Listeriosis is the least of it

There has been an unrecogized factor in the recent Listeriosis epidemic. My wife was in an extended care area in the 1990's. The food was prepared at first in the hospital kitchens (site 1) and served a la carte on the ward. Then it was decided to centralize food preparation for such facilities for the whole city (site 2). They in turn availed themselves of prepared foods such as cold cuts from a central Canadian source (site 3). If a break in preparation technique had occurred at (1) then only the one institution would have been affected: at site (2) the city, but at site (3) the whole country could have been involved. Bigger is not better. You could apply the same reasoning to the financial crisis but then everybody knows that Doctors have no financial sense. James Battershill MD FRCP (retired) North Vancouver BC

Conflict of Interest:

None declared

Lax regulation costs lives When Political Ideology Trumps Public Health and Safety…

The feeble, inadequate response by the federal government to the listeriosis epidemic, which so far has killed at least 20 Canadians, has been to appoint an independent commission. This ”so-called" independent investigation promised by the Prime Minister, if, in fact, it ever gets off the ground, will be closed to public participation and will have no power to subpoena witnesses or documents. The Canadian Medical Association Journal (CMAJ), in response to this crisis, is demanding a full public inquiry into the major failings of Canada's food inspection system on the same scale as those for the Walkerton water tragedy, the SARS epidemic, and the tainted blood scandal.

It says Canadians shouldn't settle for less.

The CMAJ alleges that the federal government's lax standards on listeria, and the decision to transfer inspection duties for ready-to-eat meats to the meat industry, contributed to this epidemic. That decision to transfer inspection constitutes a reduction in regulatory oversight, as with its implementation the federal government largely gave up its regulatory oversight role. The function and authority of the regulator has been eroded. "Spot audits" by government inspectors historically regarded as critical safety checks have come to an end.

The despicable recent practice of hazardous/dangerous products having been imported into this country on such a large scale and with such impunity over such a long period of time is another classic example of the federal government's failure - in particular Health Canada - to protect the public health and safety of Canadians, let alone the environment. In this situation it was not a case of deregulation, but rather the failure to use the regulations already on the books. It is reliably estimated that over 3 million of those toys and other products entered the Canadian marketplace and should have been recalled. The sad reality is that the actual number of those products returned by purchasers to retailers and other sellers will be statistically insignificant. The vast majority of these products will continue to be used; some will find their way into attics, some into garage sales – and eventually all will find their way into landfill sites, at a disastrous cost to the environment.

Under the Hazardous Products Act, the federal government has the moral, ethical and legal responsibility and authority to ban the import into Canada, and also the manufacture in Canada of products that pose a safety and health hazard. Why was this legal instrument not used? Who was asleep at the switch? Who cared? Where was the regulatory oversight? Did the government explore its legal options, including criminal charges and monetary penalties against those importers who wantonly and with total disregard broke Canadian laws, in the process putting so many citizens at risk of sickness and injury? The Hazardous Products Act has served Canadians well for over 30 years, albeit one would not deny that parts of it are now deficient and inadequate to deal with the realities of the global marketplace. The time is now to bring this act up to speed, and provide the necessary resources – financial, human and others – to enable it to get the job done. Anything less flies in the face of public health and safety.

The tragedy of Walkerton – seven dead, over 2,300 sick from symptoms of the E. coli contamination including many on life support therapy for life, and a devastated community – awoke Canadians and the world to the hazards and pitfalls associated with ideologically driven political philosophies. Such philosophies focus on getting "government out of the lives of its citizens", however defined, and regardless of the impact on the public health and safety of its citizens.

Obviously, the lessons of Walkerton have been lost on many politicians and public servants, in the process diminishing the public health and safety of all Canadians and eroding the confidence Canadians place in our public institutions.

Government deregulation has not been limited to food and product safety.

Amendments to the Railway Safety Act in 1999 gave railway companies the authority to implement Safety Management Systems (SMS), designed as a framework for integrating safety into day-to-day operations. SMS entailed a reduction in regulatory oversight; with its implementation, Transport Canada largely gave up its regulatory oversight role. Since SMS began, there has been an alarming increase in incidents, serious and otherwise. The report by the Advisory Panel on Railway Safety recognized that SMS has not resulted in the overall improvements that were expected. The issues at hand are fatalities, injuries, environmental damage and economic losses.

With amendments to the Aeronautics Safety Act, Transport Canada largely gave up its oversight role and dismantled the system of checks and balances, including third party audits, which gave this country an enviable safety record. Those changes allow aviation companies to regulate themselves, weaken the Minister's ability to protect aviation safety and maintain public confidence, and introduce unwelcome secrecy provisions that could allow the industry to hide critical safety information from both the government and the public. An investigation by Transport Canada revealed that the organization which regulates and licences privately operated business planes was not collecting basic safety data and was too over-loaded to police the industry properly. The deregulation of aviation safety-rule making to that organization, namely, Canadian Business Aviation Association, in November 2005 was done without Parliamentary scrutiny or approval. No less of an authority than Virgil Moshansky, the retired judge who led the inquiry into the 1989 plane crash in Dryden, Ontario that killed 24 people, has expressed serious concerns about these changes to federal air safety regulations and the threat they pose to safe air travel.

As the record clearly reveals, it is false economy to cut back on public health and safety. Public health and safety-related infrastructure cannot be considered a "frill" and must not and cannot be driven by political ideology. Walkerton, listeriosis, dangerous products from abroad, train accidents/derailments are cogent reminders of the importance of effective regulatory oversight. Canadians deserve better and should expect better.

Are politicians and bureaucrats listening?

For more information, please contact:

Emile Therien, Past President, Canada Safety Council 326 Frost Avenue Ottawa, ON Tel: 613-737-4965

Dear Editor,

Congratulations on the informative and thought provoking editorial and articles recently printed in the CMAJ about the current nationwide Listeriosis outbreak. I have been fortunate to have been included on the local public health unit's response team developing and implementing the strategy to deal with the situation in the City of Ottawa.

I observe that missing from the national debate now occurring around food safety and federal action/inaction -whether it be CFIA, Agriculture Canada, Health Canada or PHAC-- is the role that local public health units have played. For example, once the recall was issued, it is local public health inspectors and public health nurses that worked with long term care facilities, day cares and retirement homes to ensure the product was not consumed. It was local public health epidemiologists that tracked cases, public health nurses that carried out individual case assessments, and local public health inspectors that carried out "effectiveness check" inspections to check that potentially contaminated product was not being sold in their communities. It was local public health units to which individual Listeria cases were reported, who kept local physicians informed as the outbreak progressed and who provided the public with information to ensure compliance and mitigate fear.

While this is what public health professionals at the local level do, the capacity to continue to employ best practices is undermined by a number of factors, not the least being diminishing investments in public health, increases in service demands and a national shortage of public health personnel. The Naylor Report was a milestone in initiating a national public health renewal agenda. But what has become of the momentum it established? The issue of local capacity to respond during a national crisis, and the depth of support that can be expected from provincial/territorial and national bodies, also must be carefully reviewed.

Sincerely,

Eve Elman Advisor, Strategic Issues Office of the Medical Officer of Health Ottawa Public Health

Conflict of Interest:

None declared