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Friday, 30 May 2014

Canadian Public Health Association - our organization

The Canadian Public Health Association conference is winding down, and looks like it was another booming success. 

Riding high, attendees need to share the glorious feeling and inspire their colleagues to rise to new heights in public health

Despite the elaborate health system we operate in, public health remains tied to a tradition of working for the public’s health, staying connected with communities, treating all public health professionals equally, and applying a level of vigour to policy that other national organizations are just trying to emulate. 

Some highlights of the organization

Through the 90’s much of the organizational success was achieved through international development grants and activities.  When the funding began drying up, the more recent boards and CEOs have accepted the challenge returning the organization to a financially viable and sustainable position.

Membership has hovered around the 1000 mark for it seems like eons.  Challenged by discipline specific organizations who have distanced themselves from CPHA, the collective public health voice has become diluted.  CPHA has advocated for interdisciplinary approaches and high standards of public health professionalism and an organization all public health practitioners in the country should stand with.

Recent changes to policy development have increased the organization’s capacity to respond to difficult and emerging issues in a timely fashion. 

Check out the great history of public health in Canada at CPHA milestones 

Recall the 12 greatest Canadian public health accomplishments at CPHA greatest public health acheivements

Put it all together in the virtual public health tour at CPHA virtual tour 

Most importantly learn about our organization at About CPHA and come join your colleagues.  If you are not yet a member, seriously give it a try.  

Friday, 23 May 2014

HIV in Canada: A Primer for Service Providers - an invaluable public health on-line resource

Recently released from CATIE is a document everyone in public health should read.  Perhaps the most definitive synopsis of HIV produced yet in Canada, it is a evidence review written for everyone to understand. 

The document goes through epidemiology, prevention, testing, treatment, care and support, and programming.  

For those not into detailed reading, the on-line document begins most pages with key points, which if read alone would form a solid understanding of HIV.   Extracted are some of the key point highlights, perhaps better labelled teasers of the gems within the document

·         Global prevalence of HIV is now 0.8%
·         Canadian prevalence is 0.2%, for a total of just over 70,000 people
·         For Men who have sex with men (MSM) the prevalence is 15%, and constitute half of Canada’s HIV infected population
·         For injection drug users the prevalence is 13% and account for 20% of the national infected population
·         Aboriginal peoples have a 2.5 times higher prevalence and a 3.5 times higher incidence than the general Canadian population
·         Correction facility residents have an HIV prevalence of 2-8%.  While condoms are available in federal systems they are not in provincial/territorial.  No corrections facility provides clean needles. Methadone is inconsistently available for the newly incarcerated. 
·         Just over 3000 new cases per year in Canada
·         Hep C is four times more prevalent than HIV
·         About 150 Canadians with HIV have been charged with failing to disclose their status

Subtly hidden in the document are the ongoing controversies about risk, risk communication, responsibility of persons with HIV with the document slanted towards the existing position of HIV service organizations.  

Take half an hour to become familiar with the key points and the resource at http://www.catie.ca/en/hiv-canada  

Tuesday, 20 May 2014

Global childhood mortality – a major public health success

A Tweet from Bill Gates noting that in the past 5 decades, childhood mortality in absolute numbers of children dying has been reduced to one-third.  The rate of childhood deaths having decreased from 143 per 1000 to 44 per thousand. 

That is 12 Million children each year that are not dying that in the past would have died. 

The key reasons
1.       Vaccination against common infectious diseases
2.       Poverty reduction
3.       Women’s education (likely the major contributing factor resulting in about half of the childhood mortality). 

The blog posting can be found at Vox May 20, 2014 .  The incredible downward graph posted below.


With Canadian infant death rates around 4.8 and the US around 5.2 (with child death to age 5 reported as 6.6) per thousand, the global rates are still nine times higher and demonstrate considerable room for improvement.  Rates in excess of 100 per 1000 persist in central Africa where the greatest opportunities exist. 

The huge improvements are a real tribute to a global community, often led by public health advocates unwilling to accept disparities between neighbours. 

Thursday, 15 May 2014

Transportation and Health - Your role in contributing to the public's health. Part 7

A fundamental operating principle of public health is to start conversations on relevant health topics.  Oftentimes without clarity of solution.   Such is the history of tobacco and obesity.   Many times solutions run smack into a few individuals’ purse and wallets as an unanticipated cost in their search for wealth.   The great success of public health being the consistency of vision to improve the public’s wellbeing and overcome short term speed bumps.

The thematic around transportation and health has few personal winners and requires massive shifts in public thinking.  It may affect all of us in the wallet/purse in gas costs, vehicle costs as well as how our taxes are used to build and repair roads and subsidize public transit.  The relative winners are those that use the roadways for product distribution and for single passenger vehicle use, and that is a lot of winners who carry votes with them. The winners in the discussion will be future generations.

