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.

Fit | Unfit

The following post was written by Jessica Powell, Master of International Public Policy 2015-2016, The Balsillie School of International Affairs, Waterloo, Canada


I have been in and out of various gyms for years. I will just start to make progress, then life gets busy and I stop attending for a while. And each time I want to start working out again, I think to myself, ‘I need to build up confidence before I can return to a gym. I have to lose some weight before I feel comfortable being in a gym’.

I have recently realized I am not the only one who feels uncomfortable in this environment. I believe fitness institutions have become places for elite users. The divide between those who are fit and those who are unfit has been increased by a ‘fitness culture’ which marginalizes those who are in average or less-than-average shape, and this deters regular people from beginning their own fitness journey.

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Hope: The Key For a Better Future

By: Aya Al-Shalchi

Mark Twain famously said that ‘the two most important days in your life are the day you are born and the day you find out why’. I knew my purpose from the age of twelve. My experiences in Iraq and Libya instilled in me a passion to change this world and make it a better place. My passion dictated my life decisions including career and academic ones. I followed the path that would lead me to making this world better, a seemingly aspirational and far-fetched goal. At times it seems like the world is too far gone in its complexities, diseases and manipulative politics. At times, it seems like even the greats have lived and worked tirelessly only to earn the title of ‘attempt’ rather than ‘accomplishment’. At times, I found there to be conflict between my passion to make the world better and feeling helpless at anyone’s ability to do so. However, I argue there is still hope.

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