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Tuesday, 30 October 2012

CPHO 2012 report released on Sex and Gender: A silent release.

David where are you?    

On Friday October 26th, the Chief Public Health Officers 2012 report was released.  No press release, no media attention, no public communication.   We know you better than that.  While your health has been assaulted this year, we know you have been active in many areas.  But, this is not the first year either.   Once again, your major document outlining the dominating health issues in Canada is silently posted to your website, with no effort to publicize its existence.

Are you so quashed by federal communications folks as to truly be painted as suffering the very intimidation that this site spoke to at Intimidation, politicians and public health professionals?  You are admired and respected across the country, and have left legacies of benefit from across the country.  DrPHealth has followed your rise from Barrie, through your home roots in Saskatchewan and back to the hallowed halls of Ottawa.  Your tenure as president of CPHA was one of the most fruitful and impactful.  You are a master of the public health professions.

Have the federal bureaucrats handcuffed you to the point of impotency?   And while awaiting translation has a measurable impact on public release of federal documents, the material is available in both official languages from time of release. 

Ranting aside, it takes bravado to release a report on sex and gender in the environment that you are working. The fundamental perspective being that of recognizes sex and gender as a determinant of health, and discussion of its known contribution.  The burden carried by males and females in society. 

The report opens with a general discussion of the state of public health in Canada.  Mixing the good and the bad, and highlighting the impact of the recession, the widening gap between rich and poor and updating knowledge on risk taking behaviours. 

The provocative discussion that follows in part 2 recognizes the impacts of sex and gender, discusses sexual health  in a frank and dispassionate fashion, and speaks to the diversity of sexual practices.  Notable is the lack of visual aids such as charts and graphs.  The differences are buried in the text and require careful reading.  Is it politically unacceptable to flag the plight of single mothers? Gay men? Transgendered individuals? Stigmitized persons with mental illness?

The full report is found at 2012 CPHO report on Sex and Gender.  Previous reports are found at CPHO annual reports.  

While the efforts to speak on behalf of the health of Canadians of Dr. Butler-Jones should be commended,  there is a need for a significant reprimand for the inability to speak out on these very issues.   Somehow it is not surprising given the current government, the comparable lack of communication from Minister Aglukkaq, and the prevailing communications trend from government that the best news is not to be in the news, but it is not an excuse for not doing your job.  

Monday, 29 October 2012

Influenza vaccine suspension: Special posting: Politics trumping Public Health

Those on the inside of the vaccine distribution system and following the Novartis Fluad® and Agrflu®  product “suspension” are shaking their heads.   Why?  

At a time when influenza vaccine has become the lightening rod for anti-immunization rhetoric, it is fuel on the fire.  

The Canadian logic appears to be that since the Italians noted some minor aggregates and recalled the vaccine, then the French followed suit – that we in Canada need to look like we are doing something as well.   Even if the vaccine is okay, we need to look like we were being prudent in protecting the public’s health and reacting to a potential threat.  We will need to look like we have taken an appropriate time to evaluate the problem, consider safety and risks, determine options and make decisions.   All for the sake of appearing to do the right thing.  Another case of politics trumping science. 

The vaccine has been through quality controls.  The minor issue is not different or problematic.  Every expectation is that existing product will still be released, the only question is what length of delay will be believable for the public. 

The damage is done.  There will be the usual nay-sayers rhetoric and “I told you so” from the immunizer detractors.   The calls are already coming in from those concerned their health has been assaulted having all ready received the vaccine.   Those seeking vaccine will want the “other vaccines” as they are perceived as safer.  Some who received the vaccine will not believe it worked and will return for a second dose of another brand. There may be a shift away from getting any vaccine as distrust builds against vaccine manufacturers and public health, or there could be run on vaccine if the perception is that there now will not be enough.  

Through it, the decision makers will not be standing on the front line fielding the tirades and inquiries.

Normally there would be a media feeding frenzy, but Hurricane Sandy will take precedence.   If we at DrPHealth were making the public relations decision -  wait until the storm passes and influenza vaccine starts creeping back towards the front page, and then re-release the vaccine for general use.   We could be wrong and perhaps some magical scientific finding will appropriately justify the caution and a full recall -  but heck, why not unmask the predictability of the current shallow politicos who are more worried about public perception than public health.

