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Thursday, 30 May 2013

Solid advice for public health workers - How to partner.

Many of us move from across multiple work locations and subsequently engage in “office surfacing” – that is temporarily hanging out in other people’s home office space.  It can provide an interesting glimpse in individual lifestyles and values. And so it was recently, hanging in a office as a set of value statements, but rings so true for those that choose public health as a vocation – and perhaps for just good everyday advice. Modified for this readership and there is no reference to the source available - some principles for public health workers to work by:

1.       Be clear on your goals and objectives – what is it that you want to achieve?
2.       Assume everyone is a potential ally – look for what others bring that will aid in your effort, and there is always something.
3.       Relationships are foundational:  – build relationships, which builds trust, which builds understanding and that you build just about anything.
4.       Look at the world from the eyes of the other person:  understand what they what and what they see. When they believe you have understood their position, it is a step in the relationship process.
5.       Find the common currency: – each of us is swayed by an incentive, whether moral principles, money, power, common values etc.   Learn to negotiate around the common currency
6.       Negotiation is a give and take process: Remember you need to give before you can expect others to offer you something in return. 

Public health professionals are inherent masters in working with others, building partnerships and collaborating.  It is nice to see the key elements of partnering so succinctly documented,  and a fervent reminder of why public health is a vocation and not just a job. 

Monday, 27 May 2013

Health Council of Canada 2013 report - not the greatest and perhaps the last.

The 2013 Canada Health Council report is the tenth and possible the last from this group.  Funding was announced as being curtailed in the latest cost saving efforts by the Harper government. While their impact has not been notable, the work is solid and perhaps a few more years might have led to demonstrable change.

One key component of the 2003 accord, was an attempt to put greater accountability of the provinces for the funding that they received.   Comparative analysis of any health jurisdiction seems a hornet’s nest, as while the best appreciate object to the results. 

A shame that the indicators were more of service than of health: hip replacement wait times, cataract wait times and coronary bypass.  No measures of appropriateness are included. 

While the report bemoans the national variation – more striking is actually the comparability across the country.

Measures of access to primary health care are limited to emergency visits to the practice.  There is a good comparison of adoption of electronic health records, but the best provinces are still only at 3/4 adoption.

Public health progress monitored only by the prevalence of obesity across the decade.

A worthy read, but perhaps also good rationale why cessation of funding should run its natural course.

Access the report and other Health Council of Canada materials at http://www.healthcouncilcanada.ca/

Tuesday, 21 May 2013

Canada’s 2013 Active healthy kids report card is released

The 2013 edition is out, and nicely reformatted and packed rich with information.

The report card is tracking year over year progress on 17 indicators of physical activity for children.  Not surprising, in many areas Canada is not performing well, but in some areas there are good grades.

The title of the report speaks to the basic message.  Are we Driving our Kids to unhealthy behaviour provides ample evidence of the shift from active transportation to inactive transportation in every day activities such as getting to school. 

Another step in the right direction to getting Canada back on the pathway to physical fitness. 

Thursday, 16 May 2013

Food swamps and deserts in Canada – a food environment assessment hidden from public view.

Health Canada released (or perhaps didn’t release) a very well written treatise on Measuring the Food Environment in Canada.  The publication states it will posted at Health Canada’s  Nutrition Policy website and it is not there yet, hopefully delayed only in processes like translation.

However, the kind readers who forwarded to me, suggested that it will not be posted and perhaps the contents provide some indication.  They take full aim at food swamps.   Food swamps are areas where there is an over abundance of high-fat high-calorie foods and often associated with lower socio-economic areas of communities.  Translated, the major fast food chains congregate in poorer areas of town, and one might expect that these food chains will have a strong voice of objection to the report. The Harper government has already buckled several times to food industry pressure. 

The other key findings, none of which are a surprise:

o   Most of the Canadian literature published to date shows associations between features of the food environment and residents’ diet-related outcomes, even after adjusting for important confounding variables.
o   Food deserts appear to exist based on already performed food environment assessments.  These are areas where residents may find it difficult to obtain quality food options. 
o   There is insufficient information on food environments in northern Canada.

If you are interested in obtaining a copy, use the link about and go to Publications and request the document directly. Enough demand may stimulate its release. (Health Canada is indicating they are in a website revision)  If you are having problems, contact drphealth@gmail.com and a copy will be sent to you.

Tuesday, 14 May 2013

Hockey Night in Canada - Body checking going to the penalty box

Gone for 2013 are the Canucks, Canadians and Maple Leafs – and going is body checking.   Shame about the first three but this posting is about body checking.

