Lost Moleskins and much entertainment

The beginning of April saw the winter term drawing to a close. My last day of teaching was Monday 10th, which as it turned out was also the last day of term. I had not realised that. A pity, because I had a panel of colleagues from the community to talk about wellbeing. The class was not all there, some having started travelling on their spring breaks. Indeed not all those that attended were mentally there either – they were thinking about deadlines, assignments and perhaps even holidays. When, the previous week, the second course I taught ended, and the class went to the pub, I was very touched that they invited me to join them. I should have gone.

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Spring is here and the snow is almost gone

The weather has finally begun warming up here in Waterloo. It is now possible to walk around without a winter coat on, although a jersey is still necessary. The squirrels are increasingly active and migratory birds are returning. We are all looking forward to spring and summer, and it really does feel as though it is imminent. What happens is that the temperature fluctuates widely. It has been as high as 18ᵒc one day and as low as -10ᵒ the next night. I wonder how the animals cope; the trees on the other hand, seem, rightly, rather reticent to bud.

I have had a very busy few weeks. On 7 March we had Stephen Lewis come and sit on a panel with a number of students and faculty members. He is extremely well known in Canada, and more broadly as an exceptional humanitarian. The auditorium was packed and a number of organisations placed tables outside to advertise their activities to the assembled company. It is good to be able to facilitate these events; it is part of building a community here in Waterloo.

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Economic Policy in an Interdependent World – “A Brave New World: Genetics, Insurance, and Policy Options in Evolving Times”

The following post was written by Kerry Solomon.

Kerry Solomon is a Graduate Research Fellow at the Centre for International Governance Innovation and a Master of International Public Policy Candidate at the Balsillie School of International Affairs 2016-2017. Her research interests include equity and global health.


Canada has protection from discrimination based on one’s race, religion, and sexual orientation; however, it may come as a surprise to some that genetics is not one of those grounds. In fact, Canada is the only G7 country that does not already have laws in place to protect its inhabitants from genetic discrimination. On a personal note, as someone of Ashkenazi Jewish heritage, I am at increased risk compared to the general population to have an inherited mutation in the genes BRCA1 and BRCA2. This means that that if I carry this mutation, I am at a much greater likelihood of developing breast or ovarian cancer. Does this leave me vulnerable to discrimination based on my genetics?

New DNA sequencing technologies mean that we can now test if a person carries a genetic risk of developing a particular disorder. These tests are more widely available and at a less prohibitive cost than even a few years ago. Genetic testing has many important benefits for health care, including improving diagnosis and therefore treatment of diseases, especially inherited diseases like Parkinson’s or Huntington’s. There is great potential for this technology, but if there is not proper protection around genetic data, people will be wary about seeking potentially life-saving information. A recent story emerged of where a 24-year-old Canadian man received confirmation that he carried the gene for Huntington’s disease, and upon notifying his employer, was fired. Further, if a person obtains a genetic test and withholds knowledge of their genetic history, their insurance company may cancel their coverage upon learning this.

European countries and the United States are already using genome sequencing as part of their medical care, but these countries also have anti-discrimination laws in place to protect patients from discrimination based on genetic heritage. So what is Canada doing to catch up with other countries on this issue?

Bill S-201, the Genetic Discrimination Act: An Act to prohibit and prevent genetic discrimination was passed on October 26, 2016. This Act will prohibit insurance companies from requiring an individual to undergo a genetic test or from forcing an individual to disclose the results of a genetic test as one of the conditions for receiving insurance coverage. The Canadian Coalition for Genetic Fairness has advocated for Bill S-201 to go even further.

In order for protection from genetic discrimination to be implemented in Canada, not only will the Canadian Human Rights Act need to be updated to include genetic discrimination, but also the Personal Information Protection Act and the Canadian Labour Code will need to be modernized to address genetic characteristics. Though this Bill received unanimous support from the Senate, it is not without its critics in the insurance industry.

Insurance companies are opposed to the Bill, claiming that requiring genetic testing is akin to asking for family history. Based on this information, insurance providers can either refuse coverage based on a specific genetic test, or charge much higher rates. The Canadian Institute for Actuaries, arguing on behalf of the insurance companies, believes that this Act gives an unfair advantage to those who have a genetic predisposition for a certain disease. They argue that someone who tests positive for a certain gene would purchase more insurance, knowing they are at greater risk, at premiums that would be below cost. The argument then follows that this would raise everyone’s insurance premiums, to the detriment of all Canadians.

In an attempt to self-regulate and pre-empt the changes required once Bill S-201 is passed, the Canadian Life and Health Insurance Association indicated that they will soon prevent insurers from requiring genetic tests results for policies that are $250,000 or less. This internal policy will go into effect in 2018 but does not fully address the discriminatory element of this issue, as discrimination is still allowed in policies above this cut-off. This does not (and should not) act a substitution for industry changes that will be required by the final legislation.

This has ramifications that go beyond insurance; without protection from genetic discrimination, we could see this affecting employee rights as an employer may choose to not hire a candidate based on their genetic information. There are other spill-over effects for scientific research because if people are confident their results could not be used against them, they may be more inclined to have genetic testing – an outcome with unequivocal benefits to public health. Finding out that you are genetically disposed to a condition that decreases life expectancy is bad enough without having to worry about whether you can afford, or even get, life insurance.