October 31 update:  As predicted, Health Canada released the influenza vaccine, although as the storm was still drenching and blowing major centres – its impact on Canada certainly nowhere as devastating as our southern cousins and therefore not in the forefront of the news. The release of the vaccine quietly occurring with minimal media attention and without some greatly needed questions answered as to why any action was taken. 

Disaster preparedness – are you ready?

The west coast was rocked by a 7.7 magnitude earthquake. Tsunami warnings were followed by swells that were mostly less than 1 metre.  Damage was minimal.  Essentially a training exercise for the predicted “Big One”

Comparatively speaking the east coast is about to be pummelled by Sandy as she makes landfall near New Jersey, will collide its warm humid air with a cold front, and then get pushed north and finally east  with the storm centre expected to pass on a track over Kingston and Montreal before heading across New Brunswick, PEI and Cape Breton.   Our thoughts in advance to those that will still feel its slightly buffered down furry.

For those in the expected path, perhaps a bit of time to scramble to prepare.  Check out some quick reliable sites like the Red Cross or the Canadian government. The only added advise, is be prepared for up to 7 days before aide becomes available.   The typical 72 hour notice is based upon Californian expectations of the time to initial contact – not the time to receive aid.

Sandy has already killed over 60 people in the Caribbean, and likely that number will substantially increase.   Deaths from falling material, wave surges amongst gawkers who feel indestructible, exposure, and add to this the exacerbation of cardiac and other chronic diseases caused by acute stresses that can lead to sudden death or disease exacerbation.   With the predicted levels of snowfall in some areas, motor vehicle deaths may increase.  A review of the Canadian weather that kills provides a reminder that annually about 20 people are killed by weather, but extreme events can increase that to 100. 

In the aftermath, there is a predicted $80 Billion clean up expected as this Frankenstorm hits some of the most populated US areas and will pass along a portion of Canada’s most populous area.   Canadians, while priding themselves in being intimately familiar with extreme weather events, may still not be adequately prepared for the consequences and conduct of this hurricane/tropical storm.  Let us hope that the predictions are exaggerations. 

When preparing for a potentially disastrous situation, pray for the best, but plan for the worst.  For those not affected, your thoughts are welcomed, and  take this opportunity to plan for your disaster, there is not a part of the country that is immune from extreme natural events. 

Friday, 26 October 2012

Intimidation: Politicians and public health professionals.

The Ford brothers in Toronto have openly done what many, perhaps smarter, politicians routinely engage in – Intimidation and harassment of those invested with non-partisan responsibilities for in the public good.  Central to this debate are comments about the Medical Officer of Health (MOH) for Toronto, David McKeown.  The epitomy of a style of public health worker who is humble, thoughtful and a considerate gentleman. Globe and mail reporting of radio broadcast and   Wellsley Institute commentary 

Perhaps there are thanks to be directed to the Fords, for openly stating in a public forum, what often occurs behind closed doors.

Where kind-hearted and truly invested individuals migrate towards public health, successful politicians must by necessity invoke multiple personalities.  One of those personalities is hard nosed, ruthless and dispassionate.   Hence we have a butting of heads that could occur.  For the Toronto case, perhaps the lack of credibility of the Fords can make the situation laughable.

The more challenging situations are the backroom discussions that place MOHs in conflict with governance people, where expectations are linked to performance and resourcing, a form of insidious blackmail and clearly personally intimidating.  Some MOHs can ride the situation easily, in particular those that have stability in a community that has longevity that exceeds the current political regime. 

One has to assume that the relatively inability to speak out of our Chief Public Health Officer Dr. David Butler-Jones is linked to implicit expectations on towing the government’s line as much as possible, and speaking rarely where public policy may compromise the public’s health. The CPHO situation is also echoed by stories that slip out of the chief provincial health officers. 

In fairness, butting heads constantly leads to resource reductions making doing the job more challenging. While a skirmish may be won, the battle can easily be lost.  Strategic posturing is essential and rarely is a fight worthwhile that leads to succumbing and lost of a job worthwhile. We have seen many a CPHO and MOH fall to the side as they have fought their way on the mountain.    Sometimes groveling or dancing to the political piper can be rewarded with the tools to make a difference in another area. 