Nova Scotia was second out of the block, followed the next day by Alberta and one can assume other provincial minor hockey league governing bodies will quickly follow suit. The announcement for the upcoming year is the elimination of body checking in the Pee Wee competitive leagues.   Quebec which still leads Canada in many aspects of protecting the public’s health has not permitted body checking until Bantaam ages for some time.  Many provinces have acted on body checking in the less competitive leagues and in women’s hockey already, so not a major jump.

Much of the rationale is based on evidence comparing Alberta and Quebec which demonstrated a three-fold increase in injuries including concussions at the Pee Wee level. The report is worth the read Hockey Calgary review 

Canadian and American Pediatric experts have recommended that body checking be precluded prior to age 15. Those that worry that Canadian players are at a disadvantage need only to look to Europe where leagues don’t allow the body to be used right through to age 15 and European players have taken a very prominent role in North American hockey because of their other skills in skating and shooting, and staying healthy. 

Of course, Pee Wee ages are just 11 and 12.  So there remains a gap in the policy that can better protect 13 and 14 year old Bantaams – and given young hockey players a better chance of ever even making a go at major hockey levels. 

Not that any of this is new, a 2009 review of 20 studies dating back to the late 90’s have consistently demonstrated the risk.  Clinical J Sport medicine 

A small win for health advocates.  Good luck Senators.

May 26th - two days ago, Hockey Canada moved to ban bodychecking under the age of 13.  A first step.  The Canadian icon of on-ice violence Don Cherry promptly dissed the national move.   The next day the Senators began their summer vacation.   

Thursday, 9 May 2013

Canadian National Household Survey (Long form Census) - low response rates potentially bias findings.

Not surprisingly, Statistics Canada has put innumerable caveats on the release of the long form information.  Under mandatory completion, rates exceeded 94%.  Under voluntary completion, a full third have not completed the form.

There are innumerable stories out in the last 24 hours on the identified shortcomings with Statistics Canada disclaimer on the data problems.

Census coordinators often used to hand hold individuals who were challenged in completing the form.  So, who most likely choose not to complete.   From the privacy paranoid individuals wanting to protect their secrets who have forced the change, they are likely those with something to hide like illicit income or total wealth. A very small fraction of the respondents.

No, it was the literacy challenged, those with less proficiency in English or French, those with fewer resources, those that might feel unwelcomed that are likely the ones who avoided replying.  This skews the census results to a higher socio-economic grouping, perceptions of fewer problems and challenges and makes Canadian social policy look better than it likely actually is.

Great if you are the government in power.  Great if you want to trivialize the country's problems.  Great if you disperse funds based on documented need.

Bad if you are actually trying to do the right thing.

There doesn't seem to be any appetite of the Harper government to move back to an evidence base on which to base policy decisions. It is however a great example of policy based evidence making.

Monday, 6 May 2013

International exploitation – out of mind, but in sight – So why do we turn a blind eye?

In the previous posting International exploitation out of sight out of mind , this site decried the global consumerism impacts on developing country workers.  Far afield, their stories only make headlines when a major travesty happens.

Exploiting international workers is also a domestic issue.  Slavery aside, historically, Asian workers were brought to Canada to work the railroad and even now are engaged in mining operations that few Canadians do not find acceptable as working conditions.  European and African immigrants engaged in a variety of usually blue collar types of work which are difficult to fill domestically.  Central Americans who work Canadian agricultural operations including fruit and vegetable picking. 

Some of these workers relegated to less than desirable working conditions.  Most are expected to come with their own health insurance.  Health services may require out of pocket up front payments that may exceed a months income. They may not be informed of their option to apply for Canadian health benefits on arrival or in some provinces after a mandatory 3 months residency before becoming elibigle.  Workers are discouraged from reporting unacceptable working conditions.  They will lose their income and may lose employment if they are ill or injured. 

Wide variability exists in provincial supports for foreign workers.  Work camps regulations are minimal to non-existent.  A source of water and hygiene facilities may be all that is required.  Accommodation can be as minimal as requiring workers to bring their own (and interprovincial farm workers are often expected to tent).  Workplace safety is not applicable as some workers may be paid as they sell their pickings from the day and not as an employment relationship. Inspections may be non-existent for transient work camps (tree planting, fruit picking, farm work), and if there is a problem workers are fearful of filing complaints, don’t know how to file such complaints, and put their tenuous jobs at risk as they lack the same level of workplace protection as domestic workers.

