Welcome to DrPHealth

Please leave comments and stimulate dialogue. For those wanting a bit more privacy or information, email drphealth@gmail.com. Comments will be posted unless they promote specific products or services, or contain inappropriate material or wording. Twitter @drphealth.

Wednesday, 30 January 2013

Stroke – brain attacks fighting back

Perhaps no illness strikes as much denial of fear as stroke.  Healthy one moment, potentially life like disability the next.  Whether thromboembolic or hemorrhagic, the consequences can be profound, the impacts on family disturbing.  

Yet, stroke takes second fiddle to heart disease in all aspects.  It ranks third in causes of Canadian deaths with an estimated 50,000 new strokes every year.  Six times as many live with the consequences of a stroke, just over 1% of the Canadian population. Only 1/3rd of stroke victims recover all or most of their function, 40% are moderately or severely disabled, 10% require long term care, and 15% die from the initial insult.  Learn more at the great organization, although infamously named Heart and Stroke Foundation statistical information where stoke remains in the shadows.

 PHAC has a developed a vested interest in stroke, and more in an upcoming posting.  See details of their work at PHAC synthesis 2011

The notable change in the graph is that while numbers of deaths have remained fairly constant, rates of deaths, hospitalization, and numbers of hospitalizations have been consistently decreasing since the early 90’s.    The benefits of reduced smoking, better blood pressure control, lipid control efforts, and in some cases low dose anti-thrombotics (ie. low dose aspirin).

Further improvements would require stemming the increase in diabetes, increasing physical activity further and lots of discussion on reducing salt consumption (see DrPHealth Jan 2012 Sodium reduction)

Overall, a hidden public health success story, that barely makes the public health agenda.  One of the reasons, three of the main preventive actions result from using pharmacotherapy – and perhaps a strong indication on the need to collaborate on disease prevention efforts that combine drugs with lifestyle interventions.  

Thursday, 24 January 2013

Dementia – a public health problem not to be forgotten

The WHO has done a global service with the publication of a Dementia - A Public Health Priority.  It is a 100 odd page document, filled with the latest and greatest related to epidemiology, social challenges, caregiving issues and public awareness.   Such a tome is a really solid foundation for finally internalizing into the public health arena the issues of abnormal ageing.   

While the document is global in scope, and those numbers can be staggering and hard to put individual countries into perspective, it lays out some solid philosophical approaches to what can consistently be done to grapple with the using of abnormal ageing.  That some 6-8% of persons over the age of 60 right across most of the earth suffer from dementia is notable.   Lower rates are only noted in sub-Saharan Africa. 

Canada lacks a definitive approach to dementia.  Scant background information can be obtained at the Alzheimer’s Society http://canadadementiacrisis.ca/  .  This greatly exceeds the amount readily accessible from PHAC.  There are sections on dementia from the 2010 PHO report Chapter 3 on seniors   and the Women’s Health report Women's Health report .   The lack of attention speaks loudly to how this illness that in some way or another has affected most Canadians, is just not on the radar as a public health issue.

Seems we have taken the policy approach of warehousing those with dementia, and the forgetting about them.    Some simple steps on awareness are worthwhile, and the WHO report dedicates a full chapter to the issue of public awareness as a major step.  

Monday, 21 January 2013

Calories, calories everywhere – not a kilojoule to spare.

For those looking to gross themselves out with pictures and stories of high caloric food, there are an increasing number of postings.   This one for the Centre for Science in the Public Interest is bound to make your stomach turn  CSPI xtreme foods.

Hidden is a message that is well worth more attention within Canada, the US and other countries.   Clearly identify caloric content of foods that are prepared for consumption. 

Menu based calorie (or kilojoule) listing was mandated in New York City in 2008.  The evaluations of the effectiveness of such an intervention have been at best mixed, with some slight suggestion of value.  Huffington Post article

McDonald’s has now indicated it will voluntarily list caloric content on its menus .  A laudable corporate initiative which probably should be applauded.  The evidence does not support that individual decisions will be affected by such menu changes, but what is lacking is good information on whether long term decision processes are changed. 

When caloric content (or kilojoules) are included routinely, perhaps we can hope for two changes. First, a corporate minded shift to reduce overall content that might be identified in such extreme content foods, and second, increased public knowledge about food consumption on which to make better decisions.

So while McDonald’s efforts aren’t likely to attract more consumers, perhaps they will once again lead an industry change that this time has the potential for social benefit.  

Thursday, 17 January 2013

Gun control proposal in the US. Brilliant public health policy development

If you are not impressed with President Obama’s proposals on controlling gun violence, you should be,    some will call it very bold.   It is  at least politically astute.  In the two party political system of the US, it takes an issue with clear political lines, and has carved a ditch in the sand.