While the current issues seem to relate to censoring the mayor and his brother, the reality is the issue is much broader than a public spat.

The job of the Medical  Officer of Health or other senior leader in Public Health is not a job for the faint of heart or fragile egos.  It is also not a job for those that are stubborn or overinflated egos.  In the end, our better public health leaders are rarely accumulators of friends, or of enemies. They are also infrequent recipients of expressions of gratitude or offers of personal support.

So thanks to Dr. McKeown for his leadership and foresight, and our expressions of condolences for his current challenge of having to work with such disrespectful politicians.  

Tuesday, 23 October 2012

Blogging with DrPHealth - Viewers Choice

Sometime next week, DrPHealth will turn over 10,000 views.  There will have been about 230 posting over the 17 months of contributions, suggesting an average of about 50 views per posting.  Blogspot has gotten better over the year of tracking individual posting views, but the number of tracked views is probably only about half of the views. 

A massive one day surge about fracking, which led to a historic high number of single day views prompted this posting about what do you as the readers say are the most important issues.  

There are some clear favourites amongst readers.  Not only do they have high numbers of views, but intermittently there are surges in activity around a particular posting.  Most continue to have views months after the posting. Except from the fracking post, the most frequently visited posts tend to be over several months old. 

Viewers who subscribe to an emailed version are not counted as there is no listing of the number of persons who receive the blog on a regular basis through email. 

So, here for everyone’s pleasure, are your favourite postings, in reverse order by volume of views. 

Public Health hot topics
Canada`s 2012 Budget - Public health implications
The cost of US medical costs - Financial stress has a health cost itself
The Determinants of Health - moving description into solutions
Tweeting the public's health. Social media as a knowledge adjuvant
HIV progress in Canada – A great public health success story to start the New Year
Eggceptional news: Its no yolk. The myth has been laid
Healthy Build Environment Part 3: Health and social services, food stores and fast food outlets
Social injustice - Attawapiskat, Aboriginal Health and Janus
Hot public health topics worth reviewing: Provincial budgets, low sodium diets, smoking cessation and perinatal indicators

Electronic Health Records - so much spent and so far from achieving the goal
Smart meters –The role of public health in scientific controversy


Hookah pipes – a new generation of smoking hazard

Telehealth: A real public health contribution - or at least a major convenience 

Fracking - Is it an obscene public health word 
The Cost of Poverty in Canada - a potential way to reduce health costs

Thanks to everyone that makes DrPHealth worth continuing to post. 

Monday, 22 October 2012

Injury report 2012 - Prospecting for Public Health Gold

If information were gold, there is a whole mine out there to prospect through for nuggets called the Internet.  And just like a gold mine, public health surveillance in Canada tends to be filled with buried nuggets – not the ones that are shiny and easily found.   It is even more perturbing when the Public Health Agency of Canada documents, are transplanted and hidden in other locations and not readily available on the PHAC website. 
Today’s goldmine is a 2012 injury report spotlighting road and traffic safety amongst youth and young adults that was just released from PHAC in conjunction with several  groups like SafeKids, Traffic Injury Research Foundation and Transport Canada.

If you go to the PHAC site, you can order the document because it is not available there on-line   PHAC ordering information    or a short summary is available at PHAC posted html summary .  

Thankfully it has been posted in a few other locations traffic injury research foundation, Transportation Research Board; and summaries at Safekids.  
So, can somebody please tell us why PHAC remains cloistered - doing great work in behind the scenes, and yet has this incredible cone of silence when it comes to communicating, and a shyness on promoting its own excellent work?    Leave an comment, anonymous or otherwise. 

Fortunately there are a few effective prospectors out there that track down the nuggets and share the wealth. This one surfaced quietly through a Twitter posting.

While the focus of the injury report is on youth to age 25, the message is clear.  For the most part, we are doing well in reducing injury related health consequences associated with transportation. The graphic shows mortality rates extending back to 1950 and peaking in the 70’s.  Since then, and with the concerted efforts looking at vehicle and road engineering, as well as directed interventions on enforcement and driving behaviours, mortality and hospitalization rates have continued to decline. 

The gains have been less impressive over the last decade, despite the substantive increases in gasoline prices which are often thought to modify vehicle use behaviours. 

