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Tuesday, 23 December 2014

Public Health year in review - top stories from the readers and writers perspectives

As the year rolls to an end what are the biggest stories in public health over the past year? Trite by some standards however a reflection of where we have come from in the past 12 months.  The site having received its 33,000th visitor this week

First your votes based on views of various postings in descending order by number of views.  The list of most popular sites contrasts dramatically with the list of what DrP thinks about the key public health issues for 2014 which follows

  1.       Hookah use:  A Science Update on a widely read subject  Feb 17
  2.       Public health officers under duress.   How well do we stand up for Canadians?Nov 20
3.       Assessing Minister of Health Ambrose's first 8 months in office. Not even close to a passing grade  March 5
4.       One year of Minister what’s-her-name? Ambrose’s first year.   Aug 13
5.       Quebec's public health system under siege  Oct 16
6.       Influenza 2014 - pandemicH1N1 the sequel  Jan 3
7.       Minimum wage, Living wage, Assured Basic Income, and the shift to Part-time work  Jan 19
8.       Positioning public and population health: An optimistic view for the future Aug 5  
From DrPHealth’s perspective, the major Canadian public health stories.
1.       Ebola and its implications July 30 threat analysis ,  Oct 20 Ebola-ied ,  Oct 20 Ebolaphobia 
2.       Appointment of the new Chief Public Health Officer and the immediate stripping of his responsibilities.  Aug 25,  Nov 13
3.       The siege against public health in Canada  Nov 20 ,  Oct 16

4.       The rise of the Oil and Gas sector – and while published in 2013, the series speaks to the very issues that played out in 2014 Dec 27, 2013 summary posting

Exploration, specifically fracking                                   Dec 5, 2013 and Oct 18, 2012
Upstream issues (mining, collection and pumping)          Oct 29, 2013
Pipeline and transport issues                                        Oct 30, 2013
Downstream operations (refining)                                  Nov 4 2013
End user contributions                                                  Nov 6, 2013
Boom- bust economies of rural and remote development Oct 9, 2013
Boom economies and the community left behind            Dec 10, 2013
5.       The rise of Transportation infrastructure as a contributor to health

Part 1 Transportation and health:  Apr 22

Part 2 Cars: Our love and addiction to the vehicle may be making us sick.   Apr 24

Part 3 Moving to active transportation: A Public Health winner: Apr 28

Park 4 Public Transit - moving the masses in a sustainable fashion. Apr 30

Part 5 Mass transit. Which method is healthiest? May 5

Part 6 A Rural Reply. May 12

Part 7 Your role in contributing to the public's health. May 15

6.       Coming of age of public health economics Dec 3

7.       The rise of Generation Squeeze Apr 9

8.       The death of the Canada Health Council and the Canada Health Accord Mar 26,  Mar 24

9.       Chikungunya disease that in one year has infected over 1 Million people and has crossed into the USA Feb 18

10.   The untold story that may belong at the top of the list is the resurgence of discrimination as manifest by racial protests in the US following police shootings, sexual discrimination at University and by own Minister of Health’s (Twitter profile showing her standing among a group of handsome males), persistent policy neglect of Canadian Aboriginal peoples, mistreatment of residents of African countries hit by Ebola, immigration debates in the US, Religious tensions that fuel the tensions between Islamic and Western nations

Please comment on which stories you believe should have made this list, or perhaps those that don’t belong here. 

May the year 2014 close with happy holidays for those who enjoy a break and our heartfelt thanks to those dedicated to serving others who selflessly work during the season so colleagues may spend time with their families and friends, or serve to protect us from others and ourselves during festive times.  

Saturday, 20 December 2014

Happy Holiday tidings - a time for Public Healthers to reflect on our personal vocations

The holiday season is upon us and DrPHealth wishes everyone the best for the season, however you celebrate.  Be sure to connect with those that have fewer friends than you, live by themselves or in whatever fashion are isolated.  Set an extra place at dinner and take the time to find someone to sit with you, your family and friends so they can share in your generosity.

Canadians are know for their generosity, a giving trend that has slowly slid over the past decade, perhaps in part from tighter finances and tighter pocketbooks.  Throughout global religions a common theme of caring for those that are less fortunate than yourself is pervasive.  Most of use have entered the caring professions with a true desire to be charitable.  At this time of the year take a moment to look into your heart and ask how true you have been personally to this lifetime commitment?

It is a time to relish in the eyes of children, whose view of this vast world is full of optimism, wonder and joy.  Our world will fall to them in the near future, and we will be dependent on their wisdom, leadership and sense of globalism for our personal wellbeing.  Keep those children within your reach filled with hope, charity and happiness - and reach out to those children who if touched by just one silent angel may blossom.

Look in the mirror and ask those insightful introspective questions - what more can I do to be a better person and what can  I do to make the world a better place now and in the future.

Happy holidays to all our friends.


Wednesday, 3 December 2014

Inequity – an economists view of the public health issue (and very supportive)

When economists speak to the need to address a central public health issue, we need to pay attention. 

