Players from NHL, junior leagues seeking brain scans without team involvement.

More than 200 current and retired National Hockey League players have taken concerns about existing or potential brain injuries into their own hands by visiting a neurosurgeon in Kingston, Ont., for MRI brain scan procedures.

Dr. Douglas James Cook says at least 120 former and some 80 active NHL players have undergone the scans over the past two years. He said that about 50 active players combined from the Ontario Hockey League and Western Hockey League have also been tested at Queen’s University over the same time frame.

The tests have not been done with the oversight or formal participation of any of the active players’ teams, Dr. Cook said in a series of interviews with TSN.

“Some guys come because teammates tell them about it,” Dr. Cook said. “Some players bring a teammate with them and then when they come for a follow-up say, ‘Can I bring these other two players with me? I think they might be interested.’”

TSN could not independently corroborate the number of NHL players who have had the tests completed.

Dr. Cook, who operated twice on Tragically Hip lead singer Gord Downie after his brain cancer diagnosis, said the technology used to measure the flow of blood through the brain’s millions of blood vessels is new and that his methodology for analyzing the data collected is unique.

Following a brain injury, Dr. Cook said, the flow of blood can accelerate through damaged or stressed parts of the brain as the brain directs oxygen-rich blood to the affected areas. In other nearby parts of the brain, blood flow can slow if it is redirected to injured areas in need of repair.

“We simplify it for players,” Dr. Cook said. “We explain that there are areas of stress in the brain after an injury and that there are changes in blood flow that we can monitor in those areas of stress.”

Dr. Cook said he’s discovered blood flow abnormalities in the brains of about one-quarter of the roughly 80 active NHL players he has examined.

“Unfortunately there are a number of them,” he said. “They just are not comfortable telling anyone about it.”

Dr. Cook said he’s talked about his testing with some NHL team owners and is hoping to meet with the NHL Players’ Association to discuss the testing. The NHL Alumni Association has also been involved in helping to build awareness of the tests, he said.

NHL Alumni Association president Glenn Healy declined to comment.

“We think this is exciting but it’s also controversial,” Dr. Cook said. “From the players’ perspective, some are concerned about what we might find out, what we might see. Some people don’t even want to know what’s going on in there. They know that they have accumulated damage and don’t necessarily want to face it. And obviously there are always concerns from the owners’ side. …  We worry the [NHL] perspective and perhaps the owners’ perspective is that this … is potentially damaging for the reputation of the league.”

The active players who have been tested include some of the NHL’s top young stars, a source told TSN. Their identities have not been made public and Dr. Cook declined to identify any players involved in the tests, citing privacy rights.

Toronto neurologist Dr. Charles Tator once taught Dr. Cook when he was in medical school at the University of Toronto and calls the 39-year-old Cook a rising star in the field of neurology.

“He was very inventive when he was working in my lab. He’s smart and well trained and he’s an expert on blood flow. … He told me about this project at least a year ago. … He’s a clever guy and has attracted their [NHL players’] interest. There is word of mouth and players encouraging their colleagues to go. That’s the way it happens.”

Dr. Tator said he has also examined NHL players in his Toronto office, but said he’s worked with far fewer players than Dr. Cook.

“Many players are capable of independent thought and they are concerned and sometimes they are pushed into seeking other opinions from their families if their families detect some alteration in behaviour,” Dr. Tator said. “Despite the best efforts of the NHL officials to play down concerns, there is concern among players’ families. They are thinking more about it. And this is escalating as time goes on.”

After finishing his residency and PhD in Toronto, Dr. Cook moved to California and worked at Stanford University, establishing himself as an expert in cerebral blood flow. In 2013 he returned to Canada and began working at Kingston General Hospital.

Using the nearby Queen’s University MRI machine costs about $600 an hour, Dr. Cook said. Players are not charged for the exams. The costs are covered with funding from Queen’s and from a family foundation whose administrators want to remain anonymous.

In Kingston, Dr. Cook said that the brain scans take about 45 minutes. Patients lie down inside the MRI machine and put on a facemask known as a rebreathing machine, which controls the amount of inhaled oxygen and carbon dioxide.

Dr. Cook said the MRI is then able to identify areas of the brain that have been damaged.

“We’re looking at the brain’s vascular physiology following injury,” Dr. Cook said. “There are patterns of impairment that are recoverable and there are patterns of impairment that set in and become more permanent. So we are using this as a technique as a way to detect concussion and also to identify the chronic syndrome that we see in older athletes as they age – issues like sclerosis, scar tissue, impaired vessel function and flow. It’s an exciting technology in a lot of ways.”

Dr. Cook said he began examining patients with suspected brain injuries four years ago and has received about $1.5 million in funding so far. After researching military personnel with a grant from the Canadian Institute for Military and Veteran Health Research, the Canadian Institutes of Health Research and the Natural Sciences and Engineering Research Council offered funding for a study of varsity football players at Queen’s.

Brain injuries and concussions are perhaps the most polarizing issue facing the NHL. On one hand, the NHL’s critics, who include nearly 200 former players who are suing the NHL, say the league has not done enough to educate and protect players from the long-term consequences of repeated head trauma. They point to NHL internal emails that show senior league officials have scorned independent medical experts who scrutinize or critique the NHL’s medical decision making.

For its part, the NHL has argued that any interested players could seek out medical journals and do their own research about the impact of brain injuries. Moreover, its officials point out that the NHL was the first pro sports league in North America to introduce baseline neurological testing for its players.

Reposted from:

Hospitals as a Safe Space for Opioid Injections?

Interesting opinion piece I came across in the NY Times regarding the promotion of safe injection sites in hospitals.

In all honesty, I have the agree with the rationale behind this thought. As healthcare providers we can’t tell our patients to do something and expect them to follow through, particularly when battling addiction. What we can do as professionals is build trust, the foundation of any healthcare provider-patient relationship. It’s the one aspect we can control, by telling or restricting a patient from doing something because of fear, patients will rebel. It’s similar to telling a teenager they can’t drink, chances are when they do have the opportunity to sneak out (which they will) and have the chance to drink they don’t maintain control.

By promoting a safe environment for patients, we can delve deeper into understanding their addiction and working with them to promote health, rather than being seen as the unreasonable dictator. With opioid use on the rise, it’s important our healthcare system is doing what we can in promoting the best interests of our patients. While illegal drug use is obviously not condoned, promoting patient centred health care is, and we need to do a better job at understanding the complexities of treating drug addictions. In health promotion you are taught that you can’t encourage or expect change if someone doesn’t want it or is restricted. So why not start with treating the addiction in a safe space and building patient trust?



