Chapter One
Introduction:
What Is Canada?
It takes a night and half a day to get from Vancouver, British Columbia, to Jasper, Alberta, by train. But this trip through some of the world's tallest and newest mountains is the dot on an "i" in Canada's great expanse. The second largest country in the world spans six time zones. It is largely uninhabited. The population of just over 32 million is roughly the same as the population of California. Most Canadians live within a hundred miles of the U.S. border.
Human beings are thought to have first entered what is now Canada around 24,000 years ago, crossing the Bering Strait from Mongolia to present-day Alaska and then moving south. Native peoples are known to have lived in some parts of Canada for at least 10,000 years. Around a.d. 1000 Vikings settled on the coast of Newfoundland for around a decade but then left.
The Frenchman Jacques Cartier was the next European of record to return. He sailed from St. Malo on April 20, 1534, with two ships and sixty-one men, looking for gold and a passage to Asia. He found instead a land "composed of stones and horrible rugged rocks," claiming it for France. Forty-nine years later, Sir Humphrey Gilbert claimed Newfoundland for England. This was the beginning of a conflict between the English and French for control of this territory that finally ended with the French defeat on Quebec City's Plains of Abraham in 1759.
However, the defeat was only partial. Canada has two official languages—English and French—and the Quebecois ("Quebecers" in English) have a culture distinct from the rest of Canada and a lingering sense of being second-class citizens in an English-speaking hegemony. Although many of Canada's premiers have been from Quebec, the province's alliance with the rest of Canada has often been uneasy.
The beaver is Canada's national animal, and rightly so. From the seventeenth to the mid-nineteenth century, the European hunger for beaver skin hats was insatiable. Starting around 1600, explorers, trappers, and traders pushed farther and farther west, seeking beaver pelts. The Hudson's Bay Company, founded in 1670, and the North West Company, founded in 1783, were built on trading fur with natives and with the European trappers who learned from them. Seeking furs, in 1793, a Scot named Alexander Mackenzie first crossed the Rocky Mountains and made his way to the Pacific Ocean.
The Hudson's Bay Company once controlled most of the land in modern Canada, from the Atlantic Ocean to the Pacific, from the Arctic Ocean to the Great Lakes. But the taste for beaver hats waned in favor of silk hats and less pricey furs. In 1870, the Hudson's Bay Company ceded most of its domain to the Dominion of Canada and became a department store supplying the needs of the farmers who flooded the prairies in response to Canada's offer of cheap land to anyone who would cultivate it.
Because of its size, terrain, and climate, and because of its political history, Canada has not been an easy country to govern—certainly not at a distance. By the 1860s, with the value of Canadian furs diminished and the United States unstable and bloody from civil war, the British Crown was quite willing to let its colony take care of many of its own problems, including defense from its neighbor to the south.
The British North America Act of 1867 established the Dominion of Canada as a confederation of provinces governed by a premier and a parliament in Ottawa. The first four provinces in the confederation were Ontario, Quebec, New Brunswick, and Nova Scotia. The Statute of Westminster, signed in 1931, further loosened the ties with Britain, giving Canada control over its external affairs. Finally, the Constitution Act of 1982 (which Quebec refused to sign) allowed Canada to change its constitution without asking permission of the British government. The Canadian Charter of Rights and Freedoms, guaranteeing Canadians freedom of religion, thought, belief, opinion, and expression, was part of that document.
When Canadians talk about what it means to be Canadian, it's often to this charter that they return as an expression of fundamental principles and beliefs. They also define themselves as a peacekeeping nation and as a nation with respect for law. "Peace, order, and good government" is how they put it—the "POGs." They will also tell you that they take care of one another. "It's not just a matter of public policy but of personal behavior," said Mary-Anne Hurley-Corbyn, who lives in New Brunswick. "I live in rural Canada," she said. "New Brunswick only has 750,000 people—but it's very community-oriented."
Canada's universal health care system is sometimes mentioned in this connection. In the fall of 2004, CBC Television initiated a contest to designate "the Greatest Canadian." The winner, with 1.1 million people voting, was Tommy Douglas, the Saskatchewan premier who spearheaded Canada's universal health care system. TV host George Stroumboulopoulos, who argued for Douglas's "candidacy," said that if Douglas were removed from the national equation, "you remove the caring, sharing legacy of everything that we value. . . . This is our most treasured national characteristic."
