PHM-North America was excited to hear about a movement against privatization of health services closer to home in Alberta, Canada. Friends of Medicare sprung to action when they learned of a proposal to outsource laboratory services to a private company. We spoke to Sandra Azocar, executive director of the organization, to learn more about their mobilization.


Sandra Azocar is the executive director of Friends of Medicare in Alberta, Canada. Prior to becoming executive director, she’d been a board member of the organization representing the Alberta Union of Provincial Employees (AUPE), the largest union in Alberta with over 98,000 members, a majority of whom are involved in direct healthcare delivery. As the vice president of the AUPE, Sandra was well aware of challenges health workers face and issues that needed to be resolved.  

Knowing the importance of public healthcare is something that drives me everyday to protect it to make sure that, as we made a pledge in Canada over 50 years ago, no Canadian would ever have to die because they can’t afford healthcare and that no Canadian would ever have to go bankrupt because they can’t afford health care. –Sandra Azocar

Background

Friends of Medicare works to promote the protection and expansion of public health services across the Canadian province of Alberta. It is a coalition of individuals, service organizations, social justice groups, unions, associations, churches and other organizations with the aim of raising public awareness on issues related to Medicare in Alberta and across Canada, in partnership with similar organizations in provinces across the country through the Canadian Health Coalition. One of the key issues it focuses on is privatization of health services, and in this specific case privatization of laboratory services.

When this campaign began, a conservative government had been in power in Alberta for 40 years. Throughout this time, the government had been chipping away at public health care through developing new tiered systems of healthcare provision and through privatization, including contracting out laboratory services to the private sector. 

In 1994 the government of Alberta spent CAD 12 million to build a state-of-the-art, full-service laboratory at the Royal Alexandra Hospital in Edmonton, a public hospital run by AHS. However, just two years later in 1996, the government contracted out these services to a private company. This decision changed the status of the lab from full-service to “rapid response” [meaning that the lab would only provide certain services]. This led to protests by lab workers and, ultimately, the resignation of John Jacques, chief of laboratory medicine at the hospital, who stepped down in protest of the decision to privatize. He said: “The government was very determined to privatize and their decision had not much to do with economics or with patient care.” 

In 2006, the partnership between corporations and the public sector to run lab services was declared a failure as corporations pulled out and all lab services returned to Alberta Health Services (AHS). But once the labs were in the public sector, they were never given priority as far as expanding their capacity or improving their technology.

In 2013 AHS issued a request for proposals for running the labs. Sonic Health, an Australian company won the bid and, with the award of a CAD $3 billion contract, would become the provider of lab services for AHS in 2014. The government never justified this action, and the process was not transparent. A reasonable case as to why further privatization of laboratory services was necessary was never presented, and, further, there was a lack of consultation and involvement of concerned citizens and health workers in making this decision.   

In response, Friends of Medicare began to form their campaign to stop privatization of the lab.

How did they do it?

Friends of Medicare was able to use a range of tactics in this campaign, from different ways of awareness-raising activities to targeting political leaders. 

Research

At the outset, Friends of Medicare took time to research the companies who submitted proposals to run the lab services. This research showed that most companies that had submitted proposals were multinational corporations seeking to expand their global operations. And historically, companies had used Alberta as an entry point the Canadian healthcare market, as had happened with home care and seniors care. The research of Friends of Medicare showed that this thinking from corporations held true as Sonic Labs, which ultimately won the contract, reported to shareholders that size of the contract and the potential to generate profits made this an attractive opportunity to enter into the Canadian market.

Friends of Medicare also looked into the track record of companies in terms of the services they provide which revealed a checkered histories. One of the companies that submitted a proposal actually had outstanding litigation concerning failure to provide services at a level of quality Canadians would expect. As this level of quality was already being delivered at public labs the question remained: Why was this privatization necessary? 

