Conseil canadien d'agrément des services de santé, Développement des marchés nationaux et internationaux, candidat au doctorat en santé publique, Faculté de médecine, Université de Montréal. martin.beaumont@cchsa-ccass.ca
The objective of this pan-Canadian study was to evaluate the feasibility of developing a set of accreditation standards supported by an accreditation process for public health in Canada.
Twenty-four telephone interviews were conducted, recorded, transcribed and analyzed.
The scope of public health implied in respondents' answers included health protection, health promotion, disease prevention and surveillance. A large majority of the experts were in favour of implementing accreditation in public health. Of these, close to two thirds answered that public health needed its own standards to address some of the current gaps. People in health systems were faster to question the relevance of separate standards for public health to avoid creating artificial barriers within the continuum of care. Respondents who opposed an accreditation process for public health cited the lack of capacity currently in the system. Yet, proponents argued that accreditation could actually be used as a capacity-building tool and assist "to fight the tyranny of the urgent". Some identified the actual process of developing accreditation standards for public health as being a valuable exercise.
It appears that public health in Canada would benefit from an accreditation process developed in consultation with the field, to enhance visibility, capacity building, and performance through pan-Canadian standards which would also have to be flexible enough to accommodate specific provincial and local contexts.
In addition to establishing Canadian federal institutions for public health to work in cooperation with provincial and local health authorities, the infrastructure of public health for the future depends on a multi-disciplinary and well-prepared workforce. Traditionally, Canada trained its public health workforce in schools of public health (or hygiene), but in recent decades this has been carried out in departments and centres primarily within medical faculties. Recent public health crises in Canada have led to some new federal institutions and reorganization of public health activities as well as other reforms. This commentary proposes re-examination of the context of public health workforce training and especially for schools of public health as independent faculties within universities as in the United States or, as developed more recently in Europe, semi-independent schools within medical faculties. The multi-disciplinary nature of public health professionals and the complex challenges of the "New Public Health" call for a new debate on this vital issue of public health workforce development. Public health needs a new image and higher profile of training, research and service to meet provincial and national needs, based on international standards of accreditation and recognition.
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Comment In: Can J Public Health. 2006 May-Jun;97(3):251-416827419
Until recently, bed bugs have been considered uncommon in the industrialized world. This study determined the extent of reemerging bed bug infestations in homeless shelters and other locations in Toronto, Canada. Toronto Public Health documented complaints of bed bug infestations from 46 locations in 2003, most commonly apartments (63%), shelters (15%), and rooming houses (11%). Pest control operators in Toronto (N = 34) reported treating bed bug infestations at 847 locations in 2003, most commonly single-family dwellings (70%), apartments (18%), and shelters (8%). Bed bug infestations were reported at 20 (31%) of 65 homeless shelters. At 1 affected shelter, 4% of residents reported having bed bug bites. Bed bug infestations can have an adverse effect on health and quality of life in the general population, particularly among homeless persons living in shelters.
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Cites: Lancet. 1994 Mar 26;343(8900):761-37907732
Cites: S Afr Med J. 1991 Mar 16;79(6):320-22017742
1) To describe the community health nursing workforce in Canada; 2) To compare, across political jurisdictions and community health sectors, what helps and hinders community nurses to work effectively; 3) To identify organizational attributes that support one community subsector--public health nurses--to practise the full scope of their competencies.
Our study included an analysis of the Canadian Institute for Health Information nursing databases (1996-2007), a survey of over 13,000 community health nurses across Canada and 23 focus groups of public health policy-makers and front-line public health nurses.
Over 53,000 registered and licensed practical nurses worked in community health in Canada in 2007, about 16% of the nursing workforce. Community nurses were older on average than the rest of their profession. Typical practice settings for community nurses included community health centres, home care and public health units/departments. To practise effectively, community nurses need professional confidence, good team relationships, supportive workplaces and community support. Most community nurses felt confident in their practice and relationships with other nurses and professionals, though less often with physicians. Their feelings about salary and job security were mixed, and most community nurses would like more learning opportunities, policy and practice information and chances to debrief about work. They needed their communities to do more to address social determinants of health and provide good quality resources. Public health nursing needs a combination of factors to succeed: sound government policy, supportive organizational culture and good management practices. Organizational attributes identified as supports for optimal practice include: flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; coordinated public health planning across jurisdictions; and strong leadership that openly promotes public health, values their staff's work and invests in education and training.
The interchangeable and inconsistent use of titles used by community nurses and their employers makes it difficult to discern differences within this sector such as home care, public health, etc. Our studies also revealed that community nurses: thrive in workplaces where they share the vision and goals of their organization and work collaboratively in an atmosphere that supports creative, autonomous practice; work well together, but need time, flexible funding and management support to develop relationships with the community and their clients, and to build teams with other professionals; could sustain their competencies and confidence in their professional abilities with more access to continuing education, policies, evidence and debriefing sessions.
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Comment In: Can J Public Health. 2010 Jan-Feb;101(1):10620364550
Comment In: Can J Public Health. 2010 Sep-Oct;101(5):427; author reply 42721214062
Several population-based health databases exist in Canada which provide valuable systematic information for facilitating epidemiological evaluation of human health in the Great Lakes Basin. They include the long-established Canadian Mortality Database, a national birth defects registry, a provincial hospitalization database, and provincial and national cancer registry systems. The most recent addition is the National Enhanced Cancer Surveillance System which currently is being implemented to allow for detailed evaluation of air and water quality concerns in relation to a range of cancer types. The system includes statistical evaluation of geographical cancer incidence patterns; development of a national environmental quality database; and systematic collection of individual risk factor information for a large number of newly diagnosed cancer cases and a population control group. A brief description of each database and examples of relevant research using each of these databases is presented.
Indigenous people across the globe have generally had suboptimal access to quality medical care and effective prevention programs. The available programs that existed have generally been poorly funded and have primarily focussed on infectious diseases. More recent trends denoting significant rising morbidity and mortality of chronic diseases have brought some limited medical focus on cardiovascular diseases, their risk factors and their prevention. However, there is a growing body of evidence-published and unpublished-of developed and developing successful programs to provide culturally appropriate and sensitive treatment for cardiovascular diseases and prevention. Within this report, we aim to describe some of these programs in order to understand common approaches and links that make them successful. Once this survey is completed, a template for successful CVD programs can be created for the development of future programs.
We used several methods to gather information about successful Indigenous CVD programs: Pub Med search (keywords: Indigenous, native, First Nation, Aboriginal, cardiovascular, cardiac, etc.), online searches of government-based health programs (World Health Organization, Centers for Disease Control, etc.) and non-government health programs (World Heart Federation, Bill & Melinda Gates Foundation, etc.), and, importantly, personal communication with multiple thought leaders and program directors in the field of international CVD treatment and prevention.
Programs can be divided into: (1) epidemiologic programs, which focus on data collection, (2) focussed prevention programs and population approach to CVD prevention, and (3) clinical prevention and intervention programs.
Common themes that define successful Indigenous CVD programs include: dedicated focus on the Indigenous population, widespread community involvement within the Indigenous population, often through the use of Indigenous community health workers, a focus on high-risk individuals within the population and regularly scheduled contact between the program and participants. We recommend that these themes are incorporated during development of future CVD programs for Indigenous people.
