Health Promotion Efforts Booming


By Matt Borsellino

The Medical Post

September 21, 2004

Programs across the country look to encourage healthy lifestyles and save the system money


TORONTO - Tiny Prince Edward Island does it but so do the country's largest provinces. In fact, it takes place, to varying degrees, from British Columbia to Nova Scotia. It's also begun making the rounds of various specialties, such as endocrinology, pediatrics and radiology. Indeed, the number, breadth and scope of health promotion ac­tivities either now in place or be­ing considered by numerous bodies and agencies are nothing short of impressive.

One reason, according to a poster session co-ordinated by the Canadian Medical Association's office for public health and dis­ played at this year's annual meet­ing here, is undoubtedly cost.

But it's far from the only reason. At least one other benefit has been the new relationships spawned among various health­ care providers. Preventing disease and injury, promoting healthy lifestyles and co-ordinating activities by a number of players on the health-care team saves money in a time when money is the focus of the national health-care debate.


Office of public health


The CMA itself jumped on board in a big way when it launched its office of public health, headed by Dr. Isra Levy, its chief medical officer, in the fall of 2001. Last year, it extended that commitment by setting up a cen­tre promoting the health and well-being of its 58,000 members. It's monitored regularly by Ottawa-based psychiatrist and Medical Post columnist Dr. Mamta Gautam, a specialist in treating physicians, through her position as chairwoman of the CMA physician health expert advisory group. Research and collection of data on issues affecting the health and morale of doctors are among its functions.


Many of the session's posters dealt with tobacco cessation, but an increasing number are fanning out into various clinical areas. In B.C.,  for instance, 75 clinical teams led by primary care physicians, but including medical office assistants and nurses, in a collaborative effort are engaged in a year-long province wide proj­ect to redesign clinical practice and enhance management for 7,000 patients with diabetes, a condition described in its literature as "serious, prevalent and costly."


The project's goal is "to help build an infrastructure for chronic disease management in B.C. that will maximize the length and quality of life for patients with chronic disease while maintaining or decreasing the cost of care." Diabetes patients are known to have a life ex­pectancy 13 years shorter than average. Efforts by CMA divisions in Alberta and Ontario were also represented. The Alberta Medical Association has projects addressing youth smoking, municipal smoking bans, breastfeeding, drug abuse and gambling, as well as prevention of unwanted pregnancies, sexually transmitted dis­eases, fetal alcohol syndrome and what its poster described as "over-nutrition and under-activity."


The clinical tobacco interven­tion (CTI) program is a co-operative effort involving the Ontario Medical Association and the province's pharmacists and dentists "to recruit, educate and sup­ port" tobacco use cessation interventions with patients. The poster described CTI as "the first program of its kind to have the active, ongoing participation of these three professional groups." It has trained 4,000 health-care professionals and distributed 8,000 education kits.


Smaller CMA divisions, such as Doctors Nova Scotia (formerly the Medical Society of Nova Scotia) and the Medical Society of P.E.I., are also on board. One of the reasons the Nova Scotia group recently changed its name to Doctors Nova Scotia, ac­ cording to the group's poster, is to take advantage of the group's un­ tapped potential to improve the health of residents who live in a province that ranks as one of the country's unhealthiest.

"Health promotion is not only about getting the message out to our stakeholders and the public but also ensuring they believe the message and therefore act on it," stated its poster. "This was one of the driving forces behind our recent name change."


Smoking cessation, flu education and Pap test awareness are its "three longest-standing health promotion initiatives." But its public health officials are "constantly looking" at others. Physi­al activity has quickly become one of its most important efforts. Physician presenters visit Grade 6 classes across Prince Edward Island. Most smokers recall having their first whole cigarette when they were about 11 years old, and the Staying Smoke Free program, a component of a provincial smoking reduction strategy, targets that age group and focuses on tactics used by tobacco firms "to entice young people to begin smoking."


Pediatric surveillance program


Almost 2,500 pediatricians are involved in a project called the Canadian Pediatric Society Sur­veillance Program. The initiative urges them to report "high-impact uncommon diseases and con­ditions" every month through standardized questionnaires. Though simply designed, the program has yielded eye-popping participation and has helped build a broadly based clinical in­frastructure, Marie Adele Davis, the society's executive director, told delegates attending a session associated with the poster display. Initial and follow up re­sponse rates were 83% and 97% respectively, she said.


Universal varicella immunization, a herpes vaccine, vitamin D supplementation, timely workup and follow up of jaundiced newborns, and a mandatory ban on baby walkers and development of mandatory weight/size-appropriate care restraints and booster seats are among results reported by program officials.


"Systematic analyses, inter­pretation and dissemination of survey findings have identified important public health actions that benefit Canadian children and their families," the group's poster stated.

The Canadian Association of Radiologists was on hand promoting uterine fibroid embolization instead of traditional hysterec­tomy to treat fibroids.

Interventional radiologists say the procedure takes less time and relieves heavy bleeding, pain and other symptoms. The Canadian Interventional Radiology Associ­ation, a CAR sub-group, was be­hind that initiative.