While much has been made about defining relationships between transportation and health, in part to stimulate dialogue.  Astute readers asked “so what?”   What is it that you want me to do differently at work and in my personal life?  Here for your consideration are DrPHealth’s recommendations for improving the public’s health through addressing transportation related issues:

At work
1.       Incorporate transportation and health issues in public health reviews of community planning documents
2.       Advocate for improvements and support to public transit and stimulate local conversations on public health and transportation topics.
3.       Support decisions that provide meaningful options to single occupant vehicles for transportation.
4.       Advocate for separated lanes for active rolling wheel transports (bikes, blades, boards)
5.       Support school programming that encourages walking buses and riding or other active transportation to and from school
6.       Build on existing well established agendas (eg. air pollution reduction,  obesity or motor vehicle safety) to promote public and active transportation
7.       Support solutions that reduce the demand for individual travel such as telecommuting, teleconference and telemedicine, or have professionals commute to multiple clients in a single trip rather that multiple trips of those clients to see the professional. 
8.       Educate yourself further by following the conversation on transportation and health
9.       Advocate for your own organizational policies to promote healthier travel
a.       Telecommunications solutions for meetings
b.      Itinerant services that reduce demands for client travel to services
c.       Work hours that align with convenient public transit schedules
d.      Car pooling policies that reward employee participants (eg. preferred parking)
e.      Preferred parking/storage for those that use active transportation
f.        Equitable Vehicle reimbursement policies that support alternate forms of transportation (eg mileage for bicycle use, bus fare reimbursement to events where parking might be provided
g.       Rewards for creative transportation solutions.
h.      Link the above incentives with disincentives (eg more realistic mileage pricing that lowers mileage reimbursement as distance increases)

In your personal life attempt to reduce your personal fossil fuel footprint through some of the following
1.       Set a budget for vehicle-kilometers travelled, and develop a plan for a reduction of 10-25% to begin with.
2.       Make the switch to car pooling, public transit or active transportation. Even if just for one day a week
3.       Analyze how you could to manage the household on one less car
4.       Explore options for long distance travel (vacation or work) that are more fuel efficient per traveller
5.       Build active transportation into your daily routine
6.       Be an advocate as an individual citizen within your neighbourhood and your local community for active and public transit.

As this is a forum to stimulate discussion, your ideas are welcomed.  Please leave a comment or write to drphealth@gmail.com .  The list can be updated with more great ideas.

Monday, 12 May 2014

Transportation and Health: A Rural Reply. Part 6

The Transportation and Health series has resulted in several supplementals.  First was a distinct push back from rural Canada, and rightly so.  With major themes like abandoning the single passenger vehicle for taking public transit, active transit and mass transit, the reply was that just doesn’t work where services aren’t provided and distances are too far.  

There are 33 census metropolitan areas in Canada, dwelling locations for 21.5 of Canada’s nearly 34Million people.  The smallest CMA being Peterborough at just over 115,000 people.  That leaves about 1/3rd of Canada living in communities of a size where convenient public transit may be questionable.  Hence the accusations of an urban bias are likely justified.

Just under 20% of Canada lives in “rural” areas as defined as outside a population centre and less than 1000 people and less than 400 persons per square kilometer. Census areas are defined by populations greater than 10,000 of which there are 114 smaller than Peterborough, and home to some 4.3 Million persons .

Whether you live in Whitehorse, Val D’Or, Yellowknife, Prince George or Elliot Lake – one shares a commonality of a midsized community with many resources, but long commutes to major urban centres. 

One of those key needs to commute is rapidly becoming specialized health services.  Anyone living in rural areas will speak about the logisitics of arranging to see a specialist, which may require a multiple day commute, only to have a 30 minute chat.   Or to accommodate families, drivers or friends who accompany someone for interventional treatment such as radiotherapy, surgery or even to deliver a baby.  

Hence the challenges of rural transportation.  At a recent conference in a rural community, someone asked if there was not a need for more park space in their community to increase physical activity.  Surrounded by some of Canada’s best natural resources, the question was almost absurd.  Their issue was how to transport folks efficiently for medical appointments out of town.   Collusion amongst major intercity bus carriers precludes a competitive environment, and bus schedules don’t align with medical appointment needs even where such appointments try to cater to out of town attendees.  The costs for bidding on new bus routes extending into hundreds of thousands of dollars, and public transit solutions predominately limited to within catchment area solutions and not addressing intercity public transit along main provincial corridors. As noted subsequently by a rural colleague, insurance costs for volunteer agencies or good neighbour solutions can be a significant barrier to local solutions unlike the urban setting where driving a neighbour to the doctor is not considered something unusual by insurance companies. 

As an added challenge, an isolated First Nations community is grappling with medical transportation costs approaching $2 Million for some 1000 residents.  Most of the medical transport for minor health services not available in the community.  Many provinces and territories also have rural health subsidization programs that defer some costs for persons needing to seek medical or hospital care out of the region. Others limit such subsidization for those on social assistance. 

