CPHO 2012 report released on Sex and Gender: A silent release.

David where are you?    

On Friday October 26^th, the Chief Public Health Officers 2012 report was released.  No press release, no media attention, no public communication.   We know you better than that.  While your health has been assaulted this year, we know you have been active in many areas.  But, this is not the first year either.   Once again, your major document outlining the dominating health issues in Canada is silently posted to your website, with no effort to publicize its existence.

Are you so quashed by federal communications folks as to truly be painted as suffering the very intimidation that this site spoke to at Intimidation, politicians and public health professionals?  You are admired and respected across the country, and have left legacies of benefit from across the country.  DrPHealth has followed your rise from Barrie, through your home roots in Saskatchewan and back to the hallowed halls of Ottawa.  Your tenure as president of CPHA was one of the most fruitful and impactful.  You are a master of the public health professions.

Have the federal bureaucrats handcuffed you to the point of impotency?   And while awaiting translation has a measurable impact on public release of federal documents, the material is available in both official languages from time of release. 

Ranting aside, it takes bravado to release a report on sex and gender in the environment that you are working. The fundamental perspective being that of recognizes sex and gender as a determinant of health, and discussion of its known contribution.  The burden carried by males and females in society. 

The report opens with a general discussion of the state of public health in Canada.  Mixing the good and the bad, and highlighting the impact of the recession, the widening gap between rich and poor and updating knowledge on risk taking behaviours. 

The provocative discussion that follows in part 2 recognizes the impacts of sex and gender, discusses sexual health  in a frank and dispassionate fashion, and speaks to the diversity of sexual practices.  Notable is the lack of visual aids such as charts and graphs.  The differences are buried in the text and require careful reading.  Is it politically unacceptable to flag the plight of single mothers? Gay men? Transgendered individuals? Stigmitized persons with mental illness?

The full report is found at 2012 CPHO report on Sex and Gender.  Previous reports are found at CPHO annual reports.  

While the efforts to speak on behalf of the health of Canadians of Dr. Butler-Jones should be commended,  there is a need for a significant reprimand for the inability to speak out on these very issues.   Somehow it is not surprising given the current government, the comparable lack of communication from Minister Aglukkaq, and the prevailing communications trend from government that the best news is not to be in the news, but it is not an excuse for not doing your job.  

Influenza vaccine suspension: Special posting: Politics trumping Public Health

Those on the inside of the vaccine distribution system and following the Novartis Fluad® and Agrflu®  product “suspension” are shaking their heads.   Why?  

At a time when influenza vaccine has become the lightening rod for anti-immunization rhetoric, it is fuel on the fire.  

The Canadian logic appears to be that since the Italians noted some minor aggregates and recalled the vaccine, then the French followed suit – that we in Canada need to look like we are doing something as well.   Even if the vaccine is okay, we need to look like we were being prudent in protecting the public’s health and reacting to a potential threat.  We will need to look like we have taken an appropriate time to evaluate the problem, consider safety and risks, determine options and make decisions.   All for the sake of appearing to do the right thing.  Another case of politics trumping science. 

The vaccine has been through quality controls.  The minor issue is not different or problematic.  Every expectation is that existing product will still be released, the only question is what length of delay will be believable for the public. 

The damage is done.  There will be the usual nay-sayers rhetoric and “I told you so” from the immunizer detractors.   The calls are already coming in from those concerned their health has been assaulted having all ready received the vaccine.   Those seeking vaccine will want the “other vaccines” as they are perceived as safer.  Some who received the vaccine will not believe it worked and will return for a second dose of another brand. There may be a shift away from getting any vaccine as distrust builds against vaccine manufacturers and public health, or there could be run on vaccine if the perception is that there now will not be enough.  

Through it, the decision makers will not be standing on the front line fielding the tirades and inquiries.

