Lead author Wei Zhang

Back problems, mood disorders and migraines cost millions in productivity loss, recent research has suggested.

Led by Centre for Health Evaluation and Outcome Sciences and the Partnership for Work, Health and Safety postdoctoral fellow Wei Zhang, the research looked at 28,678 eligible respondents to the 2010 Canadian Community Health Survey, the latest data available at the time of the study. These respondents were aged between 15 and 75 years of age and had reported employment in the last three months, with 16 chronic conditions considered in the survey.

Published this month in the Scandinavian Journal of Work, Environment and Health, the research found 1.35 days missed on average due to health problems over a three month period. The three chronic conditions most associated with missed workdays were mood disorders, heart disease and bowel disorders, at 1.17, 0.81 and 0.80 more missed work days respectively, than workers without this condition.

The research, co-authored by School of Population and Public Health assistant professor Chris McLeod and professor Mieke Koehoorn, found that the conditions associated with the largest productivity losses

SPPH assistant professor Chris McLeod

These losses were calculated by multiplying the incremental number of workdays missed by the number of employees with the specific condition, the average hours per work day (eight hours) and an average hourly wage of $24.33. The final losses also included the employee benefits paid by employers and the impact of employee absenteeism on their colleagues’ productivity.

The research listed several limitations, including chronic conditions being based on self-reporting and wage information not being asked as part of the CCHS.

The authors argue the study could help employers prioritize chronic conditions when implementing programs to manage these conditions and employee absenteeism.

SPPH professor Mieke Koehoorn

Targeted programs or interventions addressing the conditions most associated with high absenteeism and lost productivity could be cost-effective for employers, Zhang said.

“If the employer is willing to address the problem but has a limited budget, and they
want to have a target, they can target those areas.”

Lead author Wei Zhang

McLeod said the study supported a continued focus on understanding the burden of chronic diseases and interventions on an employer level, and awareness on a societal level. “It helps support the idea that chronic conditions, and particularly some chronic conditions…relate or create significant productivity losses. That’s something not only employers need to think about but it’s also a broader societal issue.”

Koehoorn said for the most part, employers, human resources (HR) departments and other supportive groups had done a fairly good job of accommodating individuals with acute conditions such as cancer. However the conditions the research had identified, which people lived with chronically, were not as accommodated for, and this research drew attention to these chronic episodic conditions. There was a need to be innovative when it came to working out how to accommodate these chronic conditions, she said, in such areas as the benefits available, job sharing, and job accommodation.

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Every person has a right to achieve the best possible health.

Watching scholars, staff and students from different units of the School of Population and Public Health (SPPH) unite thanks to this shared belief has been a career highlight for outgoing director Dr. David Patrick.

Patrick, who is stepping down this week after five years in the role, said this experience was “simply remarkable”. His advice for faculty, staff and students is to complete the job of pulling together.

“We can take our place as a globally-leading Public Health School if we work together toward becoming an irresistible target for a transformative philanthropic gift.”
Outgoing director Dr. David Patrick

Speaking at a farewell luncheon, Patrick said his time at SPPH had seen rapid growth, concentrations of study and Indigenous health advancements including the opening of the Centre for Excellence in Indigenous Health.

Moving forward, Patrick said he had research to write up, courses to teach and that he would represent the B.C. Health Officers Council to the B.C. Healthy Living Alliance. He will also have more time to write new material for his role as trumpet player in two bands.

These musical skills saw an outing in the SPPH Jar and Jam sessions, regularly scheduled jams with SPPH students, staff and faculty who could tickle some ivories or rock a guitar. “We’ve got some capable musicians around the School. Where else could I have dressed up like John Snow for a gig?”

The wider community should know that the School had already made a big difference in health in B.C. and around the world, he said, including in informing Asian governments of the burden of illness from air pollution, and changing the World Health Organization’s approach to prevention of HPV related cancers. His fondest memories of the School are the infectious joy of working with his students and with newer faculty or newly installed research chairs.