HANOVER, N.H. — “How am I feeling, Doc?” my new patient answered. “I’m feeling like a caged dog.”

Hospitalized for a heart-valve infection resulting from injection drug use, my patient had purple hair and arms covered with hand-drawn tattoos. She smelled unwashed.

“I can’t go out to smoke. My boyfriend can’t visit,” she said. She gestured to the security guard in the doorway. “I can’t even pee without her watching me!” The guard rolled her eyes.

So, rather than building a therapeutic bond through small talk or discussion of her symptoms, we spoke of her confinement. The ban on visitors and the other unusually restrictive terms of her hospitalization were not a consequence of her drug addiction. They resulted from her behavior in the hospital.

Once a nurse found the patient in the bathroom shooting heroin into her I.V. line, the sink spotted with blood. A housekeeper changing bedclothes was almost spiked by a used needle hidden under the mattress. A constant influx of boisterous visitors came to her room day and night, some delivering heroin.

With quality of care, professional propriety and staff safety at risk, polite conversations escalated to rancorous confrontations. Finally, the patient got an ultimatum: She would receive care with a 24-hour guard in her room, with no exit and no visitors; or she could leave.

It is a new world in health care as America grapples with an epidemic of opioid drug abuse. The Centers for Disease Control and Prevention reported that opioid overdoses killed over 28,000 people nationwide in 2014, more than ever before.

From heart-valve infections to drug overdoses, the casualties of this epidemic wash up in our hospitals. It has changed my hospital service significantly. Almost every day, we try to save a young person dying from infectious complications of injection drug use.

Addicted patients usually bond with their providers over the shared goal of healing. Yet these interactions, which often bridge divides of class, culture and personal psychology, can break down. When addicted patients inject drugs in the hospital, doctors and nurses can find themselves cast in the role of disciplinarians, even jailers.

Confining patients to their rooms, restricting their activities and posting guards is expensive. It may also compromise a patient’s well-being: Ambivalent providers may visit less often, educate patients less avidly and spend less time devising the best treatments.

The worst effect of confining addicted patients in the hospital may be the damage to the patient-provider bond. I couldn’t blame my patient for feeling caged, even if she had brought those consequences on herself. Her nurses told me they felt conflicted, too. They wanted the simple bond of caregiving back — and they wanted the patient to stop getting high and jeopardizing staff safety.

The problems presented by injection drug use are legion, but creative solutions exist. One is the provision of safe drug-use rooms. Cities as far-flung as Vancouver, British Columbia, and Paris and Berlin have opened safe, well-lit rooms where addicts can get clean needles and other equipment without fear of incarceration. In New York State, Ithaca and Manhattan are considering similar initiatives. Such facilities can also connect addicts to needed services like preventive testing, acute care and treatment for addiction.

Safe drug-use rooms are typically designed to help keep addicts out of the hospital, but they could work for addicts within hospitals. A safe place to inject for addicted patients in the hospital could reduce conflict with staff, protect patients and providers from dirty needles and other drug hazards, and enable patients to receive respectful, high-quality care when back in their hospital beds. Safe drug-use rooms could also offer treatment for addiction, a step often neglected in hospitals.

The creation of these rooms for hospitalized addicts won’t be easy. There will be legal liability concerns, and hospitals must safeguard against the risk of overdose or unseemly behavior. It will be worthwhile to tackle these issues if it enables the provision of compassionate care for at-risk patients whose treatment would otherwise be endangered by conflict with providers.

As for my patient, I looked her in the eye and told her I was sorry she felt caged, and that I cared. In time, she relaxed, and trust grew. We discussed her symptoms, her life, and how we hoped to get her better.

We hadn’t cured her yet, not even close. Many challenges remained. I was glad we now had a chance to face them together.

Drummond Report Chapter 5 Review (Part 2)

The Drummond Report was commissioned for the purpose of addressing the rising costs of health care in the provincial budget and gave a series of recommendations in a variety of areas related to the health care system. One such area under review was hospitals, which the report argued was not being incentivized to increase efficiency due to a funding model based on average costs across the province. The report goes on to state that there is little understanding of the true costs of procedures and that in order to ensure Ontario is getting the best value for its money, the costs incurred by hospital procedures needs to be examined from region to region and hospital to hospital (Ministry of Finance, 2012). The Drummond Report makes six recommendations in this area related to changing how hospitals are funded, operated, and administrated. Almost 3 years after the release of the report it is clear that Ontario has made great strides towards achieving many of the recommendations outlined in the report pertaining to hospitals.

Recommendation 5-50 proposes the use of the Health-Based Allocation Model (HBAM) system to set appropriate compensation for procedures (Ministry of Finance, 2012). This proposed change would represent a shift from the use of the prevailing global funding model, in which every hospital received lump-sum funding, to HBAM which estimates expected health care expenses based on demographics and clinical data on complexity of care and type of care (Ministry of Health and Long-Term Care, 2012). This recommendation has been realized to some extent in Ontario through the introduction of the Health System Funding Reform (HSFR). By 2015/2016 the HSFR will represent 70% of the funding envelope provided to hospitals, while global funding will represent the remaining 30% (Ministry of Health and Long-Term Care, 2015). The organizational-level funding component representing 40% of the HSFR allocation will be determined using the Health Based Allocation Model, while the quality-based procedures component will see specific procedures funded based on a “price x volume approach” meant to incentivize providers for delivering high-quality care.

Recommendation 5-51 was aimed at creating a blend of activity-based funding and base funding managed through accountability agreements. Ontario has begun the shift towards activity-based funding also known as patient-based funding, by categorizing hip replacement, knee replacement, dialysis and other treatments for chronic kidney disease and cataract surgery as quality-based procedures in which outcome is used to help determine payment (MOHLTC, 2012). The province plans to add to the list of procedures classified as quality-based procedures in the coming years in the hopes that it will maximize efficiency and incentivize providers to increase the quality of care they deliver to patients receiving these procedures.

The introduction of the HSFR in the funding model can also be seen as helping to facilitate recommendation 5-53 of the Drummond Report, which pushed for a new funding model that would incentivize hospitals to specialize so that not all were trying to provide all services regardless of comparative advantage (Ministry of Finance, 2012). By tying the performance outcomes of procedures to payment, it encourages hospitals to specialize in procedures for which they can deliver high-quality outcomes in order to maximize the level of funding they receive. This change to the funding model follows the logic proposed by the Drummond report, which believed that the way to encourage hospitals to cut costs and provide better quality care was to incentivize them to specialize (Ministry of Finance, 2012). Specifically the report stated that if a certain reimbursement rate were set for an activity, hospitals that could not provide the service within that rate would gravitate away from it. The quality-based procedures component of the HSFR model is meant to achieve the goal of better quality and system efficiencies by basing payment on outcome. Ontario has decided to continue down this route with the planned addition of other procedures in coming years (MOHLTC, 2012).  In 2013, six other procedures were added as quality-based procedures which included: chronic obstructive pulmonary disease, congestive heart failure, vascular, stroke, chemotherapy, and endoscopy (South West LHIN, 2014).