Normally there would be a media feeding frenzy, but Hurricane Sandy will take precedence.   If we at DrPHealth were making the public relations decision -  wait until the storm passes and influenza vaccine starts creeping back towards the front page, and then re-release the vaccine for general use.   We could be wrong and perhaps some magical scientific finding will appropriately justify the caution and a full recall -  but heck, why not unmask the predictability of the current shallow politicos who are more worried about public perception than public health.

October 31 update:  As predicted, Health Canada released the influenza vaccine, although as the storm was still drenching and blowing major centres – its impact on Canada certainly nowhere as devastating as our southern cousins and therefore not in the forefront of the news. The release of the vaccine quietly occurring with minimal media attention and without some greatly needed questions answered as to why any action was taken. 

Disaster preparedness – are you ready?

The west coast was rocked by a 7.7 magnitude earthquake. Tsunami warnings were followed by swells that were mostly less than 1 metre.  Damage was minimal.  Essentially a training exercise for the predicted “Big One”

Comparatively speaking the east coast is about to be pummelled by Sandy as she makes landfall near New Jersey, will collide its warm humid air with a cold front, and then get pushed north and finally east  with the storm centre expected to pass on a track over Kingston and Montreal before heading across New Brunswick, PEI and Cape Breton.   Our thoughts in advance to those that will still feel its slightly buffered down furry.

For those in the expected path, perhaps a bit of time to scramble to prepare.  Check out some quick reliable sites like the Red Cross or the Canadian government. The only added advise, is be prepared for up to 7 days before aide becomes available.   The typical 72 hour notice is based upon Californian expectations of the time to initial contact – not the time to receive aid.

Sandy has already killed over 60 people in the Caribbean, and likely that number will substantially increase.   Deaths from falling material, wave surges amongst gawkers who feel indestructible, exposure, and add to this the exacerbation of cardiac and other chronic diseases caused by acute stresses that can lead to sudden death or disease exacerbation.   With the predicted levels of snowfall in some areas, motor vehicle deaths may increase.  A review of the Canadian weather that kills provides a reminder that annually about 20 people are killed by weather, but extreme events can increase that to 100. 

In the aftermath, there is a predicted $80 Billion clean up expected as this Frankenstorm hits some of the most populated US areas and will pass along a portion of Canada’s most populous area.   Canadians, while priding themselves in being intimately familiar with extreme weather events, may still not be adequately prepared for the consequences and conduct of this hurricane/tropical storm.  Let us hope that the predictions are exaggerations. 

When preparing for a potentially disastrous situation, pray for the best, but plan for the worst.  For those not affected, your thoughts are welcomed, and  take this opportunity to plan for your disaster, there is not a part of the country that is immune from extreme natural events. 

Intimidation: Politicians and public health professionals.

The Ford brothers in Toronto have openly done what many, perhaps smarter, politicians routinely engage in – Intimidation and harassment of those invested with non-partisan responsibilities for in the public good.  Central to this debate are comments about the Medical Officer of Health (MOH) for Toronto, David McKeown.  The epitomy of a style of public health worker who is humble, thoughtful and a considerate gentleman. Globe and mail reporting of radio broadcast and   Wellsley Institute commentary 

Perhaps there are thanks to be directed to the Fords, for openly stating in a public forum, what often occurs behind closed doors.

Where kind-hearted and truly invested individuals migrate towards public health, successful politicians must by necessity invoke multiple personalities.  One of those personalities is hard nosed, ruthless and dispassionate.   Hence we have a butting of heads that could occur.  For the Toronto case, perhaps the lack of credibility of the Fords can make the situation laughable.

The more challenging situations are the backroom discussions that place MOHs in conflict with governance people, where expectations are linked to performance and resourcing, a form of insidious blackmail and clearly personally intimidating.  Some MOHs can ride the situation easily, in particular those that have stability in a community that has longevity that exceeds the current political regime. 

One has to assume that the relatively inability to speak out of our Chief Public Health Officer Dr. David Butler-Jones is linked to implicit expectations on towing the government’s line as much as possible, and speaking rarely where public policy may compromise the public’s health. The CPHO situation is also echoed by stories that slip out of the chief provincial health officers. 

