Thursday, November 1, 2018

Who's really abusing paid sick days?

Ontario's Bill 148 includes 10 Personal Emergency Leave (PEL) days, the first two of which are paid, and an end to sick notes for minor illnesses. But Ontario Premier Doug Ford considers these minor reforms "disastrous." With his government's proposed Bill 47, Ford wants to bring back sick notes, eliminate the paid days, cut PEL days to eight and restrict them further -- allowing only three for personal illness, three for family duties and two for bereavement. So you better get out your calendar and carefully plan out your medical emergency, family deaths and other unexpected crises for the year.
Health providers, backed by clear medical evidence, had lobbied for seven paid sick days; Bill 148 provided two. But Ford wants to cut these to zero, based on demands from the big business lobby (like the Ontario Chamber of Commerce and the Retail Council of Canada), who claim workers are "abusing" their paid sick days. These claims are based on the common myth that providing paid sick days invites widespread abuse and, therefore, requires medical surveillance.
For example, an article in the Financial Post claimed, "abuse of sick leave policies in the workplace is rampant," driven by every "employee with a sniffle" who wants to get "paid for staying longer at the cottage." It suggested a modest proposal: that employees "will think twice about taking a day off if it costs them a day's pay, or even costs them their job." The article also invoked medical surveillance: "The best way to diminish unwarranted absenteeism is to require those who are not 'totally' disabled from performing any task to show up at work to perform whatever duties the report establishes they are capable of. If the medical reports are still not credible, have an independent examination done."
Unfortunately, this punitive approach to illness is already the norm for minimum wage workers.
Until this year, those at workplaces with fewer than 50 employees could have been fired for taking a single unpaid day off work to deal with a personal emergency. By extending job-protected personal emergency leave to all workplaces, nearly 2 million workers will have job security if their child care falls through, or they have a medical emergency. Millions more gained the legal right to paid sick days for the first time, as Ontario became the first jurisdiction in Canada to provide two paid emergency leave days (sick days) for all workers after only seven days on the job. Among those benefiting from the new provision are thousands of unionized workers who did not previously have the right to paid sick days in their collective agreement.
Unsurprisingly, the opposition to expand paid sick days in Ontario is encountering the same opposition as in other jurisdictions. But where paid sick days have been given a chance, the myths against them have melted, and the evidence has shown that the real abuse doesn't come from employees taking advantage of them but employers not granting them.
Ideology vs. evidence
More than a decade ago, San Francisco became the first jurisdiction in the U.S. to mandate paid sick days for all employees. The big business lobby claimed the sky would fall, but a survey of more than 700 employers and nearly 1,200 employees found otherwise. Despite having access to up to nine paid sick days every year, the average employee used only three -- and a quarter used zero. The most common reasons for using paid sick days were to visit a doctor or dentist, or care for a sick child or other family member -- exactly as the paid sick days were intended -- and this helped parents stay home with a sick child rather than sending them to school to expose others to infection.
Six out of seven employers did not report any effect on profitability, and two-thirds of employers were supportive. "I thought the sick day ordinance could become an excuse for my servers or other employees to call in sick at the last minute and leave shifts unstaffed," said one restaurant owner. "Turns out, that hasn't been a problem at all." This is because paid sick days encourage people to access health care and recover at home, promoting faster and healthier return to work, and greater retention and productivity. Where there was abuse, it was on the employer side: nearly a quarter of employees reported that their employers responded punitively to their illnesses, threatening wage loss or giving fewer hours or worse tasks -- and these abuses disproportionately affected women, people of colour and low-wage workers.
In 2014, New York City expanded paid sick days to 1.4 million employees. This was against the wishes of a small but powerful group: the mayor predicted "deleterious impacts on businesses," and the Manhattan Chamber of Commerce claimed it would add "additional financial burdens." But as a follow up study explained:
"When it was first proposed, critics of the paid sick time law argued that it would lead to a loss of jobs in the City and impose a major cost burden on employers, especially small businesses. They also predicted that such a law would invite widespread abuse by employees. However, as this report shows, these fears have proven unfounded. By their own account, the vast majority of employers were able to adjust quite easily to the new law, and for most, the cost impact was minimal to nonexistent. Indeed, a year and a half after the law took effect, 86 per cent of the employers we surveyed expressed support for the paid sick days law."
As a former chamber of commerce official explained, "I don't know anybody that has actually had to cut people because of this policy. I also thought there might be abuse. But in our case there was absolutely no abuse." This experience was shared by 98 per cent of employers who reported no known cases of abuse, while only 0.3 per cent reported more than three cases. Once again, where there was frequent abuse it was on the employer side:
"While 87 per cent of the employers we surveyed made paid sick days available to some or all of their workers, 13 per cent failed to do so -- a surprisingly high figure given the fact that all those surveyed are covered by the law and required to offer paid sick days. A year and a half after the law took effect, among the employers that provided paid sick days, only 58 per cent offered them to all employees, as the law requires, while 42 per cent provided paid sick days only to some categories of employees."
Making Ontario open for sickness
Doug Ford was elected on a promise to listen to health providers and end hallway medicine. This would mean supporting Bill 148 -- which starts to expand paid sick days, end sick notes, and supports broader social determinants of health by raising the minimum wage and providing equal pay, fair scheduling and easier unionization. But with Bill 47, Ford wants to do the opposite: ending paid sick days, bringing back sick notes, freezing the minimum wage and rolling back healthy labour law. This is not based on medical evidence, but rather big business ideology -- the same ideology that leads Ford to guess that Bill 148 has led to tens of thousands of job losses, when unemployment is actually down.
The evidence is clear that paid sick days increase preventive care while reducing emergency department visits, and protect public health by making it easier for people to recover at home rather than spreading germs in the workplace, and for parents to keep their sick kids at home rather than spreading germs in school. Paid sick days are a key component of public health and there is no evidence that employees abuse them. Where there is abuse, it is by employers not providing them as mandated by law and as required by public health.
As a fourth temp agenda worker has been killed at Fiera Foods, Ford wants to reduce workplace inspections that uncover real abuse, while bringing back the red tape of sick notes to police a problem that doesn't exist. Forcing people with minor illnesses into doctor's offices and emergency rooms just to get a sick note is not only unnecessary but a drain on public health care and a threat to public health.
As the former head of the Ontario Medical Association explained, "you don't want to encourage people who have infectious diseases to go to their doctor's office when it's not necessary. They're in a waiting room with other people, some of them have very serious illnesses like cancer. There are pregnant mothers and children. They're putting those people at risk…[these visits] are expensive, they're unnecessary and they put other people at risk. We don't have the resources in the health-care system to police absenteeism for employers." This was reiterated by the current head of the Ontario Medical Association, who explained that "with flu season upon us, prolonged wait times and hallway medicine, we need to find ways to keep doctor's offices free for patients sick enough to need it. We need to find ways to let people stay home to recover for minor illnesses."
This means expanding rather than ending paid sick days, and policing abusive workplaces rather than sick workers. This starts with defending Bill 148, and revoking Bill 47.
Follow @DecentWorkHlth and visit www.15andfairness.org to take action today.

