Sunday, July 6, 2014

National Autism Strategy is a Distraction

My fellow blogger over at Autism in New Brunswick is a strong advocate of what he calls a "National Autism Strategy" for Canadians.  In the latest post on the topic, he mentions four key points for such a strategy:

a.) the development, in cooperation with provincial-territorial governments, of evidence based standards for the diagnosis and treatment of autism spectrum disorder;

b.) the development, in cooperation with provincial governments, of innovative funding methods for the care of those with autism spectrum disorder;

c.) consulting with provincial-territorial governments and other stakeholders on the requirements of implementing a national surveillance program for autism spectrum disorder;

d.) the provision of additional federal funding for health research into autism spectrum disorder.

This is not news; many people have advocated for this strategy in the past, and some will advocate for in the future.  I personally feel pushing this politically is a waste of time and amounts to us chasing our own tails when there are real advocacy issues and pursuits we could be tackling.

First, a little lesson in Canadian politics.  Canada is a federation, which means that there is a division of powers between the federal (national) government, and the sub-national governments, the provinces.  Canada's constitution guarantees that both governments can legislate in their respective jurisdictions.  When there is disagreement, the Supreme Court of Canada usually must rule to determine which government may legislate (this happens more often then you would think).  There are also many areas of shared jurisdiction, which makes some legislation fuzzy in terms of validity as per the Constitution.

Autism Services in Canada fall under three main areas:
1.  Health
2.  Education
3.  Social Services

All three of these areas fall under almost exclusive provincial jurisdiction (the exceptions being federal monitoring and approval of drugs and treatments and the health, education and social services of on reserve native Canadians).  In Canada, although the federal government approves drugs and other health treatments, the provinces are responsible for regulation of health professions and which treatments are covered under provincial health care.  Thus, from an autism services perspective, this is largely an area of provincial jurisdiction (and I would say mostly exclusively).

Some people argue the federal government could use its spending powers to implement a National Autism Strategy, but I would argue all this would do is setup the federal government as a transfer payment agency with zero accountability on how that money is spent.  While I would enthusiastically support direct federal transfers to people with disabilities including autism, this is not a National Strategy, it's just more money.  There are no guarantees of new outcomes.

I will also mention that I held these views before I moved to Alberta and my presence in this province does not alter my opinion.  While some may say it is nice for me to have this opinion in the province that provides by far the best services in Canada, I'll remind you we moved to get here rather than wrestle with the Ontario government.  If you are in Canada, there is no reason you could not do the same.

Now, let's look at the four items proposed above on what would make a true "National Autism Strategy":

Regarding Evidence-Based Standards for Diagnosis and Treatment
There is already lots of evidence and reports on what is considered evidence-based practice.  I don't think we need to make an official Canadian document to espouse what is already well known and described in the scientific literature.  Any standards created would add nothing to the existing literature and could be largely ignored by the provinces, since diagnosis and treatment are in the health, education and social services areas of government and thus not within the federal government's ability to legislate.

Innovative Funding Methods
I am not sure if this is code for "transfer more money from the federal government to the provinces" or let's talk about best practices for funding autism services using the charitable sector.  While this is a good idea, I am not sure we need to pay a bunch of people a lot of money to do this when there are great examples of many organizations doing good things across Canada.  Why do we need a National Strategy to tell us this information when it is already available?  I do think there is some room here for funding methods in more remote regions of the country but this problem is not unique to autism.

National Surveillance Program
I agree it is odd that Public Health Canada does not track statistics on autism, and this actually in their area of jurisdiction.  So okay, let's do that.  But this alone is not a National Strategy on Autism, it's just a policy correction.

Federal Funding for Autism Research
Translation:  Please give more money for autism research oh rich and powerful federal government.  Okay, fine.  But again, not a strategy people, just a policy variation.  Who is not asking the federal government for research money?

Lastly, let's look at one area for which we do have a national strategy - mental health.  The strategy itself gives many "priorities", but all this really amounts to is a laundry list of asks to Canada's provincial governments.  There is nothing here that will practically change the lives of people with mental health issues.  It's a useful document, but one that will be shelved like all others with some of the recommendations implemented by some provinces.  For a national strategy, it is not effecting any national standards in mental health.  Why is this?  Because it can't.  Mental health, like autism, is largely in provincial jurisdiction.  Many provinces have local boards or authorities running programs for both autism and mental health so services are not even consistent across provinces let alone nationally.

Even assuming you could create a strategy and have it implemented by the federal government there is no way all Canadian provinces would accept it and implement it.  It's a fantasy.  Could we change this?  Maybe. We could attempt to change the constitution but we all know how that went last time.  Most constitutional changes in Canada attempt to weaken, not strengthen, the position of the federal government anyway.

Real advocacy in Canada could be a national effort, but it must be directed at the provincial level.  The provinces can legislate in these areas and the provinces have responsibility for them.  A National Strategy for Autism is just a distraction for the real advocacy we need in Canada.

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