Category Archives: CarletonDataJournalism1

As Alberta’s population grows so does the cost of a hospital bed

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The cost of a standard hospital stay in Alberta has risen by almost 30%, an analysis of data released by the Canadian Institute for Health Information has revealed. This coincides with an increase in population for Alberta of nearly 12%.

 

The data shows an increase in the cost of a standard hospital stay, up by 26% between 2011-2012 and 2015-2016. Census data collected by Statistics Canada shows that Alberta’s population has increased by 11.6%—the highest of any province or territory— between the 2011 census and the most recent 2016 census.

 

According to John Church, a political science professor at the University of Alberta who studies health care in Canada, there are a number of reasons for this increase. The first reason is the lack of an integrated healthcare option outside of the hospital setting, which means “that everybody gets driven into the hospital setting, whether they need to be there or not.” And the hospital setting, Church said, is the most expensive setting for a patient to receive medical services.

 

“If you have a situation in which I don’t need to be hospitalized… then my hospital care is going to look pricier” said Dr. Raisa Deber from the University of Toronto’s Institute of Health Policy, Management and Evaluation. Deber said that it’s where and how the money is being spent as opposed to the fact that money is being spent.

 

It’s the issue of “what exactly am I paying for in the hospital as opposed to what am I paying for in other settings?” said Deber. She pointed to chemotherapy as an example, saying that if the drugs are delivered in a hospital, as opposed to an outpatient clinic, the cost of the drugs count towards the hospital’s budget.

 

The second reason that Church pointed to is the lack of a single patient record system, which can result in patients undergoing tests which other healthcare workers have already administered.

 

Church also pointed to the fact that wages in Alberta are typically higher than other healthcare workers across the country. A separate report from CIHI states that the average gross clinical payment to Alberta physicians was $380 000, the highest in the country.

 

And given Alberta’s rising population, Church says that this issue is poised to get more expensive. “More people means more people potentially needing health services” Church said. Church said that the demand on Alberta’s healthcare system will increase, both in numbers and in demand on its services, that as the population ages it will require more health services that can handle the more complex health issues inherent with age.

 

Church pointed out that elderly people often require the most amount of healthcare, that most people consume the most health services in terms of cost in the last few months of their lives. Deber concurred, stating that “if [the] population [is] going to be younger and healthier, then you would expect [the cost of an average hospital stay] to be smaller.”

 

A report from the Alberta Auditor-General has identified these three reasons for expensive healthcare in Alberta as “pervasive barriers” that prevents Albertans from “receiving the quality of care they could receive.”

 

“Unless there are fundamental changes… people will continue to flood to the emergency room” Church said. Church identifies timely access to healthcare outside of hospitals as necessary to alleviating this costly issue. This includes “everything from seeing your family doctor to seeing a range of service providers that provide services to seniors, [to services] that provide access to community-based mental health service [and services that are] providing sufficient access to things like home care.”

Nunavut consistently holds nation’s highest “avoidable death” rate

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Nunavut Health Minister George Hickes speaks during a parliament session in February earlier this year.

Nunavut has the country’s highest rate of avoidable deaths due to a variety of causes such as being given the wrong medication, leading some experts to call it a health care crisis.

According to an analysis of data provided by the Canadian Institute for Health Information (CIHI), the rate of avoidable deaths for residents of Nunavut is double that of all the other provinces and territories. Avoidable deaths are characterized by CIHI as deaths that could have been avoided through better treatment or prevention efforts. The avoidable death rate tells a lot about the effectiveness of health policies, health promotion, and health care in a given area. This means the lower the rate, the higher the quality of health care being given.

This graph compares the total number of people who died an avoidable death in Nunavut versus the national median during different time periods over the course of eight years.

The high rate is alarming and serves as evidence of the larger health care emergency that’s been facing Nunavut for some time now. The territory has been dealing with systemic problems for years.

Hannah Uniuqsaraq, a communications officer at Nunavut Tunngavik Inc. (NTI), an Inuit land claims organization, describes how there hasn’t been any visible improvement in terms of fixing the territory’s health care problems.

“People have blamed the government for inadequate action,” said Uniuqsaraq. “Problems are everywhere. Many people end up overdue for care.”

