Welcome to DrPHealth

Please leave comments and stimulate dialogue. For those wanting a bit more privacy or information, email drphealth@gmail.com. Comments will be posted unless they promote specific products or services, or contain inappropriate material or wording. Twitter @drphealth.

Wednesday, 28 January 2015

Mental Health Promotion in action: #BellLetsTalk

It is one of the largest health awareness events that we have seen in this country, and credit to Bell Canada and in particular to the leadership of Clara Hughes.  Give that lady another medal for her astounding performance.

Mental health consumers and professionals alike have striven to increase awareness of mental health issues in the country for decades.  It has been the dogged determination of a concerted charitable effort that has finally helped break through the barrier.

Throughout the day innumerable statistics and stories have been posted on #BellLetsTalk, couched in a fund raiser of 5 cents per tweet for the whole day, the attention seems to be coming from all directions and a wealth of information in just the 140 character Tweets.

If you have not done so, contribute a retweet, but more importantly search on the hash tag and scan through the richness that Canadians have revealed.  Just after this posting, Clara Hughes announced that over 100 Million texts, tweets, likes etc had been sent.  Slightly less than last year's record, but really - that is three for every Canadian, an incredible level of engagement. 

We know that mental illness will affect at least one in five, severe persistent mental illness affecting about 3% of the population, anxiety disorders are one of the most common diseases and rarely reported or treated.  The list goes on and on – learn more at #BellLetsTalk

Wednesday, 21 January 2015

Canada's children under the global spotlight. A continuing public health crisis

An op-ed published on the plight of Canada’s children deserves a quick read.  Published in Victoria of all places, renowned as a centre for retirement in Canada, the article by University of Calgary professor Nicole Letourneau hits hard at the neglect of Canadian children in comparison to our developed country peers.

UNICEF rankings show how Canada stacks up against other developed countries UNICEF state of child 12 2014  and the 2014 report focused specifically on the impact of the recession globally on hardest hit nations and changes over the 2008-2013 period. Oddly much of Canadian statistics are excluded from the main UNICEF report, but are found in a companion Canadian document at Canadian companion UNICEF 

·         Canada’s performance remains dismal overall but some good trends are noted
·         Child poverty increased overall by 2%
·         Children are more likely to be living in poverty than adults and seniors in Canada
·         Canada still ranks 20 of 41 countries in poverty rates, and a whopping 16% absolute less than Norway where only one in twenty children lives in poverty.
·         10% of Canada’s youth either not employed or in school, however this fairs better than most countries (rank 7)
·         Canada ranked 34 of the 41 countries in the perception that children’s opportunities have declined
·         Canada ranks 32 of the 41 countries on perceptions of increased stress on children.

Both the global report and Canadian companion are excellent documents that detail the impacts of the recession and lessons to be learned from global comparisons.  Canada’s performance close to dismal based on the op-ed Times-Colonist January 11.

Both documents are to be commended for lengthy discussions of the economic rationale for supporting children, and both speak of the successes that others have accomplished.

Time for Canada to step to the plate at more than the tokenism expressed in addressing income  splitting amongst high single income earning families. 

Wednesday, 14 January 2015

Canadian women continue to be denied a health benefit available globally. The case of politics and mifepristone

Canadian women are being denied a health benefit that is widely available in the US and Europe.  Why? because for some bizarre reason, despite being on the WHO list of essential medications, despite twenty-five years of global distribution, despite fifteen years of approval and distribution in the US, despite political upheavals and protests in Australia it had been banned and now approved for use, despite all  this, Canadian regulators suggest that they need “more information” before approval can be considered in Canada. See Globe and mail coverage of delayed decision on abortion pill  

The Canadian regulator system tends towards precaution and conservatism and that has served Canadians well in many instances.  This however should be called what it really is – blatant political interference in the regulatory process.  The government will likely move to an election this year, and merely is clearing the plate of a potential ideological embarrassment if a Conservative government were to issue an approval, they stand to alienate the far right.

Shame on such political pettiness that women in Canada are continued to be denied a more comfortable and perhaps safer alternative to pregnancy termination.

Abortion evokes a variety of emotional responses that span the continuum and have entrenched camps at both extremes of the spectrum. The health ethics of abortion have long been clarified with the duty to support a client in their choice.  That in Canada we would continue to utilize technologies that are antiquated and may not be as safe is astounding.

Mifepristone is not an innocuous drug.  It has a very intended purpose that disrupts endocrinological responses and induces uterine endometrial degeneration, essentially mimicking processes involved in normal menstruation.  Its pharmacological targeting is more appropriate than the one approved medical regime in Canada which combines the cytotoxic drug methotrexate with misoprostol which is better known for its gastric protection action than its use in obstetrical induction as a cervical ripening agent and stimulator of uterine contractions.  The non-medical alternative remains the Canadian mainstay of pregnancy termination using the invasive procedure of vacuum extraction. 

The technical details aside, that politics have played into what is supposed to be a non-political regulatory approval process fuels further concerns of the interference politicians have played on government scientists and silencing of their voices The Canadian muzzling of scientists October 2013 .  In this case scientists should be speaking up loudly in addition to the voices of women (and men) who are being subjected to abuse by being denied a treatment alternative that ultimately leads to a higher likelihood of physical attack on their bodies.  

n any other legal realm, this would be considered violence against women.  