Friday, October 19, 2018

To end hallway medicine, defend Bill 148


Doug Ford campaigned on a promise to end hallway medicine, but this can’t be done by implementing corporate demands to scrap Bill 148, along with further healthcare cuts. From a higher minimum wage and equal pay, to paid sick days and fair scheduling, to easier unionization, Bill 148 has many health implications—and is part of the process of rebuilding public healthcare and ending hallway medicine.


$15/hr minimum wage and equal pay

To end hallway medicine we need to prevent illness in the first place. As Juha Mikkonen and Dennis Raphael explain in Social Determinants of Health: the Canadian Facts, “Income is perhaps the most important social determinant of health. Level of income shapes overall living conditions, affects psychological functioning, and influences health-related behaviours such as quality of diet, extent of physical activity, tobacco use, and excessive alcohol use. In Canada, income determines the quality of other social determinants of health such as food security, housing, and other basic prerequisites of health…Increasing the minimum wage and boosting assistance levels for those unable to work would provide immediate health benefits for the most disadvantaged Canadians.”


But the minimum wage in Ontario was frozen for 12 of the 20 years between 1995 and 2015, and many have been denied equal pay for equal work—from temp agency workers to contract faculty. This undermines health and disproportionately impacts those concentrated in jobs that pay poverty wages and deny equal pay: Indigenous, migrant and racialized workers, especially women. By raising the minimum wage to $14/hr this year and 15 in 2019, and promoting equal pay for equal work, Bill 148 is an important step towards reducing income inequality and promoting health equity, which keeps people out of hospital. As the Canadian Centre for Policy Alternatives explained, “the minimum wage hike will produce a particularly large benefit for First Nations women in the workforce, 36% of whom will get a raise on January 1, 2019…The effect is similar to the strong impact a $15 minimum wage will have on the incomes of immigrant women, 42% of whom will get a raise.”


