Nicole Kain is a PhD Candidate in Public Health Sciences at the University of Alberta
Cindy Jardine is a professor in the School of Public Health at the University of Alberta
Autumn 2003: Hurricane Juan claims eight lives, destroys countless buildings and residences causing power outages across the Maritimes, and is recorded as the most damaging storm in Halifax’s modern history.
June 2013: Southern Alberta is pummeled by torrential rains, combined with melting ice that causes rivers to overflow their banks; paralyzing communities and resulting in the loss of four lives and an estimated $6 billion in damages. Hospitals are forced to close, physicians can’t get into their offices due washed out roads - including portions of the Trans-Canada Highway.
Summer 2014: the “worst fire season in decades” sees more than 130 wildfires burning in the Northwest Territories blanketing massive geographical areas in thick smoke, resulting in twice as many individuals being treated by physicians for severe asthma attacks and other serious respiratory issues as in other years.
Flooding, wildfires, and hurricanes. Is this the coming of the apocalypse?
Not quite. But these events do share a common theme. They have all been referred to as a “public health crisis” by Canadian family physicians. The World Health Organization defines a public health emergency as “an occurrence or imminent threat of an illness or health condition, caused by bio-terrorism, epidemic or pandemic disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a significant number of human facilities or incidents or permanent or long-term disability”. With infectious diseases remaining an enormous threat to population health globally, and pandemics such as SARS, H1N1, and the Ebola outbreak in West Africa making global news headlines, public health crises are on the forefront of government and healthcare agendas.
Yet in recent interviews with Canadian family physicians, it seems that many are using a much broader definition that that of the WHO. When asked to define a “public health crisis” physicians' responses characterized a public health crisis as an event that has the potential to impact health negatively, or increase public health risks to many people at once – sometimes with devastating consequences. Although physicians cited the usual suspects (SARS, H1N1, Ebola), adverse climate events were also discussed as significant events impacting physicians’ lives and practices.
A physician in Halifax detailed an experience during Hurricane Juan:
I left to go to my clinic, despite trees having been collapsed everywhere and roads flooded... I climbed my way into the hospital... All around me the roof had blown off some of the hospital, and so we were trying to move patients but there was no ability to call out to physicians in the area, ‘we need you, we need help.’
An Alberta doctor outlined an experience during the 2013 floods:
The hospital, clinics, everybody’s houses were flooded and closed so they couldn’t get to them; even when the waters receded after a week or two, there was so much damage to the clinics and the hospitals that you couldn’t reopen and work.
Finally, a physician practicing in the N.W.T. spoke of their experience with wildfires:
Last summer we had an incredibly big forest fire season, and it was a horrible summer from the standpoint of anyone with respiratory diseases. That was a big concern for me, a crisis.
Redefining a public health crisis to include climate-related events and environmental disasters has enormous implications for practice, planning, resource allocation and policies in Canada. With such environmental crises becoming more commonplace and impacting the health and well being of many people in a short amount of time, concerning questions arise: who is addressing these crises? Is the government prepared to deal with such a breadth of possible emergencies that have the potential to decimate the healthcare system? How does family medicine practice in Canada fit into the evolving face of public health emergencies?
Some doctors have opined that we need not “re-invent the wheel”. Whether those crises are caused by a particularly virulent strain of antibiotic-resistant C. Difficile, a novel respiratory virus, or by Mother Nature, every crisis must be dealt with using a multi-pronged approach and current infrastructure. A paper published by the College of Family Physicians of Canada in 2005 details recommendations for the integration of family physicians and public health authorities/ government during public health crises; yet in these recommendations the authors reference primarily infectious disease outbreaks or pandemics (“family doctors should be educated in the science and clinical aspects of potential public health emergencies, e.g. infection control during an influenza pandemic”), the so-called “typical” public health emergencies. Ten years on, organizations need to start thinking outside the box when it comes to these situations, and update existing recommendations to address a wider variety of public health crisis.
Recently the federal government detailed a $12M investment for natural disaster and public health emergency response, involving four specific projects to mitigate the impact of natural disasters and tackle public health emergencies. This is a good start – but more needs to be done. Instead of merely reacting to a crisis when it occurs, public health authorities and governments need to be proactive: upgrade existing emergency programs and conduct real-time exercises to enhance preparedness for anticipated public health crises related to climate change.
The Canadian government must work with physicians to develop electronic applications to track relevant and concurrent crises in real-time; enable electronic medical records to update for current air quality reports and climate events; implement immediate emergency notification systems detailing the same information from a single trusted source; and allow for such tools to be readily available to all family physicians. If such changes are not made at the systemic level to recognize the evolving face of public health crises, the consequences could be catastrophic, resulting in lives lost and costly damages to property and infrastructure, as exemplified by the flooding, hurricane and forest fires detailed above. Canada’s government must decide how to allocate and utilize current resources, in addition to generating novel practical resources to assist physicians in dealing with the changing face of public health crises.