“Fresh ideas and approaches are more than just fun, they revolutionize the way we deal with previously intractable problems.”
Outgoing director Dr. David Patrick

SPPH Professor Emeritus Gary Poole worked closely with Patrick as the first Associate Director of the School, where he gave Poole room to try new things and grow in the role. “He brought valuable perspective and humour to the difficult times. And he made me feel appreciated. It was with this kind of support that we were able to do some good things, like creating the Teaching Assignment Committee and introducing some important new elements to our MSc/PhD requirements. I am thankful for David’s sense of belief and commitment during our years together.”

Occupational and Environmental Health Division Head Professor Mieke Koehoorn said the Division Heads had consistently used the word ‘supportive’ to describe Patrick and his leadership, in their roles as Heads, and of their initiatives, such as merging the School of Environmental Health into SPPH. Other adjectives used to describe his leadership included ‘collaborative’, ‘conciliatory’, and ‘consensus-building, she said. She was thrilled that the School was pursuing undergraduate courses and a curriculum, something that had been talked about for years, but that was finally happening under Patrick’s leadership.

“To draw a Star Trek analogy, we required Captain Jean-Luc Picard to ‘make it so’.”
Professor Mieke Koehoorn

SPPH Senior Administrator Virginia Anthony said during his time as director, Patrick had appreciated her input and experience. He had been encouraging in difficult times, particularly when it came to meeting the School’s mandate during challenging financial periods.

Professor Jane Buxton said Patrick brought people together not just at work but in social settings, such as the Jam and Jar sessions. She appreciated his jokes and efforts to make interactions more lighthearted, she said, such as Patrick’s bringing a fluorescent green torch to his last faculty meeting to ‘pass on the torch’ of the directorship – which, he said, for health and safety reasons, he was not allowed to light.

Assistant Professor Chelsea Himsworth, who was supervised by Patrick for her PhD, said he had had a profound impact on her, both personally and professionally. His courage and creativity in taking on Himsworth, a veterinarian with a project looking at whether urban rats posed a health risk to humans, in recognizing the merits of the project, and of its interdisciplinary nature, steered her own thinking and had influenced her career, she said. And he had been “incredibly supportive” of Himsworth as a person.

“He’s a very courageous academic and an outside-the-box thinker and risk–taker.”
Assistant Professor Chelsea Himsworth

Patrick supervised Master of Public Health student Xiaoying Kang (KK) for her practicum this year, working on chronic fatigue syndrome. KK said she was influenced and inspired by Patrick’s positivity and creativity towards scientific questions, which motivated her to achieve more. “I believe what I have obtained from this practicum will be an invaluable experience on my way to becoming a true scientist in infectious diseases.”

Patrick’s last day as director will be Wednesday 31st August, but he will continue as a Professor at the School.

Professors Carolyn Gotay and Chris Lovato start today as the interim co-directors of the School of Population and Public Health (SPPH).
 
Dr. Gotay, an expert in cancer prevention and control, is also director of the Centre of Excellence in Cancer Prevention and previously served as interim director in 2011. She said she was glad to have exceptional faculty, staff, and student resources to work with.

“It’s a privilege to help to steer the SPPH ship during this exciting period of transition for the School, the Faculty of Medicine, and the University.”
Co-director Dr. Carolyn Gotay

 Dr. Lovato focuses her scholarship on conducting health research and evaluation that informs decision-making. Her research has looked into effectiveness of community health initiatives, health services, and medical education. She has previously served as the Founding Director of the Evaluation Studies Unit in the Faculty of Medicine.  She said she was looking forward to working with faculty, staff, and students in this role.

“We have a very bright and talented group of people in SPPH.  I believe that together we can move forward and help each other be the best we can.”
Co-director Dr. Chris Lovato

 The co-directors will serve until a new director is appointed.

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Research conducted by a team including School of Population and Public Health (SPPH) scientists has been reflected in changes in the World Health Organization (WHO) consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.

Funded by WHO and published today in Lancet HIV, the research found that certain antiretroviral therapy (ART) regimens were more effective than those recommended by WHO for patients who had not previously received such treatment, including in such areas as rates of patients discontinuing the drug and suppression of the virus.

The systematic review and network meta-analysis looked at randomized clinical trials up to July 2015 comparing ART regimens in people aged 12 years or older with HIV who had not been treated before and included data on 34,032 patients across 71 trials. According to the authors, this was the first time a network meta-analysis had been used to inform WHO guidelines.

