Dental public health - an unsung group of Canadian heroes

A news item out of Quebec is one of the few positive stories recently for the somewhat marginalized dental public health community Dental coverage extended to age 16.  Even DrPHealth can be accussed of not providing adequate attention to what is one of the great Canadian public health stories – the huge success in ensuring healthier mouths throughout life through proper hygiene, fluoride, nutrition and care.  While the controversies around fluoride surface frequently DRPHealth on fluoridation , the ongoing successes of dental public health are not sufficiently celebrated.

Do check out the Canadian Dental Public Heath Officer’s report at Canada CPDO report   Quietly hidden in the number that the average number of teeth effected by decay in Canadian children is 2.5, is that amongst the previous generations these numbers were four or more times higher.  It is this reduction which is the unsung public health success.  

Most public health entities retain some vestige of oral health prevention services which often require constant self-justification.  The Canadian Association of Public Health Dentistry is a national professional group for all public health dental professionals.  On their website is a link to a variety of dental public health reports in Canada CAPHD site for links  including the 2012 Ontario CMHO annual report which focused on dental public health however the link is broken and is provided here Ontario CMOH report 2012 .

Collectively, all public health workers need to express gratitude to the dental community for their work, and support for the key areas that need ongoing emphasis, namely:

• ·         Universal access to dental coverage and preventative care for children across Canada
• ·         Reducing the current burden of dental ill-health carried by Aboriginal populations
• ·         Improving oral health services for street oriented populations and those economically challenged
• ·         Improving oral health services for aging persons.

To this should be added a refined strategy to make widespread the utilization of preventative measures such as water fluoridation, childhood varnishes, and targeted childhood sealants.  

Be sure to send a smile to your dental health co-workers.  Their phenomenal Canadian success is buried in the history books. Their ongoing challenge to be acknowledged, appreciated and supported by the rest of the public health community.  

Today, lets celebrate Quebec's good fortune in once again demonstrating a commitment to both the public's health and to children.  

Northern Gateway pipeline, can the current Canadian assessment process support Prime Minister’s comments?

The Enbridge northern pipeline proposal has more than its share of detractors on our west coast.  Certainly the debate was taken up an added notch by Prime Minister Harper in a speech that suggests that the decision will be based on science, not politics.

Fair – that was what the original intent of an environmental impact assessment  (EIA) process was to be, a way of ensuring project benefits exceed risks. 

Here lies a triple misdirection. 

First is the belief that the existing standard EIA process is objective and comprehensive.  Harper’s comments speak to the “economic costs and risks” and that projects are evaluated “on an independent basis scientifically”.  While some economists may suggest that the discipline is a science, it was not the intent of the original EIA process which informed decision processes. Nor was the EIA process ever structured to be the only component of project evaluation.

Second, the project comes months after the Harper government “streamlined” the EIA process, which has raised considerable concern about the independence and objectivity of the process EIA process DrPHealth April 2012.  The question raised previously was what will happen to the human health component of an already flawed EIA process? 

One has to wonder about the timing of the Enbridge proposal, which came first, the proposal or the changes to the EIA process.  If the EIA changes were actually independent, then the Enbridge proposal must be seen as opportunistic . 

The third flaw, is the ultimate approval process for the project rests within Cabinet, a closed door, highly politically based location where transparency and objectivity is parked in favour of testing the political acceptability of any decision.

 The objectivity of the EIA process will be tested by its ability to incorporate health sciences and social sciences in addition to environmental impacts.  The test of the Harper government will be how this information is balanced on the “economic costs and risks” which remains enshrouded in political values and tested behind the closed doors of Cabinet.  As for holding Harper and the government accountable for its actions, that is a duty of the democracy. http://www.cbc.ca/news/canada/british-columbia/story/2012/08/07/pol-gateway-tuesday-harper-bc.html   

Ebola – a term that sends shivers in everyone’s mind

Uganda is suffering from another Ebola outbreak.  Its fourth since 2000. 

For those that are not familiar with PROMED, you can find postings and listing on the outbreak at ProMED Ebola recent posting .   ProMED is an open source system that permits timely reporting on any disease activity from local to national jurisdictions.  A useful and essential tool in monitoring global disease spread.  About ProMED.  

Ebola was first recognized in Sudan in 1976.  It has surfaced in a number of central African countries stretching from Uganda to the Ivory Coast.  Four distinct subtypes of the virus  have been located.  No natural host has yet been identified, although suspicion remains with fruit bats.  Initial human illness tending to occur through infected monkey meat consumption.  Several occupationally related cases have been related to necropsy of monkeys and to care of infected persons.

The prototypical view of North American or European workers entering an African village wearing space suit type biocontainment units fuels the international fear associated with the illness. 

The dramatic characteristic of the illness being the high mortality rate, predominately due to hemorrhagic fever compounded by limited medical intervention.  Mortality rates of greater than 50% are typical.  The most recent Ugandan outbreaks are suggestive of a less virulent strain with only 20-25% mortality.  While person to person occurs, sustained transmission has not been the norm when good hygienic precautions are put into place.

In total some 2270 persons have been infected, 1625 deaths with a combined mortality of just over 70%.  Ebola has surfaced on about two dozen occasions over the last 35 years, seven of those outbreaks effected more than 100 persons, nine others between 10 and 100. 

