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A Canadian high blood pressure study sees ‘exciting’ early results as investors bank on healthy returns

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It is early days, but investors in a unique health promotion experiment are bullish.

A six-month regime of personal coaching, exercise and healthy eating sponsored by the Heart and Stroke Foundation of Canada has succeeded in keeping blood pressure in check — without drugs — for several hundred Toronto-area adults at risk of developing hypertension.

Doug Purdy, 73, walks his Wheaten terrier Chloe near his home in the Keele and Finch area. Purdy says he’s lost 16 lbs. since he signed up for the Heart and Stroke Foundation's Activate program aimed at curbing high blood pressure.
Doug Purdy, 73, walks his Wheaten terrier Chloe near his home in the Keele and Finch area. Purdy says he’s lost 16 lbs. since he signed up for the Heart and Stroke Foundation’s Activate program aimed at curbing high blood pressure.  (Richard Lautens / Toronto Star)

The three-year, $3.4 million project that will eventually involve 7,000 participants in the GTA and Vancouver was launched last year as Canada’s first health-related social impact bond, or “pay-for-success” initiative.

Results for the first 500 enrolled last May are “very exciting,” says Heart and Stroke senior manager Erin Kim, who is leading the “Activate” project in partnership with the MaRS Centre for Impact Investing.

Eleven private investors, including businesses, charitable foundations and wealthy individuals, are funding the initiative through the MaRS Centre. The Public Health Agency of Canada will pay up to $4 million depending on how many participants are recruited, complete the program and see their blood pressure stay the same or go down.

Hypertension is the leading cause of stroke, a key risk factor for heart disease and one of the most common reasons for a person to see a doctor and be prescribed a drug, says Kim. It affects more than 6 million Canadians and costs the health-care system more than $14 billion a year.

Left untreated, half of Canadians over 60 with blood pressure in the “high-normal” range (121-139 systolic/80-89 diastolic) will develop hypertension within four years.

In the first cohort, more than 90 per cent stuck with the program for the full six months. And blood pressure readings for a sample of 100 of the first 500 participants showed an average 5.2-point drop. It means some participants moved their blood pressure readings from “normal-high” to “normal” — a significant finding for a drug-free intervention, researchers say.

Heart and Stroke is enrolling its second cohort of 4,100 participants from across the GTA between January and May. Another 2,400 participants in Vancouver will be signed up in 2020.

If the prevention initiative keeps average blood pressure stable for all 7,000 participants during the six-month program, Ottawa will pay the MaRS investors a return of 6.7 per cent. If the program overshoots this target and average blood pressure goes down, investors will receive an 8.8 per cent profit, or $600,000 in total. If the program fails to meet its goals, investors lose most of their money.

“Health promotion is hard. But it’s much better for individuals and society to adopt healthy lifestyle changes and prevent high blood pressure and the need for medication,” Kim says. “And that’s what this program is trying to demonstrate.”

Most of the support is provided through the Heart and Stroke’s “Activate” website and a specially designed app which includes coaching, health information, recipes, mindfulness training and goal setting, says Kim.

Participants with elevated blood pressure must be over 40, non-diabetic and not on medication for hypertension. Once enrolled, they are encouraged to keep a daily log of what they eat and how much exercise they get. The program includes free access to a Loblaws dietitian, a two-month YMCA membership and opportunities to meet others enrolled in the project through periodic community events. Participants receive PC Optimum Points as a reward for healthy behaviour.

The six-month program aims to help participants make “small, healthy choices” to help prevent the onset of high blood pressure, Kim says.

Toronto retiree Doug Purdy, who lost 16 lbs. “and two belt loops” between May and October, says the program changed his life.

“I always had good intentions about exercising. But this helped me get with the program,” he says.

Purdy, 73, credits his Wheaten terrier Chloe and a new exercise partner he met at the YMCA for keeping him on-track. He became so accustomed to working out at the Y, that he took out his own membership when the two-month free trial was up.

“My blood pressure is down to normal now,” he adds.