The name "Canada" first appeared on a map circa 1547, bestowed by Jacques Cartier after he heard the word on his second voyage of exploration. Two young Indian men on his ship used it to refer to a village; Cartier thought they meant the whole country. As it turns out, though, Canada's influx of immigrants has made it one of the most multicultural nations in the world. Cartier may have been right. Canada has many characteristics of a village, whose inhabitants are mutually dependent and who believe that the well-being of one impacts the well-being of all.
SNAPSHOT: Canada
Location The northernmost country of the North American continent, bordered by the Arctic, Atlantic, and Pacific Oceans and by the United States of America. The land border with the United States is 3,145 miles long. The water border is 2,380 miles. Canada touches the states of Maine, New Hampshire, Vermont, New York, Pennsylvania, Ohio, Michigan, Minnesota, North Dakota, Montana, Idaho, Washington, and Alaska. Most of the border with the United States runs along the forty-ninth parallel.
Canada extends from latitude 41 degrees 58 minutes N at Pelee Island in Lake Erie (the same latitude as Rome, Italy) to 83 degrees 7 minutes N at Cape Columbia on Ellesmere Island, well above the Arctic Circle and within five hundred miles of the North Pole.
Canada's easternmost point is Cape Spear in Newfoundland (longitude 52 degrees 37 minutes W). The westernmost point is on the Yukon/Alaska border at 141 degrees W. It stretches 3,400 miles from coast to coast. From north to south, Canada covers 2,900 miles.
Geography Canada is 3.8 million square miles in area, mostly plains, with mountains in the west and lowlands in the southeast. It has seven major geological regions centered on the Canadian Shield, an area of 500-million-year-old Precambrian rocks surrounding Hudson Bay like a crescent and extending over almost half of Canada. The Canadian Shield is rugged, covered with forests, and dotted with lakes and is rich in minerals. Much of it is inaccessible. Very little of it can be cultivated.
Climate Temperate to Arctic. Proximity to water (the Pacific and Atlantic Oceans, Hudson Bay, and the Great Lakes) moderates the climate in many places. The prairies are among the coldest places in Canada and get more snow than the Arctic regions. Mountain ranges in the west also have an effect. The tall Coast Mountains shield the Yukon and parts of British Columbia from moist and temperate Pacific Ocean air, leaving them very cold in winter and hot in summer.
Population 32,378,122 (est., October 2005)
Capital Ottawa
Provinces
British Columbia; Alberta; Saskatchewan; Manitoba; Ontario; Quebec; New Brunswick; Nova Scotia; Newfoundland and Labrador; Prince Edward Island.
Territories
Yukon; Northwest Territories; Nunavut.
Population of Major Cities
Toronto 4.5 million
Montreal 3.4 million
Vancouver 2 million
Ottawa 1 million
Ethnic Diversity
English, Scottish, Irish 28 percent
French 23 percent
Other European 15 percent
Asian/Arab/African 6 percent
Indigenous Amerindian 2 percent
Mixed Background 26 percent
Religious Affiliations
Catholic 44.4 percent
Protestant 29 percent
Other Christian 4.2 percent
Muslim 2 percent
Other 4 percent
Languages English, French (official languages. Many others are widely used, particularly in areas with large immigrant populations). The Official Languages Act of 1969 made bilingual communication mandatory at the federal level. New Brunswick is the only officially bilingual province.
Education Literacy—99 percent of population aged 15 and over has at least a ninth-grade education.
Health
Average Life Expectancy:
Males, 77.1 years
Females, 82.2 years
Infant Mortality Rate: 4.75 per 1,000 live births (est. 2005)
Economy
Workforce: (December 2005) 17.4 million
Goods-producing sector: 25 percent
Comprises manufacturing; construction; agriculture; natural resources; utilities
Service-producing sector: 75 percent
Comprises trade; health care and social assistance; educational services; accommodation and food services; professional, scientific, and technical services; finance; public administration; transportation and warehousing; information, culture, and recreation; management, administrative, and other support
Nominal GDP (2003): $869.2 billion
Real GDP growth rate (2004): 2.4 percent
GDP per capita (2004): $40,483
Natural resources: Petroleum and natural gas, hydroelectric power, metals and minerals, fish, forests, wildlife, abundant fresh water
Agriculture: Products—wheat, livestock and meat, feed grains, oil seeds, dairy products, tobacco, fruits, vegetables
Industry: Types—motor vehicles and parts, machinery and equipment, aircraft and components, other diversified manufacturing, fish and forest products, processed and unprocessed minerals
Trade Merchandise exports (2004): U.S. $331.74 billion: motor vehicles and spare parts, lumber, wood pulp and newsprint, crude and fabricated metals, natural gas, crude petroleum, wheat. In 2004, 84.6 percent of Canadian exports went to the United States.