Recommendation 5-52 encouraged the creation of policies to move people away from inpatient acute care settings by shifting access from emergency rooms and toward community care, home-care, and long-term care (Ministry of Finance, 2012). Currently in Ontario over 184 family health teams have been operationalized with the purpose of expanding access to comprehensive family health services across Ontario by ensuring teams are set-up based on local health and community needs (MOHLTC, 2014). Family Health Teams in the province are community-centered and have been established in traditionally underserved rural and northern communities with unique populations and specialized health needs. By virtue of the many different types of health care professionals that comprise a Family Health Team including family physicians, nurses, social workers, and dieticians, Family Health Teams are meant to facilitate a more comprehensive and coordinated level of care for patients. The broad range of services they can provide are expected to help decrease reliance on the more costly and overburdened emergency departments in part by helping to prevent and treat chronic disease.

Recommendation 5-55 highlights a huge problem that has plagued the Ontario health care system, which is the lack of coordination between the different health care professionals including hospitals, Family Health Teams, and long-term cares facilities. In order to facilitate the discharge of patients and reduce costs there needs to be coordination with other health care professionals to optimize patient outcomes. Recommendation 5-55 proposed the use of hospitalist physicians to co-ordinate inpatient care from admission to discharge and follow a patient as they move through the health care continuum (Ministry of Finance, 2012). Increasing health care costs and chronic illness have led to a need for better coordination of care and the creation of hospitalists, the fastest growing medical specialty in North America with more than 300 practitioners and 62 programs operating in Ontario hospitals today., who are defined as physicians who spend the majority of their professional time providing general medical care to hospitalized patients (White, 2011). However, there are concerns as to the financial sustainability of hospitalist programs, satisfaction amongst patients and providers and perhaps most importantly, whether patient outcomes are adversely affected by the transfer of responsibility between providers.

The province of Ontario has restructured the funding model for hospitals in recent years from the traditional global health model towards the Health-Based Allocation Model and activity-based funding in the hopes of cutting costs and increasing efficiency and quality of care. This restructuring addressed many of the concerns in the Drummond Report about the way hospitals are funded, in particular the lack of incentives the old model contained for to specialize based on comparative advantages. The province continues to head in the direction proposed by the report by decreasing the portion of the payment that is under the Global Health Model and is expected to continue to do so in the upcoming years. The province also continues to employ hospitalists with the hopes of increasing coordination of care to ensure better health outcomes and cutting costs. The controversy surrounding the profession of hospitalists indicates more research should be done into the cost effectiveness, financial sustainability, and impact on patient outcomes to determine whether the profession is attaining the goals it set out to. This also highlights the importance of remaining critical of the recommendations in the report as they are implemented, and the need to ensure that there are not unintended consequences stemming from these changes to the system.

Works Cited

Ministry of Finance. (2012). The commission on ontario’s public services. Retrieved from  

Ministry of Health and Long-Term Care (2015). Health system funding reform (HSFR). Retrieved from

Ministry of Health and Long-Term Care (2014). Family health teams. Retrieved from

Ministry of Health and Long-Term Care (2012). Patient-based funding overview. Retrieved from

South West LHIN (2014). Health system funding reform update. Retrieved from

White, Heather L. (2011). Assessing the prevalence, penetration and performance of hospitalist physicians in Ontario: implications for the quality and efficiency of inpatient care. Retrieved from


Why Cannabis Should Not be Legal in Canada

Cannabis sativa, a species of Cannabis, is a flowering plant that is used in the creation of marijuana (United States Department of Agriculture, 2011). Although its use has been illegal in Canada since 1923, cannabis is the most widely used illicit drug in Canada, and the country has the third highest prevalence rate of marijuana usage in the world (Haines-Saah et al., 2014). Cannabis is often referred to as pot, dope, marijuana, ganja, and hemp and has been classified as a pychotropic drug which acts as a modulator of the central nervous system (Nolin & Kenny, 2002). In Canada, it has been labelled a Schedule II controlled substance, a drug that has a higher than average potential for addiction and abuse (The Canadian Consortium for the Investigation of Cannabinoids, 2014).  The illegality of cannabis is a highly debated and controversial subject with many calling for its decriminalization and others suggesting a public health approach to minimize the consequences that follow its use (Haines-Saah et al., 2014).  Decriminalization would involve the removal of a behaviour or activity, in this case cannabis, from the scope of the criminal justice system in which an administrative decision is made to not prosecute acts that nonetheless remain against the law. On the other hand, legalization would involve legislating under a regulatory system the culture, production, marketing, sale and use of a substance (Nolin & Kenny, 2002). The use of cannabis-containing products has been linked to increased respiratory and reproductive health concerns, increased likelihood of psychosis including schizophrenia when used in adolescence. A lack of scientific consensus and knowledge on the long-term health impacts of cannabis would make it difficult to predict what outcomes the legalization of marijuana would have. The decision on whether or not to legalize cannabis should be made solely on the basis of scientific knowledge and not based on public desire, and current research is insufficient to support legalization. The arguments for legalization including lessening the burden on the criminal justice system and lessening exposure to other illegal substances if marijuana was regulated in a similar way to alcohol, are not sufficient to override the health concerns that have been raised. At this time, the benefits shown for patients with chronic conditions including reduced pain and symptoms are enough to support the continued legality of medicinal marijuana if prescribed by a physician and stringent regulations are in place to prevent misuse or abuse. I contend that current scientific evidence supports the continued illegality of cannabis in Canada, but medical marijuana should continue to be available for individuals when prescribed by a health care professional.