One might also be disappointed with the proportion of alcohol related crashes as not having improved over the past decade despite several interventions.  

Whether much stiffer penalties as implemented in several provinces in the last couple of years will again begin to move the curve downwards is yet to be determined.   Quite notable are the differences in alcohol use by type of vehicle. 

Finally is the not too surprising impact of injury from off-road vehicles highlighting the increasing importance of ATVs as a dangerous mode of transportation for youth and supporting the CPS and others call for age limits on ATV use.

For any golddiggers out there, if you come across other nuggets, please drop a line to drphealth@gmail.com.   Share the wealth.  Information is a major driver of change.  Protecting information is merely a way to express power over others and not in keeping with public health principles. 

Thursday, 18 October 2012

Fracking – Is it an obscene word in Public Health?

In the space of a couple of weeks, this posting has had hundreds of hits, moreso than other postings on DrPHealth.  On one side it is a measure of the interest in fracking.  Please leave some comments so that others can benefit from what you find here.  

If you are aware what fracking is, you either live in oil and gas provinces, or deserve to be at the top of your class.

Fracking is the future of natural gas recovery and is opening up otherwise difficult to mine gas deposits located in predominately shale like rock formations.   It involves injection of high pressure fluid (water/salt water with additives) causing hydraulic fracturing of the rock and increasing accessibility for gas mining operations. 

Frankly, fracking is merely the lightening bolt for the expanding oil and gas industry.  An industry who have successfully argued in the past their technologies as safe and beneficial for health and environment and which are now sacred and untouchable from environmentalists and public health professionals. 

So in the midst of the quiet stalemate in provinces with long standing oil and gas operations like Alberta and Saskatchewan, novel reviews of the public health impacts of shale gas operations are coming forward from New Brunswick and struggling for legitimacy in BC. 

Hence the document released by  Dr. Ellish Cleary as Chief Medical Health Officer in New Brunswick is a bold and brave foray into the issues.  Coming from a province where an economic boon would likely be welcomed, the cautionary words on boost and bust economies and rapid industrial growth from such development investments are a courageous statement. Moreover the document is grounded in solid public health principles ranging from determinants of health, clear health delivery objectives and public health ethics.  For those not intimately involved in discussion with the industry, the document is an excellent example of taking a fundamental public health approach to a problem.   NB CMHO report on oil and gas industry

It is the sort of document that the industry might fear, but the type of material that is fundamentally grounded in principles and the need for appropriate information that decision makers will be challenged to ignore.   As the recommendations are based on a whole of industry perspective, it mitigates some of the past challenges about operation specific concerns such as debates over a particular sour gas well.  It also pushes hard for Public Health involvement in many aspects of the work to be done.

One can only hope that the province looks favourably on these common sense recommendations, and most importantly on the context of inclusion of human health as an outcome of interest in resource sector development.  

Kudos to New Brunswick and Dr. Cleary and thank you for displaying such courageous leadership. 

Tuesday, 16 October 2012

Gambling - Toronto taking chances with the public's health

When someone comes along and announces $3 Billion in development, heads will turn.  It is in the fine print that the centrepiece of the development is a new casino for downtown Toronto.  Vancouver, Montreal and other major cities have recently debated the relative harms and benefits of expanded access to gambling and its health consequences. 

For provinces the addiction to revenues from gambling is in the billions and reflects other sin taxes and fossil fuel incomes that support a diverse range of social and health programming. Reducing such incomes means either increasing revenue from other sources like taxation, or cutting programs.  Moreover, the dependence on gambling revenues is sufficiently scared that advocacy efforts opposing expansion of the industry, research on reducing harms and efforts are prevention are actively discouraged.

Hidden deep inside the Canadian Centre of Substance Abuse is a good resource with links to existing data on gambling CCSA weblinks.   Oddly, becomes gambling income is a provincial revenue source, national information is more readily accessible through credible groups like Statistics Canada.  Hidden is that gambling amounts increased from the early 1990’s when casinos became more widely abundant, though to the last five years where total revenues have leveled out. The Stats Can report includes the following graphics. 