Given the current environment, I have not participated in genetic testing for mutations in BRCA1/2. Without the knowledge of my mutation status, I do not know whether I need to make any lifestyle changes or other preventive steps such as a mastectomy.

Genetic discrimination could affect all Canadians, and we need to be more progressive and keep up with the evolving technology if we want to encourage genetic testing to improve long-term health. As we enter this brave new world of genetic knowledge, we want to avoid a dystopia where our genes determine our future.

Sources

Bill S-201 “Genetic Non-Discrimination Act: An Act to prohibit and prevent genetic discrimination”

Brandt-Rauf, Sherry I. Victoria H. Raveis et al. “Ashkenazi Jews and Breast Cancer: The Consequences of Linking Ethnic Identity to Genetic Disease.” American Journal of Public Health 2006 November Vol. 96(11): 1979-1988.

Canadian Coalition for Genetic Fairness

Canadian Institute of Actuaries “Canadian Institute of Actuaries’ Proposed Amendment to Bill S-201, An Act to prohibit and prevent genetic discrimination.” November 21, 2016

Gold, Kerry “How genetic testing can be used against you – and how Bill S-201 could change that.” The Globe and Mail. April 3, 2016

Mcquigge, Michelle. “Insurers trying to self-regulate on genetic testing.” Chronicle – Herald; Halifax, N.S. January 12, 2017

Walker, Julian “Genetic Discrimination and Canadian Law” Library of Parliament September 16, 2014

Economic Policy in an Interdependent World – Let’s Talk About It: Men and Mental Health

The following post was written by Jeremy Wagner.

Jeremy is a Graduate Research Fellow at the Centre for International Governance Innovation and a Master of International Public Policy Candidate at the Balsillie School of International Affairs. His research interests are in food security and public health.


Openly discussing depression and anxiety can be difficult for anyone who struggles with their mental health — but for men, the cultural baggage of traditional masculinity bears with it unique challenges.

There’s an obvious stigma when it comes to men and anxiety. Research suggests many men find it difficult to disclose anxiety and depression symptoms. In a society where “being a man” is conflated with being stoic, it’s hard for men to come forward and reveal they struggle with their mental health. As a result, it goes unheard; it hides in the shadows.

Yet, it’s a chronic public health issue. Anxiety is systemic in men and women alike; an estimated 11.6% of Canadians aged 18 years or older have a depression or anxiety disorder. Gendered social constructions ensure that mental health experiences can vary between men and woman.

Depression is characterized by the lowering or elevation of a person’s mood and aversion to activity that can affect a person’s thoughts, behaviour, and sense of well-being. On the other hand, anxiety is more so an excessive and persistent feeling of nervousness, fear, and guilt. Both disorders, often comorbid diagnoses, interfere with an individual’s everyday life.

The symptoms of anxiety and depression are challenging to deal with, but for different reasons. It’s easier to cope with symptoms of depression at school or work. After all, just getting dressed and showing up means you’re fighting back. It’s when you’re alone that’s the hardest. Anxiety can be a bit trickier because of the social triggers (large crowds, public speaking etc.) and physical symptoms that come with being anxious such as difficulty breathing and becoming overheated.

Men with anxiety and depression often feel something additional – shame. If you’re male and have been socialized to be in control of your emotions, struggling with mental health is perceived as a sign of weakness. “I’m vulnerable, and I’m failing” may be the common narrative. It’s a vicious cycle; when you’re suffering from it, one bad interaction or over-analysis is enough to send you into a destructive spiral of thought. Embarrassment can prevent men from acknowledging their struggle publicly.

Instead of seeking help, 30% of men with anxiety turn to substances such as drugs and alcohol as a way to cope with their symptoms. Men can be more impulsive, and this partially accounts for their higher reliance on substances to cope with feelings of stress, anxiety, and depression.

Self-medicating substances override the brain’s natural reward system, which is usually activated by pleasurable stimuli, such as sex, and produces a rush of feel-good chemicals. The ingestion of substances including alcohol, marijuana, and nicotine produces identical pleasure effects. When endorphins, the same chemicals responsible for the “runner’s high”, are released naturally or by substances, they bind to receptors that dull emotional pain and calm the nerves. Feelings of calm and relaxation are what people with anxiety are seeking when they self-medicate.

If men struggle to talk about their depression and anxiety in fear of seeming weak or vulnerable, then perhaps there’s other ways to cope. After all, going for a run and having a glass of wine (or two) have similar effects on mood. If you find it difficult to talk about and professional care isn’t a viable option for you, then engagement in self-management strategies can at least manage, if not improve, your well-being.

I recently had the privilege of sharing dinner with Clara Hughes. She’s a Canadian cyclist and speed skater. She is tied as the Canadian with the most Olympic medals, she’s the only person ever to have won multiple medals in both the Winter and Summer Olympics, and she’s been an unwavering advocate for mental health awareness and the National Spokesperson for the Bell Let’s Talk Mental Health initiative. I could go on…

In her humility and kindness, she shared with me her own struggles with mental health. And while I paraphrase, she explained to me that “for so many people, mental health and addiction is a daily battle. It doesn’t go away, it’s always there, but it can be managed. For me, movement is my medicine.”

