Week 9: Environmental Health II - Blood Safety

Week 9: The Bite of Blood Safety: Environmental Health II

• West Nile Virus Outbreak (2002): Concerns about mosquito bites and blood supply transmission prompted policy responses.
• Policy Responses:
  • Nucleic acid amplification testing (NAT) introduced for screening.
  • Emphasis on evidence, ethics (precautionary principle), cost-effectiveness, and federal-provincial collaboration.
• Environmental Health (WHO): Assessing and controlling environmental factors to protect current and future generations.
  • Systems-based and ecological approaches to focus on risks and promote health-supportive environments.
• Emerging Infectious Diseases (Naylor Report, 2003):
  • Examples of diseases like Ebola (1977), West Nile Virus (2002), and COVID-19 highlight the importance of disease preparedness.
• Vector-Borne Diseases (VBDs):
  • Transmitted by infected arthropods, like mosquitoes and ticks.
  • Examples of VBDs include West Nile Virus, Zika, and Lyme disease.
• Precautionary Principle: Act to prevent harm, even in the face of scientific uncertainty. Emphasizes proportionality, non-discrimination, and consistent measures.
• Risk Management Framework:
  • Risk Assessment: Identifies hazards, toxicities, and exposure levels to characterize risks.
  • Risk Management: Evaluating regulatory options, implementing actions (remediation, communication), or making policy changes.
  • Failure Modes & Effects Analysis (FMEA): Identifying failure modes, causes, and consequences to determine criticality and risk levels.
• Economic Evaluation in Policy:
  • Comparative analysis: Comparing costs and consequences of interventions to determine the best option.
  • Cost-Minimization, Cost-Effectiveness, Cost-Utility, Cost-Benefit: different types of evaluation frameworks based on the nature of the impact.

Week 10: What to Do With the Queue?

• Case Study: Princess Margaret Hospital (PMH), Toronto, faced radiotherapy wait list issues.

• Key Challenges:

  • Specialist shortages (therapists, oncologists, physicists).
  • Significant wait times (over 8 weeks for 20% of patients, nearly 50% waited over 8 weeks).

• Policy Issues: Wait list management, ethical rationing, and human resource planning.

• Framing the Problem:

  • Distribution: Sending patients to less-demanded centers, raising ethical concerns.
  • Human Resources (HHR): Staffing shortages, wages/work conditions, machine operation hours.

• Management: Strategies to coordinate wait times (e.g., establishing oversight bodies).

Week 11: Mandatory Gunshot Reporting

• Mandatory Gunshot Wounds Reporting Act (2005, Ontario): Hospital reporting of gunshot wound cases.
• Key Policy Issues: Balancing safety and patient privacy.
• Ethical physician-patient relationships.
• Expanding reporting to other violent injuries?

Week 12: MAID in 2024: A Rapidly Evolving Ethical Landscape

• Legal Cases:

  • Rodriguez v. British Columbia (1993)
  • Carter v. Canada (2015)
  • Truchon v. Superior Court of Quebec (2019): Landmark cases and legal challenges regarding MAID legislation.

• Legislation: Bill C-14 (2016) established criteria for MAID, with subsequent amendments.

Week 13: Inching Toward Reform: Health Care Transformation

• Role of Reform: Primary care reform is needed for sustainable and high-performing healthcare systems.
• Care Settings: Primary care (home, clinics, health centres), Secondary and Tertiary/Quaternary care, Public Health, and Alternative/Complementary Care.
• Continuous and sustainable funding mechanisms for health care services are essential for the delivery of optimal care.
• Framework for care: From individual care to health care teams, patient needs and the need to address wait times and care quality.