Tetrahydrocannabinol, also known as THC is the active ingredient in marijuana and is thought to produce feelings of relaxation, enhanced sociability, a diminished ability to focus, distorted time and depth perception, and physiological side effects including an increased heart rate, increased appetite, and reddened eyes (Canadian Public Health Association, 2003). While intoxicated It may also result in impairment to short-term memory and attention span, motor skills, skilled activity and reaction time, and anxiety and panic reactions (Hall & Solowij, 1998). Heavy marijuana usage is associated with chronic bronchitis symptoms, development of chronic obstructive pulmonary disease, and is a possible risk factor for the development of lung cancer (Joshi, M., Joshi, A., & Bartter, T 2014).  The dosage of marijuana needed to produce these lung diseases is not yet known and must be further studied. The research on the reproductive effects of cannabis smoking is inconsistent, however, low birth weight babies, impaired sperm production and viability, and behavioural and developmental effects on infants exposed in utero have been suggested as potential consequences of cannabis use (Hall & Solowij, 1998). Long-term use of cannabis can also lead to psychological or physical dependence and withdrawal symptoms when the user is unable to use cannabis (Centre for Addiction and Mental Health, 2010).

The long-term effects of cannabis on the health of the user are not well understood and are widely debated due to the lack of epidemiological evidence and different interpretations of existing studies (Hall & Solowij, 1998). It is for this reason in particular, that I do not believe that cannabis should be made legal in Canada. The National Institute on Drug Abuse has determined based on the limited evidence available, that marijuana is harmful to the developing brain and has suggested that more research must be conducted in this area (Alcoholism & Drug Abuse Weekly, 2014). However, research on the effects of cannabis on the health of individuals is difficult to conduct because it is hard to collect data from individuals who regularly consume cannabis while controlling for other factors due to ethical implications. The existing gaps in research would make the legalization of cannabis dangerous because of the unforeseen impacts on health that could potentially occur should drugs containing cannabis be made more widely available.

Much of the emerging research on the effects of acute and chronic cannabis use is focused on adolescents and the connection between marijuana usage and psychosis suffered in adulthood. A revolutionary study conducted in Sweden was one of the first to show a six-fold increase in the occurrence of schizophrenia in individuals who used cannabis heavily at age 18 (Andréasson, Allebeck, Engström & Rydberg, 1987). However, it must be said that the study is limited in the sense that its findings are only correlational and cannot be used to determine causality. The study was unable to draw a conclusion as to whether schizophrenia was caused by the use of cannabis, or whether pre-existing symptoms of schizophrenia led to the use of marijuana (Arseneault, Cannon, Poulton, Murray, Caspi & Moffitt, 2002). Further studies have been conducted examining this relationship. The exact neurobiological process that leads to potential psychosis is unknown because a cause-effect relationship has not yet been established, but current research is focusing on the identifying the factors that contribute to the developmental pathway of psychosis (Shrivastava, Johnston, Terpstra, Bureau, 2014).  A study conducted on college students found that heavy marijuana usage, defined as smoking marijuana 29 out of 30 of the previous days, resulted in impaired executive functioning even after controlling for confounding factors (Pope Jr & Yurgelun-Todd, 1996). This study was unable to determine whether impairment is due to a residue of drug in the brain, a withdrawal effect from the drug, or a neurotoxic effect of the drug. Another study reached the same conclusion as the Swedish study, adding that rates of schizophrenia increased after cannabis use even after controlling for psychotic symptoms preceding cannabis use, early use (by age 15) conferred greater risk than later use (by age 18), and risk was specific to cannabis use as opposed to other drugs (Arseneault, et al., 2002). A tenth of the individuals in this study who used cannabis before age 15 developed schizophrenia by the age of 26. The effects of cannabis on the developing brain are not fully known yet but current research suggests that some adolescents may be psychologically vulnerable and thus legalizing marijuana, thereby making it more widely available, could potentially have long-term detrimental effects on the mental health of these individuals.

Many proponents for the legalization of the drug have argued that the illegality of the substance has not prevented it from becoming one of the most widely used drugs in the developed world, and that the government should regulate the substance much in the same way it regulates alcohol or other medications. This claim is made with the belief that the regulation of cannabis would reduce the number of adolescents selling marijuana and their access to other illegal drugs, and would reduce the cost of prosecuting offences related to the use of cannabis. In response to suggestions that the legalization of cannabis would reduce costs to the judicial system, opponents of legalization have proposed decriminalizing marijuana and instead imposing civil penalties for possession including small fines (Alcoholism & Drug Abuse Weekly, 2014). The health of individuals should be the first and foremost priority of health and government officials and the substance should not be made legal simply to reduce the strain on the judicial system, or as a means to prevent the usage of other more harmful and addictive substances. Although many of the findings about the physical, and psychological health effects of cannabis usage are limited or are correlational instead of demonstrating causality, this should not serve as a basis to decriminalize cannabis. In Canada, any potential new drug must go through a rigorous screening process including clinical studies that are then reviewed by the Therapeutic Products Directorate of Health Canada and the findings are then assessed for the safety, efficacy, and quality of the drug (Health Canada, 2001). The potential benefits and adverse effects of cannabis have not been rigorously studied to the extent that other drugs have had to undergo when going through the drug review process (Sullivan, 2012). Health Canada states that its first and foremost concern is ensuring the safety and well-being of Canadians, and the current research and findings on long-term cannabis usage must be addressed before any discussion of legalization could take place (Health Canada, 2001). More scientific research is needed for this purpose. There are also a host of other concerns which would emerge if legalization were to happen including whether or not it would increase the number of individuals who become addicted to marijuana, whether accident rates would increase due to cannabis usage particularly in the teenage demographic, and what impacts on health this would have in the long-term.

Cannabis products for medicinal purposes are a widely debated topic in Canada. In 2001, the Supreme Court of Canada ruled that there must be reasonable access to a legal source of marijuana when authorized by a physician, which resulted in the creation of Health Canada’s Marijuana Medical Access Program (Health Canada, 2001). A report published in 1999 by the Institute of Medicine found that marijuana functioned to treat chronic pain and physical symptoms and produced anti-anxiety and sedative effects (Rubens, 2014). Medical marijuana has been shown to benefit patients suffering from chronic pain due to diabetes, multiple sclerosis, and hepatitis, relieves eye pressure caused by glaucoma, increases appetites in patients with AIDS and cancer, and relieves acute anxiety, insomnia and other sleep disorders (Friedman, 2013). The stance of the Government of Canada is that it does not condone the use of marijuana and it has announced that the Marijuana Medical Access Program will end on March 31, 2014 at which point the only legal access to marijuana for medical purposes will be through licensed producers even if you have an authorization to possess or a license to produce the drug (Health Canada, 2013). Many individuals argue that these new laws are unconstitutional because they interfere with the rights of patients to access medication. The Government of Canada has responded that these new laws must be put into place in order to protect public safety, while making sure patients still have access to what they need to treat serious illness (Health Canada, 2013). My belief is that based on current evidence medical marijuana has been shown to effectively treat many health issues and alleviate chronic pain. Medical marijuana should remain legal because of the strict regulations that are in place to prevent misuse and abuse of the system. Government regulations require that a physician prescribe medical marijuana and the new laws will limit the distribution of medical marijuana to licensed facilities only. I believe that the benefits to patients in this case supersede the potential consequences, as those who would qualify would already have chronic and debilitating health issues, and their quality of life would be dramatically improved through the use of medical marijuana. I believe the new restrictions concerning which facilities can distribute medical marijuana will ultimately be beneficial, as the facilities will be regulated by government legislation, and it will ensure that only those who have been prescribed medical marijuana are serviced at these facilities. The Special Committee on Illegal Drugs stated in its report that public policy concerns should not be considered by a physician when making a professional decision on the extent to which and in what circumstances marijuana serves a therapeutic purpose for the patient (Nolin & Kenny, 2002). The legal status of medical marijuana should be continually reviewed and reconsidered based on the most current and up to date evidence on the health impacts of marijuana. The therapeutic value of medical marijuana must always outweigh any potential health impacts for patients suffering from chronic health conditions. One line of research that should be conducted is on the psychological effects of cannabinoids which could lead to undesirable effects for certain patients and could negate any potential medical benefit from its usage (Joy, Watson, Benson, 1999).