Why would we be willing to give up the track record of excellence that we had in our public system for corporations that had some serious concerns that were being addressed through litigation? –Sandra Azocar

Bringing stakeholders together

The many member organizations and partners involved in Friends of Medicare have a range of expertise and priorities, which may suggest difficulty in concerting focus on a single issue. However, Sandra highlighted that all of these partners joined Friends of Medicare because they share the value of strengthening the public health system. And from that common ground they act strongly and cohesively. 

The structure of Friends of Medicare facilitated stakeholders being able to quickly organize and do important outreach and organizing for this campaign. The organization’s board consisted of union representatives, so they rallied their members to join the campaign. These groups came together to organize workers they represent and helped those workers understand what privatization would mean for them, and for the health system. Friends of Medicare also organized directly with health professionals, such as pathologists, who were eager allies to the cause.

Raising awareness and educating the public

Friends of Medicare quickly saw that the role that laboratories play in healthcare delivery was not widely understood by the public. They put together background information and organized town halls to raise awareness among the public. They also used petitions, and the interactions with the public in gathering signatures, to spread the word about the privatization proposal.

Developing background information. Friends of Medicare collaborated with partners to gather as much information as they could to distribute to the public. Backgrounder blogs for websites and posts on social media helped people understand the changes that would come with privatization of laboratory services. They also condensed information in the backgrounder to develop pamphlets and consistent talking points to deliver at any event they attended. Organizers took care to ensure that any information they distributed was at everyone’s level of understanding, not only academic articles, so that everyone they came in contact with left with a clear understanding of what they stood to lose if the privatization went forward.

Town hall meetings. The campaign organized town hall meetings for the community. At these town halls, speakers would talk about the importance of laboratory services, explaining, for example, that 70% of care relies on test results that come from labs. They made sure to invite pathologists and frontline workers who had direct experience with the system to the town hall meetings, not only policy experts and academics. These workers’ unique first-hand knowledge and expertise put them in a position to clearly explain how the system worked and why it was important to keep labs under the public system. Friends of Medicare is also part of the Canadian Health Coalition, a nationwide organization, and were able to rely on those connections to bring in perspectives from other parts of the country to the town hall meetings.

Canadian Health Coalition is a coalition of healthcare workers, seniors, unions, community organizations, faith-based organizations and academics across Canada. They are also a national umbrella organization, bringing together the provincial healthcare coalitions. They speak out against privatization of health services and advocate for strengthened public health care in every province. As a member of the Canadian Health Coalition, Friends of Medicare was able to rely on this nationwide reach to draw on further research and experiences of privatization taking place in other parts of the country. They used this information in the material they distributed and invited speakers with experience of privatization in their own provinces to their town hall meetings. This connection with a larger organization with more resources to collect nationwide research and with connections to people in different provinces heavily benefited this campaign.

It’s being able to create those relationships with various experts in the area that you’re trying to target so that you have the ability to kind of share facts and things that you can prove as experiences. Because sometimes people just don’t want to look at numbers. They want to see whether or not it has worked in other places. Albertans are really good at saying it worked [in other places] but they don’t understand sometimes that the political landscape, the economic landscape, or the government landscape is completely different. So, what we have always maintained is that we need to find solutions that are based on the Canadian reality and, for us, even more, based on the Alberta reality of what it is we need to do to improve our public system.  –Sandra Azocar

Petitions. Friends of Medicare worked to raise awareness through petitions that called for halting the privatization process in order to protect lab services. In the end they collected over 22,000 signatures. 

It was a two-fold thing…trying to get the workers to understand their role in this fight and trying to get the rest of the population to understand the importance of the services and the role that the workers play in this part of our healthcare. -Sandra Azocar

Media

The group used the media as much as they could to highlight key points that were broadly understood: the lack of transparency of the decision making and the profit and growth motives driving the companies. 