In March of this year, the auditor general of Canada also released a report which pointed to a number of causes for this health care crisis. While people were directly affected by inappropriate prescriptions, wrong vaccine doses and inaccurate diagnoses, the report also pointed to systemic issues. Nunavut’s Department of Health was failing to support staff at health centres across the territory, procedures were being disregarded by staff, and major deficits in staff recruitment and training bogged down the system. Existing staff received inadequate cultural and technical training.

“The territory’s health institutions are constantly finding themselves with vacant positions and the high use of temporary staff affect continuity and quality of care,” the report stated.

The department also failed to track incidents relating to patient care, therefore rendering them unable to identify any trends. All of these factors and more are said to have contributed to the premature deaths befalling the people of Nunavut. The report ended up giving 17 recommendations to improve care in the territory.

Connie Siedule, the executive director of Ottawa’s Akausivik Inuit Family Health Team, a clinic that specializes in the care and treatment of Inuit persons, said that the need for proper care for the Inuit is particularly great.

“The problems facing the Inuit in Nunavut are especially complicated. Besides Nunavut’s own health care woes, Inuit deal with additional problems due to their language and culture being at odds with today’s systems,” said Siedule. “I’ve also seen so many of them being referred to clinics outside of Nunavut.”

An annual survey on Nunavut’s Inuit culture and society in 2008 by NTI also found that the Inuit are particularly susceptible to Nunavut’s health care pitfalls. The language barrier was an issue faced in many health centres, where some physicians are unable to speak Inuktitut and are without any interpreters.

Stories about preventable deaths of Inuit people have populated the news over the years. In 2015, the government of Nunavut apologized for the death of a three-month-old Inuit baby, whose health issues were left undiagnosed by the health center the family sought care from.

It doesn’t look like the territory’s deeply flawed health care system is going to rectify its problems any time soon, as its avoidable death rates have stayed consistent over the past decade. Meanwhile, reports are surfacing every couple of years recommending measures to combat the system’s many ills, but the people of Nunavut have yet to see any real change.

Peterborough Hate Crimes on a Decline

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On a November night, 2015, a window at Masjid Al-Salaam Mosque shattered as an arsonist doused the building with an accelerant and set Peterborough’s only mosque ablaze. The incident was a “wake-up call” for the community, according to Charmaine Magumbe, chairperson for the Community and Race Relations Committee of Peterborough.

The rate of hate crimes in Peterborough have been among the highest in the country, according to Statistics Canada and the Peterborough Police Service. However, hate crime incidents have been decreasing since 2015.

“If you’re looking at the statistics you’d have to say there’s something’s not right,” said Magumbe. “Look at the hate crimes—we are in the top five and it’s consistent. Having said that, there is a good group of people in Peterborough who are inclusive and welcoming.”

According to an analysis of Statistics Canada data, in 2015 Peterborough had the fourth highest rate of hate crimes in Canada at 7.4 crimes per 100,000 people, an 18% drop from the previous year. Data from the Peterborough Police Service, which covers a smaller jurisdiction than the Statistics Canada area, showed that the number of hate-motivated incidents dropped from 25 to 16 between 2015 and 2016. Nine incidents have occurred so far in 2017. Other cities with high hate crime rates include Thunder Bay, Hamilton, Kitchener/Waterloo/Cambridge, and Ottawa.

The majority of incidents in Peterborough targeted victims based on race. According to an analysis of 2011 census data, Peterborough is 97% white, and Magumbe said that notions exist among some people to  keep Peterborough a white majority. “People are not used to seeing people of other nationalities,” she said.

Magumbe’s family was the target of a hate crime when her children, the only visibly black students, went to their elementary school to find “I hate Black people, please leave..haha” graffitied onto the building exterior. “My kids came home from school, and they were really hurt. They were in tears,” said Mugambe. After talking with the school principal, the offender was found, and Magumbe held a healing circle.

Despite xenophobic sentiments, Shegufa Merchant, a member of the Muslim community and organizer for the interfaith Abraham Festival, said that not enough attention has been drawn to the people and organizations working to build an inclusive community.

There was an outpour of public support following the 2015 mosque fire, as local churches and synagogues offered their spaces for prayer. Community members quickly raised enough funds to cover the $80,000 worth of damages. “The response of the community far surpassed that hate crime,” said Merchant. “I was so proud to be part of the community at that time.”

Merchant and Magumbe work towards improving race relations and inclusivity in the city. The Abraham Festival celebrates acceptance and tolerance between religious groups, and the Community and Race Relations Committee works to make minorities feel socially included and holds vigils in solidarity against racism. “We need to have discussions as to anti-racism and creating an inclusive society,” said Magumbe.