A special report from TD Bank Economics discusses the implications of income inequality on economic growth and long-term prosperity.  TD economics special report November 24, 2014

The headline message to take home is the TD report references an OECD 2014 report  that shows a 1% increase in inequality results in a 0.6-1.1% reduction in GDP growth.  The TD study details further how Canada has performed internationally (and there are some positive indicators).   Both these resources will aid in future conversations.

Notable in the discussion is the debunking of the myth that global productivity growth benefits everyone and detailed analysis of who is benefiting the most and least. It further demonstrates that the Canadian misalignment of growth has actually been carried mostly by the middle-income earners.  The change in relative average income is reproduced below.

The growth by highest-income earners is punctuated graphically with the Canadian income share earned by the highest 1% having increased from 7 ½% to 12 ½% in the past thirty years, and one of the larger absolute and relative increases among developed countries. 

Our colleagues south of the border may well be interested in the report as well as it lays out the relatively poor performance of the US (and Mexico) on an international basis.   Comparisons between the US and Canada are notable as charted below in the disproportion of the distribution of wealth, however less “fair” work practices has fueled recent productivity gains in the US and stymied Canadian competitiveness in the international marketplace. 

The paper explores a variety of options to continue to support equity in Canada and draws heavily on analysis of changes in Gini coefficients arguing Canada’s relative success at holding the Gini coefficient relatively constant. (For more on the Gini coefficient September 2011  June 2012)   While negating increased taxation, the document does explore alternative approaches to ensuring income equality mostly through differential costs of services based on means (a more palatable form of taxation based on actual use and less open to taxation avoidance).  DrPHealth March 2014 discussed an International Monetary Fund report that supports redistribution of wealth as an economy improvement activity as well as reducing inequity.

A great read and an invaluable resource for those engaging with business and economists about the value of addressing a central public health issue.  The economic case for public health continues to mount. 

Sunday, 30 November 2014

Canada steps to the plate and sending personnel to fight Ebola

Let us give credit where credit is due. 

DrPHealth Octo 29 Ebolaphobia chastised the Canadian government for not only its token response to the very real issues around Ebola but what also turned  out to be limiting the NGO sector response for Canadians. Curing this time several other countries including Cuba and China stepped up and sent significant human and support resources to this international effort.   For those wishing to protect our borders, containment of Ebola in its current location is the most logical, rationale, and less expensive option.

The cost of all the planning that has occurred in the past month must run into the millions, but without a solid accounting of the meetings, the training, the teleconferences, the documents, the videos and numerous other resources aimed at protecting Canadians on Canadian soil, the real cost will never be measured.  Instead, the number of West African deaths has increased by some 2500 and tentative success is being suggested in Guinea and Liberia (but not Sierra Leone).

This week, the normally silent Minister Ambrose stepped to the plate with an announcement that Canada will send up to 40 military medical personnel to combat the spread of the disease.  Globe and Mail coverage.  Not only are they being deployed, but are headed to the hottest of the countries in Sierra Leone.

Before shining our Canadian egos, a few points need to be made.
·         These military medical personnel are being specifically deployed to a British hospital which is treating only health care workers who have contracted the disease. 
·         In making the announcement, Ambrose blamed the failure of the Canadian medical system to be prepared to manage individuals with Ebola rather than the goverment's lack of leadership
·         There has been no lifting of the visa restrictions for persons from areas with intense persistent transmission of Ebola
·         The past month has seen a trickle of Canadian volunteers join the fight with a clear discouragement from allowing Canadians to contribute their skills (save for a pair of laboratory teams from the Level 4 NML facility)

The chastisement done, let us now regroup and look at how much further we in Canada can muster our humanity, compassion and expertise in the defense globally against this threat.  

The Canadian Red Cross is seeking up to 1200 health care workers to work over the next 6 months in response to the need, and much of this is supported by Canadian government funding.  The Canadian government has commited over $100 Million in aid support for fighting Ebola, much of which will help defray costs of Canadian health care workers who join this important effort.  

Thursday, 27 November 2014

Children: Governments may not be listening. Two previously successful provinces slide away from their roles as leaders.

With age/experience/expertise perhaps we begin to better appreciate that people like being part of a winning team and ignore the messages of underachievement.  If we want populations to adopt a certain behaviour, reinforce that that is part of the majority as well as being smart.

While there were constructive messages entrenched in the posting on the suggestions of Campaign 2000 and the Royal College of Physicians and Surgeons of Canada, the dominate theme is that governments are failing in their commitment to children.  Despite couching this in the most positive of packages, two Canadian provinces drove spikes into the lives of children over the last week in the name of protecting the taxpayer.

Quebec, long held up for its very progressive child care program, has begun to back away from a universal program and applying an equity lens to access to subsidy.  On the surface perhaps a logical step.  Deep down it is the erosion of a policy that had the most hope for addressing the failings of the Canadian early childhood development system Globe and mail reporting on Quebec child care subsidy

Way across the country in Alberta the Alberta government after typically buying in fully to the EDI (Early Development Index) mapping and improvement program, quietly abandoned the initiative and  withdrew its funding. So quietly that we can’t even provide a link to reporting on the event but need to rely on those inevitable “reliable sources”.

In the face of the calls for action as outlined in the previous posting Canada's children getting needed support, and all within the week of International Children’s week, not only should the two governments be ashamed and taken to task, but those in public health should be sitting up and asking some very very difficult questions on who is directing policy regarding children.