In conclusion, my contention is that current research supports the continued illegality of cannabis in Canada. The legalization of cannabis should not occur because of public demand, or as a new source of revenue for the government of Canada, but should only be done on the basis of science. Currently, scientific research has shown many potential adverse effects from the use of cannabis and thus does not support the notion that legalization should take place. To allow legalization to occur at this point would go against the objectives of Health Canada and could potentially jeopardize the health of Canadians and lead to many other unforeseen outcomes. More research must be conducted in this area in order for researchers and policy makers to make an informed decision about whether the legalization of cannabis should take place. Some researchers predict that rates of marijuana usage could double or triple if legalization were to occur, thus it is important to understand what implications this will have on the health of individuals and society as a whole before legalization can occur (Alcoholism and Drug Abuse Weekly, 2014). The lack of scientific consensus on the health impacts of cannabis usage and studies showing correlations of cannabis usage and adverse outcomes have led me to draw the conclusion that cannabis should not be legalized at this time. However, I do believe that an exception for medical marijuana should be made as it has been shown to alleviate chronic pain and benefit patients with certain medical conditions. Unless more research is conducted which shows adverse effects to human health that outweigh the benefits to patients who use medical marijuana to treat their symptoms, the removal of medical marijuana would serve to do more harm than good and would infringe on their constitutional right to life, liberty and security of person. There should be controlled access in this case, regulated by the Government of Canada which bears the responsibility of creating and upholding regulations for medical marijuana production and distribution to ensure access to medical marijuana, while continuing to ensure the safety of the Canadian population as a whole.  It is important to note that my position is based off of current scientific literature, which has not yet drawn conclusions as to the long-term health impacts of cannabis usage and the impacts it will have on society in other aspects. The interest and controversy in the debate on the legal status of cannabis products has not diminished and the next few years may prove critical for reaching both scientific and political consensus on the health impacts of cannabis and what the legal status should be respectively.  In 2013, Uruguay became the first nation to legalize the growing, sale, and smoking of marijuana (Castaldi & Llambias, 2013). There are also other nations and cities known for openly selling marijuana to locals and tourists, including Jamaica and certain “coffee shops” in the Netherlands. In my opinion a lack of aversive consequences in these countries does not help to strengthen the argument that cannabis should be legalized in Canada, as the findings are non-generalizable because of the vast difference in culture, history, society, and other confounding factors. Colorado and Washington are now in the process of legalizing marijuana and are serving as experimental labs for the rest of the United States (Rocky Mountain HIDTA, 2014). The impact of legalization will be heavily studied in the upcoming months and potentially years. This may serve as an unprecedented opportunity for scientists to study the usage of marijuana and cannabis products in cities that more closely resemble Canadian cities and may prove to be key in ascertaining the scientific data needed to make a more informed decision on whether cannabis should continue to remain illegal in the future, or whether we should proceed with decriminalization or legalization.







Works Cited

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Drummond Report: Chapter Five Analysis

I’ve decided to post my partial analysis of the Drummond Report, which was commissioned by the federal government of Canada in 2012. In February of 2012, a document known as the Drummond Report was released into the public realm. Chapter 5 of the report detailed over 100 recommendations for sweeping changes across the health care sector. In particular, setting out terms for reorganizing the structure of our health care system and how health care services can be delivered more efficiently. Under this section of Overall System Planning, the report sets our 5 recommendations, while pointing out that although our health care system possesses some positive qualities, there is still room for improvement. Fragmentation of services within the health care system has been evident. Drummond notes that although Local Health Integration Network’s (LHINs) were initially given a specific set of responsibilities, it has now become apparent that they were not given the proper authority or resources to execute the vision for renewing our health care system. Therefore, the Drummond Report set out 5 recommendations under the category of Overall System Planning to continue the movement towards integrated regional health care delivery.

Recommendation 5-1, under the category of Overall System Planning, pointed to a need to develop and publish a comprehensive plan to address health care challenges over the next 20 years. It encouraged the use of set objectives and solutions built around nine principles ranging from the system being centered on the patient to the coordination and quality of services. In 2012, the Ontario Ministry of Health released the Action Plan for Health Care, which set out the government’s commitment the restructuring of a health care system that is patient centered. Since then, there has been some progression towards completing the recommendation with the release of Patients First: Action Plan for Health Care, a blueprint like document released by the Ontario Ministry of Health in 2014.  The document establishes a framework outlining the need to put patients at the center of the system by focusing on their needs first.  Objectives of the document include: improving access (ex. Faster access to the right care, faster access to specialists), connect services (ex. Delivery of coordinated and integrated care in the community), supporting people and patients (ex. Education, transparency), and protection of our universal public health care system (ex. Making evidence based decisions) (Ministry of Health and Long-Term Care (MOHLTC), 2014). So far, the reaction to the announcement has been positive, with the Ontario Association of Community Care Access Centers, Ontario Hospital’s Association and Registered Practical Nurses Association of Ontario (RPNAO) giving the report a stamp of their approval. Specifically, the RPNAO commends the decision to improve access to home care, in hopes that it will benefit those who need it most, as well as the removal of barriers for nurses to perform their duties and control costs in the system (ex. Prescribing assistive devices) (Registered Practical Nurses Association of Ontario, 2015).