Race relations will be brought to the forefront next weekend as an anti-immigration rally will be hosted by the Canadian Nationalist Front, an organization that “would like to see the return to Canada’s predominantly White-European and Native-Aboriginal ethnic make-up,” according to their website. A peaceful counter-protest called Chalk Out Hate has been planned in response.

Half of Canadian seniors in hospitals because of ‘potentially inappropriate medication’

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Potentially risky prescriptions are the leading cause of hospitalizations for one in two seniors across Canada, according to an analysis of data from the Canadian Institute of Health Information (CIHI) report.

More elderly persons are living longer than ever before, and the healthcare system buckles in effort to not only provide the proper care, but prevent unnecessary harm to Canada’s aging population.

“Medication errors occur all the time,” said Jennifer Jin, a pharmacist at the Queensway Carleton Hospital in Ottawa, Ontario. “The result can be clinically insignificant to fatal, depending on the medication involved.”

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Jennifer Jin. Image via Facebook.

Between 2015 and 2016, upwards of four million seniors aged 65 and older were admitted to a Canadian hospital, according to numbers in the CIHI report. 1.9 million of them were admitted because of either wrong or potentially harmful medication.

A medication error can happen at any point before the prescription reaches the patient.

It can be as simple as an incorrectly written administration route, a wrong dosage supplied, or a prescription picked up from the wrong tray.

“There’s not one nurse that can say ‘I’ve never done a medication error,’” said Guylaine Gallant, the director of health and wellness at the Prince of Wales Manor in Barrhaven, a retirement home in Ottawa.

“It does happen,” she said. “But we try to make sure that there are no room for errors.”

Hospitalizations put a strain on the healthcare system, especially when it can be prevented.

“The hospital beds would ideally be available for patients who need care due to their medical conditions,” said Jin. “And not filled with patients who have iatrogenic illnesses from taking wrong or inappropriate medications.”

The terms ‘inappropriately prescribed’ and ‘potentially inappropriate’ have completely different meanings, she noted. The latter refers to unsafe prescriptions for the elderly population that should be avoided altogether.

The Institute for Safe Medication Practices Canada’s ‘Beers List’ compiled medication names, cases and research for potentially inappropriate medications for older persons. Listed as ‘high alert’ are: warfarin, oral antiplatelet, insulin, opioids and digoxin – all medications used for blood clotting and blood sugar regulation, narcotics or various cardiovascular problems.

In Jin’s experience, the top three prescriptions given to partients are heart medications, antidepressants and narcotics. All of which are commonly used by seniors as well.

While the Canadian Institute for Health Information report doesn’t show for which inappropriate medications are most frequently used or administered by who, healthcare professionals have systems in place to prevent risks and errors from happening.

Gallant oversees the Manor’s implementations of the College of Nurses of Ontario standards to ensure mistakes and risks are minimized. Some examples include operating their own in-house pharmacy, a self-reporting system for errors and numerous trainings and audits per year.

“It’s like CPR. You think you now it until you’re being asked at a course and think, ‘s**t, is the ratio 50 to two? Thirty to five?’” Gallant said, highlighting the importance of  accountability in her line of work. “It’s the same with medication—you get a little comfortable and you forget some stuff.”

On the other side of the counter, another problem occurs. When a patient sees multiple doctors, specialists a locations, they don’t bring their medical history slip and ends up on serious medications, this is known as ‘poli-pharmacy’.

“It’s huge. Next thing you know, this medication interacts with that one— but the physician didn’t know—  the patient is 80,” ,” Gallant said. “She can’t tell she’s already on that medication. They end up having so much medication and that’s why they’re in the hospital.”

“The aging population is getting too much,” she said, stressing the need for for better care. “I just feel the need for them is here.”

Cost of a Hospital Stay Varies 51 per cent across Canada

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The same treatment at a hospital will cost you up to 51 per cent more, depending on what Canadian province or Territory you’re in. An analysis, done by Tamara Spitzer with data from the Canadian Institute for Health Information (CIHI), showed the growing increase in the difference in costs of an average hospital stay.  It also marks a continued trend in the increase of health care costs across Canada.