Gambling can be typed into gaming activities like bingo; lotteries; paramutual betting like horseracing; casinos and slots; video lottery terminals (VLTs); and on-line gaming.  The graphics represent a good sense of the shifting gambling dollar.   Provincially, gambling increase going west.   The coalition of gaming research organization production from 2012 provides an excellent resource on the current utilization of gambling in Canada Canadian Partnership for Responsible Gambling.  Safety in numbers through collective sharing of statistics, but also an excellent example of comparative data between provinces which is sometimes challenging to find for other health issues. 

Hidden deep in these documents is the consistent identification of 2% of the adult population have problem gambling issues.  Problem gambling is known to be associated with financial problems, relationship difficulties, violence, and suicide. Although, an Alberta study suggests that gambling is not the risk for health outcomes, but merely a covariant – similar to early work on smoking and health UAlberta economics study on gambling and health

The successful work on defraying the impacts of casino expansion in Vancouver might form an excellent model in public health advocacy for the wellbeing of the community, if one could only find solid documentation still posted on-line. Publication bias remains a significant barrier to putting the public’s health centre stage in the debates.

Good luck Toronto. Hopefully Toronto Public Health will provide outstanding leadership on an uncomfortable topic. 

Monday, 15 October 2012

Bullying and its Tragic Consequences - A public health issue deserving consistent intervention

The tragic events surrounding the suicide of Amanda Todd in BC re-raises the long standing issue of school “bullying” and the potential fatal outcomes.  It poses questions on what went wrong? but how well are we doing in facing the issue?

Data are not rigourous, but work suggests up to 2/3rds of middle school students have been bullied  and an equal number just consider bullying part of school life.  One in 8-12 of these students being bullied at least weekly and a similar number being the instigator of bullying.  At Grades 4-6 the rates of bullying are about one-quarter of students.  Rates amongst males are slightly higher than females and more likely physical whereas female bullying more likely verbal.  More on what we know in Canada can be found at a Public Safety Canada website Bullying - Public Safety Canada and  a non-profit stop bullying group.

Canada has had its share of high profile consequences from bullying, with Amanda Todd being the most recent.  Another BC situation resulted in murder charges associated with the death of Rena Virk in 1997.   In the wake of Columbine in the US, imitative behaviour led to another school shooting in Alberta.

Bullying activity peaks in Grades 6-8, but the consequences are lifelong.  Perpetrators of bullying are eight to ten times more likely to engage in other delinquent behaviour and subsequently to be associated with gang activity, sexual harassment, and other criminal activity.  Bullys are also more likely to continue abusive behaviours in the workplace, relationships, and with children and elders.  Victims of bullying are more likely to have episodes of depression including suicide.

Prevention of bullying can be facilitated by numerous packaged programs which are provided to the school setting (eg PREVnet  Bullying.org ).    The best solutions likely rest in comprehensive school engagement on the issues of bullying throughout the students experiences and include developing social skills and camaraderie, education, family and student counselling, intervention and enforcement.

Racial tension, sexual orientation, religious beliefs, academic achievement, physical stature and gang association are all well established characteristics associated with bullying. The forms of bullying expand to the available modes of interaction, and considerable attention is being paid to the import of cyberbullying through social media, in particular Facebook or other forms where filtering and censoring of messaging is minimal.

While knowledge of bullying is increasing, little exists on what might have been considered normal school yard behaviour in the past.  Is bullying increasing, or actually decreasing as schools have recognized their contribution to development social skills in addition to rote knowledge development.

Schools are asked to perform many functions beyond that of just education of the traditional 3 “R”s.  Enlightened school districts are willing to step forward and address issues of health, wellbeing and self-esteem.  Pressures from other inclusion programming such as children with special needs can detract from addressing common issues such as relationship development, building collaboration, exceptional students, delinquency and  bullying.  The further form the walls of the school, the less the perceived role of the school setting – yet where else will such issues be resolved?

Public health professional need to be engrained into the school setting to assist in identification of school health needs, both for immediate management, but just as importantly for the lifelong impacts that have their roots at school.

October 15 - CIHR has also responded to the bullying issue and published a short piece on bullying at http://www.cihr-irsc.gc.ca/e/45838.html   

Thursday, 11 October 2012

Justice and incarceration. A hidden Public Health issue

Stats Canada just released annual incarceration statistics which are accessible at adults in justice system.  .  Hidden in the release is that incarceration is slightly up for the first time while many other measures indicate reduced persons under supervision.  Note that roughly 1/3rd of incarcerated persons are in federal facilities, and of the remaining half are sentenced and half are in remand awaiting action by the courts. That such a large proportion are awaiting court action should in of itself be considered unacceptable. 