An innovative universal shared transportation system is in place in Northern BC NHConnections .   Such programs demonstrate that transportation solutions that contribute to wellbeing can be supported through innovation. Telehealth provides many options for reducing travel, limited on one hand by technology and on the other hand by volume driven solutions that still require face to face visits for payment of service.

While much of urban Canada may benefit from the shift to active transportation and public transit, rural Canada’s solutions will require deregulation of the bus industry, creative healthy transport solutions and adoption of telecommuting solutions like Telehealth.  

Monday, 5 May 2014

Mass transit. Which method is healthiest? Transportation and health part 5

On a per passenger per kilometer basis, how do forms of transit stack up against each other.  Put differently, in trying to minimize a personal fuel footprint, what chooses should we make when given options? Which is safer? More comfortable? More fun? 

Perhaps not the easiest questions to find an answers for but given that such questions may well influence people in the choice of transit that they prefer it is worth the exploration.  Piecing out the impact of personal transport from freight transportation is not easy.  Total fuel use also supports recreational, industrial, agricultural and other activities which are often included in attributions of fuel consumption for greenhouse gas emissions. Having flagged the caution, fasten your seatbelts for a bumpy but interesting ride. 

Canadian transportation sector information can be accessed at Natural resources Canada in a distinctly unfriendly user format.  Buried in the data are estimates of energy consumption per passenger kilometer (expressed as Megajoules per passenger kilometer. 

efficiency MJ/PKm
Efficiency compared to passenger vehicle (higher is better)
Proportion of total energy consumption
School - 0.43
Urban – 1.67
Intercity – 0.77
Light trucks

Wikipedia in quoting a US Energy Data Book would put intercity rail as the most efficient, at about 40% better than cars, with other forms of rail transit where stopping and starting are involved, slightly less efficient.  Air transit comes in 25% more efficient.   Urban buses at 18% less efficient (presumably due to lower ridership than full capacity).  Wikipedia energy efficiency.   The full energy data book can be found at US Energy Data Book 2011  Table 2.12 provides 2011 estimates with a well stated cautionary note on trying to develop comparisons.

Notable in the US figures is that energy efficiency for most forms of transport has improved considerably over the past few decades, averaging about 1% per year per passenger-km for cars, 1.3% for rail, and a whopping 3% per year for air transit.   The efficiency of transit buses is reported as having remained constant on a vehicle-km basis, but declined due to reduced ridership.  Canadian efficiency figures are harder to interpret but rightly appear to parallel US efficiency measures. 

The distinctly different pattern of efficiency combined with utilization between the countries is provided as a caution in making generalizable international comparisons.   Having said that, globally total greenhouse gas emissions are attributed as 74% on road, 12% in air, 10% marine, and 4% by rail.  These numbers are inclusive of freight and passenger transport. 

An older Australian report with dated material from 80s and 90s attempted to compare safety of various 
modalities, placing air, bus and rail at a fraction of the risk from travel in a car (respectively at about 1%, 15% and 20%).  Comparatively motorcycle travel was about 20 times more risky, bicycling at 8 times, and walking about 15 times.  Recent comparative information would be welcomed if someone is aware of a source  (contact drphealth@gmail.com ) .   The comparative risks would appear to carry some face value and better domestic data would be useful. 

May 15:  A follower directed DrPHealth to a CJPH article from November 2012 that attempted to compare Canadian rates and these provide some relative comparisons that confirm the relative safety of driving, cycling and walking.  

Fatalities per 100,000 population
Fatalities per 100 Million person-trips
Fatalities per 100 Million km
Injuries per 100 M person-trips
Injuries per 100 M km
Driver and Passengers

Nothing was located about the relative social value of various forms of mass passenger transport.  Comparisons of noise exposure for users are also lacking. Likewise are impacts on non-commuters in proximity to transportation channels. (there are studies of noise exposure near airports, sleep disruption near railways, air pollution exposure near roadways that collectively may inform the discussion on total impacts for non-commuters as a separate issue)

While inherently mass transit is passive to the user, as noted in the posting on public transit, there appears to be an inherent value in the exertion required to move to and from access to the transportation unit, and for those frequenting airports some would say a rigorous exertion, others might note that most car transport is associated with minimal out of vehicle exertion.  However in presenting a comparative analysis, the lack of comparability on issues that contribute to health and wellbeing is notable.  Lacking also is good information on the decision processes that normalize daily routines around specific forms of transit, or those factors that contribute to longer distance transit choices. 

For some the choice in which form of transportation to use may be limited.  For many the decision is based on existing routines.  Hence research on factors affecting decisions, comfort, ways to improve socialization and ways to increase activity while in transit can and should supplement work on energy efficiency and safety. One of the best examples is the Stockholm subway effort to increase users selecting the stairs over escalators.   Enjoy viewing at Piano stairs.