Maybe you can’t seek help, but an active lifestyle can at least be a first step to ultimately enabling you to lead a full and productive life. Men also struggle with anxiety and depression, and it’s a public health issue we can’t afford to hide in the shadows — so let’s bring it into the light. Movement is my medicine too, and tonight I’m going for a run.

False Spring? I hope not!

In the middle of February I greatly enjoyed sitting in my office or my apartment and watching the snow fall. It was quite magical. In total we probably had about 10 cm, enough to cover the ground and make everything into a winter wonderland. Normally here there is a period when the ground is covered by grey snow as it slowly melts. In the corner of the parking lots there are piles of the white stuff, bulldozed there by the clearance teams. This year it warmed up from about the 18th of February and most of the snow disappeared very rapidly. I woke one morning to see a digger loading the snow into large trucks in our apartment parking lot. It is taken away and dumped somewhere. There must have been at least six or seven loads. It was probably necessary to do this, because the piles take a very long time to melt, and the snow was heaped in the guest parking. It provided an insight into the workings of Canada in the winter, and perhaps even into the cost, as I’m sure this service will appear on the bill.

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Understanding AIDS

I’ve written a guest blog post on Oxford University Press’s blog titled Understanding AIDS:

In 1981, the first cases of patients with the disease that was to become known as AIDS, were identified in hospitals in New York and San Francisco. By late 1983, the cause of AIDS — the human immunodeficiency virus (HIV) had been identified. Significant numbers of cases had been reported from central Africa. In southern Africa, where I lived and worked, we had seen only sporadic occurrences — mainly among gay white men. However by 1987, HIV-infected men were identified in the workforce serving the mines industries and farms of South Africa. Armed with knowledge of labour migration and the potential for the spread of this disease, I wrote and presented my first (highly speculative) paper on AIDS at the first ‘Global Impact of AIDS’ conference held in the Barbican Centre in London.

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‘January brings the snow, makes your feet and fingers glow’.

It is most unusual for the first of the month of the year to have come and gone without my having prepared a new blog. I’m not quite certain what happened. I can only think it was a combination of the pressure of teaching and preparation which distracted me. There is quite a lot to report, both events of the past month and ones for the next few months. I have been, and will continue to be, busy.

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Returning to Canada, not as easy as I hoped

Christmas day in Norwich was abnormally warm. The temperature rose to 14° C and it was possible to walk around without even a coat on. It then turned very cold, with a layer of ice on the car in the morning, and much scraping before we could go anywhere. I was quite pleased with this. I had cut up a lot of wood for our wood burner in the lounge, so I was able to use some of it. In addition to this, one of my Christmas presents, which I must stress I actually asked for, was a couple of sacks of coal. I had such fun building and tending the fire.

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Sharing 60

Sharing 60

Normally when I post on the website I comment, at the end, on films I have seen or books I have read. This month’s post unusually begins with the two films I watched on the flight from Amsterdam to Johannesburg in early November. The first was the new Ken Loach film I, Daniel Blake. It was excellent, thought provoking and depressing. The story is of a 59 year old scaffolder who is unable to work because of a heart problem. He is caught in a bureaucratic nightmare of not getting the state benefits he should, because he is deemed fit enough to look for work. It is a searing indictment of the failure of the welfare state, increasingly the case in the UK. This is the result of global trends to elect people who don’t care, at least not in the way I was brought up. It made me ask what I would do if I had power, probably a basic income grant for all.

In Durban I am sharing the car with Rowan, who has travelled over to spend five months in South Africa. She has two days’ work a week in Umhlanga, so on those days I walk. There was a youngish white man, on crutches, begging on the street a few hundred metres from the flat. I asked him over to tell me his story and, in exchange, gave him a decent amount of money. He said he was a welder by trade. He lost the lower part of his left leg in a motor accident a few years ago. He said he was trying to scrape together enough money to replace his identity document in order to get work. He is living with his wife and child in one room in the town centre. How much of that was true? I don’t know. South Africa is a harsh society for people who don’t have resources.

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HIV and AIDS: A Very Short Introduction

The second edition of HIV and AIDS: A Very Short Introduction, by Alan Whiteside, has just been published by Oxford University Press.

HIV/AIDS: A Very Short Introduction provides an introduction to AIDS—the most serious human epidemic in centuries—tackling the science, politics, demographics, and devastating consequences of the disease. The first case was identified in 1981; by 2004 approximately forty million people were living with the disease, and about twenty million had died. The outlook today is a little brighter. Although HIV/AIDS continues to be a pressing public health issue, the epidemic has stabilized. The worst affected regions are Southern and Eastern Africa. Elsewhere, HIV is found in specific, often marginalized populations. Although there remains no cure for HIV, there have been unprecedented breakthroughs in understanding the disease and developing drugs

You can find out more on the Oxford University Press website.