Let us continue to celebrate by reinforcing the work happening in provinces like Newfoundland and Labrador and Ontario, where children, and in particular children living in poverty are receiving central attention of government.  Least we be depressed, it may be worth reminding the governments of Alberta and Quebec that they were in conjunction with Newfoundland and Labrador the only three provinces that demonstrated improvements in the proportion of children living in poverty Campaign 2000 25th anniversary report.

Why when provincial governments are able to demonstrate best practices are they embarrassed and unwilling to take pride in their actions?   Kudos to the three for their successes – they are something that should be sung so loudly from the top of the Rockies, Appalachian and Torngat mountains so that all of Canada can be astounded by their success.

Because everyone loves a winner!!!!

Wednesday, 26 November 2014

Canada's children getting needed attention from two very different groups.

Two papers of utter importance in relation to the state of our children are essential reading. 

Campaign 2000 that continues to remind us of Canada’s failed commitment to eliminate poverty by the year 2000 issued its annual report on the lack of success of the last 25 years of effort.  Most notable in the report card is the need to migrate to the Low income measure based on half of the median level of income in an area since the long form census shifted to the National Household Survey(NHS).  By its very nature the NHS will undermeasure those in poverty, those in single parent situations, and those that are less engaged with community. 

The good news is that poverty levels continue to creep down slowly, but still 19.1% of Canadian children are living in impoverished conditions. Regrettably this is still an increase over the base year of the parliamentary resolution in 1989 of 15.8%

Restructuring the low income level (poverty) level, has significantly shifted relative rankings of provinces in respect to poverty rates.  The Yukon and Alberta at the lowest end, while Nunavut, Manitoba and Saskatchewan at the highest levels. 

Welcomed in the report is emphasis on the state of indigenous children with estimated rates of poverty approaching 40%

The full report can be accessed from Campaign 2000

Balancing activism with academics is becoming a natural linkage when change is required.   The Royal College of Physicians and Surgeons of Canada , a body that rarely wanders into advocacy issues, has released one of the best and most comprehensive policy statements on children’s wellbeing punctanted by a message from the CEO.  This body steeped in tradition is taking a bold step by adopting and communicating a position on early childhood development. 

One needs to remember that the  Royal College oversees only the specialists of the country, of the 40,000 active fellows only 5% or so are pediatricians.  That the Royal College recognizes the lifetime investment and health benefits in substantive attention to the early years is an endorsement of the required attention. 

Read the 15 recommendations of the policy statement on early childhood development from the Royal College, and compare with the Campaign 2000 recommendations.  When such disparate organizations are saying almost the same thing, is it possible that someone may listen?  

Thursday, 20 November 2014

Public health officers under duress. How well do we stand up for Canadians?


This week saw public health officers nationally licking their wounds following a scathing commentary Globe and  mail - November 17th by a Maclean’s editor.   Colleagues within Canadian Doctors for Medicare among others responded G&M November 19 with a bolstering defense.  Those wishing entertainment need only scroll down to the commentaries submitted to either of the pieces to see the divisiveness of the debate.

As one commentary suggests - what is worse six health officers saying don’t limit our activity? or a magazine editor thinking they understand disease better than doctors?  

Colleagues, time for some solid reflection.  Clearly the debate on Canada's CPHO role has fueled burning embers and ignited a few fires.   There are those on either side of the fence that are using the opportunity to express opinions.  In the absence of a solid documented evidence base we have excellent individuals expressing opinions.  

The medical profession led by the Canadian Medical Association have increasingly migrated in the past few years to encouraging governments to address foundational issues that affect health and support those in staying healthy.  On National Children’s Day the Royal College issued a policy statement calling on greatly increased spending on early childhood development Royal college statement on early childhood development .  Such migration is also being seen in other health disciplines as well. 

However, the Globe and Mail editorial is a sobering reminder that Canada is a nation of diverse opinions,  and we are stronger for the diversity.  It is a reminder that as a public health professional we need to continuously justify our roles and carry our responsibilities with dignity.  It is a call to action to meet with those groups that perceive investment in social supports as a drain on their wallets rather than as a contributor to economic vitality nationally.  

To address the concerns on a moral basis will have limited benefit.  To speak in economic terms using well established value for money arguments will help influence the Peter Taylor’s of the world who are not prepared to accept moral arguments on the betterment of society. 
Can we use this latest in a series of onslaughts to rise to something better?  Or do we wallow in self-pity and fuel the skepticism of our critics?

It is notable that on numerous public attempts to eliminate or constrain the voice of public health, the public has risen in support.   It has been the behind doors suppression of the public health voice that has been most hurtful, and even more hurtful when such suppression is supported by other health colleagues. 

Thursday, 13 November 2014

Disempowering the Chief Public Health Officer - another blow to the Canadian public health infrastructure

The new Chief Public Health Officer (CPHO)  is facing his second test.  Dr. Taylor is merely a month into his tenure when the federal government announced that they are restructuring the senior approach to management at the Public Health Agency of Canada and separately the medical leadership from the mundane administrative functions.  Gone are the seemingly insignificant functions of acting as a deputy minister, of controlling how and where resources are directed, and presumably gone are making key hiring decisions including that of the new president.  Globe and mail November 12 Thus the new president of the agency becomes a political appointment and not selected for their prowess in public health, a trend that has castrated public health entities across the country outside of Ontario.

