unlikely that West Papuans will relinquish their dream—and right—to self-determination. However unobtainable their goal might appear now, it is a right and good thing for onlookers, members of the academic community included, to share the journey with them.


 

Read Camellia Webb-Gannon’s article Merdeka in West Papua: Peace, Justice and Political Independence in the most recent issue of Anthropologica 

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UntitledBy Guest contributor: Ivan Robinson

William Petty’s atlas of Ireland is an historic document that deserves to be better understood beyond the shores of the island it depicts. Published under the title Hiberniae Delineatio in1685, it comprised a general map, a map of each of the four provinces, and thirty-two county maps. It was the first printed atlas of Ireland and the first in Europe to be based on measured surveys. The regional maps contained a level of accuracy and detail never previously printed and drawn to scale across a whole country. The general map provided the earliest, widely available outline of Ireland substantially as it is known today. It became the definitive shape of Ireland for the next century.

But the atlas was more than a mirror of the physical and human geography of Ireland; it was also testimony to the role maps themselves can play in the historical process. Its main source was Petty’s Down Survey, which was an instrument of state control designed to transform Irish society through a massive change in land ownership, from Catholic to Protestant hands. The effect of this ‘plantation’was dramatic: in the twenty-year period between 1640 and 1660, Catholic ownership of Irish land dropped from 60 percent to less than 10 percent.

There is a growing acceptance amongst cartographic historians that an understanding of early maps is best achieved by integrating scientific and non-scientific approaches to map history. The scientific approach, which stresses the value-free, objective nature of maps, needs to be balanced with the idea that maps are also the products of other factors, including social, economic and political influences prevailing at the time the maps were made.          

From a scientific perspective, the Down Survey and atlas were not noted for cutting-edge methods. Rather, the success of Petty’s cartography was due to his organizing ability and his access to central government control. With the backing of a military government under Oliver Cromwell, he engaged a thousand men on the survey and completed the bulk of the work over a thirteen-month period in 1655-56. The field surveyors used well-tried traversing methods where lengths were measured by chain, and bearings by a surveying instrument called a circumferentor. Petty had these measurements plotted, or “surveyed downe”(hence the name of the survey), onto manuscriptparish maps. The parish maps were subsequently used as the ultimate source of much of the detailed information for the printed maps in the atlas.

The historical context largely determined the non-scientific influences on Petty’s maps. The English government determined that it would repay, with land confiscated from Irish Catholics, the costs incurred by Cromwell’s New Model Army to crush the Irish Rebellion (1641-53). But the government had little knowledge of either how much forfeited land would be available to settle its debts or where, precisely, such lands were located. The overriding purpose of the Down Survey was to provide this urgently needed information. The consequences that flowed from this direction were evident on the atlas maps. Firstly, the focus was on territorial boundaries within each county; physical and cultural features were usually included only where they helped to define those boundaries or to identify unproductive mountain and bog land. Secondly, lands already in Protestant ownership were not mapped in detail, leaving significant information gaps across half the country. Nevertheless, by virtue of the quality and unprecedented extent of mapping in the areas it did cover, the atlas provided a considerably clearer picture of Ireland’s geography than previously found in the seventeenth century.

Petty was aware from the outset that the incomplete coverage of the Down Survey stood in the way of his (ultimately unsuccessful) ambition to map the whole of Ireland. He compensated, in part, by conducting a concurrent boundary survey of baronies, the territorial divisions that fell between counties and parishes, across the entire country. The resulting barony maps, which continued to rely on the parish maps for detailed information within each barony, became the principal source for the atlas maps.

Much is known about the sources Petty used for his atlas but some unanswered questions remain. Almost 40 percent of the place names on the map for the county of Donegal were derived from sources other than the barony maps. Does the pattern in Donegal, an area not well covered by the Down Survey, apply to other regional maps and, if so, what other sources were used? The general map of Ireland also poses questions with respect to sources. Its coastlines did not follow those on the regional maps, as might have been expected. Again we are left to ask: what alternative sources were relied on?

It appears that with deeper understanding comes a heightened awareness that much remains to be learned about Petty’s atlas of Ireland…

 

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Read the full paper: Ivan Robinson, “Understanding William Petty’s Atlas of Ireland.”Cartographica 49:1, 2014, pp. 35-51. http://bit.ly/carto491robinson

Contact the author: jrobi@shaw.ca

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#UPWeek: Throwback to Canada’s History

November 13, 2014

We’re thrilled to be one of 32 presses participating in this years UP Week Blog Tour. Each day this week, presses will be blogging on a different theme that highlights the value of collaboration among the scholarly community. Each day, we will round up of all the university presses that posted on that day. Today’s […]

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University Press Week: Day 3

November 12, 2014

We’re thrilled to be one of 32 presses participating in this years UP Week Blog Tour. Each day this week, presses will be blogging on a different theme that highlights the value of collaboration among the scholarly community. Each day, we will round up of all the university presses that posted on that day. Today’s […]

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University Press Week 2014: Day 1 and 2

November 11, 2014

We’re thrilled to be one of 32 presses participating in this years  UP Week Blog Tour. Each day this week, presses will be blogging on a different theme that highlights the value of collaboration among the scholarly community. Each day, we will round up of all the university presses that posted on that day. Yesterday, […]

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Canadian Journal of History Author, Victoria Vasilenko, Explores the History of Federalism and the Search for Settlement in Postwar East Central Europe

October 27, 2014

Photo Credit,Olga Smolyak Written by guest blogger, Victoria Vasilenko. Interest in federalist concepts by thinkers and politicians from the former Soviet bloc has grown following the biggest expansion of the European Union in 2004. Although Western Europe paved the way for the formation of the EU, recent scholarship proved that at times Eastern European concepts […]

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“Exciting and terrifying”: A young feminist scholar reflects on (social egg freezing as a solution for) “having it all”

October 16, 2014

Guest post by: Lesley A. Tarasoff In the most recent issue of the International Journal of Feminist Approaches to Bioethics (IJFAB) you will find an article critiquing the view that social egg freezing is the solution to “having it all,” that is, a thriving career and a family (children) at the same time. This is […]

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