The average cost of a hospital stay in Canada costs $6,098 in 2016, jumping almost 5 per cent from last year’s average cost of $5,820. This staggeringly high number is more than the total increase of the past 5 years combined. Not only has the average cost drastically increased, but the disparity of cost per province and territory continues to grow.

The financial burden of a hospital stay in Canada varies greatly from province to province to territory. Take the Yukon. An average hospital stay in this territory costs  $8,094 while in New Brunswick it costs $5,339. The 51 per cent difference in cost accounts for inefficiencies in provincial and territorial health care systems.

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Riley Denver, a CIHI  specialist says that the reason these costs, “vary among peers and over time, is an acknowledgment to many factors including staff mix and facility size and classification.”

Smaller hospitals tend to have a higher running cost. The smaller the size, the more remote the hospital, and the higher cost of labour in certain provinces and territories, all point to the large variation in the average cost of a hospital stay. This however, doesn’t explain why the margin is growing.

The cost of an average hospital stay is neither linked to the quality of care a patient is receiving. The Yukon, which has the highest cost of an average hospital stay, also has the highest percentage of patients experiencing worsened pain over long-term care.

The Yukon also has one of the country’s lowest rates of hospital per person in Canada. Its three hospitals are designed to take care of a population of 35,874. Furthermore, the Yukon also has the highest administration costs across Canada, more than doubling that of New Brunswick.

In a time where healthcare consumers -patients- are more informed than ever, Canadians are taking these costs into account.

“I would certainly consider relocating if I could access a treatment that was more accessible there than in Ontario,” says Brett Parnell, who’s studied medical tourism and travel services. He says that although the cost would be a determining factor, it wouldn’t be the only one.

The average Canadian costs of a hospital stay still remains largely cheaper than those of the States which, according to the Agency for Healthcare and Research Quality, costs on average of  $13,190.

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Recently released census information indicates, an ever growing Canadian narrative; the aging population is putting more and more strain on healthcare systems. With an all time high standing cost of hospital stay and an all time high variability of health care costs, resolving health care gaps could is the answer to an equitable system.

More Canadian Women than Men Hospitalized for Cases of Self Harm Report Shows.

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An alarming number of Canadian women have landed themselves in the hospital for cases of self harm last year, approximately 30% more hospitalizations were recorded than that of their male counterpart according to an analysis by The Canadian Institute of Health Information.

The data indicated that of the 19, 476 reported cases of self injury in Canada from 2015-2016, hospitals saw and treated 11,730 women and 7,746 men.

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The Canadian Institute of Health Information defines “self harm” as any act of purposely self-inflicted poisoning, injury and suicide both attempted and completed however they note that in this particular analysis “this indicator cannot distinguish whether or not the self-injury was intended to result in death (self-harming or suicidal behaviour)”.

This isn’t the first time that number of women hospitalized for self-harm has outweighed the number of men.

A study in 2008 by the Victoria Healthy Youth survey had similar findings, claiming that “sex was the only significant predictor of non-suicidal self harm with females being at a higher risk than males” and cases of self harm “tend to be most prevalent in those between the ages of 14 and 24”.

According to a study by the CIHI in 2014 on intentional self harm among youth in Canada, 5% of the general adult population and 15% of youth have self harmed with girls aged 14-17 being hospitalized 4x more than boys for cases of self-inflicted injury.

Dr. Elisabeth Melsom, a psychologist from Saterra psycholopgical and counselling services agrees, stating that self harm behaviours tend to develop from unhealthy methods of coping with particularly difficult or unpleasant situations and that boys and girls use different methods to cope.

“Those who self harm often attack their bodies as a cry for help and as a sign of psychological disturbance,” she says. “They may cut themselves, burn themselves, bruise themselves and often times girls are more likely to carry out these behaviors than boys who are more private about these feelings.”

Catherine Horvath, founder and executive director at the Ottawa Centre for Resilience, says that there are many factors that could contribute to this conclusion.

Catherine Horvath, founder and executive director of the Ottawa Centre for Resilience, Ottawa & area’s only specialized mental health centre for childhood trauma, attachment, adoption, and high- conflict families.

According to Horvath, while the report by the CIHI does not account for age, age itself plays a major factor in the outcome of the data and depending on the age group in question and that with youth in particular “primary reason for hospitalization period is accidents”, and included in “self-harm” is both accidents and intentionally inflicted self harm.

