Public health in the June news: Overdiagnositis, poverty, tobacco, health system, UV and Hep B

It is only through your readership that this blog can continue.  The diversity of readers has shifted with less than half being the target from Canada for which the blog is written.  Please provide feedback at drphealth@gmail.com follow on twitter @drphealth.  You can also follow by email by linking at the lower left hand corner however statistics are not collected and may skew away from actual readership.  Better, join the followers on the link at the lower right hand corner.   Comments are encouraged and feedback very welcomed.

The monthly popular review of what’s hot in public health.  

Overdiagnositis   DrPHealth was one of numerous commenters on the risks of overscreening DrPHealth May 14 in relation to the release of prostate cancer screening recommendations that clearly identified unintended risks as a point of concern.   BMJ continued the barrage and expanded the conversation to the whole issue of overdiagnosis.  The well written commentary clearly puts the risks of the health care system as a significant cause of avoidable mortality and morbidity.  BMJ overdiagnosis    You are referenced specifically to the estimated overdiagnosis rates noted in Table 1.  Follow this debate over the next few years.  Those who work in the system are likely very familiar with both the problem, and the avoidance behaviour demonstrated by professionals who see errors of omission as more problematic than errors of the system. “Better to have tried and failed than to not have tried at all” (often paraphrased from Tennyson)

Poverty report card  From Ontario is a report card on progress towards implementing the provincial poverty reduction action plan.  Long on baseline data and short on evidence of progress – the report card at least is an attempt to keep the issues alive and on the public agenda.   Timing is everything as the baseline data are prerecession, and the evidence shows as much the impact of the recession as efforts to ameliorate poverty.  Keep it up. Ontario poverty report card

Tobacco control report card   Out of BC and with a regional bias, hidden in the report card are some great provincial comparisons.  Jump to the appendices and see how provinces and territories stack up.  While BC is the basis, it is very useful information on performance against best practices.   The relative arbitrary grading detracts from the value of the report card as the gradings are based on rank ordering rather than progress towards the best practices. Tobacco control report card

Health Council of Canada 2012 report card: This is only included here as an example of how what gets measured gets managed.  The HCC has failed to record the unintended consequences of focusing on a limited number of doable actions - one of which has been the erosion of public health in order to shift resources to the fields flagged in by the Council.  The document is filled with political platitudes and lacks depth amongst the verbosity (including the jurisdiction analysis which do not provide for comparability between provinces.  Time to step to the plate and provide a true report card on the state of health in Canada.  Health Council of Canada 2012 report 

Effectiveness of UV index  Canadian weather risk communication was the subject of a disappointingly underread series in DrPHealth in January  Weather that kills  and Community health and weather risks.  Disappointing as these are likely definitive synthesis of the subjects that are not available anywhere else.   Many tools for communicating weather risks are substantially Canadian or Canada has played a major role including Wind chill factor, Humidex index, the Air Quality Health Index and the Ultraviolet Index.  A substantive question is on the relative benefit of such tools which are the mainstay of weather forecasters and TV weatherpeople.  The entry is a review out of Germany of the known effectiveness of the UV index and suggesting relatively low awareness and behaviour change impact.  Not surprising as what other indices show is that they don’t seem to affect decisions today, but the cumulative messaging can result in substantive behaviour changes and long term risk reduction – clearly an area for lots of study.  Review of UV Index

Prevention of perinatal Hepatitis B transmission:  Just to slip in something is a potential practice change.  The traditional approach to babies born to mothers known to be Hepatitis B antigen positive has been the provision of Hepatitis B Immunoglobulin.  A proposed alternative approach is the provision of lamuvidine (antiviral) during late pregnancy and showing good results, comparable or better than HBIG provision. Warning the review article is not the easiest to read  Lamuvidine vs HBIG for perinatal Hep B transmission .