MEDICAL HEALTH OFFICER Report – Alcohol and Health in B.C.’s Interior Region

Dr. Silvina Mema

[Excerpt] Alcohol is arguably the most socially acceptable of psychoactive substances. Drinking alcohol is socially acceptable and even an encouraged activity. Some individuals may feel pressured to drink during social gatherings. While social drinking may seem harmless, it can lead to alcohol misuse and addiction.

Many social and health harms can be directly or indirectly attributed to alcohol use. These include acute intoxication, injuries, intimate partner violence, high-risk sexual behaviour, and absence from work. Alcohol can also lead to many chronic diseases, including alcohol use disorder and cancer.

Alcohol was present in over 25 per cent of the 6565 illicit drug toxicity deaths that occurred in British Columbia between 2016 and November 2020.

Sadly, addiction to alcohol and other psychoactive substances is surrounded by stigma. Many still consider these a moral failing or due to a weakness of character as opposed to a chronic disease of the brain.

In the past decade, alcohol consumption rates have been higher in the Interior Health region than the rest of the province, as noted in the 2019 Interior Health Medical Health Officer Report.

First Nations, Métis, and Inuit Peoples
In developing this report, it was recognized that a conventional approach to health needs assessment may not encompass the unique and historical influences on substance use when considering alcohol and Aboriginal peoples.

A new partnership approach is needed, which is collaborative in nature, rests on solid relationships with Aboriginal partners, and serves to emphasize strengths, assets,and resilience. Any approach needs to be based on an understanding of the how alcohol use relates to ongoing complex trauma impacts, racism, power imbalances and colonization.

In the past decade, alcohol consumption rates have been higher in the Interior Health region than the rest of the province, as noted in the 2019 Interior Health Medical Health Officer Report.

Understanding the colonial narrative:
• Prior to European contact, Aboriginal people practised fishing, hunting
and gathering of traditional foods and medicines that led to an active and
healthy lifestyle enriched by ceremonial and cultural practices.
• Colonization introduced devastating impacts to Aboriginal peoples’ health
through forced displacement from their land, disconnection from culture,
family and community, language, ceremony and traditions.
• Alcohol was introduced by European colonizers as a tool to manipulate
Aboriginal peoples in a variety of ways including to purposefully breakdown
family structures, alliances and kinship ties to lower their defences as a
tactic to negotiate and encouraged excessive and abusive consumption.
• Aboriginal people were subject to prohibitory alcohol laws (including but
not limited to the Indian Act of 1876), as an attempt on the part of the
Canadian government to facilitate assimilation.
• The direct linkage between colonization with the historical origins of alcohol
use in Aboriginal populations, and the current effects of anti-Aboriginal
racism and colonial trauma continue to perpetuate barriers to relevant and
appropriate care.
• Being respectful of the lived experiences of Aboriginal partners. A wellintended conventional public health approach can be harmful and retraumatizing when focused only on deficits, without adequately recognizing
historical and current context, and the direct links with health inequity.
• Work that examines the drivers of alcohol and other substance misuse, and that attempts to reduce or eliminate these drivers, will inevitably involve examining: the colonial structures of power, relevancy and cultural safety of services and approaches; systemic and individual racism; and the adverse social determinants of health, including basic services (e.g. water, sewage, education, internet access etc), as well as the geographical location of services.

Self-determination:
• First Nations, Métis and Inuit communities are not a single entity, and that distinction-based approaches are required, as approaches to and perspectives on alcohol and other substances will vary between communities and Aboriginal partners.
• An approach grounded in human rights and committed to the selfdetermination of Aboriginal partners, with respect to the development and delivery of process, policy, services and governance, may be more helpful than a conventional, deficit-based data gathering approach.
• If indicators are to be used, wellness indicators developed with Aboriginal partners would be more appropriate.

Action-oriented:
• There should be concrete timelines for achieving tangible deliverables, in terms of resource allocation, service improvement and self-determination. This involves the transfer
of resources to Nations and the relinquishment of power and control by regional and provincial authorities.
• Further work with Aboriginal partners, to understand the issues and explore solutions, needs to be properly resourced at a level that respects people’s time, effort and lived experience. Primary
care may also be a key partner in this work.
• Ongoing engagement efforts with Aboriginal partners, to further health authority understanding of the issues and explore meaningful approaches to resolution.
• As well, there is required commitment from Interior Health and the Mental Health and Substance Use Network and Operations for ongoing meaningful engagement of Aboriginal partners in
any substance use service planning as determined by Aboriginal partners.
• Within the Substance Use Strategic Framework under development, additional consultation with Aboriginal partners and consideration of Interior Health actions related to the In
Plain Sight report is required to determine specific actions.