The CIHI clarifies that in this particular report “capturing intention is difficult” and that the indicator (self-harm) “might provide biased estimates of the true number of hospitalizations for self-injury, due to the manner in which intent is captured in the data sources available, poisoning can be coded as “unintentional”—an overdose—or “undetermined”—reflecting an uncertainty between unintentional and intentional motives”.

She says that it is important to note that while there is no way of determining whether or not the hospitalizations recorded in the CIHI study for “self injury” were accidents or not but its “safe to assume that at least a percentage of them were for intentional self-inflicted harm or a suicide attempt.”

“We know that males are more likely to make successful attempts in suicide or self harm,” she says. “Another piece is think has to be take into consideration is that females are more likely to present themselves to the hospital and men are not, these are all important factors that could potentially contribute to the higher number of women’s than men’s cases recorded.”

Senior women more likely than men to take inappropriate medication

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By Hayley Kirsh

Woman are more likely to take wrong medication. Photo by Charles Williams, 2009.

Female seniors living in Canada are 10 per cent more likely to take inappropriate medication like incorrect dosage amounts in comparison to male seniors, according to data obtained from the Canadian Institute for Health Information.

Sylvia King, 82, was almost one of the many senior women included in this statistic before she noticed an error on her prescription bottle. “I had just gotten home from picking up my (prescription) renewal and I saw the milligram dosage on the bottle was 25mg higher than my old bottle.”

Concerned about the difference, King contacted her pharmacy to find out where the mistake was made. “I haven’t been to the doctor in a while so it couldn’t have changed,” she says. “I called and the pharmacist said it must have been a mistake with the label but to come back so they could make sure there wasn’t an error in sizing of the prescription.”

Although the mistake was corrected, King feels very lucky she took the time to read the bottle because a lot of people, especially with renewals, she says, wouldn’t look twice because they assume that nothing changes from pick-up to pick-up.

The latest statistics from 2015-2016 show that senior women aged 65 and up have an approximately 50 per cent chance of taking inappropriate medication.

 

But as Sarah Cohen, a board certified geriatric pharmacist (BCGP) points out, “Inappropriate is a huge umbrella term.” Inappropriate, she explains, could mean wrong dose, right medicine, may cause an allergic reaction and/or reactions to medication an individual is already on.

A study of the same nature completed in 2016 by the University of British Columbia shows that of the prescriptions taken, “Women receive inappropriate prescriptions for benzodiazepines, tricyclic antidepressants and NSAIDs more frequently than men.”

Benzodiazepines act as minor tranquilizers and tricyclic antidepressants are used in treating depression according to the American Addictions Centre.

“Women are prescribed more medication than men because women are more likely to complain about symptoms than men are,” says Cohen.

It’s not a joke, the 13-year pharmaceutical veteran explains, “When I was taking the CGP (certified geriatric pharmacy) course, I was taught that older men do not complain. We’re talking about someone who is say 90 years old today, they were taught that men are supposed to be strong and stoic and to keep their mouth shut and take an aspirin.”

The UBC study suggests that a woman’s risks are higher because of gender norms built within society and therefore incorporated into the medical community, “Approaches to address inappropriate prescribing must include changing the norms and expectations of both prescribers and patients.”

Other ways of ensuring that seniors are getting appropriate medication is through government funding that pays pharmacists to do quarterly reviews, says Cohen. These reviews entail assessing every single medication someone takes. The pharmacist sees if the dose is right, is it interacting with anything, is the person feeling better/worse and then makes suggestions like maybe the dose should be increased or lowered.

Men reaching their senior years are becoming more vocal with their symptoms and pain. “Give it 5-10 years,” Cohen says. “Men will definitely start advocating for themselves and I think the numbers will change.”

Self-injury sends more women to hospitals than men

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Women in Ottawa are being hospitalized for self-harm almost double the rate of men, according to an analysis of data that a national research institute uses to track hospitalizations.

Data from the Canadian Institute for Health Information shows that 462 women were hospitalized in Ottawa last year for self-inflicted injuries such as burning, cutting, overusing drugs or attempting suicide in other means, compared to 270 men. That’s around eight women for every five men.

This trend is visible consistently in Ottawa dating back from 2010, the earliest date the data provides. But according to specialists, that is only part of the story.

“Women use different methods to attempt, so they tend to stay alive,” said Renée Ouimet in an interview. She is the coordinator of the Ottawa Suicide Prevention Coalition, which is run through the Canadian Mental Health Association’s Ottawa branch. The coalition runs workshops and trains Ottawa residents on how to manage suicide attempts.

