Big Society, or small government?

*I'm gone after this for a couple of weeks - back blogging March 12

 Britain’s “Big Society” initiative has been showing up as a story line in Canadian media in recent weeks.

Not surprising, really. Our federal and provincial governments are promoting the same principles that British Prime Minister David Cameron is putting forward in his Big Society vision.  

He calls it a Big Society and we call it social entrepreneurship, but the goals are the same: More social enterprise; more collective responsibility for societal ills; more use of the tools of capitalism to fund social care. Canada is suddenly awash in task forces, strategies and policy debate related to social innovation, including a new high-profile advisory committee in B.C.

I like much of what’s being talked about. I’m all for innovation, and for a better way of funding community services if it gets us out of the uncertain, short-term, destructive and inefficient process we’ve got now.

But I can’t shake a certain unease. It feels to me like two very different kinds of dreamers are coming together under the banner of “social enterprise.” And it’s my experience that bad things can happen when that’s the case.

Dear reader, social enterprise is not a particularly compelling column topic. I’ve already stopped and started dozens of times in writing this, struggling for a better turn of phrase to see if I can keep you reading for another paragraph or two.

It has taken me three hard months of really working it just to get the first inkling of what’s being talked about, and why. So I feel your pain (or boredom). But when a Big New Idea suddenly takes hold across the western world, we’d best pay attention even when it makes our heads hurt to think about it.

Social innovation in the current context has emerged from two distinctly different challenges.

One centres around frustrated non-profit agencies exhausted by years of starvation budgets, an absence of consistent, effective policy, and wrong-headed government rules restricting how the agencies can generate and use money.

They see the social problems around them and want to be able to use the tools of business to create their own sources of revenue for addressing them. They want to be able to get a loan just like any other business so they can improve their services. In Canada, neither are possible in the current system.

The other involves modern-day governments from ideologies that favour lower taxes and less service. They seem genuinely baffled that poverty and social ills have increased on their watch, but appear completely unwilling to consider that their governance has had a role in that.

They seem to have concluded that the problem is in our communities. We’ve become too reliant on government to fix our problems. Big Society-type initiatives aim to set things right without government having to foot the bill for it.

The kinds of changes being contemplated are non-threatening and sensible on the surface. In B.C., for instance, we’re talking about encouraging philanthropic foundations to become lending banks for non-profits, and establishing hybrid companies that combine the best of business and social-enterprise practice.

That would let non-profits seek investors to help them launch businesses supporting their work. It would leave them less vulnerable to the whims of government, and free to shape their services based on client needs instead of the dictates of funders.

The ideas aren’t new. Neither are the problems, a fact that perhaps explains some of my suspicion. What has prompted this international outburst of government enthusiasm at this particular time?

It’s striking how similar the language is in the UK, Canada and the U.S. right now around these issues. In mere months, the themes of Cameron’s Big Society have become the darlings of Canadian and U.S. governments, and the impetus for a slew of new “partnerships” between governments and non-profits charged with figuring it all out.

Have governments suddenly awoken to what a jewel they have in the non-profit sector?  Or is this about the opportunity to shrink government funding even further, saddling beleaguered communities with even more of the work of social care that governments once provided?

Intent is everything. Wonderful to see the lion suddenly eager to lie down with the lamb, but a smart lamb will play that scene very carefully. Sometimes you’re a new fuzzy buddy, sometimes you’re dinner.

The conservative governments that have dominated western politics in the last 20 years played a starring role in creating the social ills they now want the Big Society to fix. I guess I just don’t trust them. 

Andre Picard is easily the best health reporter in Canada in my opinion, not only because he writes great stuff and takes the serious measure of issues, but because he gives a public platform to important issues that we need to know about.
Today's column in the Globe and Mail is a good example of that - he's highlighting a study that pokes big holes in the prescription drug industry's assertion that the reason drugs are so expensive is because the industry is spending vast sums on creating them.

OK, I don't usually go in for the flavour-of-the-day studies that have us scrambling this way and that trying to follow whatever new wisdom has popped up to help us guide our lives into better health.
But I'm a long-time devotee of regular exercise, and this latest study on lab mice underlines that exercise really does seem to be the magic bullet.
While it would be hard to test the same theories using weight-training (although I'm enjoying the image of mice doing tiny little bench presses and squats, I can tell you from my own life that weights are definitely part of the magic-bullet equation as well.
And never mind that every now and then you end up with a bit of an injury from too much enthusiastic gym time (like at this very moment, in my case). Weight-training helps restore the muscle we start losing in our 30s as part of the aging process. For every pound of muscle on your body, you're burning at least 10 times the calories just maintaining it as a pound of fat burns in the course of a day. What's not to like? 

Good read from my partner Paul Willcocks, who dug up some enlightening information by taking a look at the B.C. Progress Board reports assessing the record of Gordon Campbell's Liberals in the last few years.
Campbell's government created the Progress Board to measure performance, so you have to give him credit for that - up until that point, it was pretty much impossible to gauge how effective a government had been. But as the reports reveal, the Liberals haven't quite been the saviours of the economy that they position themselves as. 