Tuesday, 6 January 2015

Picard hits a home run: Hospital congestion not just an influenza problem

A national treasure, André Picard once again tells it like it really is.  Influenza is not the cause of the winter bed surges – its bad management and planning.   The increased volume of influenza hospitalizations may hit a 1% surge above background levels, whereas some hospitals are looking at over 25% excess populations  above bed numbers - and doing nothing other than blaming something over which they perceive they have no control. Jan 7 - a calculation of current admitted clients by number of beds in one are of close to 1 Million population, suggests overall impact on bed utilization is 3%  - well below the reported capacity overflow for the same area. if you have local statistics, please share them and help debunk the myth

Well done André – hit a knockout punch to ring a few bells.   Hospitals manage very well planning for holiday slowdowns, planning for reduced services on weekends, and coping outside of the 8-5 work day.  They even have demonstrated marvelous capacity to respond to labour strife with strikes and walkouts, without poorer health outcomes.

Yet, annually the surge occurs to align with the predictable wave of influenza.  And predictably the hospitals will argue for more beds, the emergency departments will complain of backed up patients, long wait times and poor quality care.  And come April, while the rhetoric reverberates, planning for a summer slowdown will be in full swing.

The cynics might reply with its just public health complaining and pushing more vaccine. If public health did a better job getting people to wash hands, cover their coughs, be immunized and even ensure that the walking ill don’t see it necessary to use the emergency room, that the hospitals would manage better.

Talk about victim blaming!!!  

That a large number of people inside and outside the hospital this year are gripping about the poor planning is a faint light that perhaps somebody might think differently.  With a dozen years at senior executive tables and nearly 30 years in the field, this writer’s skepticism is justifiably a learned response.  As one person said, “its like the movie Groundhog day.  We just keep repeating the same mistakes over and over and painfully slowly learn from our mistakes.

So good on you Picard for taking the system to task.  We deserve the criticism and we deserve chastisement for our failure to learn from the past.  

In this day and age, few senior executives last more than a couple of years – corporate history is so short that we are destined to repeat our errors, over and over and over again and sentenced to the annual winter surge to be taken in stride as a “normal”.  Besides, were it not for the winter surge, we would not have the numbers on which to argue for more beds, bigger emergency departments, more, more, more…. 

Thanks André.   We’ll be looking forward to your next home run. globeandmail ER congestion January 6 2014

Sunday, 4 January 2015

2015 – What the New Public Health Year may bring. Predictions of what is hot and what is not.

2015 comes with no promises, but heck – why not stick a neck out and provide some predictions on where things are going in public health.

For the optimist, look to:

·         ·         Successful trials of candidate Ebola vaccines and the beginning of control on the West Africa outbreak. While not the biggest public health issues, it will continue to be the dominant media attraction for at least the first half of the year.
·         Mental Health issues will continue to receive appropriate and perhaps even expanded attention as a public health issue, more than just increased clinical services.
·         Improved involvement of public health in commenting on significant policy issues in some format of health assessment with some useful tools available to support the work
·         Further subtle migration of other health sectors to areas of prevention (without necessarily involving traditional public health experts)
·         Enhanced emergence of the specialized disciplines of public health economics and public health services research.
·         Tokenism to public health controls by implementing policy restrictions on flavoured tobacco and electronic nicotine delivery systems (/ENDS/e-cigarettes/vaping), with perhaps some attention to food advertising to children.
·         Continued general improvements in nutrition and diet – led predominately by market forces and social trends and not by organized public health responses. 

Social issue trends with significant long term health benefits.

·  ·         Increased attention to the issues of ethnic and racial discrimination as a public policy and public health issue
·         Further rhetoric on the maldistribution of wealth – without solutions
·         Attention being formally given to the issues of Canadian youth underemployment
·         Renewed attention to women’s health issues of gender equity, domestic violence, sexual discrimination and harassment. 
·         Persistent downsizing of governments and limiting growth in the health sector.
·         Continued shift in public policy power to the oil and gas megaindustries.
·         Continued migration from collective recreation to dependence on electronic communication devices

For the pessimist:

·         Further migration away from, and the disempowering of the traditional public health infrastructure
·         The continued disciplinization of public health in Canada to the detriment of the organization of public health
·         Continued flailing of the explicit poverty agenda with mere shuffling of the issues
·         Further government short selling of the future of children in the country. 
·         Expansion of faith based tensions and discrimination

And things that we might want but can expect are unlikely to happen:

·         Minister Ambrose taking a leadership role in forging federal-provincial health bridges
·         Real leadership from the Public Health Agency of Canada and the new Chief Public Health Officer
·         Multilateral international efforts to resolve tensions and expand peace

As with any list, DrP invites your suggestions and comments, posted to the website or with an assurance of anonymity if directed to drphealth@gmail.com.

Finally, renew your resolutions in support of your vocation as a public health professional. The list from 2012 remains as relevant today as from three years ago.  Dec 30 2011

May 2015 fulfill your best dreams and gift you with happiness and health