Regular exercise, along with healthy shopping and eating also produced positive results for Mississauga accountant Babatunji Farinloye, 50.

“I had a health club membership, but this program really helped me develop a habit,” he says. “Now, if I don’t work out, my body feels like something is wrong.”

A grocery store tour along with instructions from a dietitian on how to read product labels, “was a real eye-opener” Farinloye says.

“No more white bread,” he says with a laugh. “I am eating a lot more vegetables, especially colourful ones.”

Mississauga accountant Babatunji Farinloye, 50, says he's happy with the positive results produced by regular exercise and healthy eating since he became part of the Heart and Stroke Foundation's Activate project.
Mississauga accountant Babatunji Farinloye, 50, says he’s happy with the positive results produced by regular exercise and healthy eating since he became part of the Heart and Stroke Foundation’s Activate project.  (J.P. MOCZULSKI)

Elementary school teacher Teresa Galati, 56, says the program has helped her manage stress — and her elevated blood pressure.

“I have learned how to take time to meditate and it really helps,” she says.

Galati found the personal coaching particularly useful.

“I was able to go online and ask questions and even if my coach wasn’t available, someone always got back to me,” she says. “If you don’t have time to meet with someone, it’s great to be able to go online. It was phenomenal.”

Investors are also happy.

“We are very pleased with how the first cohort worked,” says MaRS director Adam Jagelewski. “We are setting ourselves up for the second and third cohorts that will ultimately dictate whether investors will get their returns or not.”

While some critics say government should not be paying a “middle man” to deliver public health and social services, Jagelewski says the pay-for-success premium makes everyone involved work harder and allows public officials to show taxpayers what their money has been able to accomplish.

“It doesn’t have to be a social impact bond,” he says. “Outcome-based contracts that have rigour around outcomes-based measurement are where we ought to be going generally.”

A social impact bond using private investors to take on the risk is just one way to do it. Governments could just as easily take this approach, he adds.

“The question is how can we learn from the way this program was designed and apply it to diabetes and other chronic disease and even mental health and addictions,” he says. “I’m hoping this program is a beacon of light for preventative programs across the board.”

As Heart and Stroke gears up to enrol its next cohort, the foundation is inviting employers, unions, health care providers, community associations and other groups to encourage their staff, members, patients and clients to join the free wellness program. Staff from Loblaws, Shoppers Drug Mart and CAA Club Group have already participated and Deloitte and others are on board for the next cohort, Kim says.

For employers with more than 500 staff, Heart and Stroke will send volunteers to the workplace to measure blood pressure and enrol those who qualify. Those who don’t qualify still get access to the foundation’s health resources and a free two-week YMCA membership.

“As everyone knows, a healthier workforce is a happier workforce, with less days off etc.,” Kim says. “We are really keen to know if corporations would spread the word for us because it could really benefit them too.”

Laurie Monsebraaten is a Toronto-based reporter covering social justice. Follow her on Twitter: @lmonseb

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‘Business as usual’ for Dorel Industries after terminating go-private deal

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MONTREAL — Dorel Industries Inc. says it will continue to pursue its business strategy going forward after terminating an agreement to go private after discussions with shareholders.

« Moving ahead. Business as usual, » a spokesman for the company said in an email on Monday.

A group led by Cerberus Capital Management had previously agreed to buy outstanding shares of Dorel for $16 apiece, except for shares owned by the family that controls the company’s multiple-voting shares.

But Dorel chief executive Martin Schwartz said the Montreal-based maker of car seats, strollers, bicycles and home furniture pulled the plug on a deal on the eve of Tuesday’s special meeting after reviewing votes from shareholders.

“Independent shareholders have clearly expressed their confidence in Dorel’s future and the greater potential for Dorel as a public entity, » he said in a news release.

Dorel’s board of directors, with Martin Schwartz, Alan Schwartz, Jeffrey Schwartz and Jeff Segel recused, unanimously approved the deal’s termination upon the recommendation of a special committee.

The transaction required approval by two-thirds of the votes cast, and more than 50 per cent of the votes cast by non-family shareholders.

