The public health arena: Intervening on behalf of the general population

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It was the largest boil water advisory in North America at the time and, as the acting VCH Chief Medical Health Officer, Dr. Patricia Daly’s was thrown in at the deep end.

“My predecessor and mentor Dr. John Blatherwick was away in November 2016 when the region experienced exceptionally heavy rainfall,” recalled Dr. Daly during VPSA’s recent Breakfast with Leaders session. “The boil water advisory we issued affected 2 million people for 11 days. It was a difficult time for everyone, particularly our homeless population. And, with large news conferences every day, it was also a great opportunity to learn how to manage the message so people take action.”

That’s a lesson Dr. Daly, who has been the VCH Vice President, Public Health, and Chief Medical Health Officer since 2007 has applied throughout her career.

“In public health, the general population is the patient, rather than any individual person,” she said. “We lead interventions at the population level.”

Dr. Daly’s portfolio is varied; her primary mandate is to improve the health of the population that VCH serves through prevention and health promotion. She is responsible for communicable disease control including management of outbreaks, health protection and environmental health, community care facilities licensing, population health and public health surveillance within the health authority.

“Some of the most effective work we can do is with public policy,” she said. “You have my office to thank for not being able to buy wine at Vancouver grocery stores as data shows easier access to alcohol can cause harm. Our office opposed the expansion of the Edgewater Casino in False Creek because data also demonstrates that gambling addictions rise when there are more casinos. We also advocated for suicide barriers to be included in the redesign of Burrard Bridge. The City of Vancouver was a great partner in addressing all these healthy public policies.”

Dr. Daly’s team works with vulnerable populations including immigrants and refugees, and people who live in poverty and have mental health concerns and addictions. The opioid overdose crisis has been the office’s biggest and most challenging piece of work in recent years.

“When it comes to discussions about providing a safer drug supply, I look at the evidence,” said Dr. Daly. “If we know a food item is causing harm, we remove it from the shelves. We know the illegal drug supply is contaminated and therefore people are pushing for public policy to provide access to legal alternatives. An example is a proposal for heroin compassion clubs that has come from people with lived experience and the BC Centre on Substance Use.”

When questioned about the role of public health vis-à-vis climate change, Dr. Daly responded that it has been identified as an issue and that her office both advocates preventing climate change while also dealing with its local implications.

“A longer fire season is the new norm and that impacts air quality; droughts affect our watershed and our drinking water. Vancouver has developed a heat response plan and opens cooling centres.”

Food security and access to safe, nutritious food is another important part of her team’s work, as are other healthy lifestyle programs such as preventing smoking and encouraging physical activity.

“Much of our focus is with children as well as pregnant women,” said Dr. Daly. “The payoff is greater when we have opportunities to influence them at this critical time.”

The response from VPSA members to the opportunity to meet with Dr. Daly was overwhelmingly positive. Everyone felt they would now feel more comfortable reaching out to her if they had questions or concerns and close to 90 per cent of survey respondents felt they now had a better understanding of her role.

On the follow-up survey, one physician wrote, “I loved getting a chance to eat breakfast with colleagues and getting to know Dr. Daly. I was very impressed with how professional and personable she was. She has an extremely challenging and important job and, after getting a chance to hear her speak at the breakfast, I think we are lucky, and I feel more secure, knowing that she is helping lead the response to such critical but difficult issues, like vaccine hesitancy and overdoses.”

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