Merchandise imports (2003): U.S. $289.7 billion: motor vehicles and parts, industrial machinery, crude petroleum, chemicals, agricultural machinery. In 2003, 70 percent of Canadian imports came from the United States.
Government Confederation with parliamentary democracy
Confederation: July 1, 1867
Constitution The amended British North America Act of 1867 patriated to Canada on April 17, 1982, Charter of Rights and Freedoms, and unwritten custom
Branches
Executive—Queen Elizabeth II (head of state represented by a governor-general), prime minister (head of government), cabinet
Legislative—bicameral parliament (House of Commons, 308 members; 105-seat Senate)
Judicial—Supreme Court
Federal-level political parties: Liberal Party, Bloc Québécois, New Democratic Party, Conservative Party of Canada
System of Measurement Canada uses the metric system to measure such things as distance, temperature, volume, and weight.
HEALTH CARE: How It Works
Arnold Bennett and his wife, Nancy, moved from the Washington, D.C., area to Newfoundland in 1996. They've been Canadian citizens since early 2004. Arnold Bennett, who edited a book called Looking North for Health: What We Can Learn from Canada's Health Care System (San Francisco: Jossey-Bass, 1993), says there are two realities about Canada's health care: "(1) Almost all Canadians believe deeply that our health care system is the best in the world and (2) that almost all Canadians complain about it all the time."
Bennett notes that Canada began the 1990s with a massive national budget deficit and managed to eliminate the deficit in a few years, running surpluses for the last several years. "That was done in large part by cutting spending throughout the nineties. One result was that the health care system was tightened up enough to cause some discomfort. Some shortages developed, and wait times for some elective services increased."
Bennett says that most of these problems have been fixed or are in the process of being fixed. The federal government, he says, has funded agreements with the provinces to increase accountability for delivery of services, create twenty-four-hour primary care centers, and improve home care services and drug insurance programs. "I live in Canada's poorest, most rural, province," he says, "and I'd take our health care system over what I saw in the richest, least rural, U.S. states any day."
Basic health care in Canada is publicly funded and available to all residents, though a waiting period of up to three months before enrollment is often required. Those moving from the United States to a province with a waiting period will want to continue their health insurance for that time. Those moving from one province to another are generally covered by their previous province for the first few months.
Anyone moving from the United States to Canada who is 65 or over should know that, while Social Security goes with them, U.S. Medicare does not. They should get short-term insurance to cover the first three months, if necessary, until they are registered in Canada's system.
Canada's national health care system is called Medicare, but unlike Medicare in the United States, it is not just for senior citizens. Canada's Medicare evolved in the 1960s from what was termed "socialized medicine" in Saskatchewan, and by 1967, Canada's centennial year, universal health care was a national commitment.
As Arnold Bennett noted, budget cuts in the 1990s have strained the system, but many of the problems were already being addressed when, in June 2005, the Canadian Supreme Court handed down a ruling that led some to fear that Medicare would be seriously and permanently undermined by the creation of a parallel private insurance system for basic care.
Ruling in a case brought by a Montreal doctor and a patient who had to wait a year for hip replacement surgery, the court said, "The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care."
Specifically, the court struck down Quebec's ban on private medical insurance for core medical services, saying, "The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services."
Then Prime Minister Paul Martin's response was to say that Canada would not have a two-tiered health care system that could siphon off doctors from the public system. He said his government was making progress in strengthening the public health care system, allocating additional funds toward reducing wait times.
In fact, the Supreme Court ruling thus far applies only to the province of Quebec, and the net effect there and in other parts of Canada may simply be to make fixing the health system a legislative and financial priority. In August 2005, the Supreme Court issued a second ruling saying that the implementation of the first one would be delayed by twelve months to give Quebec and the federal government time to address the waiting period problems.
How Good Is Canadian Health Care? Canada spends less per capita on health care than the United States (U.S. $2,931 per person in Canada vs. U.S. $5,267 in the United States, both figures, 2002) but Canadians live longer on average. In 2005, the estimated Canadian life expectancy at birth was 80.1 years, compared with 77.7 years in the United States.
