Public health emergency planning includes a consideration of public health human resource requirements. We addressed the hypothetical question: How many public health physicians could Canada mobilize in the event of a public health emergency?
We used the 2004 National Physician Survey (NPS) to estimate the number of public health physicians in Canada. Using weighting to account for non-response, we estimated the numbers and population estimates of public health physicians who were active versus 'in reserve'. We explored the impact of using diverse definitions of public health physician based upon NPS questions on professional activity, self-reported degrees and certifications, and physician database classifications.
Of all Canadian physicians, an estimated 769 (1.3%) are qualified to practice public health by virtue of degrees and certifications relevant to public health, of whom 367 (48%) also report active 'community medicine/public health' practice. Even among Canada's 382 Community Medicine specialists, only 60% report active public health practice.
The estimation of the size of Canada's public health physician workforce is currently limited by the lack of a clear definition and appropriate monitoring. It appears that, even with a reserve public health physician workforce that would almost double its numbers, Canada's available workforce is only 40% of projected requirements. Public health emergency preparedness planning exercises should clearly delineate public health physician roles and needs, and action should be taken accordingly to enhance the numbers of Canadian public health physicians and their capacity to meet these requirements.
Beverage consumption by poor, lone mother-led, "milk-friendly" families living in Atlantic Canada was characterized over a one-month income cycle.
Beverage intake and food security status were assessed weekly, using a 24-hour dietary recall and the Cornell-Radimer food insecurity questionnaire. Families were classified as "milk friendly" if total consumption of milk was 720 mL on a single day during the month. Beverage intake was assessed using t-tests, analysis of variance (ANOVA), repeated measures ANOVA with post hoc comparisons, and chi-square analysis.
Milk consumption by milk-friendly families (76; total sample, 129) was highest at the time of the month when they had the most money to spend. During all time intervals, mothers consumed the least amount of milk and children aged one to three years consumed the most. Mothers consumed carbonated beverages disproportionately, while children of all ages consumed more fruit juice/drink. Mothers' coffee consumption was profoundly increased when either they or their children were hungry.
The quality of beverage intake by members of low-income households fluctuates in accordance with financial resources available to purchase foods. Mothers' beverage intake is compromised by the degree of food insecurity the family experiences.
To explore the boundaries and overlap of practice profiles of primary care physicians (PCPs), including FPs and GPs, and community medicine specialists (CMs), particularly in the area of community-oriented clinical care.
Analysis of data from the 2004 National Physician Survey. Analyses included frequencies, cross-tabulations, and chi(2) statistics.
Primary care physicians and CMs who responded to the 2004 National Physician Survey.
For PCPs and CMs, we compared main work and patient care settings, areas of professional activity, and credentials to practise public health or family medicine. Among CMs, we examined the most commonly treated conditions and services provided for evidence of community-oriented clinical care.
Data were available for 154 CMs and 11 041 PCPs. The most common work setting for CMs was government or public health agencies, while for PCPs it was offices, clinics, or community care settings, including community hospitals. Among CMs, 59.7% indicated that community medicine or public health practice was an area of professional activity and 13.0% indicated that they participated in primary care. The corresponding proportions for PCPs were 15.3% and 78.2%, respectively. Generally, CMs engaged in a mixture of individual-level and population-level practice activities, although the former was not distinguished by increased clinical prevention, health promotion, or disease prevention services. Of CMs who indicated that primary care was an area of professional activity, 55.0% had the relevant credentials, compared with only 1.9% of PCPs who conversely indicated that community medicine or public health was an area of professional activity.
In Canada CMs and PCPs have distinct practice profiles, despite some overlaps. Further role and practice profile refinement for both physician groups has implications for training, credentialing, and deployment within the health care system.
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The first annual report of the Chief Public Health Officer on the State of Public Health in Canada draws notable attention to health inequalities in Canada. This report provides a compelling presentation of our current health status and the uneven distribution of health across the population, noting persistent and sizeable gaps in life expectancy, infant mortality, self-reported health, prevalence of chronic diseases, and other health indicators between higher- and lower-income groups, as well as the extraordinary disadvantage experienced by Canada's Aboriginal peoples. However, the report falls short of offering a critical approach to addressing and reducing health inequalities. It fails to stimulate thinking about integrated strategies by profiling current responses that do little to address the underlying structural drivers of health inequalities and ignoring the population health framework's recognition of the complex interactions among the determinants of health. Despite its shortcomings, the report shines a light on major health inequalities in Canada, providing a foundation for further action. Public health workers in this country must build on this foundation, working together and with all sectors and levels of government to identify and implement integrated strategies to reduce health inequalities and inequities in Canada.
Best practice guidelines recommend vision testing in children 3 to 5 years of age for the prevention of amblyopia; however, universal vision screening is controversial. In Canada, amblyopia screening can be the responsibility of physicians, optometrists, and/or Public Health. We review the evidence underlying preschool vision screening for amblyopia using an Evidence-based Public Health (EBPH) approach, and consider implications for the Public Health provision of universal screening programs for amblyopia in Canadian jurisdictions in light of present practices.
We searched the literature to address each major screening criterion (disease, test, treatment, program requirements) necessary to support preschool vision screening for amblyopia. We also reappraised papers cited in two systematic reviews related to the impact of vision screening. The Chief Medical Officer of Health of each province/territory was sent a short survey asking whether there currently was a Public Health preschool vision screening program in place and if so, for specifics about the program.
An EBPH approach to the literature with respect to the criteria for screening and available intervention studies support amblyopia screening by Public Health. There is a public health divide in amblyopia screening practice in Canada; while some provinces maintain organized programs, others have chosen to delegate the task to other professionals, without a concurrent surveillance function to monitor disparities in uptake.