Paid sick days and fair scheduling

In order to help relieve overcrowded hospitals, we need to make it easier for people to access primary care, stay home when sick, and work in a healthy environment. Until this year, workplaces in Ontario with less than 50 workers could fire an employee for taking a personal emergency day, and many more workers would lose wages for staying home sick. Without paid sick days, workers are forced to go to work sick, which spreads infection to others. As the Canadian Medical Association Journal summarized, “The Public Health Agency of Canada, the World Health Organization and every major public health body recommend that people stay home from work when they have influenza. Leading medical and public health associations also recommend that people who handle food not go to work when they have gastroenteritis or other contagious diseases. However, many employees cannot follow these recommendations if it means forgoing their wages or risking their jobs… Employees who have access to paid sick leave are more likely to stay home when advised to do so by a physician; employees with no sick leave are more likely to go to work and expose others to infection.”


The lack of paid sick days encourages hallway medicine by making it more difficult to workers access preventive health like vaccinations and cancer screens, and more likely they will rely on off hours visits to the emergency department (ED) rather than their primary health providers during the work day. Which is why the American Journal of Emergency Medicine concluded that “to reduce ED utilization, health policymakers should consider alternative reforms including paid sick leave.”


Unpredictable schedules also make it difficult to keep medical appointments, and are a source of stress that undermines mental and physical health. As a World Health Organization report on psychosocial work hazards explained, “stress at work is associated with heart disease, depression, and musculoskeletal disorders and there is consistent evidence that high job demands, low control, and effort-reward imbalance are risk factors for mental and physical health problems, thereby leading to further strain on public spending for increased costs on healthcare.” These are exactly the sort of precarious jobs that have increased in recent years, especially temp agencies that combine low pay, unequal pay, erratic schedules and no paid sick days: a prescription for injuries and illness, which worsen hallway medicine.


Bill 148 provides 10 personal emergency leave days, the first two of which are paid, and fair scheduling. These are essential to provide a basic level of stability to reduce workplace stress, and to encourage workers to stay home when sick—which allows a faster recovery, prevents the spread of infection in the workplace and to the public, and makes it easier for workers to see their primary health providers rather than relying on the emergency department. As with a minimum wage increase and equal pay provisions, paid sick days especially benefit women—who disproportionately provide child care—and parents with paid sick days are more likely to keep their sick child at home rather than send them to school, which helps prevent infection.


Unionization

Unions have played important roles in supporting healthy wages, promoting environmental and workplace safety legislation that prevents injuries and illnesses, and defending public health systems like Medicare. That’s why governments intent on privatizing healthcare have attacked unions—from Ontario Premier Mike Harris who went after unions in his campaign to close hospitals in the 1990s, to BC Liberal premier Gordon Campbell who slashed wages of health workers in 2000s. As Mikkonen and Raphael explain, “a greater degree of unionized workplaces would most likely reduce income and wealth inequalities in Canada. Unionization helps to set limits of the extent of profit-making that comes at the expense of employees’ health and wellbeing.”


Bill 148 makes it easier for workers to join unions, which helps workers defend healthy wages and working conditions, and contribute to campaigns to defend public healthcare. Recently Gordon Campbell called for privatizing healthcare based on the claim that “health costs relentlessly escalate faster than population growth and far faster than economic growth.” But as the Ontario Council for Hospital Unions explained in their report Hallway Medicine: it Can Be Fixed, “in 2017, real funding per person was still less than in 2008—although the Ontario economy was about 17% larger than it was in 2008 in real terms. The hysteria about runaway health care costs is just that—hysteria. Two-thirds of this dollar cut came from cuts to hospital funding. Between 2010/2011 and 2017/2018 real provincial hospital expenditures were cut 8.3%” It is these cuts that created hallway medicine, combined with broader policies like income inequality, and Ford was elected on a promise to help the situation, not bring further harm.