Those incarcerated represent about ¼ of the adults who are under supervision of the correction system, with the majority on probation. As for youth, nearly 15,000 are under the oversight of the correction system. youth 12-17 involved with justice system 

Look carefully at the two charts and the summaries.  Specifically what conclusions would you draw on the rate of youth crime?   As presented and on the surface, the data might suggest substantially lower rates in youth.  Certainly the overall reduction in incarceration and persons under supervision is highlighted.  The minor blip of an increase in 2010-2011 of those in facilities is opposite to the overall trend of the past decade and perhaps partially related to tougher economic conditions.

If you look carefully at the actual rates of persons under supervision, the units of presentation are per 100,000 for adults and per 10,000 for youth – making the youth under supervisions numbers look much smaller. Put differently, 0.6% of all adults and 0.8% of youth 12-17 are actively involved with the Canadian justice system. Why the higher rate in youth?  Why the differential presentation of the data? 

Another question is given the reducing number of persons in custody, why are we redefining minimum sentences – to boost jailhouse business?  Why are we looking at building new facilities for an expected increase in incarcerated persons?   And most importantly, why in the face of advice to the contrary, does the Harper government ignore the facts and openly propagate misleading information on crime in Canada. 
Canada is a relatively safe place and becoming safer with time. 

The justice system already imposes barriers to rehabilitation and re-integration into society such that the wellbeing of those ever involved with the justice system is compromised as an additional penalty for their actions - something that has lifelong implications. Such added implications are not inherent in a society where maximizing individual potentials is to be prompted.

While considerable focus is placed on reforming the health care system, where on the pundits on justice reform in a similar fashion that might lead to improvements in social and health wellbeing? 

Monday, 8 October 2012

Sex, Fraud, and Assault. The Supreme court decision on HIV disclosure for persons with low viral loads

Beware of news released on the day before a long weeked, it tends to be controversial, unwanted, and politically divisive.  A curious day to release a Supreme court decision on HIV disclosure.  Previously the standard was an absolute need to disclose HIV status as such was considered a risk for bodily harm, and persons could be found culpable of aggravated sexual assault.  This decision was based on a 1998 court case involving transmission of HIV to a person subsequent to the failure to disclose.   Subsequent decisions have expanded the definition to not require the standard of HIV transmission, hence an absolute requirement for persons with HIV to disclose their status.  Putting aside the small percentage of long term low viral HIV positive persons, this likely was a reasonable decision at the time. The science standard was predominately one of reasonable probability that transmission could occur and hence persons not informed in advance of engaging in mutual consenting sexual relations were seen as having not had sufficient information to make an informed choice.

Now, aggressive antiretroviral therapy can result in reduction of viral particles to levels that are typically not detectable by routine laboratory tests.  Starting in Switzerland, legislative or judicial decisions have slid towards recognizing that transmission of HIV is highly unlikely in persons with negligible viral loads and therefore the standard of informing partners might not be required.

However, it is known that persons with non-detectable viral loads are unlikely to have been cured and still have the potential for resistance development and recurrence of viral activity.

The Canadian courts have placed the second standard of still requiring the use of a barrier method – a prudent action for persons engaging in sexual activity who are not intimately familiar with each other. 
The reaction of various HIV organizations has been interesting.  Many denouncing the Supreme Court decision as failing to recognize the autonomy of someone carrying the HIV virus.  An odd reaction given the decreased standard of protection that the courts will now be applying.  Ultimately many would argue that sexual relations are a buyer beware scenario. Negating the foundational communication that forms the basis of relationships and making sex a recreational activity.

Even in other forms of recreational activity some forms of protection are mandated, whether helmets for hockey players or automatic release bindings for skiers.  Football helmet butting is resulting in serious punishments and use of performance enhancing drugs are banned as of lifelong health protection.  
The Supreme Court decision is likely reasonable given our current knowledge and respects many of the Canadian values surrounding intimate relations and sexual assault.  Questions will remain such as what is a reasonable level of proof of low viral loads, one day? one month? one year? since the last viral load test.  Some will question the need for and importance of the barrier protection if viral loads are negligible, however that standard was not tested in the court decision. 

