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Wednesday, 30 October 2013

Oil and Gas - Pipelines and other transport technologies and their impact on public health

Keystone XL:  Alberta to Texas
Northern Gateway:  Alberta to BC port of Kitimat
Enbridge’s Line 9 reversion :  Alberta to Montreal
TransCanada Corp West to East line – Alberta to Quebec or New Brusnwick ports
Kinder Morgan twining: Alberta to Vancouver port

If approved, daily movement of oil from Alberta outwards would approach 3.7 Million barrels per day or roughly what is predicted as production for 2020. Details about the pipeline proposals were written up in Globe and Mail Feb 2013.

Each of the projects has a story of consultation and conflict; Politics and ploys; Fundamentally about how to get oil from Alberta oil sands (and other production well fields) to market to make a profit. 

While only 4% of Canadian crude makes its way across country in trains, two very high profile and disasterous scenarios have underlined why train movement has its limitations.  The Lac M├ęgantic   tragedy killed 42-47 persons while the Gainford incident was the latest and just month previous a train derailed near Calgary.

The National Transportation Safety Board maintains statistics on pipelineaccidents and incidents (as well as trains).  TSB pipeline data .  The term accident inappropriately reserved for situations where damage to person or property has occurred, incident where no damage has occurred but a near miss was identified.  Some of these definitions don’t seem to match that an incident could cause environmental damage in four instances in the last decade.

The vast majority of incidents and accidents are associated with releases of <1 cubic metre of petroleum material.  Only 18-20% of both defined outcomes were actually associated with transmission pipelines, most instances appear related to start or end of the transmission, or with compressor or pump stations with a handful of others that deserve better definition.

The key statistic from a public health perspective are the health outcomes.  The data tend to merge injury sufficient to require hospitalization with death – and report on a total of 4 such instances in the past decade with the last fatal pipeline related death in 1988.

Contrast this with the full rail industry where an average of 80 or so deaths occur annually, most with persons on the tracks or at intersection collisions.

For those concerned with environmental damage, pipelines also have a good (but not great record), and certainly compared to the high profile train derailments, the environmental damage is more constrained.
So, if one had to choose, which would be the best option – trains carrying petroleum, or a pipeline?  

Both of which may end up at a port, where the product is loaded onto ocean liners for distance transport.  

Tuesday, 29 October 2013

Oil and gas - upstream public health impacts. Do the benefits outweigh the costs, and who gets to decide?

This series on oil and gas industry and public health impacts stated with a the previous blog looking at the tar sands and impacts DrPHealth October 28 2013, only to discover misrepresentation of a scientific study that wasn’t about the tar sands at all.

Previously, and still the most referenced blog posting,  is an article on fracking from just over a year ago DrPHealth fracking October 2012. Related to the boom and bust cycles of rural and remote industry is a post DrPHealth rural, remore and northern development October 9 2013.

The oil and gas industry is a complex multitude of processes and health threats. Routine operational aspects such as flaring, fracking, and refining are common day terms with a multitude of implications.  “Upstream” resource extraction activities tend to be associated with more rural locations, transient workers, boom and bust economies with associated health challenges.  Some 120,000 people in Alberta are employed in the upstream activities.  The annual “investment” in oil sands activity being in the range of $20B.  The royality benefit to Alberta in the range of $4.5B annually.  One of the best measures of personal and community health is economic vibrancy, so supporting a dynamic economic environment has value, while monitoring and mitigating the potential negative impacts. 

Itinerant worker camps over double the population of the area, and while many are concerned about the health impacts of such camps, the proportion of emergency visits to local hospitals in oil and gas country which are industrial driven or even camp related is a small percentage (reportedly ~5% in NE BC).   Not surprising given very healthy workers and rigorous occupational safety requirements. 

Add to the requirement for good health prior to employment, many camps are moving towards strict drug and alcohol restrictions for workers in camp.  Camps are becoming managed mobile communities – not specific to any one employer, but cautiously managed to ensure a supply of able bodied persons. 

The major concern in these developing communities is less about health care system demands, and more about the social disruption to communities, the threat of recession and loss of income for local businesses (itinerant workers merely travel somewhere else).  

There are few local protests to the environmental damage, and while concerns are expressed about personal health and wellbeing and the potential negative impacts, they do not dominant discussion.  Some excellent work has been done in flagging the real and potential concerns on health (and other consequences) and should guide public health’s approach to upstream energy sector impacts.