Defend Bill 148

But the big business lobby Ontario wants to tear up Bill 148 and all of its health benefits. They want to freeze the minimum wage and reverse equal pay provisions—which would maintain poverty wages and income inequality, undermining a key social determinant of health. They want to revoke paid sick day and fair scheduling—which would force sick workers into their workplaces and sick kids into schools to spread infection, and divert patients into overcrowded hospitals rather than primary healthcare. They want to make it more difficult for workers to unionize—which would make it easier to cutback and privatize public services. All of these policies will worsen hallway medicine, under the guidance of Gordon Campbell, just as we head into flu season—and will disproportionately impact Indigenous, migrant and racialized people, especially women.


Bill 148 won’t end hallway medicine on its own, but it is part of broader efforts towards that goal—by promoting the social determinants of health like income equality, supporting public health measures like staying home when sick, and encouraging safe workplaces and public healthcare. If Ford wants to maintain his promises of ending hallway medicine and being premier for the people, then he should listen to the people—from the large majority in the polls who support $15 minimum wage, to the more than 50 actions on October 15 in support of Bill 148, to the rally for public healthcare October 23.






Friday, November 17, 2017

Medicalizing high blood pressure


This week I developed hypertension, not because my blood pressure increased but because new guidelines lowered the threshold for defining what is abnormal. In the US, this has doubled the number of hypertensive women under the age of 45, tripled the number of hypertensive men under 45, and increased the overall rate of high blood pressure from a third to nearly half—and more than half for African Americans. 

But will expanding the definition of hypertension, while keeping its prevention restricted to medications and individual “lifestyle changes,” help mass prevention?

Silent killer

Cardiovascular disease is the leading causes of death but is also preventable because it tends to develop after people have been exposed to risk factors for years. One of the main biological risk factors, high blood pressure, has been called the “silent killer” because people don’t experience any symptoms for years until they suffer a heart attack or stroke. The concern that our bodies are ticking time bombs frequently leads people to go the emergency department in the absence of any symptoms, just because their blood pressure reading is high. But as the saying goes, “treat the patient, not the number.” In the vast majority of cases, hypertension—in the absence of symptoms or signs of organ damage—is not an acute medical problem requiring immediate treatment, but a chronic risk factor requiring prevention.

For decades we’ve known that the risk of cardiovascular disease increases as blood pressure rises, and that normalizing blood pressure can lower the risk. But trying to prevent cardiovascular disease in a population by treating “high risk” individuals, without addressing what determines the population risk as a whole, runs into the problem inherent in this approach. As epidemiologist Geoffrey Rose explained in his article Strategy of prevention: lessons from cardiovascular disease,

“The preventive strategy that concentrates on high-risk individuals may be appropriate for those individuals…but its ability to reduce the burden of disease in the whole community tends to be disappointingly small. Potentially far more effective, and ultimately the only acceptable answer, is the mass strategy, whose aim is to shift the whole population’s distribution of the risk variable.”

But rather than expanding the approach to cardiovascular disease prevention in order to shift the whole population distribution of risk, guidelines have focused instead on expanding the definition of high blood pressure—labeling more people as “high risk” and in need of treatment.

Medicalizing prevention

Whereas hypertension was previously defined as 140/90 (“normal” being 120/80), the 2003 guidelines created the concept of “pre-hypertension”: blood pressure at the upper end of normal (120-139/80-89), which was at risk of becoming high blood pressure. In other words, “pre-hypertension” was a risk factor for a risk factor for a disease. While broadening the concept of risk, treatment remained the same: individual “lifestyle choices” like diet and exercise.

At the same time studies have found that intensive blood pressure lowering can reduce mortality rates in high-risk groups. Much of the discussion of the new guidelines quotes the 2015 SPRINT trial that reduced mortality by lowering blood pressure to 120. But this was in a selected group of patients with previous heart or kidney disease or other high risks, and the small absolute mortality reduction came at the cost of more emergency department visits for low blood pressure and kidney injury. Now this cost-benefit decision in a high-risk group of patients has been generalized to everyone—which will be eagerly received by pharmaceutical and insurance companies. In the same year as the SPRINT trial, the Journal of Insurance Medicine found that “switching to a ‘normal’ reference range of SBP<130 offers superior risk assessment relative to using BP<140/90.” In the latest blood pressure guidelines, “high blood pressure” has been lowered from 140/90 to 130/80, “pre-hypertension” has disappeared, and 30 million Americans have been labeled with a pre-existing condition. If this results in high premiums or reduction in health care coverage, the expansion of diagnosis in the interest of promoting health could could reduce access to healthcare or force more people to chose between medicine and food.