Recommendation 5-2, relates to the evaluation of all proposals for changes that include efficiencies and cost savings relating to the vision and plan developed (Ministry of Finance, 2012). In regards to this portion of the recommendation, there does not seem to be a whole of a transparency into evaluations of all proposals by the Ministry of Health and Long Term Care (MOHLTC). Health Quality Ontario, an arms-length agency of the Ontario government, is a partner in helping to transform Ontario’s health care system to deliver better outcomes of care and cost-effectiveness. Hence, the organization researches and makes recommendations about the uptake, diffusion, and distribution, or removal of health interventions to the MOHLTC, policy-makers, and clinicians. One example included the evaluation of cost-effectiveness and budget impacts in regards to the interventions of chronic disease cohorts as part of the Optimizing Chronic Disease Management (Health Quality Ontario, 2013). Of the 70 potential cost-effective analyses, only 8 met the inclusion criteria set out by the organization. Hence, this is one recent example of the MOHLTC seeking to evaluate all proposals of change by ensuring cost-savings, and efficiencies to the vision were adhered to.

Next, recommendation 5-3 calls for the diversion of patients not requiring acute care in a hospital setting and moving those patients into a more appropriate and less expensive form of care to reduce exposure to new health risks. This recommendation has been addressed in Ontario’s Action Plan for Health Care, a document released by the MOHLTC in 2012. Particularly in the sense that one of the greatest challenges in our system are patients who are being cared for in a hospital setting, but could be cared for at home or in the community if the right supports are in the right place (MOHLTC, 2012). The report focused on 3 principles: support to become healthier, faster access and a stronger link to family health care, and “the right care, at the right time, in the right place”. Limited solutions were offered by the MOHLTC in Ontario’s Health Action Plan to address this recommendation for all forms of patients. Instead the MOHLTC sought to focus on seniors and chronic disease management, which relates to recommendation 5-4 of the Drummond Report. Of particular interest was the exclusion of those suffering from mental illness and addiction, a notable cost driver in our health care system, as Drummond points out. The Commission recommended that more Family Health Teams should be better equipped to more effectively serve this population. It seems that in recent publications the MOHLTC has sought to address prevention, and building a system that is responsive to children, youth, and their families through their mental health strategy released in November 2014. Hence this was addressed in Ontario’s Comprehensive Mental Health and Addictions Strategy, a ten-year comprehensive strategy. The strategy focuses on the promotion of programs in schools and workplaces, a heavy focus on virtual applications to access services, integrated coordination between Health Links and agencies under the Ministry of Children and Youth Services, and increased supportive housing to prevent homelessness (Ministry of Children and Youth Services, 2011). Similar to Ontario’s Health Action Plan, this report also seeks to provide “the right care, at the right time, in the right place”.

Recommendation 5-4 encourages the increased use of home-based care where appropriate, in order to reduce costs. Similar to the previous recommendation, home care was also addressed more specifically in the action plan. Home care has been a significant part of the plan, with the MOHLTC noting that changes in the structuring of the system are required to meet the needs of the current population (MOHLTC, 2012). Although our system still faces patients venturing to emergency rooms, many of who could be better cared for at home or community, the government does intend to take steps in restructuring the system, with a specific focus on seniors and chronic disease management. This would be seen as a positive step, as home care has often been noted as the much cheaper alternative in comparison to the traditional hospital model. Thus, a Senior’s Strategy has been devised which calls for an expansion of house calls, more access to home care through additional support from Personal Service Workers, and the use of care-coordinators who will work in collaboration with health care providers to ensure the right care is being administrated (MOHLTC, 2012). Hence, the new Patients First: Action Plan for Health Care plan sets out a more detailed plan on the types of services that those who need home care will be able to access, including personal support, assistive devices, and increased use of technologies such as tele-homecare (MOHLTC, 2014).

Lastly, recommendation 5-5 focuses on improving the coordination of patient care through the integration of all health services in a given region. It has been noted that a considerable amount of integration has occurred over the last few years across in the health care sector. The MOHLTC addressed the need for local integration reform when they released their Health Action Plan in 2012. Much of the integration that has been seen recently has sought to bring programs and organizations together in an attempt to enhance service delivery to those that need it.  One such example includes the Canadian Mental Health Association (CMHA) integrating some of its services (primary and mental health care) with the LHINs (Canadian Mental Health Association (CMHA), 2014). The mental health system in Ontario has often been fragmented and inaccessible to many Ontarians needing services in this area, integrating services within the LHINs is a positive step. While the CMHA has been supportive for the most part on the recommendations of integration, there have been concerns in regards to the process not involving patients and stakeholders (CMHA, 2014). The organization has also raised concerns in regards to the integration of services just based on a number value, raising concerns that patient’s needs were not always considered in the decision-making process of integrating services. Hence, the organization recommended their own set of steps to be considered when looking to merge and integrate organizations, also emphasizing the need to focus solely on the patient as the primary objective (CMHA, 2014).

As pointed out by the Drummond Report, “the system should be centered on the patient, not the institutions and practitioners in the health care system” (Ministry of Finance, 2012). The recommendations under the Overall System Planning category have seen some promising shifts towards trying to make the health care system more patient centered over the past few years. Particularly with the release of the “Ontario Health Action Plan” and more recently the “Patients First: Action Plan for Health Care” pertaining to the reconfiguration of the health care system. It will most likely be a few years until we see the impact the changes will have on the system, but the recommendations in this category have clearly been acknowledged by the MOHLTC and LHINs in terms of both system planning and integration of services.

Hopefully this gives a little bit of insight into how our healthcare system in Canada is progressing (or how its not) and for those motivated to make effective and efficient changes (like me!) an opportunity to see where improvements can be made.



Works Cited:

Canadian Mental Health Association. (2014). Local health system integration act review:     Canadian Mental Health Association, Ontario division. Retrieved from

Health Quality Ontario. (2013). Optimizing chronic disease management mega analysis:    economic evaluation. Retrieved from         analysis-economic-evaluation-130912-en.pdf

Ministry of Finance. (2012). The commission on ontario’s public services. Retrieved from  

Ministry of Children and Youth Services. (2011). Ontario’s comprehensive mental health  and      addictions strategy. Retrieved from          strategy.aspx
Ministry of Health and Long-Term Care. (2012). Ontario’s action plan for health care                   Retrieved from  
Ministry of Health and Long-Term Care. (2015). Patients first: Action plan for health care Retrieved from  

Registered Practical Nurses Association of Ontario. (2015). RPNAO applauds government’s         commitment to put patients first. Retrieved from                         put-patients-first

Revitalizing our Blood Donation System

The Canadian Blood Services (CBS) is a national, not for profit, charitable organization that oversees and manages the collection of blood for all the provinces and territories of Canada, outside of Quebec.  Donors are the heart of our blood supply system and the vital lifeline to thousands of people across the country who, each year, need blood and blood products.  Yet in late September 2014, Canada’s blood supply reached a six year low, prompting an urgent appeal for donors to roll up their sleeves and donate blood, particularly calling on those with blood types O and A (Lang, 2014).  A sustainable blood supply usually requires the organization to keep a 5-to-8 day blood supply on hand, however, in recent months the inventory has dropped below three days’ worth of major blood groups (Lang, 2014). To put this into perspective, every minute of everyday someone in Canada requires the use of donated blood. Without the help of donors, the CBS will eventually have the difficulty of meeting the expected hospital demands across the country.  Similar to many other developed and developing countries, the CBS shortage is the result of recent “extremely low attendance” at donor clinics, combined with the constant demand for blood (Lang, 2014).