People respond to that financial information. We let them know that, for example, the year that [Sonic Labs] won the contract their financial reporting indicated that they had lost an incredible amount of money in Australia that year because flu season had been so bad for them financially…not enough people had gotten sick for them to be able to make a profit. People know that trying to benefit or making any kind of profit from the poor health of others just goes against the values that we hold as Canadians. –Sandra Azocar

Albertans have always known that we can’t afford private healthcare and that this opens the door for the possibility of a whole bunch of things that ultimately impact our ability to receive healthcare based on need and not on ability to pay. –Sandra Azocar

Despite all actions Sandra noted that the government in power at the time was set on privatizing the laboratory services and would not budge.

Targeting those in power

When the campaign began, the conservative government was in power and had initiated the process of privatization. However, during the campaign elections happened and the government that came into power supported keeping the labs in the public health system. The change in government necessitated a change in strategy to push the campaign’s agenda forward.

Persuading opponents at the outset of the campaign

There was never an opportunity to engage with the conservative government. Thus, the campaign relied heavily on the media to communicate their messages to those in power. They also circulated petitions, gathering signatures to show support for keeping labs in the public sector. In particular, Friends of Medicare also placed a lot of political pressure on the conservative government’s Minister of Health to stop the laboratory privatization. They held two rallies at his office to bring attention to the issue and express their displeasure with the move toward privatization. 

The group did a door-to-door knocking campaign in the electoral district of the Minister of Health to explain directly to his constituents what was happening and why it was important for Albertans to stand up to protect public laboratory services. They also contacted Friends of Medicare members in districts where the Member of the Legislative Assembly (MLA) was in a greater position to make policy decisions to ask them to meet with their MLA directly to express their concerns about privatization. 

Working with allies after the change in government

At the beginning of the campaign, the New Democratic Party, which would support improvement and expansion of public health services, was in opposition in the provincial legislature. Friends of Medicare built relationships with and worked very closely with these lawmakers. They provided them research on the companies that had submitted bids to support concerns they raised in the legislative assembly.

After the 2015 election and change in government, Friends of Medicare were in a position to collaborate with those who’d come to power and were able to communicate what they expected. They worked hard with government officials to get a sense of the direction they would go with the new governance structure and what that meant for the health system. The new government decided to create a new public structure to oversee the laboratory services, and this was not exactly what Friends of Medicare wanted. So, while working with the new government, Friends of Medicare also continued to rely on media and direct pressure on decision makers to spread their message and vision for the place of laboratory services Alberta’s public health system.

Engaging around the election

Sandra noted that the large number of people reaching out to politicians to say that privatization was not the direction they should be going made these politicians take a step back and rethink their decisions. The New Democratic Party included as part of their election platform ending expensive experiments in privatization, and Sandra identified Friends of Medicare’s work raising awareness around the issue played a role in that and validated some of their concerns and platform directions. 

During the election, Friends of Medicare organized a door knocking campaign in the district of the health minister, who at this point was appointed and had not yet been elected. Although the district is a high-income neighborhood, people seemed to understand the importance of the campaign against privatization of laboratory services. This door knocking campaign was different because they were not for/against a politician or party but were for an issue and sought to share information and answer questions about that. For many of the people Friends of Medicare spoke to it was their first time hearing of the importance of lab services. Friends of Medicare campaigners in this district asked people to get in touch with their Member of Legislative Assembly, who has a duty to meet with constituents, and express their concern and disapproval of the plan to privatize laboratory services.

The actions we led…they always have an impact on politicians because I don’t think they ever see the light they basically feel the heat. And when they have so many people standing there basically saying this is not the direction they should be going, they kind of take a step back and rethink it. –Sandra Azocar

Reflecting

In May of 2015 provincial elections brought the New Democratic Party to power, and they halted privatization of the labs, cancelling the contract with Sonic Labs. The province saw expansion of public health services, specifically around laboratory services. But this lasted for only about four years when another conservative government came to power after the next elections. This new government again threatens a shift back to privatization.

Past lessons that were useful in this campaign

Friends of Medicare makes sure not to lose sight of history so it doesn’t repeat. They make sure to recall  past experiences to drive home an understanding that some politicians don’t evolve and see the world in terms of profit and a privatization agenda.