The excellent Royal Society report is augmented by a few other key public health documents

A fundamental question to be asked is whether industrial development of this nature should have a new positive benefit (utilitarian ethic of the greatest good for the greatest number), or that there should be no negative consequence for any person/community (liberal ethic that there is some good for all)?  Depending on your view, the tolerance for negative consequences may be different, and respecting differences of opinion a key to conflict resolution that can be a significant issue. 

As environmentalists across the globe project their concerns about the impacts of oil and gas growth in Alberta (and concurrent growth in BC and Saskatchewan areas benefiting from natural resource fields), the issues facing residents, workers and local communities are at a disconnect from what critics located in urban settings and at distance from the “coal face” purport as the problems. 

To come, distribution and pipelines, downstream refining and processing, and product utilization 

Monday, 28 October 2013

Oil sands health impacts. A misrepresented study leads to misperceptions of public health harm.

The oil and gas industry’s increase in intensive activity is garnering considerable attention.  Protests mount in BC, Ontario and other locations in opposition to pipelines, train derailments in Quebec and Alberta highlight long distance transport, fracking is at the centre of attention in civil disorder in New Brunswick, and central to the debate rests Canada’s lucrative and extensive oil sands where worldwide fears mount and sanctions are at times imposed because of claims of negative environmental impacts.

The oil sands debate centres around Fort McMurray.  A boomtown atmosphere that began in the late 70’s and has exploded again since the turn of the century as oil sand mining has become a key central source of petroleum products for North America supplying about 10% of North America’s daily needs

A tweet came over the wires “Carcinogens detected in emissions downwind of AB oil sands” speaking to a recent article from University of California at Irving (UCI) which supposedly noted  associations between high levels of contaminants and male cancer rates of persons living in the area.  UCI press release.  An astute observer might delve a bit further and ask the questions, why the alarms from California and not from Canadian health monitoring agencies?  Why did this group find a correlation when previous studies have not?  As the residents of the area are predominately Aboriginal, were ethical principles followed? 

It took only a few moments to discover the first important flaw.  While the press release referenced the tar sands – the study was actually undertaken in the Edmonton and surrounding areas where a wide variety of oil and gas production and refining occurs.   The distance exceeds that of Los Angeles to San Francisco and no self respecting Californian would suggest that what occurs in those two cities is in any way related.

Tracking the tweet back at #tarsands shows what can happen as stories pass through multiple hands. The original tweet on Oct 22 from a local reporter in Orange County alluded to the association with tar sands.  It reinforces that referencing the original  story, and those interested in the primary source might find reading the original material less than overwhelming Atmospheric Environment   in terms of methodology and findings.  (A small area was monitored. Sampling occurred over only 2 days.  The health data were historical ranging from 4-14 years prior to the air monitoring survey, ....) (In reviewing the full primary article, in fairness to the authors there was no attempt to represent the data for more than it was, nor was there reference in the article to implicate the oil sands.  The guilty party being the communications at UCI, with the authors being complacent with the misrepresentation)

Put the oil sands in perspective.  The Royal Society of Canada reviewed the impacts of the oil sands in 2010 in an extensive, objective, 3rd party report Royal Society full report.  Anyone interested in understanding the oil sand topic further   would be encouraged to read the report.  Its major authors including some of the pre-eminent environmental health specialists in Canada.  Because of it being the Royal Society, it lacked the glitz and media fanfare the UCI report is receiving.  The report was critical of many aspects of the industry and regulatory framework, but failed to conclusively identify human health threats from environmental exposure.  

While scepticism about the impacts of heavy oil mining in Northeastern Alberta are likely justified, and confirmed by some of the Royal Society report, objective research and objective reporting are critical to an informed and intellectual dialogue.

Tuesday, 22 October 2013

US’s fattened health care costs in pictorial glory

The Huffington Post in less than a decade positioned itself as a forerunner in electronic journalism, something that traditional newsprint based or even television based media have not been as successful in accomplishing.  In 2011, AOL purchased the company for $315 Million, and in 2012 one of its commentary series took a Pulitzer prize.  The point being, if you are wanting to stay on top of news globally, nationally or even regionally – plug in to Huff.

In the midst of the US government shutdown, the Huffpost did a piece on why US health care is so expensive, and helped negate the myth that Americans don’t pay much for health care through their tax dollars.  According to Huff, US citizens actually are paying more in taxes for health care per capita than Canadians. 

So the story is well worth reading, okay its not a story other than 12 pictures – but a picture tells a whole story.  From  demonstrating the costs for health care, hospitalization and  drugs,  through poorer health outcomes and life expectancy, the series of 12 graphs tell a bleak story of inefficiency and poor quality. 

