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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.