Recommendations

  1. Implement improvements to the substance use system of care
    that will:

    a. Increase access to specialized substance use treatment by expanding
    current services and introducing new, evidence-informed models of care.
    b. Enhance care effectiveness by integrating standardized and evidence
    based approaches to substance use care throughout Interior Health.
    c. Create safer services for people who use substances by reducing stigma
    and discrimination throughout the system, and ensuring that services
    are culturally-safe and trauma-informed.
  2. Approval and implementation of an integrated approach to harm reduction across Interior Health, in order to ensure:
    a. IH services provide an evidence-based approach to alcohol-related care,
    treating all clients and families/partners-in-care with dignity, compassion
    and in a non-judgemental manner.
    b. Staff acknowledges that among people who use substances (PWUS),
    abstinence may not always be the goal and that the commitment to
    permanent or temporary (while in care) abstinence is not a requirement
    for receiving care or treatment. This may mean provision of alcohol or
    alcohol replacements as the client may need.
    c. Staff shall be aware of and will not use or perpetuate stigmatizing,
    stereotyping and racist language, attitudes and behaviours.
  3. Working across Interior Health, to further strengthen relationships and collaborative action with local governments and other community partners to address the determinants of health by:
    a. Balancing risk prevention and health promotion by informing policies that reduce alcohol related harms and promote a culture of alcohol moderation.
    b. Translating knowledge to inform evidence based interventions.
    c. Helping to strengthen protective factors that improve wellness and resilience.
    d. Mobilizing collective action to promote, improve and protect community health and wellness.
    e. Integrating equity within the social and built environments, leading to improved health outcomes for everyone
https://www.interiorhealth.ca/sites/default/files/PDFS/mho-report-2020-alcohol-and-health.pdf

Canadian Mental Health Association – Running on empty – Summary Report march 2022

[Excerpt] The pandemic has had a devastating impact on mental health, substance use and homelessness in Canada. 

In 2021, the Canadian Mental Health Association (CMHA) undertook a federation-wide research project to understand how community mental health organizations have been impacted by and responded to the pandemic. 

Our research helped us formulate which federal policy responses are

required so that community mental health organizations — and the people they serve — can get through and recover from the pandemic.

Key findings from the research:

The pandemic has had devastating impacts on the mental health, substance use and homelessness of Canadians, and highlighted pre-existing and increasing needs for services.

There is a significant and growing need for mental health and addiction services available through the not-for-profit and public sectors, including ongoing in-person and virtual counseling and psychotherapy.

The current funding of not-for-profit mental health and addiction services delivered by charitable
organizations is inadequate and unsustainable.
CMHAs feel that community mental health organizations are underfunded, as the provinces and
territories currently dedicate only around 5-6% of overall healthcare spending to mental health and
addictions, a portion of which goes to community mental health organizations.

To access, click on: https://cmha.ca/wp-content/uploads/2022/02/Running-on-empty-EN-Final-Summary-Report-1.pdf

Taking action on the social determinants of health in clinical practice: a framework for health professionals

CMAJ. 2016 Dec 6 – Anne Andermann, MD DPhil

[Excerpts] There is strong evidence from around the globe that people who are poor and less educated have more health problems and die earlier than those who are richer and more educated,  and these disparities exist even in wealthy countries like Canada. To make an impact on improving health equity and providing more patient-centred care,it is necessary to better understand and address the underlying causes of poor health. Yet physicians often feel helpless and frustrated when faced with the complex and intertwined health and social challenges of their patients. Many avoid asking about social issues, preferring to focus on medical treatment and lifestyle counseling.

It is increasingly recognized that to improve population health, health equity needs to become a priority in the health sector, and measures to reduce disparities must be integrated into health programs and services.6 Training physicians, nurses and other allied health workers to address the social determinants of health is considered one of the key principles for promoting more equitable health outcomes for patients, families and communities.7 Indeed, health professional schools are socially accountable to contribute to meeting the needs of the local community. However, what exactly should health workers do to make a positive impact? In this review, we identify the concrete actions that clinicians can use to help address the social determinants of health as part of their routine clinical practice 

What are the social determinants of health?

