Friday, October 13, 2006

Health gag orders hurt the public interest

VICTORIA - It’s happening again. Another health authority is trying to gag doctors and nurses and front-line workers.
If a reporter - or MLA or mayor - calls a hospital in the Vancouver Island Health Authority and asks how wait times are in the emergency room today, the ER doctor is supposed to refuse to answer. Hang up, and call the communications department, says the edict from CEO Howard Waldner. They’ll tell you how to answer.
Or if a physician or cleaner becomes gravely concerned about conditions in a long-term care home - and gets no response internally - she’s supposed to stay quiet. The organization comes before the patients.
VIHA says the memo was just a reminder of existing policy and many organizations have similar rules.
And that’s true. In a past life I ran newspapers and sometimes, when controversy came along, said no one else could do media interviews.
But there were a few critical differences in circumstances. The newspapers weren’t monopoly providers; if people weren’t happy with us they could go elsewhere. That’s not true for the health-care system.
I was accountable to elected directors, put in place by the people who were paying for the whole operation. That’s not true for the health-care system.
And despite our airs, what newspapers do isn’t a matter of life and death, not remotely. That’s not true of the health-care system.
It gets stranger. Some reports suggest the memo was aimed at VIHA’s chief medical health officer, Dr. Richard Stanwick. His job is supposed to be talking about risks to health, based on his professional judgment. He hardly needs to clear his health warnings with communications types or authority executives.
But more likely it’s belated fallout from a devastating letter to the Victoria Times Colonist this summer by Dr. Anthony Barale, then VIHA's director of psychiatric emergency services. Barale went public with his concerns about the authority's substandard services for the addicted and mentally ill. The authority had failed in its responsibility, he said. Resources were pitiful and VIHA’s response was inadequate, "even by so-called ‘Third World standards.’"
Barale’s comments, backed up by colleagues, sparked a needed critical examination of VIHA’s efforts. The health authority never denied the issues were real A gag order, if followed, could have kept the serious problems from public view.
It’s not the first effort to silence health workers. Last year a veteran emergency room doctor at St. Paul’s Hospital in Vancouver told a CBC reporter that ER conditions were the worst she had seen in 14 years. The adminstration’s response wasn’t to address the problems; it sent a memo to staff warning that talking to reporters could be grounds for discipline. (The comments might have displeased the health minister, a senior administrator complained, who would as a result turn down funding requests from the region.)
Nurses and other employees in the Interior Health Authority have reported the same fear of reprisals for speaking publicly about problems in the system.
And Fraser Health employees say they have been told that all newsletters, internal and external, must now be approved by the health minister’s office before they are released - if not a gag, at least a micromanaging muzzle.
It’s natural enough for managers to want to hush up problems. And it’s true that complaints sometimes come from disgruntled or misinformed employees.
But health authorities and other organizations have the ability to deal with those issues. Employees who knowingly level false charges, for example, can be subject to discipline.
More importantly, the health authorities why employees don’t trust that there is the will or ability to deal with their concerns.
But a gag order - no matter how its characterized - is not the answer.
We are the owners and customers of the health-care system. We want and need to hear directly from people on the frontlines when there are problems that the health authorities aren’t fixing.
Footnote: The problem could best be addressed by provincial whistleblower legislation providing protection for health employees raising concerns about issues that affect patient care and safety. At the same time, the legislation could make it clear that people who make unfounded or malicious complaints would not be protected. The government has rejected past requests for such laws.

Wednesday, October 11, 2006

We've decide to deny some children healthy food

VICTORIA - It's alarming to think that we're spending $1.8 billion a year in B.C. on avoidable health-care costs.
But that's one of the findings in the latest annual report from provincial health officer Dr. Perry Kendall, which this year looks at "Food, Health and Well-Being in B.C."
As the conversation on health care starts it's worth noting that we'd spend up to 15 per cent less on health - enough for an annual $1,800 tax cut for a family of four - if we ate smarter, exercised a little more and didn't smoke.
It raises, among other things, some obvious questions about how serious we are about the costs of health care, or our health in general. The study reports that 24 per cent of Canadians were overweight or obese in 2004, up from 14 per cent in 1979. The percentage of children and youth who are obese or overweight has taken the same leap. (Don't take this as preachy. My diet and exercise habits are mediocre to wretched.)
Our bad habits are harmful for us and costly for society. People know about the risk of diabetes and heart disease. But the report notes that research shows that diet plays a role in about 30 per cent of cancer cases. Eat more fruits and vegetables and your risk falls.
Which all points to the value of the government's effort to promote healthier choices.
My poor choices are just that - choices.
But the report included an alarming reminder of how many British Columbians, especially children, have no option. It's impossible for their parents to feed them adequately, because they don't have enough money.
Forest Minister Rich Coleman put the problem bluntly this month when he announced the government's new housing subsidies for up to 15,000 working poor families. Children in B.C. are suffering from malnutrition because their parents can't afford food, he said. They are falling behind in school and failing to gain needed literacy skills. Inadequate nutrition is condemning them to a life of disadvantage and ill health, while creating avoidable future costs. Leaving aside the morality of letting kids go hungry, it simply makes business sense to look after them now and avoid all the future costs that will be consequences of their malnutrition.
The health officer's report found that in 2001 about 15 per cent of British Columbians worried about not being able to afford adequate food. “In B.C. child poverty diminished in the late 1990s and then rose from 2002 to 2005,” the report notes. About 25 per cent of children lived in poverty in 2005.
Many of those children were in homes where parents were working, but not earning enough to provide adequate food.
Many others lived with parents on welfare. Their poverty was based on decisions government made on your behalf.
The health report noted B.C.’s welfare rates were the second lowest in Canada in 2004. Once inflation is stripped out, people on welfare are getting 15 per cent less than they did 10 years ago.
That's not enough to feed their children properly, the health officer's report found. A single parent with two children on welfare gets about $1,450 a month, counting federal credits and all the rest. Look around your community and figure what they would have to pay in rent.
By my count, they would have about $650 left each month for everything else - food, bus passes, a phone, clothes, school fees.
But the report sets the basic cost of feeding a family of three at $477 a month. That would leave $40 a week for everything other than food and rent for three people.
Impossible, of course, so - as Coleman observed - children suffer.
For some, the deprivation is brief. Their parent finds work, the ideal outcome, and life changes.
But for disabled parents or families with very young children or "barriers to employment," the inadequate nutrition can last through childhood.
As the health officer's report reminds us, that will cost us all, for decades to come.
Footnote: Food matters. The report notes that children in "food insufficient households" are more than twice as likely to have asthma and that inadequate childhood nutritition can cause permanent cognitive damage, limiting the child's ability to learn. Inadequate nutrition for teens is linked to depression and suicidal tendencies. The full report can be found at

