Nobody could have predicted the desperate state in Syria when the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe Conference for 2015 was awarded to the Turkish Family Medicine Organisation (TAHUD) a few years ago. Few could also have predicted that Turkey would be at the very centre of a mass exodus of people not seen in Europe since the Second World War. According to the UNHCR as of September 2015 the country now finds itself providing refuge to an estimated 2 million Syrians fleeing conflict and destitution. I have heard the current situation being described as a ‘stress test’ of the European values of solidarity and collegiality, ...continue reading →
Dr. John Fletcher, editor-in-chief, gives you highlights of the May 19th issue of CMAJ. In this issue: ultrasound or near-infrared to guide peripheral IV catheterization in children, validation of a 1-hour rule-out rule-in algorithm for myocardial infarction, social media in medical education, global tobacco control, elder abuse, and more.
Dr. Moneeza Walji, editorial fellow, interviews Dr. Prabhat Jha, founding and current director of the Centre for Global Health Research in Toronto. In their commentary published in CMAJ, Dr. Jha and colleagues say that slowing tobacco sales in the next decade will depend on strengthening its implementation by increasing excise tax and improving anti-tobacco legislation. ...continue reading →
Today, February 27th 2015, marks the tenth anniversary of the coming into force of the WHO Framework Convention on Tobacco Control (#FCTC10). To mark the historic treaty's first decade the WHO's Director-General, Dr Margaret Chan, gave an address in which she called the FCTC the 'single most powerful preventive instrument available to public health'. She wasn't exaggerating. I'll tell you why.
The FCTC was the first, and remains the only, legallybinding multilateral agreement ratified by WHO member states. Most of WHO's directives are delivered with the all the authority of a global governance institution but with none of the legal teeth that multilateral trade agreements, for example, enjoy. ...continue reading →
Baukje (Bo) Miedema is Professor and Director of Research at the Dalhousie University Family Medicine Teaching Unit and Adjunct Professor in the Sociology Department, University of New Brunswick
“The constitution” of primary health internationally, as a core component of the structure of health, care can be traced back to the Declaration of Alma-Ata (1978), even though its origins go much further back in time: 1941 in the Netherlands and 1948 in the United Kingdom. The Declaration states that governments have to be responsible for the health of their people. Primary health care is seen as an important vehicle to deliver health care to the population, and is defined as care that “addresses the main health problems in the community, providing promotive, preventative, curative and rehabilitative services accordingly.” The Declaration of Alma-Ata also states that by the year 2000 there should be “health for all.” ...continue reading →
Silvina Mema MD MSc is a Senior Resident in Public Health and Preventive Medicine at the University of Calgary, Alberta
Lynn McIntyre MD MHSc FRCPC is Professor in the Department of Community Health Sciences, and Research Coordinator for the Public Health and Preventive Medicine program, at the University of Calgary, Alberta
I am sitting on a balcony in Mwanza, Tanzania looking out on Lake Victoria. This is the second public health and preventive medicine residency elective I have done here.
The Canadian Association of Interns and Residents supports global health electives as well and outlines institutional responsibilities related to resident participation. Their guidelines state that Postgraduate Medical Education Offices should offer residents predeparture training to address health, safety and “ethical challenges”; to designate a contact person; and to provide clear expectations. I have been thinking about these "ethical challenges" in addition to how sending institutions define their own responsibilities, not only towards their residents, but with regard to host institutions. ...continue reading →
Giovanni Apráez ippolito is Professorof Public Health at School of Medicine, National University of Colombia and Adviser in Primary Care in Cauca Region, Colombia. Carlos Sarmiento Limas MD MPH is Head of Public Health at School of Medicine, National University of Colombia, and ex-medical officer in Ministry of Health in Bogota-Colombia
Colombia pioneered primary health care (PHC) in the Latin American Region from the 1950s until the beginning of the 90s. There was then a crisis in PHC due to reform of the national Health system (by law 100 in 1993), which adopted a system based on the insurance model. This led to two decades of debate without any structural changes, and Colombia became the focus for international discussions on PHC and Health Organization models. During the past 60 years there was also a war in Colombia that appears to have ended during the current national government (2014-2018).
The international consensus is that health systems based on PHC have better results, lower costs, guarantee the right of health of individuals and communities, promote comprehensive care, promote health, and contribute to achieving the Millennium Development Goals (MDGs), among many other benefits. Primary care is organised according to the individual circumstances in each country (WHO 2008) but, in our opinion, this structure must be predominantly public.
There's a quote from the film 'When Harry Met Sally', (Meg Ryan, Billy Crystal) that I always thought was rather profound. One of the supporting characters, a writer, says,
Restaurants are to people in the eighties what theatre was to people in the sixties.
That dates the movie, and me, but how much more true it is now, I think. In the past three or four decades food has come to define us socially and has evolved into entertainment more and more.
Earlier this week Dr John Fletcher and I published an editorial in CMAJ called 'A political prescription is needed to treat obesity', which garnered some criticism from two high profile Canadian bloggers. Dr Brian Goldman of CBC's "White Coat Black Art", only mildly critical, suggested that the idea of a donut tax was impractical given the ease of cross border shopping for Canadians. Dr Arya Sharma, who writes the daily blog "Dr Sharma's Obesity Notes", was far more derisive . Dr Sharma misinterprets our editorial and suggests that we are naively arguing that taxation and regulation of high-calorie and nutrient-poor food products is the ONLY viable approach to the obesity epidemic. Which, clearly, it is not. We are in no way in denial about the need for a multi-pronged, multi-generational approach in response to rising obesity. In fact, perhaps Dr Sharma did not read the whole editorial before pronouncing judgement as we clearly state: "Strategies that include individual interventions, school-based nutrition and activity interventions, incentives for active commuting and changes to thebuilt environment should continue; however, we also need robust ways to restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products."
The problem of population level obesity is multifactorial and has been decades in evolution. Political solutions that involve laws and taxation will take years to show benefits - and obviously effective treatment and lifestyle-choice solutions will continue to be necessary. But that does not mean that we shouldn't back political solutions as part of a more comprehensive strategy for treating obesity and NCDs in the longer term. ...continue reading →
Azaria Marthyman is a primary care physician in Victoria, BC, who has recently returned from Liberia
“No, don’t touch the dead body!”
“Save yourself so you can save others!”
“Midwives, nurses, and doctors have died!”
“Entire families being wiped out!”
The above statements trigger memories of the experiences I had while in Liberia, each linked to one antagonist: EBOLA.
Hawa greeted her husband who just returned home from helping at a burial ceremony of a close friend who died suddenly of a terrible sickness. After being home for only a week, Hawa’s husband himself became sick with “hot skin” (fever), headache, “body pain” (myalgia), sore throat, cough, and fatigue. Hawa cared for him with traditional herbal remedies, but he continued to worsen. He suffered abdominal pain, severe nausea, vomiting, and “toilet fast-fast” (diarrhea). His eyes became gritty, tearful, and red. By day six of his illness, he was unable to get up, curled in a fetal position on the mat that was dirty with his vomit and excrements. It was impossible to keep him clean for long because of the continual vomiting and diarrhea. No one came to help her. Hopelessly, she watched her husband decline rapidly, bleeding from his gums and lips, becoming unconscious. He died soon after. ...continue reading →