She said that the means women use, in general, tend to leave time for the person to be discovered, whereas men tend to use more violent, and faster means.

Ouimet said that it isn’t really an issue of women attempting suicide more frequently than men. She said the numbers for attempted suicide are about equal, men to women, but that men tend to ‘complete’ suicide more frequently. She also said that women seek help more often, and that mental health programs tend to be geared more towards females.

Renée Ouimet, coordinator of the Ottawa Suicide Prevention Coalition. Photo courtesy of Renée Ouimet

Ouimet made a point of differentiating beteen self-inflicted injuries and suicide attempts, stating they are often different things. “You can self harm and cut and burn for years and years and never attempt suicide,” said Ouimet. She did note that many who do self-harm, however, may also attempt suicide at some point.

For the purposes of having clean, unambiguous data, the health institute slots attempted suicides with self-inflicted injury leading to hospitalization into the same category.

Mark Patton, a counsellor with Family Services Ottawa, said in an email exchange that in his work he sees the trend of more women self-harming than men. He said that in his experience, however, men tend to cut less but tend to use “methods of self-harm that are more ambiguously self-harm.” If someone is driving recklessly, he said, or drinking heavily, are these methods of self-harm?

The data would say no, but it is confined to a strict definition of self-injury.

Patton said that might be a sign of bias. “When most people think about self-harm, they likely imagine a girl or woman who cuts,” he said, so other forms of subtler self-injury are not being accounted for.

The health institute stipulates that this category includes only what is clearly self-inflicted injuries requiring hospitalization, meaning only those actually admitted to the hospital, not just the emergency room. It also recognizes that many cases were likely intentional self-harm but could not be listed in that category unless the practitioners or nurses were certain it was deliberate.

That means there are even more hospitalizations for self-injury than currently visible in the data.

Even without those cases, Ottawa hospitals still see hundreds of female patients for self-inflicted injuries. This trend of women being hospitalized more for self-harm is present across the province and even across the country.

** If you are in distress or considering suicide, there are places to turn for support, including the Ontario Suicide Prevention Network at 416-670-4689. The Canadian Association for Suicide Prevention also has information about where to find help.**

Self-injury three times higher in territories

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When Sean Hopkins reads about a suicide in Whitehorse, he braces for the worst. “It’s highly possible that I know or have even looked after that person,” he said.

Canadians in the territories are nearly three times more likely to be hospitalized for intentionally cutting, poisoning, or harming themselves compared to those in the provinces, according to an analysis of national health data.

Hopkins has worked as a mental health counsellor in Whitehorse for the past 18 years. He’s no longer surprised by the number of self-injury hospitalizations, but he can see the effect on the community.

Sean Hopkins works as a mental health counsellor in Whitehorse. Courtesy of subject.

“It’s a difficult reality and there’s a kind of intimacy here because we’re such a small population,” he said.

Nearly all of the Yukon’s mental health services are located in Whitehorse, leaving nearly 14,000 people who live outside the city with “a poverty of services”, according to Hopkins. He said a lack of mental health supports in remote communities across the territories could help explain the high rates of self-injury.

The analysis looked at data from the Canadian Institute for Health Information (CIHI). CIHI tracks self-injury hospitalizations that are deemed intentional, reflecting suicidal behaviour.

Northwest Territories suffered the highest rate of self-injury hospitalizations in 2015-2016, with 194 hospitalizations per 100,000 people. Manitoba recorded the lowest rate at 54 per 100,000.

Despite years of experience, Hopkins struggles to understand why the numbers remain so high in the territories.

“Is it isolation? Is it hopelessness? Is it the legacy of residential schools? We don’t actually know,” he said.

Mary Bartram is a health policy expert at Carleton University. If the country is serious about reducing numbers in the North, governments need to deal with issues such as housing shortages and food insecurity, she said.

Nunavut often has the highest rate of self-injury and is plagued with housing shortages. More than half of the population depends on social housing, yet the Nunavut Housing Corporation needs 3,500 new units.

Households in Nunavut are also nearly four times more likely to suffer from food insecurity compared to the provinces, according to a study by the Canadian Institute for Health Research. Food insecurity is defined as insufficient access to nutritious and affordable food.