This site has discussed gun control on several occasions for its public health benefit, most recently in  Another shot at peace .  There is no need to further discuss the public health merits of gun control, that has never been the issue.  Gun control is one potential intervention to address the excessive number of firearms related deaths in the US and choosing between equivalent options is as much a political choice as based in solid evidence. 

Look however at the process and the proposal as a solid example of policy development.   In the weeks leading up to the proposal, there were innumerable public polls demonstrating support for increased controls on guns.   The topic received a disproportionate amount of air time on the news media, even if CNN clearly was unbalanced in presenting a predominately pro-gun position. 

Ultimately, there were hearings and solid submissions from health organizations on the detriment of firearms and the health benefits that can be accrued through specific policy directions.   Many of these were directly included in the Obama proposals. 

Of course,  when a substantive majority of Americans are asking for tighter controls because of the school shooting tragedy, making a proposal for substantive leap in control becomes easier, and the President did not disappoint.  

All that rests in the way of change is a tenuous Republican party that stands to lose considerable political credibility no matter what it does, and hence the brilliance of the policy proposal.   To not support the proposal would fly in the face of what is a clear majority.   To not object will alienate the far right of the party, who garnish an incredible level of power and money.   It will take a masterful policy strategist to steer any concerted opposition that holds the Republicans as a cohesive group.  

Tea parties may soon be replaced by Hunting parties.

Check out an excellent synthesis of the proposals, direct issues, and actions through the APHA who have been instrumental in contributing to the reform proposals Public Health newswire Jan 17th.  

What a few months ago would have been a shot in the dark, has become a masterfully crafted missile that is right on target.

Unfortunately progress comes on the graves of the twenty-six innocent victims at Sandy Hook Elementary in Newtown.  

Monday, 14 January 2013

Influenza – the public health credibility killer.

Its hitting hard right across the country, and if you did not get your influenza shot, no sympathy from here.  Nearly one-third of Canadians partake in the annual ritual, and they do sacrifice themselves to the shoulder pinch not just to protect themselves, but to contribute to cocoon and herd immunity. 

Since the pandemic year, we have been fortunate with milder than average years – it leads to complacency.  Time for a kick in the ass to remember what this bug has the potential to do.  So baton down the hatches and prepare for the ride over the upcoming weeks as Influenza A/H3N2 Victoria 2011 makes its rounds. M. Picard at the Globe and Mail has a very nice realistic overview of influenza G & M influenza article

We trust you have learned the classic triad of influenza’s fever, myalgias and cough as the hallmarks of the illness.   In schools, it is even more typical with students arriving in the morning fine, and then literally dropping like flies during the day.  It is the school administrative assistant who is the first to know as the students drag into the office needing to go home. 

Emergency rooms get backed up, hospitals get overcrowded and there will be the inevitable yells that there are insufficient hospital beds and surgeries have to be cancelled – when the intelligent health administrators will have scheduled the influenza surge into their booking schedules and not let the surgeons dictate hospital utilization.   The hospital bulging will continue for weeks after students have returned to school.  The bed utilization gripping will persist for months and scarcely a word will be said that it was predictable, partially preventable and most importantly manageable through queuing theory and not the traditional seat of the pants reactivity.

Many will die in the upcoming weeks, succumbing to the complications of influenza.  It is a predictable tragedy and one that collective real efforts are made to reduce.   So why do we continue to use mortality statistics that are based on severe years and poor vaccine matches?  After many years of saying there were 4000 influenza deaths per year in Canada, the number is finally coming under appropriate scrutiny.    CBC story on influenza death numbers . Driven in part by the body counting of pandemic influenza that filled a documented 428 graves when it was supposedly a really bad illness. Of course the actual numbers are based on mathematical modelling of excess deaths, not on body counts.   PHAC lists 2000-6000 deaths, CMA 4000-8000, and none provide really good basis for their numbers.   Some of the mathematical models predate current influenza and other prevention efforts. 

The time has come clean on using influenza mortality statistics, if for no other reason than in public health we must be truthful and transparent, and when exaggerations are used, credibility drops. Some sites are already decreasing their estimates to 500-1500 deaths per year, perhaps more believable and still far too many tragedies.

Add to the flippity approach to reporting mortality, here we are mid-season with an MMWR article announcing 62% vaccine efficacy.  The media reporting a poor match, but if you read the CDC statement this is in keeping with good match years. Moreover, the MMWR statement is more about the need to use oseltamivir in vaccinated patients with ILI (is there a conflict of interest here?), than concerns about the vaccine.  Credibility hit number 2 MMWR vaccine efficacy

The third credibility whammy taken by BC’s public health folks is over the mishandled implementation of mandatory influenza vaccination policies for health care workers.   There have been prior attempts elsewhere, Ontario coroner's recommendations, court and labour board rulings supporting such efforts – but when policy abuts labour unions, and the perceptions spill over into the political arena – the groundwork was insufficiently laid for what is likely the right thing to do.   And, public health professionals are the ones with the embarrassed look on their faces.