Amblyopia deserves attention from Public Health. Efforts should be made to maintain existing programs, and provinces without organized screening programs should reconsider their role in the prevention of inequities with regard to preventable blindness in Canadian children.
Since 1989 the number of Canadian children depending on food banks has increased by more than 85%. To combat perceived hunger, breakfast and lunch programs have been initiated by localized volunteer efforts. This paper attempts to show the Foucauldian concepts of power, truths, space and time in action in feeding programs in Atlantic Canada. A potential 'relation of docility-utility' is imposed upon children by providers of feeding programs and ultimately the state. The 'power over life' or 'micro-physics of power' is accomplished through procedures that use food, rules, rewards, reinforcements, space, time, and truths. Children voluntarily subject themselves to this relation while reserving the power to resist through acts of defiance or by not attending at all. This ability to exercise one's agency allows for shifting power relations in the social dynamics of feeding programs. The potentially coercive nature of these relationships is embedded in the pleasurable environment generated by the feeding process.
Analyses of cross-sectional population survey data in Canada and the United States have indicated that household food insecurity is associated with poorer self-rated health and multiple chronic conditions. The causal inference has been that household food insecurity contributes to poorer health, but there has been little consideration of how adults' health status may relate to households' vulnerability to food insecurity. Our objectives were to examine how the presence of an adult with one or more chronic physical or mental health conditions affects the odds of a household being food insecure and how the chronic ill-health of an adult within a food-insecure household affects the severity of that household's food insecurity. Using household- and respondent-level data available for 77,053 adults aged 18-64 y from the 2007-2008 Canadian Community Health Survey, we applied logistic regression analyses, controlling for household sociodemographic characteristics, to examine the association between health and household food insecurity. Most chronic conditions increased the odds of household food insecurity independent of household sociodemographic characteristics. Compared with adults with no chronic condition, the odds of household food insecurity were 1.43 (95% CI: 1.28, 1.59), 1.86 (95% CI: 1.62, 2.14), and 3.44 (95% CI: 3.02, 3.93) for adults with 1, 2, and 3 or more chronic conditions, respectively. Among food-insecure households, adults with multiple chronic conditions had higher odds of severe household food insecurity than adults with no chronic condition. The chronic ill-health of adults may render their households more vulnerable to food insecurity. This has important practice implications for health professionals who can identify and assist those at risk, but it also suggests that appropriate chronic disease management may reduce the prevalence and severity of food insecurity.
To determine if household coping strategies for child hunger in Canada have changed over a decade (1996-2007).
We applied t-tests to data derived from Cycle 2 (1996-1997; n=8165) and Cycle 7 (2006-2007; n=15,961) of the National Longitudinal Survey of Children and Youth (NLSCY) to determine changes in household coping strategies for child hunger. Data were restricted to households with children aged 2-9 years, allowing for cross-sectional analysis of two independent samples. Logistic regression was employed to estimate the odds of reporting child hunger for socio-demographic characteristics and the odds of using different coping strategies.
The national prevalence of child hunger fell from 1.5% in 1997 to 0.7% in 2007 (p
Child hunger represents an adverse experience that could contribute to mental health problems in later life. The objectives of this study were to: (1) examine the long-term effects of the reported experience of child hunger on late adolescence and young adult mental health outcomes; and (2) model the independent contribution of the child hunger experience to these long-term mental health outcomes in consideration of other experiences of child disadvantage.
Using logistic regression, we analyzed data from the Canadian National Longitudinal Survey of Children and Youth covering 1994 through 2008/2009, with data on hunger and other exposures drawn from NLSCY Cycle 1 (1994) through Cycle 7 (2006/2007) and mental health data drawn from Cycle 8 (2008/2009). Our main mental health outcome was a composite measure of depression and suicidal ideation.
The prevalence of child hunger was 5.7% (95% CI 5.0-6.4). Child hunger was a robust predictor of depression and suicidal ideation [crude OR=2.9 (95% CI 1.4-5.8)] even after adjustment for potential confounding variables, OR=2.3 (95% CI 1.2-4.3).
A single question was used to assess child hunger, which itself is a rare extreme manifestation of food insecurity; thus, the spectrum of child food insecurity was not examined, and the rarity of hunger constrained statistical power.
Child hunger appears to be a modifiable risk factor for depression and related suicide ideation in late adolescence and early adulthood, therefore prevention through the detection of such children and remedy of their circumstances may be an avenue to improve adult mental health.
Comment In: Evid Based Med. 2014 Jun;19(3):11324361751
As part of a larger study on food insecurity and dietary adequacy of low-income lone mothers and their children in Atlantic Canada, we examined diet quality among household members.
Network sampling for 'difficult to sample' populations was used to identify mothers living below the poverty line and alone with at least two children under age 14. Trained dietitians administered 24-hour dietary recalls weekly for one month to mothers on the dietary intake of themselves and their children. We calculated Healthy Eating Index category scores for eligible mothers (129) and children (303) using Canada's Food Guide to Healthy Eating and the Nutrition Recommendations for Canadians.
Diet quality of low-income lone mothers was poor (35.5%) or in need of improvement (64.5%), with no mother having a good diet. The diet quality of children varied by age, with 22.7% of children aged one to three having a good diet or needing improvement (74.6%), 2.1% of children aged four to eight and no child aged nine to 14 having a good diet, while the diets of about 85% of older children in both age categories needed improvement.
Younger children seem to be protected from poor quality diets in households with limited resources to acquire food.