A grim but fascinating reminder from Salon magazine about our seemingly overpowering need to blame the victim when a woman is sexually assaulted - in this case, CBS reporter Lara Logan. 

Our countries talk a good game about treasuring the war veterans who serve on behalf of all of us. But as with anything, what really counts is what we DO once the heart-warming media images of returning vets fade from view and the soldier returns to "normal" life.
And as this study out of the U.S. shows, the love doesn't appear to last long south of the border, where military veterans are more likely than any other group to end up homeless.

Stigma blinds us

The dictionary defines stigma as “a distinguishing mark of social disgrace.”  Once upon a time, it was the common term for the permanent mark burned into the skin of criminals and slaves.

We like to think of ourselves as too civilized for such things nowadays. But in fact, the practice continues for all kinds of people singled out for scorn and judgment. 

That we even sort people that way is probably the most interesting aspect of this thing we call stigma.

Scorn and judgment are not attitudes a “nice” society generally wants to cultivate in its citizens, and for the most part I think we’re fairly kind to each other. We’re respectful of each other’s differences.

But not always. Some categories of people still end up singled out for social disgrace, their lives marked as surely by stigma as if we’d burned it into them.  

This is Anti-Stigma Week in Greater Victoria, and I love the theme: “Nice People Take Drugs.” People with addictions experience tremendous stigma, and never mind that almost 90 per cent of Canadians report using alcohol or illegal drugs in their lifetime.

But stigma has an impact on a number of other groups, too. Sex workers are profoundly affected by stigma, as everything about the Pickton case continues to remind us.

If it had been bank tellers or 7-Eleven workers or small-business owners who started going missing, I don’t think we’d be in the situation of pulling together a task force 20 years later to try to make sense of why so many died while we dithered.  It simply wouldn’t have happened that way. Stigma kills sex workers.

Stigma against poor people is growing at an alarming rate. It’s why we can justify keeping income-assistance rates at levels that are impossible to live on. It’s why we build way, way less subsidized housing than we did a couple of decades ago, and wince at every tax dollar spent on supporting people unable to work.

Like every group we stigmatize, the poor have become unworthy and shameful in our eyes.

We use hateful language when describing people living homeless. We ignore our governments’ endless service reductions and policy changes that crank up the misery for people in profound poverty. We watch the creep of poverty in our community, and still think it’s “their” fault.

That’s what stigma does. It blinds you to the obvious. It misleads you.

We’ve selectively stigmatized certain health issues, too. Mental illness is the most striking example of that.

If I sprained my ankle, I’d have no compunction about posting it on my Facebook page and waiting for the flood of caring comments. Or writing about it in my column.

But what if I posted that I was staying home to work through a severe anxiety attack? Or a rough period in my schizophrenia? Or had just been diagnosed with bipolar disorder?

Truth is, I doubt I’d even write such a thing if I genuinely had a mental illness, which is perhaps the worst part about stigma. It demands silence.

I’ve often thought that if a purple light suddenly appeared in the house of everyone in the region who’d had a problem with drugs or alcohol, we’d be blinded by the light.

If we could ever see the faces of the people in our community who have been affected by mental illness - or participated in the sex trade, for that matter -  we couldn’t help but rethink our views just on the basis of how many familiar faces we’d see around us.

But who’s going to step forward with such declarations when the stigma is unbearable? How many people are prepared to be brave for the good of the group, when the impact on their own lives from publicly revealing themselves can be horrendous?

Stigma costs people jobs. It costs them their children, and their housing. It brands them as outside the norm, forever “other.”

Our laws say we don’t allow things like that to happen. But we do.

Fortunately, there’s a simple enough solution. We can stop. Stigma is kept alive in this day and age primarily by our attitudes, and it will die as soon as we quit substituting prejudice for thought. 

We have banished many of the laws and practices that once fed stigma at the institutional level. What keeps it going now is just us. All it will take to banish stigma is for you and me to refuse to let it cloud our thinking.

So quit.

I guess it's no surprise that the Conservative-heavy Senate is bound to crush the bill that would create human-rights protection for transgender and transsexual people, as this story notes. For reasons that I've never been clear on, we're supposed to presume that Conservatives - at least the kind we have in Canada right now - are the type of people who just don't like transgender people.
But really, why would anyone be in favour of allowing discrimination of transgender people? I mean, it's not like providing them with human-rights protection is going to encourage more people to become transgendered, or send a bad message to Canadian children.
It ought to be unacceptable for anyone to face discrimination solely because of who they are. Let's hope the Senate just gets out of the way on this one and lets it happen. 

Helpful piece in the Globe and Mail this morning for people like me, struggling to understand what all this fuss about a metered Internet means to them. Count me among the large number of Canadians who, up until all of this became big news, never even knew I had a limited plan. (The "explainer" link at the bottom of the story is also very useful.)
It's been barely a month since I figured out how to stream Netflix onto my TV and I'm totally enthralled, having been completely frustrated and furious over the consistently lousy programming that my pricey cable subscription gets me. So I'm deeply interested in this story line.
The issue looks like it's about Internet providers' right to charge heavy users more, but it's actually about Canada's non-competitive environment. Unlimited internet plans are standard in the U.S.
 Man, this country has some strange ideas around where we'll draw the line on competition. We eat foreign-grown food, work for foreign-owned companies, dress in foreign-made clothes, drive foreign-made vehicles - but damn it, when it comes to our internet and airlines, we're proudly protectionist. And never mind that such industry-driven positions work against Canadians. 

