Past Issues

Combine issues of health care with issues of justice and you get a full schedule for a philosopher. Some of the questions to ponder: What is the philosophical basis for universal access to health care? How should we decide which health care services to provide? Do Canadians have an obligation to improve well-being in poor countries?

As Canada Research Chair in Justice and Health, philosophy professor Gopal Sreenivasan is trying to shed light on these bioethical issues.

One challenge is to come up with a solid rationale for universal access to health care. The popular "equal opportunity" argument for access to health care is attractive, says Sreenivasan, but it doesn't stand up once one looks closely into all the factors that are responsible for producing health. A more sound argument for universal health care may be developed by asking how everyone would spend a fair share of income, he says.

"If it would be rational - if they had a fair share of income - to spend a certain amount on health care, then that's what we should go ahead and do," says Sreenivasan.

As part of a large U of T research project - Defining the Medicare Basket - Sreenivasan and Arthur Ripstein, of Philosophy and Law, have been asked to help design a principled framework for deciding which health services should be covered in Canada.

In an international context, stark statistics make questions about justice and health care even more compelling. Average life expectancy in many countries in sub-Saharan Africa is less than 50 years, compared to about 78 in Canada.

"There's a question which philosophers surprisingly have not paid much attention to, which is what obligations, if any, there are on rich countries to help improve the basic level of well-being in poor countries," says Sreenivasan.

He has proposed that the richest countries give one per cent of their gross domestic product to the poorest countries for health care services, education and basic income support and nutrition - the major contributors to health. It would be a meaningful interim step, Sreenivasan says, while philosophers consider complicated questions about the full nature of justice.

-Janice Walls

Talk to Daniel Trefler about Canadian competitiveness and you may learn a thing or two about 12th century Venice.

His expertise is - in a word - eclectic. During a recent two-week period, Trefler, a professor at U of T's Joseph L. Rotman School of Management, gave a talk on the economic importance of investing in young children, expounded on the positive impact of globalization on 12th century Venice, and spoke to the governments of Canada, the U.S. and Mexico about free trade.

"I firmly believe you cannot do public policy with your head stuck in one very narrow area," he says.

As the J. Douglas and Ruth Grant Canada Research Chair in Competitiveness and Prosperity, Trefler is studying how a nation's institutions affect its competitiveness and, in turn, how international competition affects these institutions.

"Institutions respond to trade. But in the past, if you said that you recognized the role of institutions, it was to say that institutions affected trade," says Trefler. "There was no notion that trade affected institutions."

Trade with other countries can lead to the creation of strong institutions, says Trefler. "It can teach people, as it did in Hong Kong, that honouring contracts and developing a body of commercial law to protect property rights is the better route to wealth," he says.

On the other hand, in Canada, the Constitution - our most important institution - is affecting our ability to compete internationally. Toronto's financial sector is being pummelled by New York while the Ontario Securities Commission is distracted by provincial bickering over jurisdiction, he says.

"It's absurd that we don't have a national policy for securities regulation. And we don't because our Constitution is basically flawed in the way it deals with provincial versus federal jurisdiction."

A member of the Ontario Task Force on Competitiveness, Productivity and Economic Progress (led by Roger Martin, dean of Rotman), Trefler believes even a small increase in Canada's gross domestic product would have a major impact.

"Forget about fashionable silver bullet policies. It's often the little things that matter. Our Canadian institutions could be better, our companies could be more sophisticated, and our investments in children could be more generous."

-Janice Walls

Women with histories of breast cancer in their families can undergo genetic testing to find out if they are at high risk for developing the disease themselves. Those faced with a high-risk diagnosis are then informed of preventive treatments, the most radical being the mastectomy.

But what are the psychosocial implications of this form of treatment? A recent survey by Kelly Metcalfe, an assistant professor in Nursing who is cross-appointed to the Centre for Research in Women's Health (CRWH), has produced surprising results.

Metcalfe and colleagues from CRWH and U of T surveyed 60 women who had preventive double mastectomies between 1991 and 2000. The study (published in the January 2004 issue of Psycho-Oncology) revealed that two-thirds of the women said the surgery did not impact negatively on sexual functioning and almost half reported no change in self-esteem. Moreover, almost 30 per cent felt their body image improved after the procedure.

"We anticipated body image issues or sexual functioning problems, but we didn't find that at all," says Metcalfe. "When we looked at quality of life, women who had the surgeries scored higher than the general population."

For the majority of women, reconstructive surgery is performed during the mastectomies, which Metcalfe says helps ease women's uncertainties about what their bodies will look like after the procedure. Also, since the surgery is preventive and women have not been diagnosed with cancer, the lymph nodes are left alone and chemotherapy is not administered - so the side effects typical of long-term treatment are not experienced.

Metcalfe acknowledges, however, that for some women the procedure is too drastic. Through her clinical work, she counsels women and helps them decide on other possible breast cancer prevention treatments - such as taking the drug tamoxifen or having their ovaries removed.

"With genetic testing, we now know how to identify women who are at very high risk. My goal is to help women make an informed decision that they're comfortable with and that will prevent them from getting breast cancer."

-Maria Saros Leung

"Activist scholar" is not a term that Julia Sudbury shies away from. The associate professor of Social Work readily acknowledges that she's part of a new wave of researchers who say that working for social justice is a valid goal within academia.

"Creating a society that is fair and treats people with decency - these are the underlying commitments of activist scholarship," explains Sudbury. "For me, this also means working not only for my scholarly peers but for people in the community."

Sudbury has worked with survivors of violence and racism as director of a black women's group. Her research today - influenced by this experience - looks at the connections between globalization and the increase in imprisonment of women of colour and Indigenous women. Her upcoming book, Global Lockdown: Race, Gender and the Prison Industrial Complex, features scholarly articles and the reflections of formerly-incarcerated women. She's also examining how Aboriginal women and women of colour form localized resistance to globalization.

"I'm interested in what women are actually doing. As an activist scholar, I can play a role in identifying and disseminating effective social change strategies that people can learn from to build broader-based social movements."

Sudbury holds the Canada Research Chair in Social Work, Equity and Diversity, which uniquely positions her to bridge activist scholarship with traditional notions of social work education. She's also taken a lead role in U of T's Social Justice Cluster - a multidisciplinary committee of researchers who believe activism can feed into research and make it more relevant to society.

"Many graduate students, especially in social work, are so committed to the community that they're worried if they continue in academia, they'll have to sacrifice that," explains Sudbury. "We want to create a new model of scholarship, one that says to students, you can engage in the community while you achieve academic success."

-Maria Saros Leung
University of Toronto Office of the Vice-President, Research and Associate Provost