If you are looking for details, check out bill C43, Sections 253 through 258. It is buried in another of Harper’s omnibus pieces of legislation that contain some 400 sections with key changes that are buried treasure for those looking for reasons to criticize the current government.

All this is not surprising in an agency that has been a thorn to the Conservatives since elected. 
That Dr. Taylor was conveniently unavailable for comment on such a critical issue is notable, as is the carefully prepared statement that he appears supportive.  As DrPHealth stated at the time of the announcement September 25th posting  “With all respect to the person and the position, the announcement is one more step in Harper's alienation of health in general and public health specifically.”

More surprising are the public health leaders noting that such has been the trend nationally and something that might be welcomed.

This right on the heels of the embarrassing Canadian handling of movement of residents, workers, visitors and responders in the countries with persistent intense transmission of Ebola.  All good public health experts have disagreed with Canada’s phobic response, yet the CPHO has been silent and has not publically spoken on Canada’s misinformed approach to protection from Ebola. 

To his credit, we have the CPHO report  that mitigates some of the major slips, but right now the score is 2 against and 1 for. 

Greg, you have some major scoring to do to get back in the game.  

Monday, 10 November 2014

Peace and war. Remembering the tragic toll of global violence and celebrating those that serve for our protection

In an annual tradition for DrPHealth, it is time to reflect on our progress (or lack thereof) in addressing global peace.   Three deaths in the past month of Canadian military personal on Canadian soil are a sobering reminder of the costs of a path other than peace.

2013 has seen two new armed conflicts and one resolved with 33 active conflicts – a number that has remained fairly constant for the past decade.  Seven of these are defined as wars with over 1000 deaths.  The formal listing of conflicts is found though the Uppsala Department of Peace and Conflict datasets accessible at UCDP/PRIO data files.   Wikipedia maintains a good list as well and lists 12 conflicts with over 1000 annual deaths and 29 additional conflicts.  Slight variance in definitions leads to inclusion of issues like the Mexican drug war as an armed conflict with Wikipedia and not a conflict under the PRIO guidelines.

The newest conflict being in the eastern regions of the Ukraine where so far this year an estimated 3700 people have died.  Four of these conflicts appear to have taken over 10,000 lives with the Syrian Civil War accounting for roughly 40% of all global armed conflict deaths in 2013 at nearly 75,000.  The ISIS conflict is now the second largest global cause of war related deaths while the South Sudanese  conflict has abated going into 2014 and the current year deaths estimated at only 10% of 2013 where deaths exceeding 10,000. 

At nearly 2 Million cumulative deaths the Afghani civil conflicts involving the Taliban  and 4.5 Million in the tensions between North and South Korea these have the largest cumulative toll.  The Korean conflict approaching 70 years and the Taliban insurgency 35 years speaking to the challenges of intergenerational conflicts in which families are in a constant state of potential crisis.

While total numbers of war related deaths are not easily tracked, the listing in Wikipedia once again suggests deaths in 2013 as about 100,000.   The positive news is that cumulative through early November in 2014 would suggest these numbers have decreased by about a third.  In addition to the Ukraine, the surging conflicts are in Libya, Nigeria and Central African Republic where combined deaths exceed the cumulative toll from Ebola.

Four Canadian have lost their lives in military duty, two within training exercise and Warrant Officer Patrick Vincent and Corporal Nathan Cirillo in targeted killing on Canadian soil.  Fallen Canadians

The shooting of five RCMP with three deaths in Moncton in June, combined with one car crash and one on duty sudden cardiac event round out the list of those that have died in the service of protecting the people of our country from the effects of conflict.  Officer Down

In a tribute to those that serve to protect us, homicide in Canada continues to edge downwards with current rates about half of their peak in the mid 1970’s.  In honour of those that do serve, celebrate the success of their efforts Homicide in Canada 

Tuesday, 4 November 2014

It’s here at last!!!! – the 2014 Canadian Public Health Officers report

At least this year there were a couple of Tweets as the report was released on October 29.  It should be the public health event of the year and we should be celebrating like a gallery opening for an artist.  It is the release of the annual (or so) Canadian Public Health Officer’s report.  This year brought to you by our new leader-in-arms, Dr. Greg Taylor.

Regrettably once again, what should be a huge celebration has been relegated to a silent launch.  Media attention is non-existent. There were no press releases or media briefings, so why should the media be aware?  The Minister of Health (what’s her name? One year of Minister Ambrose posting ) has made no notes or acknowledgement.  It appears that this annual event is looked forward to by the government with even less gusto than the Auditor General’s report.  ‘Tis a shame.

The easy to read, very focused and only slightly government promoting document is well worth the 15 minute read despite the 110 pages.   This year’s focus being on the future of public health, with a delving into three emerging public health topics in depth, ageing, climate change, and digital informatics.  To its credit the entire report does not once mention Ebola, which these days is a real accomplishment.

