From Seniors’ Care to Opioids, Eight Critical Public Health Issues for 2020

Canada has plenty of domestic public health problems, and an infectious disease outbreak anywhere in the world is just one airline passenger away from Toronto or Vancouver.

As the year winds down, here are eight incredibly pressing public health problems — and some solutions — we’re likely to deal with in 2020.

The slow end of the Ebola outbreak. Time and again, extremist political violence and distrust of the Kinshasa government in the northeast Democratic Republic of Congo has halted the response to the Ebola crisis that has killed more than 2,200 people. We now have two effective Ebola vaccines, but getting them to people at risk will be a problem well into the new year.

The outbreak won’t be considered over until 42 days have passed since the last confirmed case. Given the violence, we won’t likely experience those 42 days for months.

Continued spread of measles. The World Health Organization estimates that 144,000 people died of measles in 2018. It’s killed more people in the DR Congo than Ebola. Encouragingly, Samoa recently shut down the country for two days to vaccinate 90 per cent of the population — and hit that target.

Social media attacks on measles vaccine have helped keep immunization rates low in countries that should know better, like the U.S. and Canada. We should learn from the Samoans.

Opioids and their collateral damage. It’s been over three years since Dr. Perry Kendall declared a public health emergency in B.C. over opioid overdoses and deaths. Deaths are trending down, but overdoses seem to have stabilized at an intolerable 22,000 a year.

It’s intolerable partly because survivors of multiple overdoses may end up with lifelong brain damage, and partly because first responders — fire and rescue and paramedics — must deal with the stress and mental health problems caused by saving the same people again and again. In 2020, we may start thinking about why people get on opioids in the first place.

Indigenous suicide. Winnipeg will host a World Indigenous Suicide Prevention Conference next August, where participants will discuss the fact that Indigenous people in Canada have triple the suicide rate of non-Indigenous people; Métis have twice the rate. In November, a 10-year-old girl from Makwa Sahgaiehcan First Nation died by suicide. Several other young people on the same Saskatchewan reserve have also attempted to kill themselves.

A national commitment to the United Nations Declaration on the Rights of Indigenous Peoples might actually help reduce this appalling epidemic of suicide in children.

Stampede for Canadian pharmaceuticals. Rather than drive down the prices of U.S. drugs like insulin, Donald Trump wants to import them cheaply from Canada, which would deplete our supplies and drive up costs to Canadians and to medicare. This should be an absolute non-starter.

Brain injury. Slowly and reluctantly, we’re beginning to realize that many sports offer entertainment that inflicts serious brain damage — chronic traumatic encephalopathy — on the players. Now we’ve learned that about half of all homeless men have suffered traumatic brain injury, usually before they became homeless. We wouldn’t allow someone with a broken leg or kidney failure to sleep on the sidewalk, but we don’t mind it if the sleepers are brain injured.

Worse yet, we’re learning that a major cause of brain injury in women is domestic violence. A Kelowna-based group, SOAR Project, is working to reduce the toll.

Seniors’ and caregivers’ health issues. Close to 600,000 Canadians now live with dementia; the number is expected to be close to one million by 2030. Double, triple or quadruple those numbers to include family and friends who are enlisted as caregivers and also suffering stress, anxiety and depression. In the U.S., four former surgeon generals recently warned that 14 million Americans will be living with dementia by 2050; lacking adequate care resources, they said, the situation will be “potentially catastrophic.”

Ottawa’s current dementia strategy is no doubt well meant, but it’s sadly underfunded and unlikely to meet the needs of 2020, let alone 2030 or 2050.

Worsening death toll from air pollution. The World Health Organization warns that we’re killing seven million people a year through air pollution. It contributes to deaths from lung cancer, stroke and heart disease, and now it’s being aggravated by smoke from wildfires — as the residents of Sydney, Australia, are learning as a fire “too big to put out” burns near their city. As long as we export fossil fuels (including liquefied natural gas), we’ll be part of the problem and not the solution.

Pleasant surprises

We can, however, hope for some unexpected good news. Recent trials of a new typhoid vaccine have been very successful. Scientists are working on high-tech means of slowing Zika, dengue and chikungunya by releasing sterilized mosquitos into the wild, rapidly reducing the number of mosquitos carrying those diseases. Similar successes could help reduce the burden of other diseases.

Nasty surprises

Diseases can come out of nowhere. SARS shook Toronto’s health-care system in 2003. When everyone was waiting for H5N1 bird flu from Asia in 2009, we got H1N1 swine flu in our own backyard instead. B.C. hasn’t had a real pandemic since the Spanish flu. We may be due for another one.

By definition, public health is a political issue. People prefer not to think about nasty diseases, and politicians prefer not to remind them. But preparation — including effective communication with a well-informed public — can literally save lives when disease breaks out.

A well-resourced, resilient health-care system can stop an outbreak in its tracks. A system that’s been cut (even if it saves the proverbially hard-earned money of the long-suffering taxpayer) can do little but count the number of dead taxpayers.

Happy holidays, readers. Our comment threads will be closed until Jan. 2 to give our moderators a break. See you in 2020.