The World Health Organization (WHO) defines social determinants of health as follows:

“the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”

The social determinants of health include factors such as income, social support, early childhood development, education, employment, housing and gender. Many of these can result from even more upstream and insidious structural forces at play. For instance, in the case of First Nations, Inuit and Metis peoples, ongoing challenges from the impacts of colonization, intergenerational trauma from residential schools, systemic racism, jurisdictional ambiguity and lack of self-determination exert a further influence on health and its determinants.

How are social determinants linked to health outcomes?

Certain subgroups of the population, particularly those who are less empowered and who have lower socioeconomic status, tend to live and work in more degraded environments and have a higher exposure to risk factors for disease, as well as physiologic impacts from chronic stress. Consequently, they have worse health and shorter lives.

How can health care workers influence social determinants?

There are many ways that physicians and other allied health workers can take action on the social determinants of health at the patient, practice and community levels.

What can be done at the patient level?

Asking patients about social challenges in a sensitive and caring way 

The first step in addressing often hidden social issues is asking patients about potential social challenges in a sensitive and culturally acceptable way. There are a growing number of clinical tools to help frontline practitioners ask about problems such as lack of employment, food insecurity and discrimination; generally taboo topics such as physical and sexual abuse, and history of psychological trauma; or factors that can further complicate care such as low literacy, legal or immigration status issues, fears regarding health care or barriers to making appointments. 3 For example, a simple screening question such as “do you ever have difficulty making ends meet at the end of the month?” is 98% sensitive and 64% specific for identifying patients living below the poverty line.3

Referring patients and helping them access benefits and support services 

Once a “social diagnosis” has been made, “social prescribing” involves connecting patients with various support resources within and beyond the health system, such as local women’s groups, housing advocacy organizations or employment agencies. A randomized controlled trial conducted in the United Kingdom involving 161 patients identified in primary care as having psychosocial problems found that referral to community-based support groups reduced patient anxiety and improved perception of overall health compared with usual general practitioner care. In one pilot study, 35 out of 131 patients initially referred were still using these support services 4 weeks later.

How are social determinants linked to health outcomes?

Certain subgroups of the population, particularly those who are less empowered and who have lower socioeconomic status, tend to live and work in more degraded environments and have a higher exposure to risk factors for disease, as well as physiologic impacts from chronic stress. Consequently, they have worse health and shorter lives. 

BC Gov News – Expert panel urges safer supply, evidence-based system of care to reduce deaths from illicit drugs

News Release

Victoria, Wednesday, March 9

A panel of subject-matter experts convened by the BC Coroners Service is calling for increased access to a safer supply of drugs and creation of an evidence-based continuum of care to better support substance users and reduce the number of illicit drug-related deaths in B.C.

The recommendations are included in a report examining the circumstances around 6,007 deaths from illicit drug toxicity between Aug. 1, 2017 and July 31, 2021. The report BC Coroners Service Death Review Panel: A Review of Illicit Drug Toxicity Deaths reveals that the primary cause of these deaths was the increasingly toxic and unpredictable illicit drug supply in the province, and that the current drug policy framework of prohibition is forcing substance users to access the unregulated market, leading to increased numbers of substance-related emergencies and deaths.

Illicit drug toxicity is the leading cause of unnatural death in B.C., accounting for more deaths than homicides, suicides, motor vehicle incidents, drownings and fire-related deaths combined.

“This report includes realistic, actionable recommendations that the panel believes will reduce the number of people dying due to toxic, illicit drugs in our province,” said Michael Egilson, death review panel chair. “We recognize that many of the timelines in the report are aggressive, but COVID-19 has demonstrated how swiftly policy-makers can act when lives are at stake – and we know that every month of inaction equates to hundreds more lives lost.”

The panel’s advice to the chief coroner included three recommendations:

  1. Ensure a safer drug supply to those at risk of dying from the toxic illicit drug supply
  2. Develop a 30/60/90-day Illicit Drug Toxicity Action Plan with ongoing monitoring
  3. Establish an evidence-based continuum of care

The chief coroner has forwarded each of the panel’s recommendations to the relevant ministries and organizations.