The international comparison from a US perspective incorporates Canada in 2/3rds of the graphs and provides a good overview of the relative benefit and inefficiencies of the Canadian system.  The data are from OCED Health data and sliced for public consumption in a fashion that tells an American story with international flavour.

The full article can be accessed at  Huffingtonpost october 3 2013 

Having adequately complimented Huffington for its work, unabashedly below find some of the key graphics “stolen” from the website for DrPHealth viewers to get a taste of what the full article will provide.

Monday, 21 October 2013

Intellectual recession - are we hiding a potential urgent national problem?

Recent events have clearly demonstrated the willinginess of governments to intervene during a recession.  An activity which predominately supported corporations and those with the largest investment portfolios and incomes.

What if we were faced with an intellectual recession.  How would governments react?

To begin the discourse, what would one expect in an intellectual recession?

·         reduced enrolment rates in fulltime undergraduate programming.  While it appears there are some 817820 enrollees in 2012 (AUCC enrollment data 2012), the last Statistics Canada data predates the economic recession and are not comparable Stats Can enrollment to 2008  (why would this data not be readily available?)

·         higher youth without jobs – while statistics are not good, rates hovering in the mid-teens to 20 % are reported in some areas which rival depressed areas of US and Eurozone and are well reported in Huff Post  .  In a weird quirk of EI statistics, in order to be “unemployed” you have to have first been employed, so the number of unemployed youth may be a significant underestimate for new graduates that have never obtained adequate employment.

·         Numbers of Canadians taking temporary or long term employment outside the country.   For which no source of information could be found on data more recent than 2008 More data from Stats Can which is untimely and pre-recession.  This used to be referred to as brain drain for the most elite of researchers, but now includes those taking jobs in US and Asia.

Help contribute to the discussion by proposing possible indicators in comments or at drphealth@gmail.com

That none of the indicators are timely, up-to-date or monitored should raise questions of itself about the openness of government to “bad news”.

If one were to analyze who benefits from an intellectual recession, it is those that likely can benefit from lower wages, less skilled workforce, more focus on labour based employment – basically corporate Canada.

The ultimate question on an intellectual recession is how would one address such a recession?  The economic recession was addressed through government subsidization, capital project spending, bolstering corporations teetering on financial collapse.   In parallel, an intellectual recession might be addressed through expanding government and private research, subsidization of education costs, bolstering post-secondary institutions in openness, and a very forward thinking fashion in investing in early childhood development.

Would evidence of an intellectual recession generate the same urgent government response that the economic recession would?   Does the lack of indicators that would even unmask such an event a sign that we are avoiding an inconvenient truth? 

Thursday, 17 October 2013

Canada's throne speech - health has been ignored and undermined

It is enough to make a grown health care worker cry.

The annual ritual of the throne speech, a document that lays out in words the direction that the government will pursue in the upcoming sitting. 

Health is mentioned eleven times in the speech. 

·         First in relation to fiscal policy on health transfers
·         Second in extolling government investment in resources that leads to spin off benefits in supporting health care

  • “Renew investments in health research to tackle the growing onset of dementia, and related illnesses;”

·         “Canadian families expect safe and healthy communities in which to raise their children. They want to address poverty and other persistent social problems, access safe and reliable infrastructure, and enjoy a clean and healthy environment.
o   Following which the first action of the government is to “reintroduce and pass the Respect for Communties Act” (see DrPHealth July 10 )
o   Expand its National Anti-Drug Strategy to address the growing problem of prescription drug abuse
o   “Close loopholes that allow for feeding of addiction under the guise of treatment”
·         Under a section on Canada’s Northern Sovereignty is a self congratulatory statement on investment in health care in the north (with no promise for further addressing inequities)
·         Under a section on Promoting Canadian Values  (excuse me but where did we come up with such a strong value statement?)
o   Canadians also know that free and healthy societies require the full participation of women. Canada has taken a leadership role in addressing the health challenges facing women, infants and children in the world’s poorest countries. These efforts are saving millions of lives.
·         And our Government will continue to work in partnership with Aboriginal peoples to create healthy, prosperous, self-sufficient communities

Put into perspective “tax” is mentioned 23 times.  Derivatives of “econom” 30, “Canad” 219, and evidence of ego boosting in “our Government” is listed 142 times, this is only added to by 18 mentions of the word government alone. 