There are many reasons for getting the influenza immunization, washing hands, coughing into your sleeve, and avoiding worksites when you are ill.  There is no need to exaggerate or to use a sledgehammer to achieve the objective of reducing influenza’s annual contribution to the graveyards of the country. 

Thursday, 10 January 2013

Norovirus – running to a bathroom near you

Its that winter stomach bug.  Hits like a truck with waves of nausea, heaving gut, urgent and frequent trips to the toilet.   We’ve all experienced it, and likely blamed bad food or that sick co-worker. 

Fortunately most of us recover in a couple of days.  It can be problematic for the medically fragile, but even among the sensitive an amazing number recover compared to its influenza cousin.  

As a virus, it is highly efficient in its spread.  It undertakes just enough genetic drifting that every few years there is increased disease activity due to greater pathogenicity.  This year, we are welcoming the GII.2 Sydney (2012) strain. 

When it hits about one in ten of us will suffer a bout, about six thousand Canadians will be hospitalized and fortunately fatalities are perhaps under a hundred.   Actually, we really don’t know since surveillance systems are not robust for tracking the impacts of norovirus.  Estimates are based on some good US work in the 2004-05 years EID August 2011 Norovirus .  Canada estimates some 300-400 outbreaks each year, although only those in long term care settings are routinely reported from most provinces.   Surveillance for what is seen as an annoyance is never good, but the cost of nosocomial outbreaks, clean up in the hospitality industry, lost wages and other indirect costs must run in the billions annually (but if you are aware of any, please send any economic analysis so this can be updated).  There are some nascent efforts on improving surveillance systems EID 2011 surveillance 

Norovirus  developed its fame as the cruise ship illness.  Put a large number of people in a confined space, and lo and behold a high proportion of them got sick.  The more you look, the more Norovirus can be implicated.  National Parks in Canada and the US routinely have norovirus outbreaks during summer holiday season.  so those campground runs might just as well have been from Norovirus as from the undercooked hamburger.

Beyond the frequent trips to the bathroom, the annoying thing about Norovirus is its propensity to spread to the unsuspected as the virus survives well outside the body.  Over half a day on hard surfaces like door knobs, telephones, shopping carts.  On more comfortable surfaces like cushy chairs, it may survive for longer than a week.  

There is no magical prevention like a vaccine, vitamins or natural products that are known to make a difference.  Immaculate personal hygiene with constant handwashing and use of hand sanitizers will reduce your chances of getting struck.  Find a bit more at PHAC info sheet 

Good luck, and keep some good reading material in the bathroom just in case.  

Monday, 7 January 2013

Idle No More, The Occupy Movement and the Politics of Power

Is Steven Harper brilliant or a bigot? 

Anyone who has watched the Prime Minister’s inaction akin to burying his head in the sand would probably lean towards the later.  Idle No More hasn’t gone away and keeps growing steam.

That other politically touchy issue the Occupy movement was carefully dismantled and compartmentalized with minimal political damage.

Was the hope, that Idle No More would go the same route?  Or, was there a hint of altruistic brilliance behind the obstinance? 

Aboriginal issues are a Canadian blemish.  This site has touched on several times in the past (eg Feb 2012 Aboriginal health,  October 2011 equity ). Lets face it, the handling of the Attawapiskit affair a year ago was not a fine moment in Harper’s approach to Aboriginal issues, it stank of the very colonialistic approaches that we have been found guilty of ( Attawapiskit ).

Both the Occupy movement and Idle No More suffer from a lack of specificity of what they are trying to achieve.  They are expressions of discontent with the status quo.  Both without concrete solutions where solutions are needed.   The Idle No More movement might effectively end with the agreed to meeting between the PM and Aboriginal leaders, and general bureaucratic acknowledgement that study and reports need to be undertaken to develop solutions – by which time governments and leaders will have changed and the effect may follow the Kelowna Accord agreement (which Harper effectively ignored). 

What Idle No More has done, just as Occupy camps did (Occupy movement  ) – was take the issues to the general populace.  They have been effective public education tools.  The peaceful round dances, and the occasional interruption in transportation services have engendered real attention.  Had the movement been truncated early by Harper agreeing to a meeting, lost would have been the needed public support for anything that might come from such a meeting.  At least now though, Canadians across the country have become more informed about the plight of our Aboriginal citizens who are caught in this jurisdictional quandary of powers assigned under the Constitution.