In a carefully crafted call to action, the report challenges the public health community to proactively address the public health issues of ageing.  Not through the lens of seniors needing care, but through the lens of the majority of persons past retirement age who are relatively healthy and wanting to maintain and sustain their relative well being in independent settings.   The report only falling off this to address the incoming tide of challenges faced by those with diagnosis of dementia, one of the few causes of mortality that is currently increasing. 

The second section acts as a primer for climate change and public health.  Nothing extraordinary or controversial other than a federal leader actually acknowledging that climate change is real and is happening, that should not be overlooked and credit to the CPHO for being so forthright in making the obvious a statement of fact.  Those who have followed the climate change and health discussions for the past two decades will note a distinct shift away from efforts to mitigate to a wholesome discussion on how public health has a role in adaptation.

The third section braves a topic that public health’s current innovators are exploring in how better to use the digital world.   In our opinion the weakest of the sections filled with longer discourse and less concrete recommendations, particularly where better examples of digital utilization exist, however DrPHealth acknowledges that after 414 posting and 3 ½ years of blogging and Tweeting, that perhaps we have a slightly skewed view of the digital world. Potential biases aside, the section could have been so much more given our current state of experimentation. Granted the section calls for research, evaluation and most importantly adoption by public health providers – something with which even we would concur.

After perusing the three sections, the reader should be left with a nagging question – is this the go forward agenda for Dr. Taylor?   There are many aspects in the report that reflect his thinking and we can hope that this is an initial statement of his vision for the future of the Public Health Agency of Canada, our national guide in public health matters.

Don’t stop reading at this point.   Just when you think the report is done lies the hidden gem.  Do not skip the Appendix A.  In the twenty pages of the appendix, the report lays out a solid statistical foundation on the Health of Canadians.   Ideal for future reference, and perhaps mandatory reading for any trainee and provider in public health to stay current on trends in health and wellbeing in Canada. 

The full report is available on line at 2014 CPHO report  or downloadable from the same link as a .pdf for future reference.

This is the first real action by the newly appointed Dr. Taylor, and deserving of a “well done Greg”.  We look forward to more of your leadership and willingness to test the boundaries. Perhaps next year you could add a press release? 

Monday, 3 November 2014

Child care and public health policy. Where is Canada heading?

The Harper government announcement on child care and family support is a pre-election activity that is drawing considerable attention with vastly differing opinions on its value. Globe and Mail coverage   

How can anyone question the value of putting money into the hands of parents so that they can provide better care? Detractors of the government will find subtle reasons, but where will this policy take Canadians? 

The downsides of the issue. How far really does $720 per child take any parent?  When child care can cost upwards of $50 per day.  It amounts to not even a month’s care. 

That the benefit will be applied January 1, but only first paid out in June, just a few months before the election smells of buying vote.  Parents and families will receive a nice retroactive pay check as the campaigning starts.   No doubt more than a few will be confused that the future cheques and benefits will reflect similar sized payouts unless they support the incumbents.

Digging deeper and most disconcerting, while the benefit increases the affordability of child care for those in need, it does nothing to improve availability or quality of care.

On the second half of the announcement is a step towards addressing a long standing inequity in Canadian tax laws that actually encourage families to obtain two incomes rather than having a single large earner.   The value however is predominately to be gained by higher incomes earners, hence a mitigating effort by the government by limiting the benefit to a maximum of $2000.  For the far left an unacceptable tax benefit for the rich, for the far right an unacceptable limitation on an inequity.  From a policy perspective, for a government that  made a promise, perhaps keeping no one happy is the sign of reasonable policy development.

It has been a decade since Paul Martin promised a universal child care program for Canadians, and an issue that Harper first dismantled and now is reconstructing in his own image.  A step forward, but not necessarily a stride in the right the direction. 

Perhaps most disconcerting in all of this policy development, is that there was no public discourse.  There was no public input, debate or opportunity for refinement.  Once again, our prime minister has taken a dictatorial approach to leadership, albeit the perception being that of a benevolent despot.

Thursday, 30 October 2014

Distracted driving, road health and a celebration of a public health success

Ontario and BC took a step upward in addressing the epidemic of carnage on the road caused by distracted driving.  It was merely a handful of years ago when debates were being held on the safety of cell phone use while at the wheel, now texting has become the major culprit.

Humans will continue to invent technologies that modify health risk and in doing so will keep the public health workforce gainfully employed.

In typical fashion when threats are being first addressed, the statistics are sensationalistic and perhaps inflated, but the numbers promoted by the CAA are staggering culminating in the conclusion that driver distraction now contributes to 20-30% of motor vehicle collisions CAA distraction information page

That impressive number can be contextualized within the continuously decreasing number  and rate of fatalities and collisions on our roads, a real testament to the efforts of the road health/safety community. 

Where the disconcerting flaw in logic may arise is the impact imposed by aggressively increasing penalities where education and options have not been sufficiently explored.  Ontario’s new fines of up to $1000 for driving with a handheld device and BC has added demerit points to tickets associated with distracted driving.  Whether either will modify behaviours sufficiently remains to be seen. 

BC is no doubt celebrating in the wake of successfully addressing impaired driving through fines, suspensions and insurance costs and such success reinforces that enforcement can be a primary driver in behavioural change. Despite these progressive actions, speeds on BC highways have increased with many divided highways having limits of 120 km/hr – and the impact of such a move will need evaluation.