Members of the panel were appointed by the chief coroner under Section 49 of the Coroners Act and included professionals with expertise in public health, health services, substance use and addiction, medicine, mental health, Indigenous health, education, income assistance, oversight and regulation, and policing. Regardless of their employment or other affiliations, individual panel members were asked to exercise their mandate under the Coroners Act and express their personal knowledge and professional expertise.

“I want to thank all of the panel members for their expertise and their shared commitment to preventing deaths from the toxic illicit drug supply,” said Lisa Lapointe, chief coroner. “We know that everyone who dies because of drug toxicity leaves behind family, friends and communities who grieve their loss. As we approach the sixth anniversary of the declaration of the public-health emergency into substance-related harms, co-ordinated, urgent action is needed to reduce the devastation illicit drugs have inflicted on so many people in our province. This report, by a panel of subject-matter experts, provides a roadmap. It is my sincere hope that their advice will be actioned.”

Findings reviewed by the panel show:

  • deaths are increasing both in number and in rate;
  • the drug supply has become increasingly toxic;
  • more drug toxicity deaths occur among younger adults – the average age of death is 42;
  • illicit drug toxicity deaths are ranked second after cancers for potential years of life lost;
  • Indigenous Peoples are disproportionately represented in drug toxicity fatalities;
  • individuals living in poverty and with housing instability are more vulnerable;
  • people with mental health disorders or poor mental health are disproportionately represented;
  • in addition to fentanyl, other substances were also detected in most deaths;
  • people had frequently accessed medical services prior to an illicit-drug-related death;
  • deaths are occurring throughout the province;
  • while the highest number of deaths occur in large urban centres (Vancouver, Surrey, Victoria), this issue spans beyond urban areas; and
  • smoking is the most common method of illicit drug consumption.

Learn More:

BC Coroners Service Death Review Panel: A Review of Illicit Drug Toxicity Deaths – Released March 9, 2022: https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/review_of_illicit_drug_toxicity_deaths_2022.pdf

BC Coroners Service Death Review Panel: A Review of Illicit Drug Overdoses – Released April 5, 2018: https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/bccs_illicit_drug_overdose_drp_report.pdf

Death Review Panel: https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/death-review-panel

https://news.gov.bc.ca/26353

Provinces using investor-owned for-profit clinics to cut wait times heading towards predictable failure

Audrey Guay, March 9, 2022 The symptoms of Canada’s strained health care system are well known by now. We see headlines about the shortages of doctors, nurses, and allied health professionals. Burnout rates, already a problem before COVID-19 hit, are reaching new highs. For patients, delayed or missed health care services resulted in 4,000 excess deaths in the second half of 2020 alone.

Decades of austerity cuts, underfunding, and neglect by conservative governments have not left Canada’s healthcare system prepared for the pandemic’s sustained pressures. In response to a crumbling system, Canada’s right-wing establishment is prescribing more of the same failing treatment: private health care.

We’re seeing a new wave of pro-privatization discourse in the media as provinces move their privatization agendas forward. Alberta, Ontario, Saskatchewan have all announced plans to outsource surgeries to private providers, a strategy already in use by the B.C. NDP-led government to clear its surgical backlog.

Private for-profit hasn’t worked

Contracting out surgical services to private companies is at best a short term measure, but evidence shows it to be counter-productive in the long run.

Evidence shows that outsourcing surgeries to private for-profits leads to:

  • Higher costs for the public to as compared to the public system where profits margins are not factored in. Back in 2016, BC’s plan to pay for-profit clinics for MRIs was nearly twice as expensive as the same service within the Vancouver Island Health Authority.
  • Lower quality and less safe services. Both Canadian and international experience shows that private for-profit facilities often cut corners to reduce costs, including hiring fewer and less skilled personnel.
  • A rise in inappropriate surgeries, when a clear profit motive drives recommendations for more and more expensive surgeries. Private, for-profits also have an incentive to take on easier surgeries, leaving the public system with more complex cases.
  • A drain of health human resources from the public system, as profit incentives pull from the same limited pool of health professionals.
  • No improvements to wait times. The 2010 Saskatchewan Surgical Initiative, which made use of chartered facilities, showed a slight reduction of wait times in the short run but an overall increase in wait times in the long run.

    In summary, private facilities are a band-aid measure for a strained public system. Heather Smith, president of  the United Nurses of Alberta, cuts to the heart of the matter: “You pull staffing, resources, and you further hamper the ability of the public system to deliver… Then you say, the ‘public system has failed, and we have no choice’”.