An area of health innovation that particularly interests me involves the realm of mobile health. Particularly, with the amount of people who have access to technology such as computer, tablets, and phones, there is huge potential to solve many of our health care system’s problems, including keeping our vital blood supply at a sustainable level.  This is an important area in our health care system that requires some innovative solutions to meet the demand set out by hospitals. Without an adequate supply of blood, some elective and routine procedures will be delayed, thus increasing wait time for those who need access to such a vital resource (Lang, 2014). These services include those who require blood for surgery and medical treatments; for example cancer treatments require 5 units of blood, which is the equivalent of 5 donations (Canadian Blood Services, n.d.). Treatments of Leukemia require up to 8 units of blood a week, thus requiring 8 people to donate. However, if blood supplies continue to go on a downward trend, those patients suffering an emergency would likely get priority, with a severely injured person from an auto accident requiring the use of up to 50 units of blood.  According to the Canadian Blood Services, approximately 52 per cent of Canadians say, they or a family member have needed blood or blood products for a surgery or medical treatment, thereby making this an important area of our healthcare system (Canadian Blood Services, n.d.)

As one can see, the blood donation system is broken, with low rates of voluntary donations and a constant need for blood and blood products. Similar to developed countries, the developing world has also struggled with acquiring blood donations to meet many of their health care problems, including the treatment of dengue fever.  However, both the Philippines and India have branched out into the mobile health market and developed apps that fulfill a genuine social need that capitalizes on the services provided by mobile telephones. Thus, Canada can look towards the Philippines where a mobile application, the Blood Donors Network, has been developed to support the needs of the Philippine Red Cross (Arce, 2013). The app is said to be the answer to the Philippines woes, where blood collection units are said to be down by almost fifty percent.  Thus, in 2011 the country’s total blood collection amounted to 550,000 units, 400,00 shy of what is needed by the population per year (Martin, 2012). Essentially, the app was designed to help communities meet their blood donation needs by establishing a comprehensive database of regular and newly acquired donors, and by brining blood donation into the mainstream.

The non-profit Blood Donor network is an app, that can be accessed both online and on mobile devices, aiming to improve and address the Philippines need to increase blood collection by building and maintaining a sustainable community of blood volunteers (Code for Resilience, n.d.).  The app has two sides to it; the first portion involving a web service in which hospitals and specialized health care providers can sign up and post their current needs. The second side involves the download of the mobile app by the owner that tracks their location. In essence, the donor signs up for the services and lists their blood type. If their blood type and location match up with what is needed in the surrounding area, they will receive an alert to go to the hospital or clinic requesting the blood.  In addition, the Blood Donor Network member has the chance to be awarded incentives depending on how much blood one donates or how many friends they invite to join the network (College of Arts and Technology, n.d.). Incentives can range from public recognition among the donors community, health organizations and agencies, free annual physical examinations, and 20 to 30 percent off in fitness centers (Martin 2012).

Unfortunately, much of the innovation’s impact has not been measured due to the technology being trialed in a limited amount of hospitals and run solely on grant money.  However, preliminary data (not released to the public) gathered on donors and the rates of patients and hospitals finding new donors has seemingly increased after the introduction of the app (Arce, 2013).  The app has also been introduced to stakeholders and corporations that have aided the app in gaining popularity during the apps soft launch in 2013 (Arce, 2013,). This launch encouraged certain hospitals in the city of Manila, to participate and assist in the on-going negotiations and partnership discussions with stakeholders (Martin, 2012).  Overall, the general expectation of the app is that it will save more lives through the use of the app and encourage volunteerism.

Unlike Canada, the Philippines have incentivized groups to come up with healthcare system solutions through Social Innovation Camps promoted by various organizations.  Thus, this is one area Canada can learn from, with the camps giving access to teams to partner up with hospitals and businesses to trial their beta projects, such as how the Blood Donors Network came into fruition. Our healthcare system has sought out little change in revitalizing ways to gain new donors, especially in regards to capitalizing on technology. The positive manner of blood donations in Canada runs on the principle of gratuity; donors are not paid for their services, nor are there charges to those who need it (Canadian Blood Services, n.d.).  However, donation clinics are not always accessible and oftentimes those in rural towns do not have the opportunity to donate, thus missing a huge cohort of the population. Many find it incredibly difficult to adhere to the timely appointment system that is currently in place, thus contributing to the lack of people not showing up for their appointments (CBC, 2014).  Thus, Canada can learn by adopting this app and using a more efficient way to encourage people to donate. Comprehensive profiles will avoid repetitive questionnaire procedures for donors and allow them to be able to access their profile from their mobile devices or computer before they come in to donate.

Implementing an app such as the Blood Donors Network in Canada may help to address this shortage, by building a network of people who will be motivated to donate and increase the sense of accountability and social responsibility that is currently lacking in the donation system.  This can be measured using surveys after a user donates to gain further insight into their motivations for participating in the program. With texts and notifications being sent out directly from the hospital through the app, it would give people a greater sense of urgency to donate since the donor can see the urgent need for their donation.  The goal of the app in implementing the Blood Donors Network would be to create an easy, accessible, trustworthy, and reliable network of donors. To implement such a program you would need the cooperation of the Canadian Blood Services (CBS), hospitals and their supporting organizations, and businesses to get involved. With the current restrictions on blood donation criteria, it would be difficult to say how willing the CBS and hospitals would be to supporting the program in its current form.  Hospitals would also need to take in a larger role collecting blood, which would require implementation by the federal government and provincial governments.  Funding would be another issue, as hospitals would need to have access to or implement a rapid lab testing service to test the blood to use in emergency situations, which may not be ideal in all areas of the country due to limited resources.