Both efforts are to be applauded, and other provinces should be encouraged to refine regulations to address more than cell phone use where such remains uniquely identified.  Distracted driving has been an offense for much longer, the change being that the definition now incorporates explicitly items such as handheld devices.

Our roads are becoming safer through the combined efforts of vehicle engineering, road design, driver training, enforcement, and public education.  Such a success is deserving of a public health high five.  

Wednesday, 29 October 2014

Ebolaphobia - when prudent caution becomes an irrational fear

Events of the last week demonstrate the level of irrationality that public fervor can escalate to amid the fear of the unseen. The irrationality verging on a new phobia aptly called Ebolaphobia and suffered by those yielding unreasonable power.  The pinnacle of inappropriate behaviour was achieved in the high level quarantine of a nurse returning from West Africa.

Canada is no less implicated in this irrationality.  Current policies essentially preclude health care workers from participating in care efforts as Canada has rescinded permission for participation pending a review of its policies.  The number of Canadian workers in West Africa has eroded to merely sixteen workers with plans only to send a small number of relief deployments once the processes with the Canadian policies are met.

These health care worker heroes are returning from months using high level protective equipment when the highest risk time for infection is early in their sojourn and disease development overseas most  likely. 

Currently upon their return, they are stripped of their autonomy, essentially placed under house arrest, and deprived of the professionalism for which they have demonstrated a level of valour that many of us admire and should be aspiring to. 

It does not make sense.

For some who are employed, provinces and employers may provide salary support to remain off work.  For physicians, having giving up to two months income to volunteer, they are further deprived of an additional three weeks income while segregated from society.

Canada has actually been relatively logical in some of its approaches, with screening occurring at the points of entry, and travelers with any risk reported to their local Medical Officers of Health who can provide support and monitor wellbeing while balancing the needs of the individual and risk to the population.  It is this balance of protecting the public and respecting the person that these professionals have been trained.

That has not precluded organizations issuing the paychecks of the MOHs from expecting disclosure of names, imposing unreasonable additional limitations, and certainly such organizations have diverted limited public funds to alley the phobias demonstrated by health care workers who would never possibly be exposed to anyone remotely linked to West Africa countries.  It behooves those in the public health community to apply a level of professionalism and skill that is exemplary.  Collectively we need the ongoing avenues to reflect on our ethics in meeting this challenge.

Political led responses have historically led to tragic consequences for individuals.  Leper colonies, Canada’s quarantine islands, tuberculosis sanatoriums, are further examples of where the political reaction has exceeded the bounds of rationality and undermined any ethical sense of autonomy.  

On November 1st Canada announced a preclusion on visas for any person from countries with widespread and persistent intense transmission. A move that violates an international convention that Canada was instrumental in negotiating in the wake of the impact travel restrictions during SARS had on the Canadian economy without adding to disease control. Such actions verge on idiocy.  http://news.nationalpost.com/2014/11/01/canada-wont-issue-visas-to-residents-of-countries-with-widespread-ebola/    

November 10, is the absence of any rational reason, Canada has announced that all travellers from countries with persistent intense transmission would be placed in a 21 day quarantine, unless they were health care workers returning who had used appropriate protective gear.  The number to be affected is likely very low, but such action is unwarranted.  Who is making these perverse decisions? 

Were we welcoming back military heroes from risking their lives to protect our country, we would do so with open arms and with social and economic supports.

Let us consider treating our health care warrior heroes similarly.  They are protecting our country by fighting an unseen enemy on foreign soil so that our borders may be safe. 

Thanks to those who have made the effort, and a voice of encouragement for those with skills to consider using them to protect not just our country, but our global community while truly saving lives.  

Thursday, 23 October 2014

When fear becomes a phobia itself

Canada collective is grieving the tragic events of October 22 and the loss of one of our country defenders Cpl Nathan Cirillo.   Terrorism has struck close to the heart of the country and unmasked our fears.  

For some the events and actions will be remembered for the heroics and a system that contained the damage when the horror could have been much worse.  For others, the sensationalist reporting and stirring into a frenzy will feed percolating fears.  Terrorism survives because it incites fear.  It restricts individual freedoms not through edict, but by activating phobias.

Decision makers are not immune to becoming phobic.  We can expect calls for enhanced security in parliament, in government buildings, in public places, in critical infrastructure.  Perhaps we can learn from the misguided response south of the border where dollars from social programs into homeland security.  The thousands that die annually from preventable deaths because services are not available in order to reduce the risk for an unseen threat.  

Terrorism has struck home.  The threat of terrorism will test our collectivity, rationality and our confederation.  The stresses and phobic reactions will fertilize our fragile mental wellbeing.  

The best words to recite and remember at this time were written by Calixa LavallĂ©e in 1880.   
O Canada!
Our home and native land!
True patriot love in all thy sons command.
With glowing hearts we see thee rise,
The True North strong and free!
From far and wide,
O Canada, we stand on guard for thee.
God keep our land glorious and free!
O Canada, we stand on guard for thee.

  O Canada, we stand on guard for thee.

Monday, 20 October 2014

Ebolaied – (pronounced 'E-bowl-a-eye-d') - The latest public health concern.