As for buyer beware mentality, in a society where power is equitable distributed between all persons, choice is inherent in decision making, and communication is transparent – perhaps there is an argument that the buyer carries some burden of responsibility – but we live in an imperfect society and depend on the courts to act in the best interests of all members.  It is notable that the basis of the decision is the test that the consenting individual would not have engaged in sexual intercourse had they known the peson was HIV positive, in essence the HIV positive person having committee fraud by withholding information that a reasonable person would have used in being a buyer. 

Read the full decision as written by Chief Just McLachlin herself at Supreme court decision  

Thursday, 4 October 2012

Thanksgiving Appetizers: Sizzling topics in Public Health

There is never a shortage of short snappers to be gobbled up around Thanksgiving time.   Here’s a set of appetizers themed just on sexual and reproductive health issues.

A small study that confirmed something that has been stated in the past, HPV is not limited to girls who have engaged in intercourse, hence the provision of HPV vaccine to sexually naive girls prior to first intercourse is further justified.  NBC report on HPV risk.

A  synthesis of interventions to reduced the behavioural outcomes of sexually transmitted illnesses amongst activities that showed strong evidence for improving knowledge and self-efficacy.  The critical link of then tying this to changes in behaviour such as condom use demonstrated some benefit and concluded the further research is required to identify what is most effective and how to further improve outcomes. behavioural interventions for preventing STIs.  The good news is that the programs did not negatively impact measures like earlier sexual initiation which advocates opposing sexual health programming frequently vocalize as a concern.

A review looked at different strategies for cervical cancer screening and actually recommended that for resource constrained areas a different strategy than for resource rich areas. cervical Ca screening    A DrPHealth plea that a new criteria for screening programming is that they not exacerbate inequities. 
For those engaging in higher risk sexual activities, the question on pre-exposure prophylaxis for HIV prevention received a review concluding that there is a benefit HIV pre-exposure prophylaxis.  Now if only we can expand cheaper HIV treatment programming in developing countries. 

This week is International breastfeeding weeks and a review article demonstrates the definite value of exclusivity to 6 months and lesser but useful benefit of partial breastfeeding during the first four months Breastfeeding duration .   Canada continues to improve on breastfeeding measures with increased initiation and duration and well worth celebrating each year  Breastfeeding review 2011.

May the Canadian Thanksgiving weekend be filled with family, friends and happiness. Thanks to the loyal readers, and to the new readers who have picked up traffic on this site in the last few weeks.  Your support and promotion of the site is integral to its success and continuation. 

Tuesday, 2 October 2012

Fighting fat. The politics of obesity interventions

In the fall of 2010 the pan-Canadian Ministers of Health released a report on Curbing Childhood Obesity in Canada.  This was followed in June 2011 with a descriptive monograph of Obesity in Canada.  This site has addressed the issue of weight control on numerous occasions October 2011 , March 2012, June 2012.

In the short time since the formal national dialogue has begun on curbing youth obesity, there is lots beginning to happen.  One would expect a shotgun approach to finding out what works, and what doesn’t.  Lining up are the academic community on one side, looking for the research dollars from the trickle of beginning to flow from places like CIHR.  On another side are entrepreneurs looking for a share of a burgeoning market, whether in specialized camps, training facilities, weight loss programs or snake oil supplements to curb appetites.  On a third side are a group of funders who have historically funded children’s health care and looking to enter into the market and new issue specific groups like the Childhood Obesity Foundation .  On a final side are the traditional program structures of health and education  who are being expected to retool their operations to accommodate new weight control initiatives, and where such retooling is often an impediment dragged by inertia and the inability to stop doing other important work.

Speak to those in the know, and the solution lies in prevention.   Solid family and school healthy eating, supported by a community that encourages healthy foods.  Reduction of fast food marketing and access to youth, reduced screen time and increased daily physical activity.  The problem is that prevention isn’t sexy.  There is nothing to fix, and the costs to existing programs and products that might lose are enormous.  Industry interests from Apple to Burger King, from Game Boys to X-Box have investments that are dependent on recruiting new converts to their products. 