While no research shows that introducing for-profit health care into a public system works, there is solid evidence in support of proven public solutions, including:

  • Fully utilizing existing public operating rooms
  • Adopting a “first available surgeon” waiting list management model
  • Scaling up innovative pilot projects like the Richmond Hip and Knee Reconstruction Project
  • Expanding “one stop shop” patient assessment clinics that make use of multi-disciplinary teams
  • Improving access to community and home care

Governments have been gutting the public healthcare system for decades, creating the scenarios that, on the surface, seem to justify allowing private actors to save the day. To fix this, we need a new set of government policies that will reverse the trend by investing in a systematic human resources and capital investment plan, bringing our public system’s capacity back to sustainable levels.

Provinces using investor-owned for-profit clinics to cut wait times heading towards predictable failure

Where Are the 495 Long-Term Care Beds Promised for BC’s Interior?

Expect some soon, says the health minister, nearly two years after NDP election pledge.

Andrew MacLeod 14 Mar 2022

Also at issue is whether beds will be in the public sector. The BC General Employees’ Union and others claim for-profit models mean poorer care and working conditions.

[Excerpt] A few months before the 2020 British Columbia election, the government made an “historic” announcement of 495 new long-term care beds to be created in the province’s interior region.

The  promise  was welcome news covered widely in the local media, but nearly two years later major questions about the beds and how they will be managed remain unanswered.

Ann Godderis, who lives in Castlegar and works in Trail, watched the announcement and what happened afterwards carefully. “It was an interest and a concern and then it just died,” she said. “We couldn’t find out anything.”

More long-term care beds are badly needed in the region, she said, but it matters a great deal whether they are really new and not just replacements for ones in older facilities that may close.

It’s also important that the beds be kept in the public sector, Godderis said.

“These beds are paid for by our money,” she said, noting the funding comes both from residents of the homes and the government. “I’m just strongly opposed to putting any money into the hands of shareholders. Private for-profit doesn’t belong in health care. I just think it’s wrong.”

The pre-election  promise the government made was for 140 beds in Kelowna, 100 in Kamloops, 90 in Vernon, 90 in Penticton and 75 in Nelson.

The beds would increase the number available in the interior by 10 per cent, it said, bringing the total to 6,550.

“The plan we are setting in motion today for nearly 500 beds is what people in the region need,” Health Minister Adrian Dix said at the time. “This historical investment is a commitment to seniors living in Interior communities, an assurance that care close to home will be available, when they need it.”

Exact locations were to be determined following a bidding process. Interior Health issued five requests for proposals and the results were to be evaluated in the fall of 2020. Contracts were to be awarded in early 2021.

Meanwhile the B.C. General Employees’ Union or BCGEU campaigned against the government’s plan to contract out 85 per cent of the new beds.

“There’s no guarantee that the contracts won’t go to for-profit nursing home chains that make millions in profits by cutting corners, neglecting seniors and mistreating workers,” the union said on a page encouraging people to write to Dix and the finance minister.

“These privately-owned corporate chains have armies of lobbyists that are probably already planning ways to secure those contracts,” it said. Unless there’s a massive public outcry, they might succeed…. We can drown out the lobbyists, and stop the government from handing over more seniors’ care to big corporations.”

Asked last week [March 9] for an update on the procurement process, Interior Health said, “The RFPs issued on July 13, 2020 have closed. We are currently working with the successful proponents and will have more information to share soon.”

Results on the government’s B.C. Bid website show the competitions all closed in October 2020.

‘At least some’ beds to be announced: Dix

Health Minister Dix said some of the results will be released shortly. “I think you’re going to see an announcement about at least some of those beds in the next two weeks,” he said.

Some, particularly those planned for Nelson, will be public, Dix said. “Others will be similar to beds developed over time,” he said. “In other words they’ll be contract beds, they’ll be public beds in private for-profit and not-for-profit care homes.”

The government’s focus is on continuing to refurbish homes built decades ago, increase the number of available beds as the population of seniors grows, reduce the number of shared rooms, improve infection control and raise staffing standards, he said.

The president of the BCGEU, Stephanie Smith, said the union’s campaign about the new beds for the interior resulted in almost 2,000 letters written to the government.

“We want to see an end to private for-profit seniors’ care,” Smith said in an email. “We hope to hear from government soon on this RFP and on the larger goal of getting the profit motive out of seniors’ care.”

