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Get ready for the H1N1 flu's second wave: Butler-Jones

The good news is that the vast majority of the pandemic H1N1 flu cases in Canada have been mild and the number of fatalities has been held to fewer than 70 as of late summer. The bad news is that we probably haven't seen the worst of it yet.

Dr David Butler-Jones, the nation's first Chief Public Health Officer, is leading the Public Health Agency of Canada's preparations for the anticipated second wave of pandemic H1N1 flu, expected to arrive this fall with the potential to cause far greater damage than the virus has caused so far. He spoke with Parkhurst Exchange about what physicians need to know.

To read the online-only full version of the Q&A, click .

Photo: Public Health Agency of Canada

Good or bad? Assessing recessions' health effects

Is a recession good or bad for people's health?

Readers of Canadian Medicine have already had a taste of this question, in two recent articles: last month in "Economic turmoil is hurting Canadians' health: CMA" and then this month in "Maybe the recession was good for healthcare, after all". In the former, we cited a survey in which Canadians self-reported cutbacks on out-of-pocket health and nutritional spending and exercise. And in the latter, we noted a recent infusion of cash to healthcare infrastructure via federal stimulus spending.

So which is it: a recession is healthful or a recession is harmful?

Well, that very question is examined in a new review published this month in the Canadian Medical Association Journal by University of Washington public-health professor and emergency physician (and University of Toronto grad) Dr Stephen Bezruchka (right), who found that "contrary to what might have been expected, economic downturns during the 20th century were associated with declines in mortality rates."

Dr Bezruchka's paper is worth a full read, but I'll point out for you a few of the most interesting items in the paper:

  • The "procyclical" (positively related) relationship between recession and decreased mortality rates was less pronounced in countries like the United States and Canada which spend less than many European nations on social programs.
  • "Health care has not been found to be a major factor in producing health in populations."
  • This is a simplification of his point, but in essence he posits that higher unemployment = less money = less money to buy cigarettes and alcohol with, and less overeating. (This logic seems questionable to me, but it's something to ponder nonetheless.)
  • Work can be stressful, and unemployment can relieve pregnant women's stress. (Highly questionable, in my opinion.)
  • Is Dr Bezruchka a socialist? See especially his assertion that redistributing wealth from rich countries to poor ones would actually be of longterm benefit to the health of everyone, from countries both rich and poor, and the claim that the "current economic crisis offers an opportunity for rich countries to rethink the social purposes of their economies."
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