Health Council of Canada has been given its termination notice

The Health Council of Canada has been given its final rites. iPolitics report April 16

Not the most auspicious group, however they did do some excellent work.  If you have not read their reports, they are very worthwhile. Most notable in the last couple of years on chronic disease and primary care issues http://www.healthcouncilcanada.ca/  .  In total their production of a few dozen publications since 2003 are a legacy that likely will only be found on dusty Ottawa shelves. 

With the expiry of the accord on health funding in the country, the federal government has pounded its autocratic fist and advised the council that they will have no funding after the accord expiry next year.   Given that the federal government unilaterally axed the accords, there is no blaming outside of the circle of Parliament Hill.

Some will wonder who the council was? and others may actually think that the loss is unfortunate. 

The questions should be if this is strategically intentional of a federal government that continues to slide away from providing any leadership in health? or is this a consequence of the widespread constriction of federal spending and a natural death?   

Certainly the painful cuts to PHAC likely will have more consequence than the loss of Health Council. 

Canadian scores on public health report cards – Children, women and hospitals

UNICEF released its 11^th annual child wellbeing report card looking at rich countries.  Canada ranked a dismal 17 of 29, although the US ranked 26^th.  The Netherlands topped the rankings and followed closely by most Scandinavian and then European countries.  

If you dig into the details several points in defence of Canada should be noted.  Canada was the highest ranked non-European country, and the US was the second highest non-European country.  All the other developed countries globally were not ranked due to lack of data, so how Canada stacks up to its other Anglophone peers of Australia and New Zealand cannot be determined. In addition, there are many indicators for which neither Canada or US data were available for ranking. 

The scale is based on five dimensions, Material wellbeing, Health and Safety, Education, Behaviour and risks, and Housing and Environment. Canada ranking mid range (11-16) on four of the scales, and a poor 27^th on Health and Safety.  The US ranking poor on all five dimension. Each dimension other than Behaviour and risks is based on four indicators, the Behaviour and risk dimension being based on 10 indicators.

Canada scoring poorly on childhood poverty (no surprise there), infant mortality rates, immunization rates, participation in post high school education, childhood obesity, being bullied, homicide,  .  Canadian youth scored poorest by having the highest rate of cannabis use in the past year at over 25%, and nearly 5% higher than the second poorest ranked country

Canada did score very well on educational achievement by age 15, and fruit consumption  ranking second, third lowest in youth smoking,  and seventh in exercise and air cleanliness.  There is a good discussion of the use of the Early Development Index in Canada as a best practice and its adaptation by Australia. 

The full report is available at UNICEF report on state of child

Another report card on gender equity from late 2012 is worth reviewing World economic forum report on gender equity that uses a similar approach to multiple indicators build into four dimensions.   This report ranks 135 countries and places Canada 21^st, as well as providing multiple years for comparison.

The third report card that has garnished considerable interest nationally is the CBC Fifth estate CBC Fifth estate rate my hospital.  Disappointingly has been the reaction of the hospitals and provinces to the release of the information.   This is Canadian Institute of Health Information (CIHI) data that is provided to hospitals routinely, and perhaps finally when given to the media, a level of accountability might be attained.  Most hospitals have either used the data to make a statement of pride, or dismissed the data as not relevant to their service areas.  

Efforts to ranks and hold administrations, governments or providers accountability for their actions are to be commended.  It is only through transparency and public discourse will veiled problems be brought to the surface and addressed.  It was the efforts of groups that began comparing specific intervention outcomes between hospitals that led to quality improvement.  Such efforts were initially dismissed, and not are embraced as quality improvement efforts.  The big question, is our leaders big enough to stand up and embrace these reports as challenges to drive local and national improvement activities? 

Public Health Plans make it to print in Ontario and BC

In the past two weeks, public health plans were released in Ontario and BC.  By the media coverage, it is obviously a noteworthy event as neither appears to have stimulated any public attention.   If you were to read both of these documents, you might think they were developed by sister teams looking at the same information.  Of course, that could be perceived as reassuring that within public health, there is concurrence on what we are trying to do.  Ontario Plan  and BC framework

On the other hand, it may also reflect that current deliverables are so short of the objectives that incremental planning needs to be laid out.  The documents are so broad that specific actions are so unclear that broad stroked high level plans are what is needed.   Neither document is earth shattering or remarkable new and could have been predominately written two decades ago.  While Ontario’s speaks of the need for big planning, BC’s was driven by a plethora of plans and a sense that a single overarching framework was needed. 