Lead author Steve Kanters

Lead author, and SPPH doctoral student, Steve Kanters, said network meta-analysis allowed researchers to make comparisons where drugs had not been directly compared before, to estimate the relative efficacy of all treatments at once, and to achieve more precise estimates about treatment efficacy, which could reveal differentiation between treatment efficacy where head-to-head trials might not. As such, these methods lent themselves particularly well to clinical guideline development and decision-making, he said.

“Using a network meta-analysis for these guidelines was important because while evidence based medicine requires the most up-to-date data, it also requires the most up-to-date methods that make sense of those data.”
Doctoral student Steve Kanters

Mr. Kanters said the team, which included many Vancouver-based researchers and fellow SPPH doctoral student Jamie Forrest, had already presented the results to WHO in 2015, and the new guidelines had reflected their research. Released in November, the guidelines added the treatments identified by Mr Kanters’ research as alternative options in first-line regimens. “We played a large role in the development of those guidelines.”

The study concludes that while alternative treatments were superior, there were still issues of complexity of care and logistics, including that one superior treatment would require genetic screening, increasing the burden on the patient.

Mr. Kanters said the new guidelines in general were exciting, since they had seen the recommendation of a ‘test and treat’ approach, where patients who tested positive for HIV would receive treatment immediately, rather than waiting to become sick.

SPPH Assistant Professor and Mr. Kanters’ supervisor, Nick Bansback, said he thought network meta-analysis should be used more frequently for clinical guideline development.

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If you have ever looked at a tree and felt more environmentally conscious, it might not be a coincidence.

That is according to the School of Population and Public Health’s newest faculty member, Assistant Professor Matilda van den Bosch, who is also an Assistant Professor with the Department of Forest and Conservation Sciences, and will be giving the first talk of the Occupational and Environmental Hygiene Seminar series for the new academic year on Friday, titled ‘Closing the gap between green and white: Using nature to improve health.’

Dr. van den Bosch, whose appointment started in July, co-wrote a theoretical paper published in BMC Public Health which posited the idea that seeing nature can trigger more environmentally conscious behaviour. What is not theoretical is the relationship between health and the environment, Dr. van den Bosch says, a relationship that covers several strata of ecosystem services, from the studies which show exposure to green spaces reduces stress, and affects mental health, to the research behind the heat-reducing impact of green spaces.

Assistant Professor Matilda van den Bosch

While working as a doctor in general practice and later in radiology in Sweden in the early and mid 2000s, Dr. van den Bosch read about a project involving health promotion and green spaces. With an already established interest in environmentalism, she decided to pursue this through a doctoral degree in landscape planning and public health, the first at the Swedish University of Agricultural Sciences to do so.

She worked at the University as a researcher and teacher until this year, when she made the move to Canada for family reasons. Dr. van den Bosch says she had been looking to join a more health-focused faculty and UBC was a good choice because of the medical and health faculty here, while the shared affiliation with the Faculty of Forestry made it a “dream position”, she says. Canada’s abundance of green spaces also helped.

Canada is an up-and-coming country when it comes to research in this area, she says, with some recent studies including SPPH Professor Michael Brauer’s and colleagues’ work. The lion’s share of research in the field has until now been conducted in the USA and Europe.

“I feel there’s a good opportunity, I think there’s an increased awareness of the importance of providing green spaces to people in times of increasing urbanization.”
Assistant Professor Matilda van den Bosch

With her time at UBC, Dr. van den Bosch says she aims to increase awareness in the general medical community that environmental health is a legitimate concern and an opportunity to change people’s health, and raise awareness of the health impact of forestry and environmental work. She also hopes to increase the research available on prevention plans and solutions to harmful exposures.

A career highlight for Dr. van den Bosch has been working with UN-bodies, for example on developing an urban green space indicator for the World Health Organization and on the Global Environmental Outlook for the UN Environmental Program.
“There’s the chance, working with these organizations, and together with other people’s engagement and support, to distribute the message and make a change for healthier environments and people.”

The field of environmental health has the potential to become more important and more recognized, given the impact of climate change and the degradation of the environment, Dr. van den Bosch says. The topic is so complex, it might be the case that new research designs and reevaluation of methodology, addressing the interrelated nature of threats and solutions, are needed.