There are however developing school based and after hours interventions for youth identified as at risk for weight problems.  While listed as “prevention”, these early intervention programs are an integral part of addressing weight concerns amongst populations that have yet to habituate lifestyles.   The Canadian Obesity Network provides a list of combined prevention and early intervention programming that is a good reference Canadian Obesity Network  although the site is a bit dated in its postings and appears inactive since summer 2011.  

The third component is in intervention based programs.  Whether hospital based bariatric services like offered in Winnipeg, Shape Down in BC, Pediatric Obesity Clinics that are sprouting up associated with children’s hospitals.   These will be necessary intervention based treatment programs until effective prevention and early intervention are in place.  Such treatment programs however should be short lived if other prevention and early interventions are effective and supported.   It would be a shame to see major funding shifts that focus on treatment without matching such dollars with prevention. 

A late addition comes out of Wellesley Institute blog http://www.wellesleyinstitute.com/news/childhood-obesity-in-ontario-why-we-must-act-now/#.UGuHb0ea0UA.twitter . Another corporate style program forwarded via Twitter, and a community based demonstration project information on SCOPE. 

So the last question is probably the toughest and comes from the Wall street journal as New York City has waded further into government’s role in addressing obesity, who’s responsibility is it to prevent obesity, society or the individual?   Obesity prevention responsibility .  A more fundamental philosophical question is whether obesity  and weight problems are even a disease?  While they are a risk for illnesses, do they meant the criteria for being an illness themselves?   Your opinions are welcomed as a comment.   

Monday, 1 October 2012

Where's the Beef? The tainted meat is a public health scandal

The massive beef recall in Alberta is on one hand unfortunate, on the other hand likely was predictable and preventable.

A visit to a slaughterhouse is not a Sunday picnic.  Employee turnover amidst the blood, guts and odours is very high and most staff are minimally trained for the importance of their jobs.  Wages are low, and in the Brooks XL meats facility employees are sometimes bussed 1-2 hours each way to get to the operation as housing in the area is not affordable. Many workers in abbatoirs and slaughterhouses contract intestinal infections from their work in their first weeks of employment, a time when taken sick leave is not seen as an option.  

Federal meat inspection is provided by CFIA, who in the last round of the Harper government’s budgetary cuts saw very significant reductions in field staff.   Just a few weeks ago the CEO of CFIA left “under mysterious circumstances” with few details released.

One might recall in the wake of the Listeria outbreak from Maple Foods, the CEO publicly apologizing.  Notable in their absence are the directors of XL foods.  Moreover it is the premier of the province that is the goat put forth to steadfastly defend Alberta beef in the wake of the US border closure to beef from the facility. A statement to the well known shady nature of the management of XL foods. 

E. Coli O157:H7 rates in large food animals have a similar seasonal incidence as in humans, a definite peak in the summer years.  The human illness often blamed on inadequate BBQing with minimal evidence that is the culprit. The point being that summer is the time that animals arriving for slaughter should be expected to have the highest carriage rates. 

Alberta is home to about 5.5 million cattle waiting their turn to be loaded into stock trucks, often in the cloak of night, transported to the slaughterhouse, corralled in line to the kill zone where a nail is ‘humanely’ riveted causes as painless a death as possible. With winter approaching and reduced feedstocks available, livestock operators try to get as many cattle to market as possible to reduce wintering costs. 

Anyone looking to brew a perfect storm for an E. Coli outbreak need look no further than a system that is efficiently designed to ensure beef, pork and poultry make it to Canadian plates with minimal publicity, minimal cost and minimal illness.  The Canadian food safety system was for the most part excellent and a source of international pride.  It has taken its share of hits, in part because the system identifies and publically reports its problems.   

The XL meats situation however was a forecast-able storm and went unscathed for too long.  The question is whether lessons will be learned on the prevention of similar situations through recognizing the public good of the food supply chain? or will this just be another Harper search for a scapegoat to sacrifice? 

Follow the debates and discussion on the Safe food for Canadians Act that is currently working its way through the house. It is currently through second reading and before senate committees.     No doubt the interest in the matter will change in the weeks ahead. http://www.inspection.gc.ca/about-the-cfia/acts-and-regulations/initiatives/sfca/eng/1338796071420/1338796152395