As health workers, foreign workers are often not welcomed at health facilities without cash in hand.  Organized programs are lacking.  Outreach programs for Canadians have seen funding whittled away leaving managers struggling to protect Canadians first and turning the blind eye to the expanding foreign worker situation.   

In 6 years the number of temporary foreign workers in Canada has increased from 200,000 to 340,000. (in 2012 there were 265,000 temporary foreign students, 220,000 recent immigrants with permanent status, and 25,000 refugees claimants all of whom also have health issues in their recent dislocations). Citizenship and Immigration Canada

New York state boasts full worker protection and benefits for temporary foreign workers with a strong regulatory system.   Canada’s growing international exploitation is another less than stellar social performance with potential future catastrophic consequences.  In this instance however, Canadian governments have the ability to ensure dignity, equity and fairness are extended and blatantly choose to ignore this, while quietly promoting foreign worker exploitation.  Take a few minutes to compare New York’s amicable approach to foreign works http://labor.ny.gov/immigrants/service.shtm with that of Citizenship and Immigration Canada http://www.cic.gc.ca/english/work/apply-who.asp  

Thursday, 2 May 2013

International exploitation – out of sight, out of mind ... until ….

May 1st is known as International workers day. This weeks tragic Bangladeshi factory collapse and death of at least 400 workers with 150 still missing has hit closer to Canadian homes than the previous similar events.  One product is widely distributed in Canada by a major grocery firm. May 13 - the final death toll currently stands at 1127.  A subsequent garment factory collapse elsewhere killed 8.  Bangladesh has considered allowing unions to form without the permission of the factory owner - that might be considered slow progress at a huge worker cost. 

Lest we not forget a similar incident in Karachi less than a year ago killed 262 workers. Numerous  factory disasters can be found which have received less attention.  The chemical disaster in Bhopal in 1984 where 3787 deaths were confirmed across the community and up to 16000 deaths may be attributed to the immediate and long term consequences of exposure to methyl isocyanate.  Estimates place the number injured at over one-half million people.   The disaster is likely the largest on record.  The International Labour Organization estimates that over 2 million deaths each year are related to workplace deaths, many directly attributed to the impact of globalization.  While larger tragic events may receive attention, most deaths go unreported.  Chronic illnesses that render workers not employable such as related to asbestos exposure or silicosis, often undiagnosed and forgotten as workers are removed from the workplace. 

Basic workplace health and safety regulations that are integral to North American culture, are neophytic or lacking in developing countries.  The lure of employment, salary, income and profit contributing to the proliferation of work in developing countries.  And let us face it, as consumers we usually seek out the best prices irrespective of the manufacturing story.  Many of us will remain blissfully ignorant of the human costs associated with the bargain priced consumer products we enjoy.  Our contributions to growth in countries undergoing industrial development.  

Moreover, when production prices rise due to increased regulatory expectations, producers may find a “friendlier” welcome mat in a neighbouring jurisdiction.  Loss of such businesses can be devasting on the economy and health of the community and individuals.  We have decades of research on such impacts in the wake of European and North American industrialization.

While the Bangladeshi tragedy might stir some short term empathy and calls for improvements, it, like Karachi and the host of previous tragedies will fade with time.  With Bhopal the consequence was 26 years later seven local employees received 2 year sentences and up to $2000 fines.  The chair of the international parent company has yet to be tried.  

And while the worker deaths receive headlines, the stories of workers abuse, sexual harassment, decrepit working conditions and routine exposure to unacceptable dangers rarely receive international attention.  The notable success may have been a reduction in child labour through international efforts which saw global rates of child exploitation for work at 25% in the 1960’s drop to about 10% of children at the turn of the millennium.  As we look back through history, the same issues dominated our  industrial revolution, and it was the efforts linked to public health structures that led in developing solutions. 

The problem is systemic and secondary to industrial globalization. The future is one where only an international effort directed to planned continuous raising of the minimum standards for all countries will result in reduction of risk.  While the current microscope is on Asia, future exploitation will merely shift to where money is scarce and potential workforces plentiful. Places like Africa are ripe for the picking. 

Public health is structured around geographic areas.  In this case, we need to spread our wings and assume responsibility not just for activities within our jurisidictions, but the impacts of our local actions on our global neighbours.

Almost concurrently, Loblaws, which distributes Joe Fresh clothing in Canada, increased their dividend to about $0.20 per share, on some 280,000,000 shares in public trading, of which 64% are controlled by G Weston. One can only hope that they match their dividend payout with at least the same investment in compensation - that would be nearly $50M.