Mental health left to scramble for crumbs

Depending on who you talk to, psychiatric care in the region for people with chronic and debilitating mental illness is either in frightening disarray or just experiencing a few bumps on the way to a better day.

A number of the doctors who preside over hospital psychiatric care in the region say the cuts of the last two years have had a disastrous impact on people with serious mental illness.

Two of the doctors have already resigned in protest from the health authority’s Department of Psychiatry, and more have threatened to.  Last month, department members in the South Island passed a motion of no confidence in Dr. Robert Miller, medical director of mental health services for the Vancouver Island Health Authority.

But a spokesman for the health authority says the vote against Miller was “completely inappropriate,” and that the issue is really about a small number of psychiatrists resistant to change. The health authority has complete confidence in Miller, says Dr. Bob Burns, VIHA’s executive medical director for population and community health.

VIHA has kept a careful eye on the 200 to 300 people (the opposing sides differ on the numbers, too) left without case managers due to service cuts in the South Island, says Burns.

The gamble was whether people would fall back on emergency services once they lost the case managers who used to co-ordinate their care. That hasn’t happened, he says. “I can only presume they have other supports in the community.” 

The psychiatrists who passed the no-confidence motion beg to differ. “Mental health management continues to bury its head in the sand and ignore a very large group of chronically mentally ill patients. They and their families rarely speak out,” Dr. Andre Masters wrote in a Times Colonist opinion piece last summer.

Who to believe? Ultimately, the fight is over quality of care for two very different groups of people with mental illness. I’d argue that it’s crazy to pit one against the other.

One group lives in the madness and isolation of the streets, bouncing in and out of homelessness and addiction. The other has housing and more outward stability, but still faces all the challenges of a life lived with chronic and severe mental illness.

The smart and humane strategy would be to ensure both groups get the kind of care they need. Just like chronic physical illness, severe mental illness tends to get better if treated and worse if ignored. The best bang for the taxpayer’s buck is effective, consistent care based on people’s needs.

But it just doesn’t work that way in times of scarce resources and government frugality - particularly when the issue is mental health.

It has been the poor cousin of Canada’s health-care system since the beginning. Services for mental health and addiction continue to be the first place governments look for savings, and the last to attract new money.

So when provincial money started flooding into homelessness initiatives a couple years ago - and hallelujah for that - I guess we should have all known that some other part of the system was going to have to pay for it.

And that’s what has happened. The money that used to pay for case managers for people with chronic mental illness now funds four Assertive Community Treatment (ACT) teams on the Island working with street-entrenched people in Greater Victoria and Nanaimo. 

Burns says the ACT model has tremendous potential for reducing hospital-based psychiatric care. VIHA acted on that presumption by closing 10 beds in the Eric Martin psychiatric hospital and eliminating six case managers to help cover the costs of the outreach teams.

Patient care hasn’t suffered, says Burns. The current dispute with psychiatrists boils down to “a small group stuck in the way we’ve always done things.”

Maybe. The multi-disciplinary outreach teams certainly have been a wonderful addition to street-level resources. They’re making a real difference in the lives of some of the most vulnerable, ill people on our Island.

But did those additional services have to come at the cost of another group of extremely ill people who also need the support?

VIHA has apparently concluded it was overserving that population, given that the group’s use of emergency services didn’t immediately increase after they lost their case managers.

I fear we’ve merely unravelled another thread in a historically skimpy safety net. Time will tell, but in the meantime two poorly served populations are left to fight over scraps.

This is the kind of reporting I think is really valuable - Robert Matas takes a press release from the B.C. government and digs into what it really means, putting in the context for readers so that they can better understand the significance (or lack thereof) of the announcement on more childcare subsidies.

Unbelievable story about the culling of sled dogs in Pemberton.  People are going to go crazy over this one, all over the world. And what a nasty taint to give the B.C. Olympics - the image of all these happy huskies touring Olympic visitors around for their little sled rides, then killed at the end of the season because nobody could be bothered to figure out a better solution.
Nice try with the "we tried to get these dogs adopted" bit, but did you hear a word about this up until now? Had the company come out with a press release saying 100 dogs were going to die unless people stepped forward to adopt them, there'd have been homes found. If we can send hundreds of rabbits to rescue projects in the U.S., surely we could have found placements for retiring sled dogs.
Here's a link to the blogosphere heating up over this one. A measure of just how big this story is going to be: I did a Google search on "sled dogs killed" and quickly pulled up search page after search page of news coverage, blog comment and tweets on the Pemberton dog massacre.
Just in case you're thinking this is some kind of anomaly in the dog-sled-tourism business, a 2005 story out of Denver, Colorado notes a similar shocking slaughter south of the border.