Health Impact Assessment – Making Whole-of-Government Decision Making Possible

On March 9, 2011, we held our fourth webinar, Health Impact Assessment - Making Whole-of-Government Decision Making Possible.
It drew on our December, 2011 report, Stepping It Up: Moving the Focus from Health Care in Canada to a Healthier Canada. 
For this webinar, we invited three guest panelists: Louise St. Pierre from the National Collaborating Centre for Healthy Public Policy in Montreal; Lyne Jobin from the Ministry of Health and Social Services, Quebec City; and Olanna White from Toronto Public Health.We'd like to thank the National Collaborating Centre for Healthy Public Policy for their valuable assistance in organizing this event.
If you missed the webinar, you can download a playback link by clicking HERE. You can download the complete PowerPoint presentations including references and useful information links HERE. Finally, below are the questions we didn't have time for...

1. If negative health impacts are realized in the future that may be attributable to the project or policy, does the burden of proof remain with the consulted community...or is the coordinator of the HIA accountable to address these issues? Has the tool ever been evaluated for expected outcomes for any project or policy­
2. Could Olanna please provide some examples of concept of 'equity-based' HIA?
3. Besides Quebec and Toronto - are other provinces or territories using HIA and if so - where?­
4. Where are the best sources of scientific evidence re health impacts on social determinants of health?­
5. Olanna, as a follow up to the question on how City of Toronto is using HIA, do you plan to propose to the City that it use HIA as part of process when reports go forward to City Council similar to Equity Lens initiative?
6. How can community health boards use the HIA tool to improve the health of the community­?

You may have your own questions, answers or comments about either the report or what you heard in our webinar. Please post them in the comments section below.

 

How Do Canadians Rate the Health Care System? Our 3rd Webinar

On February 14th, we held our third webinar, What Can We Learn From Top Performing Countries? It expanded on our November 2011 bulletin, How Do Canadians Rate the Health Care System? based on the 2010 Commonwealth Fund International Health Policy Survey. In the bulletin, we found that citizens of certain European countries feel they have the edge in particular areas of health care. 

In our webinar, we discussed those areas and what Canada and other countries can learn. We invited three guest panelists - from the United Kingdom, Nicholas Mays, Professor of Health Policy in the Department of Health Services Research & Policy at the London School of Hygiene and Tropical Medicine in London; from the Netherlands, Dr. Jako Burgers at the University Medical Centre, St. Radboud Scientific Institute for Quality of Healthcare, Nijmegen; from Switzerland, Dr. Monika Diebold, Head of Obsan, the Swiss Health Observatory, at the Swiss Federal Statistical Office, Neuchâtel. 

If you missed the webinar, you can download or playback by clicking  HERE. We apologise that it commences just after the start of panelist Nicholas May's presentation.You can download the complete PowerPoint presentations HERE. Finally, here are the questions webinar attendees asked our panelists...

• Is there additional insurance over the basic national insurance? Is this additional insurance private or governmental?
• How does the health of the population, i.e., more chronic disease, higher obesity rates, etc., translate to higher per capita costs in a country?
• One of the major barriers to moving toward electronic health records is cost. How did the Netherlands and the UK implement computerized systems without incurring unrealistic expenses?
• All three systems use primary medical care as a surrogate for primary care. How are other primary care providers integrated within your primary care solution? How are they reimbursed, fees negotiated and what incentives are there to optimize team-based care?
• In the Netherlands, the average consultation length with a doctor is 10 minutes. Is that time enough?
• How about medical education for GPs? Does your country make use of EMR systems or regional prescribing databases to provide feedback to GPs about their prescribing practices and make recommendations about optimal cost-effective prescribing?
• What are the implications for the issues discussed (access to care, timeliness etc.) in the engagement of patients with the physicians? In the case of Switzerland, have there been any changes or attempts at the patient-physician level in order to address the cultural differences among the four groups?  
• When Dutch residents seek care from one of the 100+ after-hours care centres, are their patient records available electronically to the MDs?
• Are governance models significant in promoting primary care service delivery, for example Regional Health Authorities?
• What is the impact of "culture" on the demand for specialist services in your country? That is, is there any difference in patient expectation or GP attitude between countries that impacts behaviours/expectations respecting access to specialist care?
• What is the NHS' overall approach to managing recently announced cuts to its budget? How do you perceive this will impact service provision?
• A big issue here in Canada is the high number of patients, often elderly patients, occupying acute care beds who should be cared for elsewhere. This contributes to lengthy wait times for elective care and for emergency care. Is this a problem in your country?
• In the Netherlands we are working on the implementation of a National Exchange point electronic health records. Do the panel lists think this might improve coordination? Are there any experiences?
• What about the impact of survey methodology? I suppose you all have the common problem of growing rates of non-responders. Are you worried about that? How do you deal with this limitation?
•  How do England and the Netherlands explain the low marks for patient centered care given the overall comfort with primary care in general?

You may have your own questions or comments about either the bulletin or what you heard in our webinar. Please feel free to post them in the comments section below.

Bicycle Helmets - There's Safety in Numbers

Dr. Brian Goldman is a veteran ER physician and one of Canada's most trusted medical broadcasters. He has been an award-winning medical reporter for CBC Television's The Health Show and The National. He's also known across Canada as the host of CBC Radio One's "White Coat, Black Art."

When was just starting out as an ER physician, I can remember the day a teenager was brought by paramedics to the hospital.  A passerby found him sprawled beside his bicycle.  He was semiconscious and had telltale swelling and bruising on one side of his head.  Right before my eyes, he became deeply comatose and developed profound weakness on the side of his body opposite to that of the swelling in his scalp.

I knew my patient was in deep trouble.  Fortunately, the paramedics remained at my patient’s bedside as I worked frantically to stabilize him.  I transferred him to a pediatric hospital, and the paramedics drove at speeds above 100 km per hour on city streets to get him there in time. 

The good news is that neurosurgeons were able to operated to remove an extradural hematoma, a collection of blood inside my patient’s skull.  He made a complete recovery.  Without timely transportation and skilled surgeons, my patient would surely have died.

Other patients aren’t quite so lucky.  The main reason is that far too many Canadians venture onto the roads without wearing a bicycle helmet.  According to the Canadian Community Health Survey, just 4.1 million or 36% of the more than 11.4 million Canadians age 12 and older who ride a bicycle wear a proper helmet at all times. 

That is why I support the use of health indicators that will measure the effectiveness of laws and regulations that require cyclists to wear helmets.  Injuries are the leading cause of death and disability for Canadian children and youth.  Major causes of injury include bicycle and motor vehicle crashes.  When you see the impact of trauma on the lives of patients and their families, you understand that the only 100% effective way to deal with injuries is to prevent them. 

Although helmets can reduce the risk of head injury by 85%, safety campaigns are not enough.  Looking at bicycle helmet laws is a great place to begin, since mandatory bicycle helmet laws have been shown to increase the use of helmets and have reduced head injuries.  Several provinces have mandated the use of bicycle helmets.  Some require the use of helmets at all ages, while others require their use in kids under the age of 18 only.  By comparing injury rate in these different jurisdictions, we can monitor the effectiveness of bicycle helmet laws.   

Other health indicators from CIHI and Statistics Canada that have a bearing on safety include mortality rates, hospitalizations, and the percentage of cyclists who wear a helmet. 

By focusing on bicycle helmets and laws requiring them, we’re making things safer for Canadians.  And, we’re reducing the carnage in our emergency departments. 

Key Words: Health Indicators, Health Promotion