Okay there are a couple of glimpses of good news – the dearth of these is disheartening
·         Build on the successful Housing First approach and its renewed Homelessness Partnering Strategy to help house vulnerable Canadians;
  • Take further action to improve air quality nationwide;

If you are wanting to read a health tragedy, it can be accessed at Throne speech  

Wednesday, 16 October 2013

Muzzling science - Harperism undermines Canadian contributions

For those that suffered through the Regan years in the US, where presidential policy dictated the sort of science being undertaken, and “inconvenient” types of research were systematically annialated.  The most notable being stem cell research, for which globally over a decade of right wing conservatism has held back progress.

Fast forward to Harper’s prime ministerial election in 2006, followed by a second minority government in 2008 – and then a majority in 2011.  Slowly but surely, administrative decisions have eroded the same sorts of science that Reganomics negated – those that are inconvenient to either government or more specifically conservative policy direction.  Harper’s purge of science has in some ways being even more complete.  

Gone are efforts on climate change while oilsands and energy “research” is thriving.  Basic information and research on economically challenged persons was systemically eliminate from the long form census in the name of protecting the “privacy” of a few very rich persons who did not want to disclose their actual wealth, but in reality the loss of economic data from the census hit those in poverty the worst as the issue appears less concerning than it actually is.  Research on issues like economic determinants of health have been negatively impacted. 

Moreover is the highly controlling fashion that those that oppose the prevailing conservative mentality would see their positions defunded, non-governmental agencies had their foundations eroded from underneath of them, science that potentially challenges government policy is run through so many filters it is diluted to the point of not even reflecting the findings of the research. The inability of government scientists to speak freely has been noted previously in this blogsite. 

And yet, outside of inner circles, this systematic elimination and biasing of results to misdirect public opinion goes predominately unchecked and undiscovered.  Thankfully a few lone voices in the public media are beginning to speak out.  To this extent, the Toronto Star via a Calgary journalist at least has published a scathing editorial of Harperism science.  The debate can be followed on Twitter at #unmuuzzlescience.  A new book by the writer of the Toronto Star editorial looks also worth reading The War on Science: Muzzled Scientists and Wilful Blindness in Stephen Harper's Canada.


Whether you agree with Harper politics, the public have a right to be made aware of being manipulated and deceived for the sake of conservative policy – and that is for those of us with science foundations the worst possible crime.


And some people wonder why DrPHealth insists on anonymity. Those that might like to share a story can submit through drphealth@gmail.com and your identify will be protected.  

Friday, 11 October 2013

Public health and Primary Health Care: The oil and vinegar of the health care system.

Oil and vinegar when mixed together make for a lovely combination of flavours that can enhance salads, vegetables or as a dip.  But no matter how hard you try, shaking, stirring, blending or other form of agitation, the two substances will separate out into their separate layers.

Thus it is with public health and primary health care.  

Sir Michael Marmot who continues to be a major influencer of social and health policy on both sides of the Atlantic touches on the issue in an editorial in the Lancet October 12 2013.  He even tries to find ways to blend the great works in the fields of population heath and primary health care, and concludes that even with the best efforts, there are still areas like the social determinants of health that become excluded from the primary health care agenda.  

Certainly there is a need  to support primary health care workers in embracing a population health mentality, and a need to acknowledge that the shift of public health workers to predominately individual/family services is a migration into primary care provision.

The astute reader will note the subtle variances in use of primary health care and primary care, and between public health and population health.  Building on something that has been attributed to past CPHA president and University of Waterloo MPH program director Christina Mills “ population health is the way we think, public health is what we do”.  Likewise “primary health care is a way of thinking, primary care is the delivery of the service”.

The tension faced by public health practitioners is twofold, first that because much of public health workers now do is primary care, in the regional authority megaliths they are being forced into marriage with primary health care entities.  Secondly,   since there remains a poor understanding of population health by administrators of these bastions of service delivery, there is a belief that the primary care provided by public health professionals is the de facto mysterious population health, and as such a natural union should be encouraged.

When resources are tight, and they are tight across the country, trying to kill two birds with a single dollar is natural, but highly myoptic. While the primary health care community covets the public health resources, less commonly are population health folks moving to maximize the opportunities provided by primary health care practitioners.

So who is the oil and who is the vinegar?  It probably doesn’t matter, neither is very good by themself – both will benefit from being mixed together, and nature will still dictate that they will be separate solutions. 