Americans who have been in Canada since the early 1970s recall a golden age of medical care. Many feel it is unraveling a bit today, but are grateful for the national commitment. Judith Wouk has been a Canadian citizen since 1975: "I find it is very good for acute care, but a little slow on follow-up care. Compared to the experiences of my friends and family in the United States, I am very happy with Canadian health care."
"There are definite problems and there are very definite advantages from what we've seen," says University of Winnipeg history professor Dan Stone, who moved to Manitoba from New York City in 1969. "There's a shortage of high-tech diagnostic equipment, and this can sometimes be a serious issue. There are some operations where they're not as quick as they should be. In Manitoba, it seems to be particularly hip and knee replacement. Other provinces, for some reason, that's better, and other things are worse. In emergencies, they all function extremely well."
Canada's health minister in May 2005 announced a five-year, $75 million initiative aimed at helping more than two thousand "internationally educated" health care professionals join Canada's health care system. "This initiative will strengthen our health system by helping to increase the supply of health care professionals, which will improve access to quality health care and reduce wait times," said Health Minister Ujjal Dosanjh. He noted that the initiative is part of a wider Internationally Trained Workers Initiative, involving fourteen federal departments and agencies. There is an on-line Canadian Information Centre for International Medical Graduates with more information at www.IMG-Canada.ca.
Canada's health system is funded largely by the federal government, though "premiums" are charged in some provinces, such as Alberta and British Columbia, while Ontario and Quebec have placed income-related surcharges on their provincial income taxes to help pay for health care. The care itself is administered and delivered at the provincial level, in keeping with the provisions of the Canada Health Act, which guarantees residents universal access to medically necessary hospital and medical services.
What's Covered Universal health coverage applies to many aspects of medical care, but not all. In some cases, employers will offer coverage for many uncovered services. In others, people pay out of pocket or take out private insurance.
Medically necessary hospital services are covered whether provided on an inpatient or outpatient basis and include a bed in a standard ward, meals, X-rays, most laboratory tests, and nursing care.
Physician services that are covered by Medicare include diagnosis and treatment of illness and injury, surgery, obstetrical care (including pre- and postnatal care), eye exams and treatment or operations by an ophthalmologist.
Not covered are hospital charges above the standard ward rate for private or semiprivate rooms and services not medically required, such as cosmetic surgery, experimental services, ambulance services, or dental services, other than procedures related to jaw injury or disease.
Physician services not covered by Medicare include annual physical exams, cosmetic surgery, experimental services, prescription drugs, and physical exams done at the request of a third party for such things as preschool or preemployment requirements or for medical insurance. Optometry and dental services (other than those related to injury or disease) are also not covered.
The services of chiropractors, naturopaths, podiatrists, and osteopaths as well as acupuncture treatments are generally not covered. Physiotherapy, speech therapy, and psychological services received in a facility that is not an insured outpatient facility are also not covered.
Also not covered by Medicare are services to which a resident is entitled under other legislation such as the Workers Compensation Act, Public Health Act, or other territorial or federal legislation. Veterans, for example, are entitled to treatment as a result of their service in the armed forces.
Additional services, such as prescription drugs, eyeglasses, and dental care, can be covered by an employee's benefit package, or private insurance can be purchased to supplement the federal Medicare. Canada does have private clinics offering specialized services.
A Seniors' Benefit program covering the costs of some prescription drugs and some of the things listed above is available in most of the provinces and territories, but coverage and costs are variable and often linked to income. Nursing home and home care are generally not covered under Medicare, but physician and hospital care is.
Full-time students from the United States enrolled at Saskatchewan colleges and universities are covered by Saskatchewan Health if they have valid study permits. British Columbia and Alberta offer some coverage for a fee, but students generally buy private insurance or pay for insurance with their registration fees at school.
Travel insurance is available through private insurers for residents of Canada who travel outside the country. Rates depend on the traveler's age, preexisting health conditions, and the length of the trip.
How to Apply Application forms to enroll in Canada's Medicare are available from the provincial and territorial health ministries (see Appendix, page 211, for contact information). They can also be found at doctors' offices, hospitals, and in pharmacies. Enrollees receive a health care card with a personal, lifetime health number. Once a resident is enrolled in a province, care is portable from province to province. There's usually a three-month waiting period for eligibility in the new province, but, with proper notification, it is covered by the previous province.
Each member of a family, even newborn babies, must have his or her own card. The applicant will need a birth certificate or confirmation of permanent residence and passport to obtain a card.
Copyright © 2006 by T. L. Kreuzer. All rights reserved.