In fairness, butting heads constantly leads to resource reductions making doing the job more challenging. While a skirmish may be won, the battle can easily be lost.  Strategic posturing is essential and rarely is a fight worthwhile that leads to succumbing and lost of a job worthwhile. We have seen many a CPHO and MOH fall to the side as they have fought their way on the mountain.    Sometimes groveling or dancing to the political piper can be rewarded with the tools to make a difference in another area. 

While the current issues seem to relate to censoring the mayor and his brother, the reality is the issue is much broader than a public spat.

The job of the Medical  Officer of Health or other senior leader in Public Health is not a job for the faint of heart or fragile egos.  It is also not a job for those that are stubborn or overinflated egos.  In the end, our better public health leaders are rarely accumulators of friends, or of enemies. They are also infrequent recipients of expressions of gratitude or offers of personal support.

So thanks to Dr. McKeown for his leadership and foresight, and our expressions of condolences for his current challenge of having to work with such disrespectful politicians.  

Blogging with DrPHealth - Viewers Choice

Sometime next week, DrPHealth will turn over 10,000 views.  There will have been about 230 posting over the 17 months of contributions, suggesting an average of about 50 views per posting.  Blogspot has gotten better over the year of tracking individual posting views, but the number of tracked views is probably only about half of the views. 

A massive one day surge about fracking, which led to a historic high number of single day views prompted this posting about what do you as the readers say are the most important issues.  

There are some clear favourites amongst readers.  Not only do they have high numbers of views, but intermittently there are surges in activity around a particular posting.  Most continue to have views months after the posting. Except from the fracking post, the most frequently visited posts tend to be over several months old. 

Viewers who subscribe to an emailed version are not counted as there is no listing of the number of persons who receive the blog on a regular basis through email. 

So, here for everyone’s pleasure, are your favourite postings, in reverse order by volume of views. 

Views	Title	Link
51	Public Health hot topics	Feb 6, 2012
52	Canada`s 2012 Budget - Public health implications	Apr 2, 2012
54	The cost of US medical costs - Financial stress has a health cost itself	Dec 8, 2011
54	The Determinants of Health - moving description into solutions	Jan 9, 2012
55	Tweeting the public's health. Social media as a knowledge adjuvant	Dec 6, 2011
57	HIV progress in Canada – A great public health success story to start the New Year	Jan 3, 2012
59	Eggceptional news: Its no yolk. The myth has been laid	Aug 20, 2012
60	Healthy Build Environment Part 3: Health and social services, food stores and fast food outlets	May 3, 2012
67	Social injustice - Attawapiskat, Aboriginal Health and Janus	Dec 5, 2011
72	Hot public health topics worth reviewing: Provincial budgets, low sodium diets, smoking cessation and perinatal indicators	Feb 24, 2012
81	Electronic Health Records - so much spent and so far from achieving the goal	Apr 5, 2012
85	Smart meters –The role of public health in scientific controversy	Feb 3, 2012
102 115	Hookah pipes – a new generation of smoking hazard Telehealth: A real public health contribution - or at least a major convenience	Apr 10, 2012 Apr 3, 2012
122	Fracking - Is it an obscene public health word	Oct 18 2012
142	The Cost of Poverty in Canada - a potential way to reduce health costs	Jan 12, 2012

Thanks to everyone that makes DrPHealth worth continuing to post. 

Injury report 2012 - Prospecting for Public Health Gold

If information were gold, there is a whole mine out there to prospect through for nuggets called the Internet.  And just like a gold mine, public health surveillance in Canada tends to be filled with buried nuggets – not the ones that are shiny and easily found.   It is even more perturbing when the Public Health Agency of Canada documents, are transplanted and hidden in other locations and not readily available on the PHAC website. 

Today’s goldmine is a 2012 injury report spotlighting road and traffic safety amongst youth and young adults that was just released from PHAC in conjunction with several  groups like SafeKids, Traffic Injury Research Foundation and Transport Canada.