The good news is equity and reducing inequities takes a much bigger stage than previous documentation.   

Both touch on populations with greater needs or those that are exposed to greater risks.  While the language is politically correct, it is finally entrenched. 

While both seem comprehensive, look carefully at what is missing.  Both speak of the need for indicators that will be developed and what gets measured, gets modified.  The devil will be in the detail, and both documents lack those details. The BC plan provides for more specific short term targets, Ontario's a longer term strategic plan.  Ontario's directed at the public health community, BC's supposedly looking to a whole of government/society framework as the needed implementers.

They will make good overview documents for students of public health sciences as an introduction to the scope of work that needs to be done.  

The major concern with documents of this nature is the interpretation that these are the priority areas and anything not embraced in the plans becomes ripe for picking when resources get scarce.  

Discrimination, prejudice, racism and health status

Culture and ethnicity, biologic endowment and gender are all determinants of health.   They are all components on which individuals may be discriminated.  Hence discrimination and determinants are foundational in assessing health.

While visible minorities are  the mostly widely acknowledged and perhaps studied of the discriminating characteristics, religion has historically been one of the most divisive, and the one that perhaps has resulted in the most human suffering.  Centuries of bloodshed between Christians and Muslims from the crusades to ongoing civil strife in several countries today have demonstrated how characteristics other than gender and skin colour may profoundly affect our safety and wellbeing.

Canada’s record on gender equity remains relatively poor, despite premiership positions being held by women in the largest provinces and covering 85% of the population.   Currently ranked  21^st and the US 22^nd, the placing for Canada has slipped from 14^th in 2006.   world Economic Forum gender report 2012  

Discrimination takes many forms.  The challenge to the reader is to determine if you are truly discrimination free.   At the extreme level, overt racism and acts of hatred are manifest.  Perhaps this interpretation of discrimination justifies many lesser obvious and potentially damaging acts.

Less overt are symptoms such as:

• ·         Inappropriate Terminology: Using language that can be offensive, even where such language might be perceived as commonly acceptable. 
• ·         Paternalism:  Addressing issues with paternalistic approaches where certain groups are involved
• ·         Commission:  Disinterest in inequity issues suffered by specific groups.
• ·         Avoidance behaviour:  Feeling discomfort or actively avoiding communicating or engaging members of the group
• ·         Ignorance:  Lack of effort to become further educated on the traditions or issues facing a group.

In reality, we are all members of minorities and not only potentially the instruments of discrimination but also the recipients.   Think of the number of settings where your opinion or some personal characteristic causes a reaction because it is not carried by the majority, and the sense of disempowerment you feel when your perceptions are ignored or debased.  

Nationally and globally significant strides have been made in reducing the manifestations of discrimination – but given the impact on individuals and communities, it is an issue on which silence is not acceptable.  

Avian influenza – preparing to take flight?

Attention has been drawn to southeast Asia once again for an emerging novel influenza strain.  The past few weeks have seen reports of now nine H7N9 influenza cases associated with three deaths.
April 5th update - 14 cases and six deaths. 
April 10th, 33 cases, 9 fatalities.
April 14th, 49 cases, 11 deaths
April 29   115 cases, 23 cases, 9 provinces in China and first case amongst a person returning from China.  

Historically H7 strains have been associated with poultry, and outbreaks of generally mild illness have been reported  since 1999 in at least United States (H7N2),  Italy (H7N3), Canada (H7N3), the, Mexico (H7N3),  United Kingdom (H7N3, H7N2) and Netherlands (H7N7).   The Canadian outbreak in lower Fraser Valley in 2004 resulted in widespread culling of flocks, but only two human illnesses, both mild and in occupationally exposed persons.

So the nine, non-epidemiologically linked spread across cities in four adjacent provinces in China, raise new concerns about the potential for broader dissemination.  WHO surveillance has improved since the first B5 bird influenza cases back in 2000, and augmented by SARS and can be tracked at http://www.who.int/influenza/human_animal_interface/en/  .