Wednesday, 9 October 2013

Rural, remote and northern development: Time for a dialogue on public (health) policy

Over 80% of Canadians live in urban settings with one-third of us living in one of the three big cities.  The urbanization of Canada mirrors what has occurred in many countries, and with migration into denser population centres, policies that support future city growth ranging from healthy built environments, public transportation and telecommunications dominate in provincial and national discussions.  Markets are greater and even using a free market approach supports bringing people to the product over local distribution centres.

All this begs the question of why support rural, remote and northern development? 

If you have not taken a trip lately to resource based communities such as mining, forestry and energy, the more typical rural community has  been planned from day one for being short lived.  Work camps will phase through construction and operation – with the operation designed to harvest the resource in a time limited fashion of years to decades.  Then, the camps can be packed up and rolled on to a new location.  Some secondary services may be provided by nearby communities, but most food, supplies and even the human resources are transported into the community.  Workers are typically on shifts ranging from 2-6 weeks in camp, and then out for 10-30 days.

Workers are usually not residents of the community, their permanent residence remains that of their home community – some transiting from large urban settings. When finished with one resource extraction project, it is merely a matter of moving on to another while retaining permanent residence elsewhere.  Camps are predominately male, 20-45 year olds.  Better run camps are dry and drug-free and strict behavioural expectations can result in immediate expulsion from camp and termination of employment. 

Hence we are challenged with many influences that support growth of cities while potentially ignoring rural areas.  For arbitrary discussion purposes, rural being defined as communities combined with their immediate feeder areas of less than 10,000 population.  Hence some agricultural zones are encompassed within urban areas and not included in this discussion.

The basic question is whether Canada, its provinces and territories should encourage de-urbanization, support sustainability of rural communities, and encourage geographic diversification.  Smaller communities are less efficient, service requirements are expensive, transportation costs are significant and there are many other reasons for not supporting rural growth.  Such conclusions have influenced politicians to give lip service to rural communities while implementing policies that do not support rural sustainability. 

Why is this a health question?  Rural communities typically have poorer health status, tend to indulge in more unhealthy behaviours and have more risk factors, and costs for providing health services are higher.  Our track history on addressing rural health has been poor, perhaps as a lack of commitment.

Prime Minister Harper might be commended for his annual excursions to Canada’s northern communities, as much to demonstrate Canada’s sovereignty in the area as for its benefits in supporting sustainability.  Media seem to enjoy excursions with politicians to “exotic” locations and such efforts lead to considerable publicity, out of proportion to the actual policy support of these areas. 

Fundamentally the question becomes what might be the reasons for developing a rural and remote sustainability strategy.  Here the reader is encouraged to post comments, send emails to drphealth@gmail.com and stimulate dialogue that can define our collective values, and to identify anomalies in policy that undermine rural development strategies. 

Please speak up. 

Monday, 7 October 2013

Breast is best - usually.

Breastfeeding was celebrated this past weekend with a mass latch on across the country, and in some cities, flash mob breastfeeding events were being held. A great expression of one of Canada's public health successes

Breastfeeding rates have neared 90% after dropping two generations ago to less than one-third.  An amazing celebration of both public health and feminism in reclaiming what is by far the best option for most babies.

Like many things in medicine and health care, the marginal value becomes questionable of moving through various levels of breastfeeding from supplementing with other formula (or for older infants solids), through occasional juices and water to never using anything but the real McCoy.  Not to suggest that there is no value, only to emphasize that there is  greater importance in supporting parents in any breastfeeding than to leave individuals feeling guilt over their choices.

Breastfeeding is now adopted most by older mothers, the most educated and the most economically endowed.  It has almost become a sign of social status.  Granted rates remain lower as one travels east across Canada, Aboriginal women are less likely to breast feed, as are those in non-marital relationships.

Current national guidelines stress exclusive breastfeeding for the first six months of life. Our data is less clear than breastfeeding initiation, but few jursidictions will boast achieving even 50% breastfeeding rates at 6 months, let alone at 4 months. 

Hence the question needs to be reiterated, why and how do we support families in sustaining breastfeeding?  Moreover, given that so many women choose to not maintain exclusive breastfeeding through the first half year of life, let alone continue latching up to one or two years of age – why do our public health programs remain focused on just initiation? Or moreover focus on those who seek support because of what pathologizes anomalies of breastfeeding?

The highest risk for weaning early is among those that would benefit most through socioeconomic challenges, through social conditions or just through lack of education.   Too often the professional women, highly motivated and for whom the marginal benefits of sustained breastfeeding become the target of misdirected comments and efforts – as they seek public health support in other aspects of their parenting role.

Breast is best, and better when sustained. But at least let us be focused in what value we are achieving in our comments and efforts.