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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.