It must be an uphill battle to correct certain beliefs about Aboriginal populations.  There are likely many unenlightened individuals with discriminatory beliefs who do not feel obliged to the commitment that our non-Aboriginal ancestors made to share this land.  Perhaps some like the Fraser Institute may take even more discriminatory positions Calgary Herald article, and not without reason published in Harper's home community. No mention is made of made of our commitment, or of the numerous examples where non-Aboriginals have broken that commitment.

Lost though in the movement, beyond Chief Theresa Spence’s hunger paining demands for the meeting, is what is it all about?

On the surface, the objections stem from lack of consultation on budget cuts.  But really, what Canadians have been consulted on any of the omnibus pieces of budgetary reduction legislation?  Do any of us want tax increases or spending cuts – we need only look south to what pains the US suffering from such approaches.  Were there evidence of inequitable sharing of the pain, there would be plenty to protest.  The complexity and secrecy of Harper’s fiscal planning would make it difficult for anyone to accurately determine what Canadians have suffered more.   That the Calgary article speaks to concerns over the sale of reserves is a form of misdirection and misleading the public perception that the Idle No Movement is trying to correct. 

When it comes to the budget reductions, only in the area of refugee health has there been any other concerted national effort to have the policy shifts changed, and that has not been successful either. 

So, Mr. Harper, you have the opportunity to astound us Canadians with your brilliance by turning the Idle No More movement into a positive construct with solutions.  

Given your propensity for corporate welfare and the most recent example with the auto industry handout of a quarter of a billion, perhaps DrPHealth might share some of that skepticism of our Aboriginal brethren.  Please prove us wrong and show your brilliance rather than bigotism. 

Tuesday, 1 January 2013

Lucky 13 - welcome the New Public Health year

2012 was a year like any other.   For this writer, it represented the twenty-second year of public health practice and thirty-first year as a health professional.  Oh the stories that could be told. 

The outbreaks that in the early days were a challenge to identify they even happened, and then minimal interest in detailed investigation or control.  Diseases that today are rare and emergencies, were just one of several foci of routine attention.   The immunization schedule has grown from a paltry handful of vaccines to the robust fourteen and a half antigens that are routinely included in immunization schedules (HPV getting a ½ vote for its gender specificity). 

It is time to review the year and look forward to lucky 13.  

One hundred and forty-eight posts.  Such is the pace of public health and the morphing of issues.  Expect a few less this upcoming year, twice a week will be the goal.  DrPHealth set out to score 10,000 views, and wound up just over 11,000.  Perhaps a lofty target at the onset. 

The pattern of readership continues to change with more followers and those that receive by email which are harder to track and not counted in the views.  Previously it was clear that viewership was highest during Canadian work hours.   Sixty per cent of total readership remains Canadian, but lately, the majority have been readers from Russia and the United States, skewed perhaps by two postings; More health care doesn't mean better health and Taxation and the fiscal cliff.  

The single heaviest visited site posting being on The Obscenity of fracking, followed by interest in Telehealth, electronic health records, and Cost of Poverty. Single issue odd postings get spikes in traffic such as Fracking,  Hookah pipes , and Smart meters.  Many of the core Canadian public health issues get relatively scant traffic. 

Last year DrPHealth posted a list of resolutions for public health workers – they are worth repeating:  First to assess how well did you do in 2012, Second to ask you how well did DrPHealth do? and third to reaffirm their value for 2013:

1.             Advocate for policies that specifically reduce income disparities as it is the major modifiable driving force for poorer health.
2.             Ask frequently the question, how will this service/policy/action improve the health of our children and future generation?
3.             View the world that our grandchildren will inherit and the threats caused by Climate Change, Contamination, Consumption of non-renewable resources and Consumerism. 
4.             Be a constant reminder of the prosperity we enjoy and the challenge so many others of our global neighbours face in accessing the minimum prerequisites for health of peace, shelter, education, food, income, stable eco-system, sustainable resources, social justice and equity.
5.             Support the adoption of healthier lifestyles in at least the major risk behaviours of tobacco use, alcohol consumption, poorer nutrition and sedentary lifestyle.
6.             Recognize the value of our current health care system, and constantly ask what is the added value to the health of the population of the resources we are about to expend.
7.             Encourage frequently that the solution to sustainability of our health system, is to prevent the need to utilize the health care services in the first place.
8.             Put safety and injury reduction on the agendas of those that can make safer choices
9.             Argue for incorporation of culturally appropriate approaches to improve health and reduce the existing disparity.
10.          Ensure sexism, ageism, racism, or other non-modifiable characteristics are exorcised from the places we live, work and play.   
11.          Promote tolerance of the diversity of individuals in our society including those with addictions, mental health disorders, disabilities and living street oriented lifestyles and others  
12.          Support the adoption of services that reduce harm for those who engage in unhealthy practices.  

May 2013 bring health, peace and happiness to your home, office and places you play.