My blood pressure has consistently been in the 130s over 80s—and yet I’ve gone from having normal blood pressure, to having “pre-hypertension” and now having high blood pressure. But isn’t this extra vigilance needed if cardiovascular disease (CVD) continues to be the leading cause of death? As the guidelines state, “hypertension accounted for more CVD deaths than any other modifiable CVD risk factor and was second only to cigarette smoking as a preventable cause of death for any reason.” But the only risk factors considered modifiable are individual diet, exercise, and smoking/alcohol.

The definition of blood pressure has expanded, but the approach to prevention has not. As the former past president of the American College of Cardiology explained “an important cornerstone of these new guidelines is a strong emphasis on lifestyle changes as the first line therapy. There is an opportunity to reduce risk without necessarily imposing medications.” But as the guideline co-author explained, "Yes, we will label more people hypertensive and give more medication, but we will save lives and money by preventing more strokes, cardiovascular events, and kidney failure."

In other words, the only option we have to prevent cardiovascular disease on a population level is to label more people as at risk, and focus control on individual consumption and medicating our internal environment. There must not be any other modifiable risk factor, and nothing else we can do to stop the ticking time bomb. The “comprehensive” 500-page guideline has one paragraph on “environmental risk factor,” which it redefines as diet, physical activity and alcohol consumption. Factors in our external environment—including those that restrict consumption choices and access to medicine—must be irrelevant.

Embodying our world

But hypertension, cardiovascular disease, and every other health issue are not disembodied phenomena, arising spontaneously irrespective of context. As social epidemiologist Nancy Krieger explains, “we, like any living organism, literally incorporate, biologically, the world in which we live, including our societal and ecological circumstances…The concrete reality of embodiment in turn is expressed in biological characteristics, which exhibit both individual and population distributions.”  Hypertension and its complications are not a purely biological phenomena but are intertwined with a number of social, economic and ecological silent killers.

According to last year’s World Health Organization report, Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks, a quarter of all global deaths are due to environmental factors. Modifiable factors such as air pollution, road traffic, occupational exposures, and high demand and low control work contribute to 35% of the total burden of ischemic heart disease and 42% of the total burden of stroke. Looking only at pollution as a cause of illness, this year’s Lancet commission on pollution and health found that “in 2015, all forms of pollution combined were responsible for 21% of all deaths from cardiovascular disease, 26% of deaths due to ischaemic heart disease, 23% of deaths due to stroke”. As it details, pollution influences every aspect of cardiovascular disease—from risk factors like high blood pressure, serum cholesterol and insulin resistance, to the development of atherosclerosis, to emergency department visits and mortality. Surely this should be included in a comprehensive assessment of how to prevent cardiovascular disease.

The disproportionate distribution of environmental pollution, precarious work and stress also help explain the disproportionate rates of high blood pressure in the Black community. Differential rates have been noticed for years but are often reduced to claims of racial difference. The Management of High Blood Pressure in Blacks guideline explains high rates of blood pressure by blaming cognitive factors like “nonbiomedical beliefs,” behavioural factors like less physical activity and bad diets, and physiological factors like different kidney function and salt retention. This focus on inherent biological difference has a long history. As White Coats for Black Lives explains, “biomedical research has historically characterized the very bodies of Black people as being the center of countless diseases, without thinking critically about how socioeconomic disparities and historical institutional discrimination have lead to the disproportionate amounts of disease observed in minority populations.”

Differential rates of blood pressure and other risk factors are not an indicator of inherent biological difference, but are embodied expressions of the totality of social, economic, and ecologic inequalities—which also constrain “lifestyle choices” and access to medicine. The result is higher rates of cardiovascular disease: the embodied experience of racism is literally heart breaking. As Krieger explained:

“Considering the public health problem of increased risk of hypertension in African Americans compared with white Americans, ‘embodiment’ reminds us that a person is not one day African American, another day born low birth weight, another day raised in a home bearing remnants of lead paint, another day subjected to racial discrimination at work (and in a job that does not provide health insurance), and still another day living in a racially segregated neighborhood without a supermarket but with many fast food restaurants. The body does not neatly partition these experiences—all of which may serve to increase risk of uncontrolled hypertension, and some of which may likewise lead to comorbidity, for example diabetes, thereby further worsening health status.”

In a study 20 years ago, she found that anti-Black racism and internalized oppression is a significant risk factor for hypertension: “the blood pressure differences we observed associated with reported experiences of racial discrimination, in conjunction with response to unfair treatment, are on par with or exceed those associated with other cardiovascular risk factors targeted for nonpharmacologic interventions (eg lack of exercise, smoking, and unhealthy high-fat, high-salt diets).”