If you go to the PHAC site, you can order the document because it is not available there on-line   PHAC ordering information    or a short summary is available at PHAC posted html summary .  

Thankfully it has been posted in a few other locations traffic injury research foundation, Transportation Research Board; and summaries at Safekids.  

  

So, can somebody please tell us why PHAC remains cloistered - doing great work in behind the scenes, and yet has this incredible cone of silence when it comes to communicating, and a shyness on promoting its own excellent work?    Leave an comment, anonymous or otherwise. 

Fortunately there are a few effective prospectors out there that track down the nuggets and share the wealth. This one surfaced quietly through a Twitter posting.

While the focus of the injury report is on youth to age 25, the message is clear.  For the most part, we are doing well in reducing injury related health consequences associated with transportation. The graphic shows mortality rates extending back to 1950 and peaking in the 70’s.  Since then, and with the concerted efforts looking at vehicle and road engineering, as well as directed interventions on enforcement and driving behaviours, mortality and hospitalization rates have continued to decline. 

The gains have been less impressive over the last decade, despite the substantive increases in gasoline prices which are often thought to modify vehicle use behaviours. 

One might also be disappointed with the proportion of alcohol related crashes as not having improved over the past decade despite several interventions.  

Whether much stiffer penalties as implemented in several provinces in the last couple of years will again begin to move the curve downwards is yet to be determined.   Quite notable are the differences in alcohol use by type of vehicle. 

Finally is the not too surprising impact of injury from off-road vehicles highlighting the increasing importance of ATVs as a dangerous mode of transportation for youth and supporting the CPS and others call for age limits on ATV use.

For any golddiggers out there, if you come across other nuggets, please drop a line to drphealth@gmail.com.   Share the wealth.  Information is a major driver of change.  Protecting information is merely a way to express power over others and not in keeping with public health principles. 

Fracking – Is it an obscene word in Public Health?

In the space of a couple of weeks, this posting has had hundreds of hits, moreso than other postings on DrPHealth.  On one side it is a measure of the interest in fracking.  Please leave some comments so that others can benefit from what you find here.  

If you are aware what fracking is, you either live in oil and gas provinces, or deserve to be at the top of your class.

Fracking is the future of natural gas recovery and is opening up otherwise difficult to mine gas deposits located in predominately shale like rock formations.   It involves injection of high pressure fluid (water/salt water with additives) causing hydraulic fracturing of the rock and increasing accessibility for gas mining operations. 

Frankly, fracking is merely the lightening bolt for the expanding oil and gas industry.  An industry who have successfully argued in the past their technologies as safe and beneficial for health and environment and which are now sacred and untouchable from environmentalists and public health professionals. 

So in the midst of the quiet stalemate in provinces with long standing oil and gas operations like Alberta and Saskatchewan, novel reviews of the public health impacts of shale gas operations are coming forward from New Brunswick and struggling for legitimacy in BC. 

Hence the document released by  Dr. Ellish Cleary as Chief Medical Health Officer in New Brunswick is a bold and brave foray into the issues.  Coming from a province where an economic boon would likely be welcomed, the cautionary words on boost and bust economies and rapid industrial growth from such development investments are a courageous statement. Moreover the document is grounded in solid public health principles ranging from determinants of health, clear health delivery objectives and public health ethics.  For those not intimately involved in discussion with the industry, the document is an excellent example of taking a fundamental public health approach to a problem.   NB CMHO report on oil and gas industry

It is the sort of document that the industry might fear, but the type of material that is fundamentally grounded in principles and the need for appropriate information that decision makers will be challenged to ignore.   As the recommendations are based on a whole of industry perspective, it mitigates some of the past challenges about operation specific concerns such as debates over a particular sour gas well.  It also pushes hard for Public Health involvement in many aspects of the work to be done.

One can only hope that the province looks favourably on these common sense recommendations, and most importantly on the context of inclusion of human health as an outcome of interest in resource sector development.  

Kudos to New Brunswick and Dr. Cleary and thank you for displaying such courageous leadership.