Tag Archives: health policy

Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy

 

This is not going to make me popular with my beer-drinking Morris-dancing friends, or with a lot of other people I imagine, but we need to put higher taxes on alcohol and implement other proven policies that make it less accessible and less glamorous. This is the conclusion one must come to on reading the report on Alcohol Harm in Canada just released by the Canadian Institute for Health Information (CIHI) and a 2015 report by Canada’s Chief Public Health Officer (CPHO). ...continue reading

Barbara Sibbald is editor of News and Humanities at CMAJ, and author of the recently published collection of short stories, "The Museum of Possibilities"

 

Health policy pundits should look to André Picard’s new book for a dose of common sense on some of Canada’s most urgent health issues. Picard, as most Canadians know, is the long-time health columnist for The Globe and Mail. The book, Matters of Life and Death: Public Health Issues in Canada (Douglas & McIntyre), is the best-of those columns over the past 15 years, updated and conveniently packaged under 14 topic headings like opioid use, medical assistance in dying, cancer, marijuana, indigenous health and infectious disease. Most importantly Picard delves into medicare itself.  Canadians spent $228-billion in 2016 on health care: Do we get value for our money? Is it sustainable? Picard not only asks the right questions, he provides some very credible answers. ...continue reading

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TH - PHSPTrevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy

 

In 2002 Donald Rumsfeld, then US Secretary of Defence, mused about what we know and don’t know. He suggested there are the ‘known unknowns’ – for example, we know we don’t know how life began – and the ‘unknown unknowns’ – the things we don’t even know we are ignorant about.

But he forgot one important category – the ignored knowns; the things we know but prefer to ignore. This is what Al Gore called the inconvenient truth and is the realm of the science denial industry. With the election of Donald Trump, who seems to make a habit of ignoring science, evidence and fact, we are entering an era of what Stephen Colbert called ‘truthiness’ back in 2005: ...continue reading

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Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.

 

We publishing the wrong research and funding too many of the wrong studies. This was the general message from Adrian Bauman’s keynote address - "What gets published in physical activity research and why it seldom has an influence on policy" - at the Health Advancing Physical Activity (HEPA) conference.

The talk might have been about physical activity research but the message has resonance across medicine. If we really want to change medicine we really need to understand how researchers produce evidence and how policy makers interpret, or misinterpret, what is published. There is a significant mismatch between researchers’ objectives and policy makers’ needs. And, rarely heard in a medical context, Adrian was quite sympathetic to the needs of policymakers. ...continue reading

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TH - PHSPTrevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy

 

Our health care system is not the only, and not even the most important determinant of the health of the population. But it is a determinant, and thus any threat to the proper functioning of the system is a threat to health. One such threat is the court case that started this week in the BC Supreme Court, in which Dr. Brian Day and others are seeking to overturn some of the fundamental principles on which the system is based.

Day co-founded the Cambie Surgery Centre in Vancouver in 1996; in essence it's a private hospital with a number of operating rooms, offering a wide range of surgical procedures. There is nothing wrong in principle with a private hospital. Most Canadians don’t seem to realise this, but much of our care is provided through privately-owned clinics – that is what your doctor’s office is. ...continue reading

Caprio (CHS- 2012)Anthony J. Caprio, MD, CMD serves as the medical director and an Associate Professor for the Division of Aging, in the Department of Family Medicine for the Carolinas Healthcare System, Charlotte, North Carolina

 

The Institute of Medicine (IOM), a non-profit institution which provides objective analysis and recommendations to address problems related to medical care in the United States, issued the 2014 report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The IOM report proposed changes to U.S. policy and payment systems to increase access to palliative care services, improve quality of care, and improve patient and family satisfaction with care at the end of life.

The release of the IOM report was regarded by many U.S. healthcare professionals as a significant step forward in identifying gaps in the delivery of care for seriously ill and terminally ill patients. Specific recommendations were outlined as a “call to action” to improve end-of-life care. Hospice and palliative care physicians, in particular, rallied behind the report. ...continue reading

Israel in RockiesIsrael Amirav is a Program Director and Associate Professor at the Faculty of Medicine, University of Alberta, Edmonton, Alberta

 

 

As a program director at the Faculty of Medicine, University of Alberta, I attended a recent seminar concerning residents coming from other countries to train in our program. People here are trying to design a training program to address the “culture shock” that these residents may face on arrival.

Even if not explicitly stated, the premise of the seminar was that these residents come from an “inferior” culture and thus should learn about and adjust to our “superior” culture. Although this may be true for some aspects of our host culture, particularly those related to scientifically based and clinical medicine, I find this approach too all-encompassing and dogmatic.

Recently, I faced my own “culture shock” associated with a major personal health issue. ...continue reading

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Giovanni Apráez ippolito is Professor of 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 is renewed interest in PHC in Columbia for several reasons ...continue reading

Erin Russell is Assistant Editor at CMAJ, currently attending the annual meeting of the American Public Health Association (APHA) in New Orleans

 

Along with CMAJ's editorial fellow, Moneeza Walji, I'm navigating my way through the more than  1,100 sessions on relevant public health topics that are on offer at the APHA conference this week. Yesterday I attended a session on the Ebola epidemic. Prior to coming to New Orleans, I was disappointed to hear that the State of Louisiana had issued a rather prohibitive public health advisory. The advisory calls on individuals who have traveled to the Ebola affected countries of Sierra Leone, Liberia or Guinea, or who may have been exposed to Ebola virus in the previous three weeks, not to travel to New Orleans. This, despite the CDC’s assurance that 1) Ebola can only be spread by direct contact with blood or bodily fluids and 2) people with Ebola cannot spread the virus until symptoms appear.

My first instinct was to blog about my frustration with fear-based policies; my disappointment that the state felt the need to over-rule the judgement of the APHA and its members; and my outrage that the 13,000 APHA conference delegates were being deprived of our right to learn about this major international public health crisis from those with first-hand knowledge of the situation. Fortunately, I didn’t get a chance to write that emotional knee-jerk reaction blog.

The APHA’s response to the State-imposed travel ban was much more diplomatic.

#factsoverfearIn it, Dr. Georges Benjamin, Executive Director of the APHA, acknowledged the APHA’s disagreement with the policy, their efforts to communicate their concerns to state and local leaders and their recognition that State has the best interests of the people of Louisiana [and 13,000 APHA conference delegates] at heart. The APHA has also made available pink ribbons ...continue reading