The first step in successfully implementing the app in Canada would be to acquire app developers, to work in conjunction the CBS, to develop the app and a business model.  If proper health policymaking can be adopted in terms of safety measures, the policy group, CBS, and hospitals can all work together to design a plan to roll out the program on a large scale in the long run. Large consumer demand would also be required for pressuring groups such as the CBS to look for alternative ways in changing the current system. Particularly, as our society becomes more intertwined with technology, this app would make for a perfect opportunity in encouraging a younger population to take part in this socially responsible act. Plus partnerships with other businesses within our system would need to be developed, as a large part of the successful pilot project in the Philippines has been tied to the structured incentives program donors participate in each time they donate blood.

Measurements in this system would involve evaluating how many people download the app and complete a profile, how many new people donate blood on a weekly basis, the number of people donating blood multiple times in a year; as well as gathering comprehensive data on the donor including blood types, health status, and other relevant information.  Overall, the value such a simple app could add to the system would be a welcome change and hopefully encourage more potential donors to take the time to donate blood through an incentivized program. Through the use of direct contact between the hospital, app, and donor, a revitalized form of social responsibility may develop and more lives will be saved and fulfill an urgent need for blood donations.  Given the breakthroughs in mobile technology, this could be a way for our healthcare system to create a new forum for Canadians to actively showcase their involvement in contributing to a social need.  Thus, our healthcare system and the Canadian Blood Services can take away three lessons from the development of this app. The first lesson being a new and creative way to increase the acquisition of new donors through the use of social media and technology. The second lesson involves the retention of current donors through incentives. The third lesson involves streamlining the donor process and establishing a comprehensive data system about the donors.  Lastly, as seen in the Philippines, with so many regulations set in place, innovation is often hindered and Canada needs to find ways to encourage people to think outside the box when solving our complex healthcare needs, as small incremental changes will not always suffice.

So if you aren’t a regular donor get on it! You never know when you or your loved ones may need this vital resource. Trust me. I’m terrified of needles but I would rather push aside my fears for 10-15 minutes of basically no pain (and free cookies and juice!!!) to help those in dire need. Busy you say? As a student I still found time to stop by the clinic on campus whenever they came around or went on my lunch break at work when the clinic came to my workplace. You also have the option to book an appointment in advance at your local blood donation clinic like you would your hair, dentist, doctor, or date.

Save a life (or a few!).



Works Cited

Arce, J. (2013, November 3). Mobile app launched to find existing blood donors. Retrieved November 7, 2014, from

CBC. (2014, September 30). Canadian Blood Services urges donations as supply ‘critically low’ Retrieved November 7, 2014, from

Canadian Blood Services. (n.d.). We’re refreshing! Retrieved November 11, 2014, from

Code for Resilience. (n.d.). Blood donors network. Retrieved November 11, 2014, from

College of Arts and Technology. (n.d.). CIIT professor Helps you get blood when you need it. Retrieved November 7, 2014, from

Lang, K. (2014, September 30). Canada’s blood supply hits 6-year-low, prompting donor appeal. Retrieved November 11, 2014, from

Martin, R. (2012, November 16). Blood donors network: A simple social innovation that can go     a long way. Retrieved November 7, 2014, from      donors-network/





The Impacts of Climate Change: The Implications on Human Health

One of the greatest threats to human health in developed societies is climate change. There is now consensus among scientists confirming the existence of global warming, due in part to rising greenhouse gas emissions as a result of human activity (Anstey, 2013).  Climate change is widely recognized as a major threat to human health due to its direct effects on a variety of systems including on environmental, social, and public health infrastructure (Shin & Ha, 2012).

The impacts of climate change can be seen at the individual level when examining the direct effects it has on human health and disease. Global warming has led to increased cases of heatstroke, climate sensitive infectious diseases, increased cardiovascular disease, and malaria (Anstey, 2013).   The depletion of the ozone layer has led to increased ultraviolet radiation, increasing the risk of skin cancer, and causing temperatures to rise (WHO, 2013). In turn, rising temperatures had led to altered infectious disease risks as pathogenic species and their hosts are now emerging in regions that were previously too cold for their survival (Raffa, Eltoukhy & Raffa, 2012). This has many health implications, including the spread of vector-borne diseases such as dengue fever and gastroenteritis, to regions that have never been exposed to these illnesses and therefore have not developed any resistance (Anstey, 2013).  Changes in air quality has impacted respiratory health, as increased morbidity and mortality rates can be seen for patients with chronic lung conditions such as asthma, due to heat waves, pollution, and natural disasters (Bernstein & Rice, 2013).

The effects of climate change can be particularly devastating when examining the populations who are most directly effected by global warming. Although the effects of climate change will be suffered disproportionately by those living in developing nations who are reliant on agriculture for their survival, many of the same vulnerable groups including children and the ill are impacted in developed nations (La Trobe, 2002). In the early 2000’s 88% of the deaths due to climate change were children whose physiological immaturity leads to increased vulnerability to temperature extremes, infections and malnutrition, which can be compounded by living in poverty (Kiang, Graham & Farrant, 2013). Individuals with chronic illness may suffer deteriorating conditions as evidenced in the case of patients with chronic lung conditions such as asthma (Bernstein & Rice, 2013).

The changing climate will have a devastating impact on almost all forms of infrastructure in the developed world. These effects will be seen in the form of deforestation, land degradation, housing and shelter and additional strain placed on health care services due to the increasing number of natural disasters and medical conditions exacerbated by climate change (La Trobe, 2002). The agricultural sector is particularly susceptible to climactic change, which has economic implications including rising food costs and food shortages, serving to promote and enhance poverty, which is known to have adverse impacts on health (Heltberg, Siegel & Jorgensen, 2009). The impacts of climate change on human health will also affect the labour productivity and demand for health services in many respects including increased demand for mental health services after natural disaster, increased respiratory diseases, and increased cases of vector-borne illnesses  (Bosello, Roson & Tol, 2006).

Climate change is the greatest threat to human health and is an issue that needs to be addressed by policy makers, due to the many implications it has on health. Climate change directly and indirectly affects health though lack of food and safe drinking water, poor sanitation, population migration, changing disease patterns and morbidity, more frequent extreme weather events, and lack of shelter (Rylander, Odland & Sandanger, 2013). Its impact can be seen at the individual level through its effects on disease and illness, the disproportionate consequences faced by vulnerable populations, and the impacts on infrastructure needed to promote positive health outcomes.  Environmental degradation may be an irreversible act, highlighting the need for immediate measures to safeguard the integrity of natural ecosystems, thereby lessening its impact on human health (WHO, 2013).

Works Cited

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