Alberta Health Services Speakers Series

Transcription

1 The Montréal Public Health Department s approach to reducing public health impacts of the built environment Alberta Health Services Speakers Series Direction de santé publique Richard Lessard, director Louis Drouin, coordinator, Urban Environment and Health Sector Norman King and colleagues January 19, 2010

2 Objective of the presentation To illustrate how the Montréal Public Health Department is working to improve the health of Montrealers by acting on the built environment

3 6 orientations of the Montréal public health department Children who are born healthy and grow up healthy Young people in good health who succeed in school Workplaces exempt of health risks A population immunised and protected against infections as well as against chemical and physical threats A healthy urban environment A health system which also prevents

4 Vision of the sector Montréal as a city where indoor and outdoor air quality is good; housing is accessible, affordable, adapted, healthy and safe and takes into account the needs of the vulnerable population; urban planning promotes safe active transportation, mixed land use (commercial, residential, recreational, etc.) and accessibility to local services; public transit allows for less dependence on the automobile and is accessible for all; green spaces are available for all; healthy food is accessible within walking distance of all homes.

5 Fields of interest Healthy housing conditions Air quality (outdoor) residential wood burning ragweed industrial sector Health impact of heat waves and climate change Access to healthy food Transportation, urban planning and health

6 Public health management 1. Surveillance of the health of the population 2. Analysis of the determinants of public health 4. Evaluation of these processes and outcomes 3. Public health programme development Influence public policy Community mobilisation Education (social marketing) Protective intervention

7 Examples of public health interventions

8 1. Healthy housing Research Influence public policy Field interventions

9 Evolution of hospitalisations for paediatric asthma in Montréal Legend: North Central west West Central east South-West East Source: Kosatsky and Tessier, 2009

10 Observations Reduction in hospitalisation rates Possible explanation: medication compliance and health care organisation

11 Geographic variations in paediatric asthma in Montréal Source: Berrada et al., 2005

12 Observations Hospitalisation clusters in specific areas Environmental factors could play a role

13 Research: Determinants of asthma and rhinitis What is the prevalence of these diseases? What parts of the island of Montréal are most affected? Which environmental, housing and behavioural factors are most closely associated? Cross-sectional epidemiological study by telephone and Internet surveys Results to be published and shared with our partners in the spring of 2010 Goal: orient public policy and practice concerning healthy housing issues

14 Determinants of the exacerbation and development of asthma Environmental: outdoor air pollution (transportation, wood smoke, industrial) Housing: allergens from dust mites, mould, cockroaches and rodents Behavioural: environmental tobacco smoke, domestic animals breastfeeding has a protective effect

15 Influence public policy Collaboration with the city of Montréal on a 2005 by-law dealing with housing conditions Training sessions on mould and bedbugs for municipal inspectors responsible for implementing the bylaw

16 Field interventions Supply expertise to municipal inspectors, housing authority personnel and local public health professionals Carry out investigations in publicly and privately owned buildings on potential health problems reported to the public health department: mould contamination bedbug infestation

17 2. Air quality (outdoor) Research Participation in public information programmes with partners Influence public policy

18 Research to gain a better understanding of risks to guide preventive interventions Pilot project with a local health and social services centre to map the presence of ragweed problems more extensively (eastern part of Montréal) Mapping of exposure to wood-burning related pollution, impact on indoor and outdoor air quality and public health (asthma) study to be done with the INSPQ in collaboration with Environment and Health Canada

19 Ragweed infestation on the Island of Montréal Source: Jacques et al., 2006

20 Prevalence of rhinitis symptoms Source: Jacques et al., 2006

21 Wood burning varies across the Island of Montréal Source: Ville de Montréal, Service de l environnement et du développement durable

22 Air pollution in wood burning sectors compared to downtown Source: Environment Canada, DSP de Montréal, Ville de Montréal, 2000

23 Public information programmes Info-Smog advisories Air quality health index Wood burning Ragweed

24 Info-smog

25 Information programme on wood burning

26 Information programme on ragweed

27 Influence public policy Submission of briefs on health impacts of various air quality problems and solutions Canada s Clean Air Act (Bill C-30) GHG reduction target adopted by the Government of Québec 20% reduction by 2020 compared to 1990 levels Municipal by-law on residential wood burning adopted by the city of Montréal in 2009

28 3. Heat programme Research and health surveillance Public education Heat health warning system (HHWS) Seasonal readiness Heat warning Heat alert Mobilisation plan with the CSSS, the City and boroughs Diminishing the effects of urban heat islands Working towards sustainable development promoting the reduction of GHG emissions

29 Study to determine intervention thresholds Retrospective analysis over a 20-year period ( ) to determine temperature thresholds where excess mortality is observed Result: 5 episodes covering 7 days where mortality was significantly higher than expected Temperature threshold: Tmax daytime: average of 33 C or more over at least 3 days Tmin night time: average of 20 C or more over at least 3 days These levels were incorporated into our HHWS

30 Daily deaths and T max T min May to Sept Source: Litvak et al., 2005

31 Urban heat island effect CSSS Saint-Léonard-Saint-Michel

32 Intra-urban variation in the relationship between mortality and ambient temperatures. Smargiassi et al., 2008 Results suggest that people living in micro-urban heat islands and who are more likely to be exposed to higher T have a 15% greater risk of premature death compared to people living in hot areas during hot summer days

33 Results facilitate the identification of priority sectors for interventions Greening Identification of more vulnerable groups to be covered by emergency measures implemented by regional and local authorities

34 The Heat Health Warning Systems Montréal public health department has developed a regional heat plan and provided guidance to the 12 local health and social services centres for their own plans Levels of intervention seasonal preparation heat warning heat alert mobilisation demobilisation Discussions to evaluate the entire heat programme are underway with Health Canada