The government has taken important steps by bringing home care and contracted hospital services back into the public system, she said.

Smith noted that the BC NDP’s 2020 election platform said, “BC Liberals doled out hundreds of millions to for-profit corporations to create new care homes — and it failed miserably.”

The party’s platform also mentioned four private care homes that were put under public administration for failing to provide the required levels of care, highlighted that for-profit care home operators had failed to deliver more than 200,000 hours of care the public paid them to provide, and that there was a need for “building better, public long-term care homes.”

“We’re hoping to see government follow through on their commitments and award these new contracts to not-for-profit operators,” Smith said.

“The involvement of for-profit corporations in long-term care is a huge concern,” she added. “These companies pad their profit margins by underpaying workers and cutting corners on care — and seniors and workers suffer the consequences.”

The COVID-19 pandemic exposed the dangers of a profit-driven seniors’ care system, Smith said. “Data from Ontario, where most long-term care is for-profit, show that residents were four times more likely to die during COVID-19 outbreaks in for-profit facilities than in public facilities.”

The for-profit care model is dangerous for both seniors and workers and needs to end, she said.

Read more at: Where Are the 495 Long-Term Care Beds Promised for BC’s Interior?

Inside June’s Deadly Heat Dome. And Surviving the Next One

Hundreds succumbed to scorching temperatures. Why was BC’s toll so much higher than Washington and Oregon? A Tyee special report.

Jen St. Denis 14 Mar 2022 TheTyee.ca
Jen St. Denis is The Tyee’s Downtown Eastside reporter. Find her on Twitter @JenStDen.

[Excerpts] Jennifer Thompson lives on a shaded street in New Westminster, B.C., a city of 71,000 located on the banks of the Fraser River, around a 30-minute drive east of Vancouver. Her neighbourhood is filled with colourful Victorian-era houses. Picket fences guard neatly-kept lawns, ornamental shrubs and fruit trees. 

On Monday, June 28, Thompson noticed something unusual. There was a car parked in front of her house in the shade of a cherry tree, and it was making a strained revving sound. 

Glancing inside, Thompson could see a woman in her late 60s or early 70s, leaning back in the reclined seat. Thompson asked the woman if she needed help.

“I’m really grateful that she said, ‘I’m not OK,’” Thompson said.

Depending on where you live in Metro Vancouver, temperatures that day had soared to the low to high 30s, but in many communities it felt like 40 to 46 C. Many residents hadn’t fully grasped that B.C., along with Washington and Oregon, was locked under an unusual weather system called a heat dome trapping the high temperatures. It wasn’t cooling off overnight, and the heat had been building for days.


An image created by NASA’s Earth Observatory show temperatures anomalies across North America on June 27, 2021. Red areas show where air temperatures climbed more than 15 C higher than the 2014-2020 average for the same day



With the help of her husband, Kurt, Thompson helped the woman out of her car and into their house. They led her down the stairs to the basement, where family members had been sleeping to get a break from the heat.

The woman told her new hosts that her name was Carol [pseudonym], but she was disoriented and weak. The couple gave her water and food and applied cold towels to the back of her neck to try to cool her down, but it didn’t seem to be helping much.

They asked if they could help take her home, but Carol said no: she was sure if she went back to her apartment, she would die. Later, Thompson would learn that Carol had been sleeping in her car for two nights with the air conditioning on to try to get some relief from the heat.

When Thompson called 911 for an ambulance, the dispatcher told her it would take between eight and 12 hours for paramedics to arrive. Thompson urged Carol to let the couple take her to the hospital, but she refused to go. So they decided to let Carol stay overnight in their basement.

“We were worried that she would die in the basement,” Thompson said.

June 25 to 27: ‘I witnessed everything sort of crumble’

On Friday, June 25, Kevin Marriott was heading into two day shifts followed by two night shifts as a dispatch supervisor with the BC Ambulance Service. Marriott has been an ambulance dispatcher for 20 years, and before that worked as a paramedic for a decade.

When Marriott started his shift at 5 p.m. on June 27, there was already a backlog of calls. During the next 12 hours, the dispatchers on duty never caught up. People were waiting up to 25 minutes just to talk to a dispatcher, and then they were waiting hours for the ambulance to arrive.