“At the end of the day, we are totally dependent on healthy ecosystems.”
Assistant Professor Matilda van den Bosch

And as for her own environmental efforts? She drives a hybrid only when necessary and bikes or uses public transport otherwise, buys ecological and organic products, and her family rarely eats red meat.
“I’m no saint..but I do my sorting and try and raise my children to become environmentally aware individuals!”

Dr. van den Bosch’s seminar will be held in Room B151 of the SPPH Building on Friday 9th September from 12:30pm. For more information or to view the seminar online, click here.

Academics never really retire.

That is according to Professor Emeritus Sam Sheps, and indeed, judging by his future plans, he may soon be adding to his 58-page resume, despite celebrating his retirement from the School of Population and Public Health (SPPH) this week, after 35 years in the field.

He has been a professor for more than 20 years, starting as a research associate in the Division of Population Pediatrics in 1978 in the old Children’s Hospital. In 1981, he joined what was then the Department of Healthcare and Epidemiology part-time, moving to a full-time appointment in 1984. Dr. Sheps served as the Department’s Chair for 10 years, and witnessed its evolution into the School of Population and Public Health.

He set up the Master of Health Science program in the early 1980s as part of the Department’s plan to establish clinical epidemiology as a focus, oversaw the development and implementation of the Master of Science and Doctor of Philosophy program in the early 1990s, of which he was director almost continuously until January this year, and has been inducted into ‘Tempus Fugit’, a club which recognizes 35 years of service at UBC.

“I have a whole shelf of theses and dissertations I’ve been involved in as a supervisor.”
Professor Emeritus Sam Sheps

With parents who were both physicians, and who both earned Master of Public Health degrees, it does not come as much of a surprise that Dr. Sheps ended up in the field of public health. Initially trained as a physician working in Pediatrics, he says he realized after his residency that to do the research he found interesting, he would not be able to practice, as the patients always come first. But the medical experience helped, he says.
“As a researcher, having clinical experience provides one with a critically important perspective on how the health system works.”

From there, his decades-spanning work has seen Dr. Sheps as the principal investigator of more than 100 research projects, and a member of more than 80 committees and scholarly societies, including being a founding member of the Centre for Health Services and Policy Research. He has advised governments, and been a reviewer for many academic journals, including JAMA, CMAJ Pediatrics, and Social Science in Medicine.

In addition to the above, one of the highlights of his career was serving as the director of the Western Regional Training Centre (WRTC) program, he says. Established through a 10 year grant from the Canadian Health Services Research Foundation, the WRTC saw doctoral and master’s students from many disciplines and research programs, including sociology, economics, and political science, participate in a weekly seminar, and take part in field placements within the health care system in order to learn how it really worked. Despite other professions working in context, gaining practical experience in most PhD programs was not common at the time, Dr. Sheps says.

“It was a new way of thinking.”
Professor Emeritus Sam Sheps

Starting with UBC and the University of Manitoba, the program added UNBC, the University of Calgary, the University of Saskatchewan and more, and continued over 16 years.

In 2002, Dr. Sheps first became engaged in patient safety issues as a researcher in the Canadian Adverse Events Study published in 2004, which he says has been “endlessly fascinating” and a great learning experience. He has published research on unnecessary hospitalization rates, and co-authored, with colleague Karen Cardiff, major reports for Health Canada and the Canadian Patient Safety Institute, as well as being involved in or chairing various committees, training workshops and conferences focussing on patient safety. For the last five years his particular interest has focused on the concept of resilience, and understanding the implications of the observation that ‘daily healthcare work as imagined’ by healthcare managers and senior leadership may not actually reflect ‘healthcare work as actually done’ on the frontlines.

Public health has become more bureaucratized since he started some 30 years ago, Dr. Sheps says, and risk management has become “a bit of an obsession”. Public health officers no longer have the array of powers they once had.
“Governments, unfortunately, are anxious that doing what’s right for the public’s health can mess with their agendas.”

In the future, he sees potential issues with public health workers trying to do their jobs, running up against vested interests, and trying to change the status quo. He also believes public health as a field will need to think differently about the physiology of age, given more people are living past the age of 80 years. For example, he says, it was not understood until recently how hospitalization can lead to reduced physical and cognitive function, a major problem for older patients.