This does not mean dismissing the power of medicine and the potential of individual choice, but empowering access to healthcare and individual agency by challenging their constraints. If we expand the definition of high blood pressure we should also expand the understanding of its broader causes, and if we lower the threshold for medical intervention we should also lower the threshold for social, economic and ecological improvement. As Rose explained in his book Strategy of Preventive Medicine,

“A population-wide approach can itself operate at either a more superficial or a more basic level. Health education is often only a superficial approach, when it seeks simply to encourage or persuade people to behave differently. A radical approach aims to remove the underlying impediments to healthier behavior, or to control the adverse pressures. The first or medical approach is important, but only the social and political approach confronts the root causes.”


Thankfully there are movements confronting anti-Black racism, climate injustice and precarious work—which can combine with healthcare to both treat the biological expression of high blood pressure and address the social, economic and ecological causes it embodies.

Tuesday, January 5, 2016

Mandela and anti-colonial struggles


Millions around the world are mourning the loss of the symbol of the anti-apartheid struggle, Nelson Mandela. But people are mourning for different reasons. Most are mourning a freedom fighter who spent 27 years in jail for his opposition to colonialism and racism. Most are mourning a symbol of international solidarity, who spoke out against the Iraq War, supported people with HIV/AIDS and likened the Palestinian freedom struggle to his own. But others are using his death to hide the history of anti-colonial struggles and the contradictions of his later life.

Apartheid: a Canadian tradition
According to The National Post, Conservative Prime Minister Mulroney “spearheaded Canadian push to end apartheid in South Africa and free Nelson Mandela.” Mulroney welcomed Mandela into the House of Commons on June 18, 1990, later claiming that “the very notion of South Africa’s apartheid was anathema to me…I viewed apartheid with the same degree of disgust that I attached to the Nazis…I was resolved from the moment I became prime minister that any government I headed would speak and act in the finest traditions of Canada.”

But South African apartheid was based on Canadian tradition. According to Shannon Thunderbird, a Coast Tsimshian First Nations elder, “It is ironic because the Canadian Indian Act formed much of the basis for the oppressive apartheid policies in South Africa. It’s kind of an understood custom and practice that Canada’s Indian Act came to be known as the acceptable role model for apartheid policies and there are books and websites that outline all of this. It’s actually hypocrisy for Canada to stand forward as a kind of bulwark of protest against atrocities going on in other countries while at the same time we turn a blind eye to our own people.” Mulroney welcomed Mandela while the genocidal residential school system was still operational, and two months before sending thousands of Canadian soldiers to confront the Mohawk blockade at Oka.

It is not only the Conservatives whose tributes to Mandela reveal their hypocrisy. Liberal leader Justin Trudeau and former Prime Minister Jean Chretien called Mandela’s life inspiring, but Mandela certainly did not inspire the White Paper. In 1969—five years into Mandela’s incarceration, when Canada still supported South African apartheid—Prime Minister Pierre Trudeau and his Minister for Indian Affairs Jean Chretien proposed the White Paper to forcibly assimilate First Nations. As the Cree activist Harold Cardinal wrote in his book The Unjust Society (exposing Trudeau’s claims of Canada’s supposed “Just Society”), “In spite of all government attempts to convince Indians to accept the white paper, their efforts will fail, because Indians understand that the path outlined by the Department of Indian Affairs through its mouthpiece, the Honourable Mr. Chr├ętien, leads directly to cultural genocide. We will not walk this path.”

Anti-colonial struggles
The Red Power movement emerged to challenge Canadian colonialism and defeat the White Paper, and later solidarity with Mandela and the anti-apartheid struggle swept the country. Mandela was part of a mass movement against apartheid that included student and township uprisings, armed resistance, mass strikes, and international solidarity. South African apartheid depended on black workers for profits, so the wave of unionization—including the founding of COSATU in 1985—provided a powerful weapon to organize strikes of millions against apartheid. It was South Africans themselves who spearheaded the push to end apartheid and free Nelson Mandela, not the “humanitarian intervention”  myths about Mulroney.