Extreme heat can cause a range of serious injuries. When people get severely dehydrated, there’s not enough fluid and blood in their bodies to get enough blood flow to the kidneys. The kidneys are organs that filter waste, toxic substances and excess fluid from the body and expel the waste in urine.

“When you are dehydrated and don’t have enough fluids, enough flow to the kidneys, your kidneys start to shut down,” said Dr. Elise Jackson, an internal medicine resident who worked at two Vancouver hospitals during the heat dome. “As a result of that, you get a lot of other complications.”

Toxins can start building up inside the body, and patients’ potassium and sodium levels can also rise to dangerous levels. A guide produced by the U.K.’s National Health Service explains the role potassium and sodium play in keeping the body functioning properly.

“Paramedics described going into basement suites where it was upwards of 50 C,” said Troy Clifford, the president of the union that represents paramedics in B.C.

While many patients recovered, some died weeks after being admitted to hospital.

Data released by the BC Coroners Service shows that while 526 people died during the heat dome event, another 67 died between July 2 and Aug. 12.

“The injury [that took their life] was actually the heat injury that occurred initially in that week, but the people sadly ultimately succumbed in the weeks after,” Dr. Taj Baidwan, chief medical officer for the BC Coroners Service, told CTV News. “The organs take time sometimes, and the body fights against dying. Essentially those processes take time, and that’s what we saw.”

Aftermath

In the immediate aftermath of the pandemic, the many failures of the ambulance service were under intense scrutiny. Documents obtained by the BC Liberal Opposition through freedom of information requests showed that in the weeks leading up to the heat dome, senior leadership at E-Comm 911 had issued dire warnings about staffing problems at B.C. Ambulance Service. During the heat dome, the B.C. Ambulance Service didn’t activate its emergency management centre until the most extreme temperatures had passed — a response that could have helped with staffing levels and co-ordination.

Dr. Sarah Henderson, one of the BCCDC researchers who analyzed factors that contributed to heat dome deaths, said cooling centres were available throughout B.C., but they weren’t used that much. She said creating a registry of vulnerable people, increasing green space in deprived neighbourhoods, and improving communication and outreach could help prevent a similar tragedy in the future.

To access the entire article, click on: Inside June’s Deadly Heat Dome. And Surviving the Next One

Rapidly increasing climate change poses a rising threat to mental health, says IPCC

February 28, 2022
[Note: blue text are hot links]
Ashlee Cunsolo, Founding Dean, School of Arctic & Subarctic Studies, Labrador Campus, Memorial University of Newfoundland – Breanne Aylward. PhD Student in Public Health, University of Alberta and Sherilee Harper, Canada Research Chair in Climate Change and Health, University of Alberta

[Excerpts] Climate change poses serious risks to mental well-being. For the first time, a new climate report by the Intergovernmental Panel on Climate Change (IPCC) has assessed how climate change is having widespread and cumulative effects on mental health globally.

Over the past decade, research and public interest on the effects of climate change on mental health have been increasing, as the number of individuals and communities exposed and vulnerable to climate change hazards grows.

Weather and climate extremes such as storms, floods, droughts, heat events and wildfires can be traumatic and have immediate impacts on mental health. Slow onset events like changing seasonal and environmental norms, sea level rise and ice patterns can also affect people’s mental well-being.

Growing evidence confirms that the consequences of rapid, widespread and pervasive climate events may include  anxietyPTSDhigher rates of suicidea diminished sense of well-being (stress, sadness)ecological grief, a rise in domestic violence, cultural erosion and diminished social capital and social relations.

Here are three things that the latest IPCC report tells us about climate change and mental health in North America.

  1. There is greater scientific understanding about the ways that climate change IPCCnegatively impacts mental health. Researchers have been able to examine how both climate and weather extremes such as storms, floods, droughts and fires and slower-onset climate changes such as warming temperatures and changing environmental norms interact with people’s vulnerabilities such as socio-economic inequities, age, gender, identity, occupation and health and lead to a diverse range of negative mental health outcomes.
    For example, a synthesis of global literature found that those exposed to flooding events — such as the floods in southern British Columbia in 2021, in Ottawa in 2019 and Alberta in 2013 — experience PTSD, depression and anxiety in the short term and have elevated risks for these mental health outcomes in the long term. Similar mental health outcomes were found for those exposed to wildfires and related smoke, such as the wildfires in the Northwest Territories in 2014, Fort McMurray, Alta., in 2016 and Lytton, B.C., in 2021.
  2. The mental health impacts of climate change are unequally distributed. Climate change works across intersecting social determinants of health — factors such as age or gender that influence health and how people live — to disproportionately affect certain groups.
    For example, AR6 [IPCC Sixth Assessment Report] demonstrates that some people and communities are most at risk for increasingly worsening mental health outcomes, due to their proximity to the hazard, their reliance on the environment for livelihood and culture and their socio-economic status:
    Agricultural communities already experiencing drought or changing environmental conditions.
    • People living in areas exposed to wildfires and floods.
    Indigenous Peoples and those closely dependent on the natural environment for livelihoods and     culture
    Women, the elderlychildren and young people and those already experiencing chronic physical and mental health issues.