No disrespect intended for a disease that has tragically taken the lives of over 4500 people and the numbers will continue to mount

Ebolaied is the latest public health threat.  The manifestations being irrational fear mixed with overzealous misplaced responses while misappropriating scarce resources from more important issues.  The symptoms among public health professionals being drooping eye sockets with insommia initiated shadows.  The pathognomonic symptom being the rolling of eyes upon utterance of the word ‘Ebola’.

From Tyvek space suits to unnecessary quarantines, the actions of the misinformed and sometimes purposefully misdirected have resulted in spiraling escalation of actions in the name of public health that are unwarranted and unreasonable.  

So in the midst of this overreaction, there are so things to be amused. 

The best line we have heard is the one where all we needed to do to respond to Ebola was take the CDC plan for the zombie apocalypse and replace the word ‘zombie’ with ‘Ebola’ CDC zombie apocalypse planning.   

Some of the more real responses  can only be met with irreverent laughter. CNN’s sensationalist reporting of the poor lab worker who was on holiday on a cruise;  The youth wheeled through a Nigeria airport with a plastic bag over their head as they had returned from an Ebola zone; The Air Canada pilot who refused to fly a biologic specimen requiring Ebola testing to Winnipeg; The closure of borders; The quarantine of persons returning from Africa thousands of kilometers from any outbreak zone.   Share your horror stories in the comments section of what stupidity you have witnessed.

And the irrational fervor continues to mount, dressed in parascience and the worse than the worst case scenarios with little attention to facts.

Don’t expect the overreaction to wane in the near future, or at least not until evidence mounts of control happening in the three West African counties impacted (with Guinea making fair progress while Sierra Leone and Liberia have extension into large urban settings which will confound control activities).

Moreover, as the phobias mount, continuity of food supplies and other essential services will become more problematic.  As health services are exhausted treating Ebola, other diseases will break through and the death tolls from non-Ebola disease as a consequence of the outbreak will exceed the primary outbreak.

No doubt much could have been done to more effectively respond to the initial outbreak that began back in March.  For the dozen global deaths outside of the outbreak zone perhaps these might have been avoided by more aggressive early control.  Now however, we have passed the point of reason and entered an arena fit for barbaric human combat where the price is paid in unnecessary human lives.

The positive arising from the horrific situation will include better treatments, improved mass mobile treatment facilities, perhaps an effective vaccine, for a time period improved international outbreak management, and it appears local infection control programming will get a boost.  Whether international aid efforts and approaches to managing countries in crisis will benefit remains to see.

For all colleagues suffering from Ebolaied, be assured you are not alone – we will survive and congregate over a favourite beverage to share the war stories, as we bemoan the lack of resources needed to prepare for the next global onslaught caused by an emerging pathogen.   

Thursday, 16 October 2014

Quebec's public health system under seige

Late in September, Quebec took the next leap into health care regionalization by announcing 19 regional health entities, downsizing boards from over 200 to just 28, eliminating 1300 positions and aiming to save $220 Million Montreal Gazette Sept 25  

However, the reductions don’t appear to be evenly distributed across the system and of particular concern the Quebec public health system is under siege.  Canada’s flagship for best practices in public health and shining star amongst mostly dim public health structures, recently was informed of a major structural overhaul and downsizing of nearly 30% legislative debates Sept 25(search on the number “30”)  .  The cost saving measures announced by Health Minister Barette appear to be founded in  that misguided perception that public health is not providing direct health services and the “bureaucracy” can be eliminated.

The besieged Medical Officers of Health (MOH) were first attacked on the issue of on-call support and resulted in several resignations and Montreal Gazette July 10.  The Medical Officers of Health in Quebec are amongst the lowest paid physicians in Canada despite their specialist training.  In the wake of the resignations (?terminations) the need for appropriately qualified MOHs was followed by an Op-Ed by one of Canada’s foremost in the business, Richard Lessard led Montreal for over two decades up to his retirement and earned respect internationally for his work. Montreal Gazette Aug 22.  

As we have seen in many provinces, gone are the independent voices speaking for the health of the public, gone will be the boards focused on preventing illness in a system already besieged for challenges in providing health care and gone will be the supports and assistance needed to front line workers.  The lack of clear and independent public health leadership has crippled health reform in Canada.

We are now looking south of the border for better public health practices.  Under the Health Care Affordability legislation, a specified amount of funding is dedicated to public health services research and monitoring to demonstrate effective and cost beneficial practices.  More recent research comparing local health unit structures based on funding is demonstrating that there is a positive correlation between public health funding and reduced mortality, that reductions in funding lead to increased mortality, that dose of public health intervention is important and that local/community governance of public health improves the effectiveness of the public health programming.   

So, in the light of the developing evidence, and given the horror stories arising from other provinces, the news in Quebec is disconcerting, and the impact on its public health workers undoubtably disempowering and discouraging. That the harvesting of resources by the newly elected Liberal majority government targets the fundamental services that address determinants bodes poorly for the long term sustainability of the Quebec system.  As with many governments that will be in place for four years, the electorate memory will have been erased by the next election round.