The current outbreak has infected 20 patients as of the ProMED posting, with 14 deaths.   Based on the reports, WHO, CDC, and Ugandan Ministry of Health are actively involved in containing the situation.  A simplified science blog posting linked with National Geographic provides a good overview National geographic science blog on Ebola

Ebola may not been the most critical current zoonotic threat, but it does stimulate a fear reaction that is a reminder of the hidden threats that lie waiting in animal species.  As a comparsion, H5N1 (avian influenza) has infected 607 persons total with a 58% fatality rate, SARS (possibly also bats) affected about 8000 people with a 9% fatality rate; rabies (several species including bats) may top zoonotic list with an estimated 55,000 deaths annually and a case fatality of greater than 97%.

Do the Olympics improve the general health of Canadians? A timely but odd question.

On one hand, we are being entertained by some of the world’s greatest athletic endeavours, engaged in by 0.0001% of the global population.  What is the value to the remaining 99.9999%.  For sure, each Olympian likely was the top say 1% of the elite athletes in their country.  That still leaves us 99.99% of the global population looking for the benefits of Olympic preparation.  

The average Olympic competitor is actually in their late 20’s.  Certainly very few sports offer entry opportunities for older athletes, so while there may be an argument for motivating some youth, the Olympics don’t seem to be a good incentive for the general population.

Yet, the distribution of support dollars for athletes continues to favour the elite and discourage recreational participation.  Canada spends about 200M on sport each year, one-third of which is spent on the handful of elite athletes, much of the rest on structures destined to filter to the elite level.     

There was one calculation that the success rate of high school basketball players making a career of longer than five years is about 1 in 100,000.  These are amongst the elite high school basketball players already.  Hence the odds of successfully becoming a world class athlete would appear to be sufficient to discourage more than encourage lifelong physical activity pursuits.  

Most likely the most engaging sport for the next few weeks will be couch surfing – not the healthiest of solutions in stimulating a population to engage in routine physical activity. 

There would be many questions that should be answered about our investment in physical activity for the general population.  At the moment, Canadian eyes, and those of other countries,  are watching the medal count as the measure of success of physical activity program. 

DrPHealth - what your feedback said.

A month ago, the future of DrPHealth was put out to the readership with some specific questions.

Should the site continue?  Eight votes were registered in favour of continuation.  One vote suggested it was time to wind up.

Three of the respondents recommended abandoning the anonymity guise.

Ten recommended marketing the site more and expanding its reach.

The bottom line is that only thirteen votes were received, and while those that voted were supportive, the underwhelming engagement is noted.

For the current time, DrPHealth will continue intermittently, responding to the very issues that need to be exposed in the Canadian public health realm.

There are numerous posts that reflect state of the science reviews and analysis of the Canadian system and continue to be referenced frequently enough to warrant the site remaining active.   The original target of 10,000 views will likely be reached later this year and a definitive decision made at that time.

In the meantime, DrPHealth would still like to hear from you as the reader about issues that are current in your community,  province or nationally that need comment and exposure.  Drphealth@gmail.com

Enjoy the summer, remember to stay safe.

Pertussis – whooping it up on the newswire

The past few weeks have seen resurgence in media reports related to the tragedy of pertussis and the numbers of outbreaks occurring in North America, something DrPHealth has addressed several times so far this year as the outbreak has been developing Pertussis need for adult vaccination February 7 and  Pertussis back in the news big time May 17 .

Andre Picard has synthesized and personalized the Canadian situation in the Globe and Mail  Pertussis by Andre Picard driving the issue to mainstream Canada at last. M. Picard’s poignant comments are worth reading on any good day, and his comments hack away at the non-immunizers.   For an enlightening education of balanced rhetoric, be sure to scan through the comments of fellow Canadians. 

South of the border, some 18,000 cases have been reported so far this year with at least nine deaths.  

If you are looking for more, try Googling “Pertussis outbreaks” or check out Twitter on the hash tag #pertussis.  More examples of using social media to monitor disease activity, it seems more effective than formal Canadian surveillance systems.    

NACI has not updated any adult immunization guidance to date, however recommends a single dose of acellular pertussis at some point on or after the school leaving age of 14-16.   NACI immunziation schedule

Some psychoactive drug tidbits to consume

Be sure to vote on the future of DrPHealth in the upper left side of page.  Both your vote and the number of votes are important in deciding whether the site makes a difference to Canadian public health. 

Early indications of the price of taking Oxycodone to slow release formulation and off the market Oxycodone losing funding  are showing up in increased heroin use.  Merely anecdotal reports currently, but a shift should be expected  and the failure to have good surveillance in place is a major oversight.  London report of increased heroin use.  US reports note that part of the shift reflects the discovery that heroin is cheaper than a dose of Oxycodone. 

This site is one of many that have supported a shift from the “War on Drugs” to using a rationale public health approach to the use of psychoactive substances intended to minimize the health consequences.  One of the potential unintended consequences of the shift would be an increase in secondary exposure to marijuana smoke.  Not surprisingly, smoke of any nature can be associated with health impacts.  Two Canadian articles in the journal Chemical Research in Toxocology scratch the surface on the potential downside for exposed persons Chemical toxicity of cannabis smoke  and Genotoxicity of cannabis secondary smoke .  Both studies should increase concern about secondary exposure, and in particular to women considering pregnancy.  It is an area for expanded concern.

Health Canada does try to post objective lay information on health effects of cannabis in various forms Cannabis health effects.  We would recommend the Ontario Centre for Addiction and Mental Health site as more comprehensive and current CAMH and cannabis.

As the AIDS 2012 conference progresses in Washington, more voices are speaking out loudly against the War on Drugs efforts because of its contribution to accelerating AIDS dissemination CBC story.   The comments are of themselves worth reading to reflect the diversity and sometimes very opinionated views  on HIV infection and drug use.   Check out the AIDS conference blog AIDS blog , in a year of political instability in the US, this conference is sure to carry many innuendos on both the disease and the linkage to drug use.