3. It’s not too late to promote resilience. Climate change is not a distant threat. It’s a growing
reality.  Urgent action is needed to protect the mental health of individuals, communities and
health systems under rapid climate change and support individual and community resilience and
well-being.  Resilience can be enhanced through climate-specific mental health outcomes
training and policy action, which support health systems to enhance individual and community
mental health and well-being.

Moving forward. Based on the available evidence, the mental health impacts from climate change are already widespread and likely to worsen. Even with immediate and strong action towards mitigation and adaptation, climate change will continue to be a serious threat. It is critical that we understand the serious risks that climate change poses to mental well-being and take urgent action to support health systems and enhance individual and community mental health and resilience within a changing climate.

To read more, click on: Rapidly increasing climate change poses a rising threat to mental health, says IPCC

2 years into the pandemic, Canada’s mental-health system is at a crisis point

‘Even if you realize you need help — it’s very difficult to find it’: psychologist


A person walks on the streets of Vancouver during a snowfall on Jan. 4. Fifty-four per cent of Canadians said their mental health had worsened during the pandemic in a new survey. 
(Ben Nelms/CBC

Adam Miller – Mar 11, 2022 

[Excerpt] The mental health of Canadians has deteriorated in the two years since the COVID-19 pandemic was declared, putting massive pressure on a mental health-care system that was
already close to a breaking point. 

In a new survey conducted by the Angus Reid Institute in partnership with CBC, 54 per cent of Canadians said their mental health had worsened during the past two years — with women faring significantly worse than men.

Sixty per cent of women aged 18 to 34 said their mental health had worsened throughout the pandemic, and that number jumped to 63 per cent for women aged 35 to 54 over the past two years.

Overall personal impact of the COVID-19 pandemic

Answers to the prompt: “Describe the last two years for you.”A mirrored bar chart showing two bars for each row, which represent various questions about how the pandemic has impacted people’s lives.

The survey coincides with new research from the Canadian Mental Health Association and the University of British Columbia (UBC) that paints a stark picture across the country of a mental health crisis growing in the shadows of COVID-19.

Many Canadians are stressed about what could come next in the pandemic — with 64 per cent responding they were worried about the emergence of new coronavirus variants in the future, which could jeopardize plans to live with the virus as public health measures lift.

Fifty-seven per cent of respondents felt that COVID-19 will be circulating in the population for years to come, while researchers found two years of pandemic-related stress, grief and trauma could lead to long-term mental health implications for some Canadians. 

“After two years, Canadians are really feeling overwhelmed and exhausted,” said Margaret Eaton, national CEO of the Canadian Mental Health Association (CMHA). 

“There is an epidemic of chronic stress that’s been going on for so long, and people are feeling so much uncertainty, that we’re concerned now that it will take much time for them to get over this experience of the pandemic.” 

The situation is similarly dire from a global perspective, with new research from the World Health Organization finding that the first year of the pandemic increased worldwide levels of anxiety and depression by an astonishing 25 per cent.

“The information we have now about the impact of COVID-19 on the world’s mental health is just the tip of the iceberg,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said.

“This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations’ mental health.”

‘System has long been broken’

Canada’s mental health-care system has operated for decades as a partially privatized, fragmented system of hospitals, psychiatrists, psychologists, therapists and community groups paid for either through donations, government funding or directly out of pocket. 

“We live in this patchwork quilt system of mental health where some people, if you have a good employer with a benefits plan, then you might get some psychotherapy,” Eaton said. 

“But a lot of people have suffered through the pandemic and haven’t found any support …. Many are finding that they have to get on a wait-list in order to see a psychotherapist or get into a counselling program and that has been very hard on Canadians.”