The H7 avian influenza is antigenically distinct from H5 bird flu that has continued to creep globally since 2003 and associated with over 600 cases but a markedly high mortality rate of nearly 60% amongst confirmed cases.  To date vaccine development has focused on H5 strains with candidate options similar to the adjuvanted pandemic vaccine used in Canada as the model. 

The good news from China is intensive investigation of case contacts have not identified others with illness and only two possible clinical cases which predated a confirmed case and virus was not identified.

While innumerable emerging viral illnesses occur with few progressing to illness, monitoring activity is a routine public health surveillance for which considerable depth and expertise is dedicated within Canada, US, China and most other countries – feeding into the global efforts of the WHO.

Follow the developments on Twitter #H7N9  

Canada's embarrassing intention to withdraw from global treaty on desertification and drought.

Canada again singled itself into global embarrassment by declaring its solo intention to withdraw from a 1995 pact that fights global desertification and drought.  154 countries are signatories to the efforts to mitigate the impacts, most of which are secondary to anthropogenic actions at the sites and through global climate change impacts which we all contribute to.

The Canadian rationale, is that the program is expensive and has not demonstrated value.  The decision was made behind closed Cabinet doors and not publically released.  Questions were to be directed to the Canadian International Development Agency which just had its funeral plans enshrined in the federal budget. 

And, just one month in advance of a major conference specifically designed to evaluate the impacts and benefits of the program. 

The total expense of being signatory to the pact was less than $150,000 per year for the past two years, put in perspective, that is just less than the base salary of one member of parliament,  or the supplemental salaries on top of this for two cabinet ministers. 

Perhaps the most condemning editorial comes from The globe and Mail April 1 and not an April Fool’s joke.  The Harper government is continuing its spiral from providing support to those in need and continuing to bolster corporate welfare. Having just recently announcing that the big six banks are considered “too big to be allowed to fail”, it has little heart for the failure of poverty stricken African Sarahan region countries who have already failed.

Droughts have traditionally accounted for 50% of extreme weather related deaths globally.   Since the 1990s and global mobilization on the issue, death rates have plummeted to less than 1% of the previous decades and accounting for just less than 1% of extreme weather deaths.

Desertification occurs in dryland areas, generally poverty stricken situations where some 10-20% of global drylands have already degraded to desert like conditions.  These drylands are home to a third of the global population.  The program supported by the UN convention summarizes the impacts and value of their work at UNEP desertification

Should we be surprised at the insane actions of the Harper government?  Probably not,  as is the health of the banking system not more important than global social capital?  Or perhaps it is the skewed view of blue suits unwilling to walk in the footsteps of those unable to afford shoes.  

Public Health quickies - Tuberculosis, Oxycodone restrictions, Crime and mental health, CIDA

Many Canadian families are on school break, preparing for or enjoying Easter, Passover or just a long weekend ahead.  Stay safe and healthy, and enjoy the opportunity to be connected with friends and families – it is an investment in your own personal health.

March 24^th was World Tuberculosis Day.   A remembrance of a disease that too often is forgotten, but affects over 12 Million persons currently.  Disconcerting is the 5% of these individuals with a multiple drug resistant strain of the disease.

This week has seen several articles on the implications of the near nation-wide cold turkey cessation of Oxycodone (OxyContin).  What have we seen, heroin use appears to be up.   Anecdotally, overdoses concurrently seem to increasing although the numbers are not available yet.  Almost a year later, several of the key addictions agencies in the country are proposing a plan entitled “First Do No Harm” which presumably once released will be posted to Canadian Centre on Substance Abuse . 

These are NGOs perspectives, and the Harper government just tightening the mandatory sentencing screws to persons convicted of crimes despite mental illness.  Contrast this with the excellent CBC Calgary expose on Mental Health and Crime CBC Calgary on mental health   

And, buried in the budget is the loss of the Canadian International Development Agency (CIDA).   While a colourful history, CIDA was a cornerstone of Canadian international policy – a further sign of current government retraction from issues other than what benefit themselves Life and death of CIDA