Tuesday, October 10, 2006

Almost 600,000 reasons Harper’s pot policy doomed

VICTORIA - It wasn’t exactly a newsflash that British Columbians are fond of marijuana. All those jokes about BC Bud have to be based on something.
But last week’s report on marijuana use in B.C. from the University of Victoria’s Centre for Addiction Research should be a reminder of the need to overhaul our policies on pot.
And it should be a special warning to the Harper government that tougher enforcement, longer sentences and hardline rhetoric are doomed to be costly failures. In B.C. especially, an effort to wipe out marijuana use - and by extension production and sale - has about the same chance of success as banning alcohol.
Governments concerned about the negative effects of marijuana use need to come up with a smarter approach.
The problem for the get-tough crowd is that the B.C. public doesn’t buy the idea that marijuana use should be a crime.
A majority of British Columbia adults have used marijuana, the study found, about 1.8 million people.
More significantly, almost 600,000 used pot in the last 12 months. That’s more people than voted for either the NDP or the Liberals in B.C. in the last federal election and almost equal to the number who voted Conservative.
That reality has at least three significant public policy implications.
First, a get-tough approached based on the argument that marijuana is an imminent threat is doomed. Marijuana still trails far behind alcohol as a drug of choice - about 2.7 million of us reported drinking in the last year. But by the time almost 600,000 people are using marijuana occasionally the chances of winning public support for a big criminal crackdown have vanished.
It doesn’t matter if politicians think that’s good or bad. It’s reality. Arrests for cannabis-related offences have doubled in the last decade, with 75 per cent of them for possession. There’s been no effect on use.
Second, that traditional efforts to attack the supply side - more police, longer sentences and all the rest - won’t work. When demand for a product is strong and there’s widespread public acceptance of it, than the laws of the market take effect. Suppliers will emerge to meet the demand. Shut down one, and another will step forward. That’s the lesson of Prohibition in the U.S. and of virtually every drug strategy since.
And third, that the risks marijuana - and other drugs - pose in terms of public health and safety will not be addressed as long as governments pursue a doomed strategy.
And there are risks, contrary to the claims of some marijuana advocates. The centre’s study found that about 10 per cent of users were at moderate risk of problems related to their marijuana use. No one could imagine that daily marijuana use is a good thing for an already unmotivated 15-year-old. And production and sales are fattening the bank accounts of organized criminals.
But as long as the emphasis is on talking tough, then there’s little time or money left for education about risks, smart use or recognizing and dealing with problems.
There’s no targeted effort to restrict access to youth, as there is for alcohol and tobacco. (The report notes daily use of marijuana is now more common among young Canadians than tobacco.)
And criminals still profit from sales.
At the same time, the resources going toward marijuana enforcement could be better spent. About half of drug arrests in Canada in 2004 were for cannabis offences, the study notes. Most Canadians would likely welcome broader efforts to curb meth, heroin and cocaine use, the drugs driving crime in most cities.
The former Liberal government appeared to be heading toward decriminalization for possession of pot and up to three plants. (That alone would likely make a big dent in the profits of from criminal grow-ops)
But the Harper government has so far talked about enforcement and tougher penalties, the old language of prohibition.
It’s not going to work. The study makes that obvious.
Footnote: When a drug reaches a certain level of use, enforcement becomes impossible. A University of the Fraser Valley study on grow ops found that in 1997 police across B.C. investigated more than 90 per cent of grow-op reports within one month. By 2003, that had fallen to 50 per cent. Up to 25 per cent of reports were never followed up.