Over the years we definitely have learned the difference between being proactive and reactive…We have an understanding of the processes of what has led us to where we are today. History is very important in terms of understanding some of the political decisions that have been made over the years and how we learn from those experiments. And most of them have privatization experiments that have always resulted in taxpayers having to pay these corporations out because they no longer want to be here or because they want to move on to bigger and better things. –Sandra Azocar

What worked well

Creating easy to read pamphlets and other material to hand to the public. Importantly, Friends of Medicare took into account that a lot of the people they work with are seniors and may not be computer literate. Having printed information was also important for those living in areas without good access to the internet. 

The door knocking campaign worked to make politicians be accountable to the people who elected them directly. Friends of Medicare made their constituents aware of what politicians were doing and made sure that the politicians knew that their constituents had an eye on them. 

Friends of Medicare was able to do targeted outreach. They reached out to supporters and members of member-organizations living in the districts of politicians to ask that they meet with their representative in government and others who might have decision-making power.  

Talking directly to people, one-on-one, was important for this campaign. Although Alberta is considered to be a conservative province, it was clear that people shared the same values as Friends of Medicare. They understood what was on the line and it meant if they lost an integral part of the health system. 

Working with frontline works and unions

Sandra explained that the roles and messages of Friends of Medicare’s labor partners play different roles in their campaign efforts. While unions focus directly on issues such as job security and workers’ pay, Friends of Medicare are able to mobilize people by highlighting the significance of the work that frontline workers provide to the health system. 

What we like to do is actually talk about the importance of the work that these frontline workers provide. The importance that they’re well-resourced, that they’re well-staffed, that they’re well-trained is huge. So that’s how we focus it…we value very much what each of them does on behalf of Albertans. So when we talk to them, when we have them involved in any kind of action that we undertake, it’s with that lens. To thank them for the importance of the work and to fight for their role in our public health care system. –Sandra Azocar

Importantly, through this campaign Friends of Medicare was able to build new relationships with professionals in the area and developed their ability to coordinate their work with them. Many professionals spoke out publicly, in the media against the privatization effort, and Friends of Medicare was able to reach out to them to align their efforts. They also saw the importance of broadening their reach, for example to seniors groups in order to make sure information circulates in those communities. Sandra envisions these new stakeholders and relationships being central to the success of future campaigns.  

The fight continues!

In 2019 the new conservative government in Alberta immediately stopped the construction of a public lab touting that they had stopped “nationalizetion” of the labs, and the new premier has said that the province is “open for business.” So, Friends of Medicare’s fight against privatization continues. Experiences from this previous campaign, Sandra noted, will be valuable. 

I think a lot of people like to believe that healthcare delivery is not an ideological thing but if you look at any kind of government and the way that they govern, it is purely ideological. And it’s unfortunate that health policy has to be done in this way…it’s never good when you take from the ability to provide timely and quality services and just base it on your worldview without really understanding the unintended consequences of what it is your policies will be doing. So, in a lot of ways we are back to square one, in a lot of ways we’re not because we have the experience of fighting this and now we have a lot more friends. –Sandra Azocar

In thinking about how similar struggles against privatization have continued for decades in countries around the world, Sandra acknowledged that activists may feel discouraged and lose heart when a struggle continues with seemingly no success. She notes that Friends of Medicare has been around fighting the same fight for 40 years, but what drives her is that healthcare is something that impacts absolutely everyone throughout their lives, including for future generations. Sandra says this responsibility is what motivates her and health advocates she works with to keep fighting, even when it seems they are back to square one.

There’s so many times where you feel like you’re banging your head against the wall but at the end of the day when you look at those around you–when you look at your family, when you look at community members–and the importance that healthcare has, it allows you to re-energize and continue this fight.  –Sandra Azocar

Resources

Canadian Health Coalition

Friends of Medicare