But there was widespread solidarity against South African apartheid, which has inspired a similar movement against Israeli apartheid. Which is why Western elites are so eager to detach Mandela from the struggle, counter-posing the South African freedom struggle with other anti-colonial struggles. Prime Minister Harper claims that Mandela “demonstrated that the only path forward for the nation was to reject the appeal of bitterness.” But it was the bitterness of fellow Conservative Rob Anders—who in 2001 called Mandela a terrorist—that best expressed how Western elites view anti-colonial struggles. That this label was imposed on the South African freedom fighters should lead us to challenge the criminalization of other anti-colonial struggles—from Palestine to Tamil Eelam to Turtle Island.

South Africa after apartheid
Mandela’s rehabilitation in the eyes of the elites, from terrorist to inspiration, is not because of newfound solidarity with his anti-apartheid past but rather the neoliberal policies of the ANC government. Reacting to news of Mandela’s passing, the World Bank and International Monetary Fund offered their sympathies to the South African people—sympathies that were lacking when these financial institutions imposed structural adjustment policies.

According to South Africa’s Anti-Privatization Forum and Coalition Against Water Privatization, “The majority of South Africans, made up of the poor and working class, fought and died not just for political freedom from apartheid, but for socio-economic freedom and justice, for the redistribution of all ‘national wealth’…This popular mandate was captured in the Reconstruction & Development Programme (RDP), which formed the basis of the ‘people’s contract’ with the new democratic government. However, it did not take long for the ANC government to abandon that popular mandate by unilaterally deciding to pursue a water policy that has produced the exact opposite result… Following the neo-liberal economic advice of the World Bank, the International Monetary Fund and various Western governments (and heavy lobbying by private multinational water companies, such as Suez and Biwater), the South African government drastically decreased grants and subsidies to local municipalities and city councils and supported the development of financial instruments for privatised delivery. This effectively forced local government to turn towards commercialisation and privatisation of basic services as a means of generating the revenue no longer provided by the national state. Many local government structures began to privatise and/or corporatise public water utilities by entering into service and management ‘partnerships’ with multinational water corporations. The immediate result was a massive increase in the price of water that necessarily hit poor communities the hardest.”

But the struggle for socio-economic freedom and justice, against the ANC government and global, corporations—from the Treatment Action Campaign for people with HIV/AIDS, to the protests outside the UN climate talks at Durban, to the strikes at Marikana and beyond. As Mandela himself said in 1993, “You must support the African National Congress only so far as it delivers the goods, if the ANC government does not deliver the goods, you must do to it what you have done to the apartheid regime.” The best tribute to Mandela is to continue the movement he represented—of anti-colonial resistance, student protests, workers strikes, and international solidarity.

Saturday, December 12, 2015

Photo essay: holiday carolling for decent work


To build holiday cheer, the Fight for $15 and Fairness wage brought carolling outside and inside Toronto's Eaton’s Centre, to celebrate the retail workers who are helping us prepare for the holiday season.

To the tune "Deck the halls":
Now’s the time for fifteen dollars
Fa la la la la, la la la la
We need wages we can live on
Fa la la la la, la la la la
Full time work should keep us healthy
But it’s leaving us in poverty
Now’s the time for fifteen dollars
Fa la la la la, la la la la


Wearing Santa hats, the carollers sang holiday tunes with lyrics of justice

Carollers also distributed leaflets explaining the lump of coal that minimum wage workers get on a daily basis: unstable and erratic hours, no advance notice of weekly shifts, lack of protection for workers who ask for a shift change, and poverty wages. 

To the tune of “silent night”
Workers’ rights, workers’ rights
Everyone, join the fight
Part-time and full-time deserve equal pay
We shouldn’t lose pay to take a sick day
15 and fairness is possible
15 and fairness today



The event then went inside the Eaton’s Centre to support and hear from retail workers 

To the tune of “We wish you a merry Christmas”
We wish you a merry workplace
We wish you a merry workplace
We wish you a merry workplace
With fairness for all
We’re joining the fight, with justice in sight
We wish you a merry workplace,
And a New Year that’s bright


Amidst the speeches and songs there was a banner drop to show all the shoppers the holiday wish list for 2016, calling on Premier Kathleen Wynne to make it her new years resolutions.

To the tune of “walking in a wonderland”:
Premier Wynne, are you listening?
Our resolve is clearly stiffening
We need you to say
You're help make work pay
Fifteen bucks is what we're fighting for.

In the New Year we will ask the premier
What ya gonna do for workin’ folks
She’ll say she supports us but it’s no joke
She need to change the laws that govern work



For more information visit 15andfairness.org