Schwartz said enhancing shareholder value remains a top priority while it stays focused on growing its brands, which include Schwinn and Mongoose bikes, Safety 1st-brand car seats and DHP Furniture.

Dorel said the move to end the go-private deal was mutual, despite the funds’ increased purchase price offer earlier this year.

It said there is no break fee applicable in this case.

Montreal-based investment firm Letko, Brosseau & Associates Inc. and San Diego’s Brandes Investment Partners LP, which together control more than 19 per cent of Dorel’s outstanding class B subordinate shares voiced their opposition to the amended offer, which was increased from the initial Nov. 2 offer of $14.50 per share.

« We believe that several minority shareholders shared our opinion, » said Letko vice-president Stephane Lebrun, during a phone interview.

« We are confident of the long-term potential of the company and we have confidence in the managers in place.”

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Anglais

Pandemic funds helping Montreal businesses build for a better tomorrow

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Many entrepreneurs have had to tap into government loans during the pandemic, at first just to survive, but now some are using the money to better prepare their businesses for the post-COVID future.

One of those businesses is Del Friscos, a popular family restaurant in Dollard-des-Ormeaux that, like many Montreal-area restaurants, has had to adapt from a sit-down establishment to one that takes orders online for takeout or delivery.

“It was hard going from totally in-house seating,” said Del Friscos co-owner Terry Konstas. “We didn’t have an in-house delivery system, which we quickly added. There were so many of our employees that were laid off that wanted to work so we adapted to a delivery system and added platforms like Uber and DoorDash.”

Helping them through the transition were emergency grants and low-interest loans from the federal and provincial governments, some of which are directly administered by PME MTL, a non-profit business-development organization established to assist the island’s small and medium-sized businesses.

Konstas said he had never even heard of PME MTL until a customer told him about them and when he got in touch, he discovered there were many government programs available to help his business get through the downturn and build for the future. “They’ve been very helpful right from day one,” said Konstas.

“We used some of the funds to catch up on our suppliers and our rents, the part that wasn’t covered from the federal side, and we used some of it for our new virtual concepts,” he said, referring to a virtual kitchen model which the restaurant has since adopted.

The virtual kitchen lets them create completely different menu items from the casual American Italian dishes that Del Friscos is known for and market them under different restaurant brand names. Under the Prasinó Soup & Salad banner, they sell healthy Greek options and their Stallone’s Sub Shop brand offers hearty sandwiches, yet the food from both is created in the same Del Friscos kitchen.

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Downtown Montreal office, retail vacancies continue to rise

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Some of downtown Montreal’s key economic indicators are heading in the wrong direction.

Office and retail vacancies in the city’s central core continued to climb in the fourth quarter of 2020, according to a quarterly report released Thursday by the Urban Development Institute of Quebec and the Montréal Centre-Ville merchants association. The report, whose first edition was published in October, aims to paint a socio-economic picture of the downtown area.

The survey also found office space available for sublet had increased during the fourth quarter, which may foreshadow even more vacancies when leases expire. On the residential front, condo sales fell as new listings soared — a sign that the downtown area may be losing some of its appeal to homeowners.

“It’s impossible not to be preoccupied by the rapid increase in office vacancies,” Jean-Marc Fournier, the former Quebec politician who now heads the UDI, said Thursday in an interview.

Still, with COVID-19 vaccinations set to accelerate in the coming months, “the economic picture is bound to improve,” he said. “People will start returning downtown. It’s much too early to say the office market is going to disappear.”

Public health measures implemented since the start of the pandemic almost a year ago — such as caps on office capacity — have deprived downtown Montreal of more than 500,000 workers and students. A mere 4,163 university and CEGEP students attended in-person classes in the second quarter, the most recent period for which figures are available. Border closures and travel restrictions have also brought tourism to a standstill, hurting hotels and thousands of local businesses.

Seventy per cent of downtown workers carried out their professional activities at home more than three days a week during the fourth quarter, the report said, citing an online survey of 1,000 Montreal-area residents conducted last month.

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