As the rock group Queen sings “another one bites the dust”

Canadian public health history is too frequently replete with examples of global best practices, then amputated at the knees by a system that has not and does not want to take the time to understand the value and benefit which public health has brought to sustainability in the past, and continues to contribute to its future success – or perhaps through selective clearing away of the best, to the future demise of a health care system already teetering on collapse.

In the meantime, be aware of the disastrous news and stand up in support of friends and colleagues caught in these beleaguering times.  

Thursday, 25 September 2014

Finally a new Public Health leader for Canada - Greg Taylor

Congratulations Greg - you deserve the position.

It only took how long for the sluggish Harper government to move on the announcement?  16 months.  The question is - Outside of a few public health observers, did anybody even notice?

And, while we have every respect for Greg Taylor, and he may well be the right person for the job, it is as conservative and non-controversial a selection as any government could make.

Greg has been in the public service of Canada for so many years, most Canadians in and out of public health probably have heard of him but can't place him.  Somewhat crassly put, and we do respect Dr. Taylor, he has done his job so well he has been there when we needed him, and invisible when we don't, and few save a other than close colleagues will have marvelled at his work and his accomplishments.

His selection is an assurance that the status quo will persist.  For Harperites that is reassuring as PHAC has been a thorn in a government that tries to distance from health, but really has not done much that is embarrassing to the conservatives.   For the public health community, Dr. Taylor is a know commodity, he has been president of the specialty society, is active in CPHA and is not afraid of the camera  while certainly not seeking the limelight either.

The lethargy in announcing the position is just one more black mark on Minster Ambrose who continues the very Harper agenda that this site predicted over a year ago (keep health off the federal agenda and stay off the front pages of the paper).

So Greg comes into the position with little fanfare, after acting for innumerable months with no significant 'mistakes' and without an agenda of fresh thinking or direction for PHAC.  With all respect to the person and the position, the announcement is one more step in Harper's alienation of health in general and public health specifically.

By the way, best wishes to another dear colleague David Butler-Jones who quietly slipped away from the role due to health reasons.  We did note that Dr P did not receive an invite to his retirement party, assuming one was held.

Good luck Greg, please reach out and ask how we can help you.  

Wednesday, 3 September 2014

Public Health in Canada – for students and trainees, a promising future.

University classrooms are back in swing, PhD students are arriving to aspirations of new discoveries, MPH students are arriving at the 14 public health schools in Canada,  and other graduate students entering programs in science of epidemiology, health administration or other related public health fields. New residents in public health and preventive medicine have been at the books for a couple of months in the 13 Canadian programs. Nearly 1000 future physicians are showing up for their first classes of training in 17 schools, while twenty times this number are entering nursing programs.   Innunmerable other health professional programs are integral to and contribute to the multidisciplinary world of public health training. 
The health care business is booming and the training of the workforce is an integral part of investing in our future.

The number one question most students ask – is will there be a job for me?

The demand for health services is not contracting.  Public health opportunities wax and wane with the economy and political stripes, more so than treatment or continuing care services where demand continues to increase.  Hence fluctuations in public health opportunities are to be expected, however lots of promise remains.

The past fifty years have seen smoking rates plummet, infant mortality rates approaching theoretical minimums, disease rates for most diseases consistently dropping, injury rates going down… .  In fact most measures of public health would suggest that the heavy lifting has been done.  (Essentially for physical ailments only rates for diabetes and alcohol related deaths have gone up with early signs diabetes is peaking).  

Mental health is finally getting a level of attention that it deserves and an area deserving even more focused public health attention.

Societal issues such as poverty, inequity, violence, social supports, resilience amongst a slew of health promotion and wellness related spinoffs receive at least rhetorical attention. 

Risk behaviours including inactivity, poor nutrition and mood altering substances are receiving more attention and remain a focus of those incriminating personal choice. 

Despite, or in spite, of our efforts, the future for children has is not rosy.  Childhood vulnerability at school start has increased in just the past ten years.

The point of the last five paragraphs being that while disease specific work has been highly successful and something that public health should celebrate as the major contributor to reductions, there is plenty of work to do in realms that are under-serviced currently. 

A favourite quote from DrPHeatlh.   The four reasons why we are assured continued public health work in the face of such success:

·         Bugs evolve faster than humans – control of communicable diseases while the greatest success of public health, will remain central to public health work.
·         Humans are smart – they invent new technologies which present new public health problems.  From current issues like e-cigarettes to transportation and recreation technologies like cars, skateboards and skis to drivers of sedentary lifestyles in computers, television, and gaming.   The human mind is filled with inventions that bring value and may have negative health consequences
·         Humans are not always smart, they make less than healthy choices that contribute to poorer health.  Whether using substances, gambling, fast foods or risky recreational activities – there is room to alleviate the pain and suffering associated with unhealthier lifestyles.
·         Humans are animals.   Darwin was right with the survival of the fittest.  In the human context while socially we tend to our needy far more than most species, it is still a dog eat dog world with winners and losers that engage in war, measure success in wealth, and put “self” before others in seeking dominance. 

So, for all those new students to the vocation of public health, a true heart felt welcome.   There is a whole world of opportunity ahead, filled with things we can see and an exciting menu of issues that we can’t even imagine today. 

Good luck and hold true to the values that brought you to where you are today.