Bartram said a chronic lack of social workers in Northern communities has led to higher rates of self-injury. 37 per cent of the social worker positions in Nunavut remain unfilled on a month-to-month basis, according to an Auditor-General report from 2011.

Stress levels among care workers who remain in the territories is a “very real issue”, Hopkins said. Many of his patients are paramedics and social workers, people who are intimately familiar with the number of self-injury and suicide victims in the Yukon.

“These are people who have experienced vicarious trauma from constantly, constantly dealing with these things,” Hopkins said. “It’s difficult to get any respite from that.”

Bartram and Hopkins both said conversations about self-injury in the North must also recognize Canada’s history of colonialism.

Indigenous peoples make up more than 50 per cent of the territorial population.  Bartram said the legacy of residential schools and forced relocations contribute to a suicide rate that is five times higher among Indigenous youth compared to non-Indigenous youth.

Any effort to lower the rate of self-injury must “stress the importance of supporting Indigenous peoples, communities and governments to set their own priorities and implement them,” Bartram said.

$36 million in new funding for mental health for the territories has already started to flow, but the federal government has yet to disclose exactly where it’s going. Bartram called on the government to make those decisions public, to ensure the country is closing the gap in mental health outcomes between the provinces and territories.

Reported hate crimes in Edmonton more than double between 2014 and 2015: Stats Canada

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The city of Edmonton saw a rise in reported hate crimes from 36 to 81 between the years 2014 and 2015, an increase of over 100%, according to an analysis of data that Statistics Canada uses to track hate crimes.

While Edmonton saw a major increase in reported hate crimes, other major urban centres in Canada trended in the opposite direction. Toronto, Ottawa and Calgary all reported less hate crimes in 2015 than in 2014.

“I have always had a hard time understanding why someone can harm someone else just based on a certain social characteristic.”

Despite the increase, University of Alberta lecturer and researcher Irfan Chaudhry said it might not necessarily be a cause for concern for Edmontonians.

“It is hard to say what the cause of the increase is, but it could be a case of increased visibility that hate crimes are occurring,” said Chaudhry.

Chaudhry said that it is important not to discount the issue of hate crimes in Edmonton potentially getting worse, but the context of increased awareness of hate crimes in Alberta, as well as outlets to report them, cannot be ignored.

Chaudhry spends the bulk of his professional time as a hate crimes researcher. His latest project, StopHateAB.com, seeks to make the occurrence of Alberta hate crimes more visible and easier to report. Through the site’s web portal, which launched earlier this year, people can document hate incidents or crimes they have seen or been subject to. It is because of sites like StopHateAB and various social media outlets that Chaudhry said it has become easier to not only report hate crimes, but also hate incidents as well.

A hate incident is when an act is hate-motivated, but no crime is committed. An example cited by Chaudhry is if a racial slur is uttered by someone while driving by a minority. It may be a legal grey area as well as difficult for law enforcement to do anything about. The site provides a space to document non-criminal hate incidents that still have an effect on Canadians.

“Hate crimes are the most extreme and observable against inclusive communities, but there are also microcosms that aren’t as overt that still chip away at a strong community,” said Chaudhry.

The site also includes an interactive heat map that show the areas in Alberta that have had the most hate crimes/incidents occur. The areas on the map that stand out the most are the province’s two major cities: Calgary and Edmonton.

Between the Edmonton police and not-for-profit online tools, Chaudhry said that increased visibility of hate crimes and accessibility of support services will be key in helping to stop them from happening. Chaudhry identifies himself as a visible minority (he moved to Canada from Africa when he was five) and said that creating a more inclusive community is a goal of his.

“Improving visibility is a big part of moving towards inclusive communities. I have always had a hard time understanding why someone can harm someone else just based on a certain social characteristic,” said Chaudhry.

The Edmonton Police Serve said that they refuse to speculate on why the number of reported hate crimes escalated so dramatically between the two years. Canadian Metropolitan areas as a whole registered 1362 reported hate crimes in 2015 compared to 1295 the year before.

The number of 2016 reported hate crimes in Canada, broken down by metropolitan areas, has yet to be released by Stats Canada. Although it may seem problematic on the surface, Chaudhry said that a continued increase in reported hate crimes in Edmonton in 2016 might just mean that the issue is being brought to the societal forefront.

“I don’t think there should be alarm if the number continues to rise in the 2016 [Stats Can] release,” said Chaudry. “Overall, I am cautiously optimistic about the situation [improving]”.