ECON 317 SPRING 2020 – INDIVIDUAL ASSIGNMENT 2 TO BE SUBMITTED VIA COURSESPACES BY 11:59 PM ON JANUARY 28th, 2020

Name (First, Family)

Last 3 digits of SID

TO SPEED UP MARKING, PLEASE ANSWER THE QUESTIONS IN THE FORMS AND SPACES PROVIDED. THE T.A. RESERVES THE RIGHT TO NOT MARK ANY QUESTIONS THAT ARE NOT ANSWERED IN THE EXPECTED LOCATIONS. By submitting this assignment you agree to the following honor code, and understand that any violation of the honor code may lead to penalties including but not limited to a non-negotiable mark of zero on the assignment: Honor Code: I guarantee that all the answers in this assignment are my own work. I have cited any outside sources that I used to create these answers in correct APA style.

Marking scheme – Make sure you answer all the questions before handing this in!

Question Marks

1 a 12

2 a 6

3 a 3

b 3

Total 24

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1. [Reading] Read the following article: Patel, A., Dean, J., Edge, S., Wilson, K. & Ghassemi, E. (2019). Double Burden of Rural Migration in Canada? Considering the Social Determinants of Health Related to Immigrant Settlement Outside the Cosmopolis. International Journal of Environmental Research and Public Health, 16(5), 678. Retrieved from https://www.mdpi.com/1660-4601/16/5/678 This article summarizes the results of other articles, and also explains how the authors searched for and selected the articles that were summarized. Being familiar with this will be useful to you in Group Assignment 2, where you will be asked to do much the same thing on a smaller scale. a. (12 marks) Write a 3-2-1 report using the form provided on Coursespaces. 2. [Analysis] Becker’s rational addiction model predicts that changes in the price of addictive substances will have a strong effect on use of those substances. This was seen in Canada in 1994, when tobacco tax cuts led to increased smoking: “The effect of tobacco tax cuts on cigarette smoking in Canada.” Price is not the only thing that affects addictive behaviour, however. View the following 40-minute documentary on the fentanyl crisis in Vancouver: VICE. (2018, February 15). Overdose Crisis on the US-Canada Border: Steel Town Down [Video File]. Retrieved from https://youtu.be/d2kqgX2KjTY a. (6 marks) Connect the information in the documentary about the nature of addiction, how it affects communities, and/or how communities respond to it, to at least two of Canada’s Determinants of Health (see link for a list of determinants). If you need help with this question, ask! You may contact the instructor for help in person or via e-mail at [email protected]. Determinant I: _____________________________________________________________ Connection to the video:

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Determinant II: _____________________________________________________________ Connection to the video:

3. [Analysis] This question is based on and inspired by Desveaux, L., Saragosa, M., Kithulegoda, N. & Ivers, N. M. (2019). Family Physician Perceptions of Their Role in Managing the Opioid Crisis. Annals of Family Medicine, 17(4), 345-351. Retrieved from http://www.annfammed.org/content/17/4/345.short Consider the following fictional scenario: A family physician in Ontario sees a new patient who has just moved to the province from Vancouver and suffers from chronic pain. According to both the patient and available medical records, the pain has existed for many years, and is expected to last for the rest of the patient’s life. According to the patient, the pain is severe enough that without painkillers, the patient needs to spend most of the day in bed, and is unable to concentrate or work at their job as a software engineer. The patient says that over-the-counter painkillers don’t work, and only fentanyl and other opioids can take care of the pain. The physician confirms from the records that the patient has, in fact, been taking fentanyl by prescription for the last two years. Apart from the pain reported by the patient, there are no other symptoms. Various medical tests across the years have failed to come up with a specific reason for the chronic pain, but this is not unusual in chronic pain patients – the causes of chronic pain are often difficult to pin down and in some cases are poorly understood. Many years ago in medical school, the physician was taught that chronic pain was under-treated, and that best practice was to prescribe painkillers for the patient based on the patient’s self- reporting of their pain. However, the physician is also aware that Vancouver is in the middle of a fentanyl addiction epidemic, and wants to “do the right thing” for both their patient and society.

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Note: Fentanyl, an opioid, is a powerful prescription painkiller that has legitimate uses in treating severe chronic pain. It is also an addictive drug that can easily be abused, and overdosing can lead to death. For more details, see Fentanyl [Web Page]. (2020). Retrieved from https://www.camh.ca/en/health-info/mental- illness-and-addiction-index/street-fentanyl a. (3 marks) Suppose the physician continues the treatment that the patient was on in Vancouver, and prescribes a three-month supply of exactly the same dosage of fentanyl as the patient was receiving in Vancouver. After three months, the patient has to come back for another appointment, and to renew the prescription, as appropriate. In this case, would the physician be acting as a perfect (or close to perfect) agent for the patient? Why or why not? Use material from Lecture 6 in your answer. Perfect or nearly-perfect agency with regard to the patient? Yes/No Why or Why not?

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b. (3 marks) Arguably, physicians in Canada do not only have a duty to their individual patients, but also to the health care system and Canadian society as a whole. Suppose that, as in part a., the physician decides to continue the fentanyl treatment the patient was on in Vancouver. In this case, is the physician acting as a perfect (or close to perfect) agent for the health care system and society as a whole? Why or why not? Use material from Lecture 6 in your answer. Perfect or nearly-perfect agency with regard to the health care system/society? Yes/No Why or Why not?