Working at SPPH, and for the WRTC program, was easy, productive and fun, thanks to the people he worked with, Dr. Sheps says.

“I’ve been lucky to work with very nice, competent, people.”
Professor Emeritus Sam Sheps

Dr. Sheps aims to continue his work on patient safety and resilience, including writing, taking part in a monthly teleconference with health care workers across the country and in the USA, and helping to organize the Resilience Health Care Net conference, a meeting of international inter-disciplinary researchers and healthcare practitioners planned for Vancouver in 2017.

He will also continue to serve as a university examiner for several graduate students each term and, he hopes, be generally useful to the School as Professor Emeritus. He looks forward to having more time with his family, including granddaughter Clea (now five and a half), his daughters Kate and Sarah, and his wife of 50 years, JoAnn, without whom, he says, none of the above would have been possible.

He also looks forward to doing more photography.
“I haven’t printed a picture in a very long time – I’d like to do that.”

“He has a way with everyone because he is respected by everyone.”

SPPH co-director Professor Chris Lovato said Dr. Sheps is respected by everyone – students, staff, faculty, and administration. Dr. Lovato joined the faculty in the 1990s when Dr. Sheps was Department Head, and said she will always be grateful for his support and welcome.
“His wit and wisdom were everywhere they needed to be, especially when we were facing ‘sticky’ problems. Through the years he’s been a wonderful colleague and mentor.”

Co-director Professor Carolyn Gotay said she appreciated Dr. Sheps’ insights on difficult management issues over the years. “His wisdom stems from his in-depth experience, clinical and research expertise, and personal integrity and empathy.”

“I’ll miss having him right down the hall, but I’m still going to seek him out when I need counselling!”
SPPH co-diretor Professor Carolyn Gotay

SPPH Professor, and fellow Centre for Health Services and Policy Research founding member, Dr. Morris Barer, said he and Dr. Sheps became Assistant Professors in the Department of Health Care and Epidemiology at the same time, in 1981, and 35 good and highly productive years had flown by. “During our time together in the Department and then the School, Sam was my Department Chair, a graduate student co-supervisor…a co-investigator and collaborator on a variety of projects, my right hand man in a major consultation for the Manitoba Department of Health in the 1990s, a co-conspirator on the Western Canada Waitlist Project with Tom Noseworthy, Steven Lewis, Claudia Sanmartin and others, and the inspiration, brains and brawn behind the Western Regional Training Centre, in which circumstances prevented me from ever playing more than a bit part.”

Their combined project work had covered a lot of important ground, Dr. Barer said, including the anatomy of wait lists and the dynamics of increases in health care utilization and costs, and Dr. Sheps was part of the “catchy titles cabal”, which produced works such as ‘The Quick and the Dead’ (about hospital lengths of stay), ‘The Eyes Have It’ (about cataract surgery rates), and ‘Lots of Heat, Little Light’ (about the rhetoric around wait lists).

“It’s been a remarkable privilege to have been able to collaborate, and to have had so much fun, for so many years on so many projects, with such a dedicated, generous, and conscientious soul. You’ve put in your time. ‘Take the money and run’.”
SPPH Professor Morris Barer

SPPH Professor Martin Schechter said he owed Dr. Sheps a great debt of gratitude. When in medical school and considering epidemiology, he dropped in unannounced on Dr. Sheps, who spent an hour speaking with Dr. Schechter about UBC and the Department. This prompted Dr. Schechter to apply for a job there years later. Dr. Sheps was a mentor to him, and to “countless” students and trainees, Dr. Schechter said. Together they wrote a series of articles on topics in clinical epidemiology, “and had a lot of fun doing it.” Dr. Sheps had made major contributions in many fields including pediatric epidemiology and patient safety, he said.

“He was also a wonderful colleague and we shared many laughs together. It has been a true honour for me and a distinct pleasure to have worked with him these many years.”
SPPH Professor Martin Schechter

SPPH Assistant Professor Chris McLeod first met Dr. Sheps as a trainee in the WRTC program and as a student in the Philosophy of Science course. Dr. Sheps was an engaging and thoughtful teacher, and his instruction was some of the best Dr. McLeod experienced in his graduate training, he said.
“As an early career faculty, Sam has been a collaborator on many projects and willing ear to provide the advice of many years of experience. I greatly appreciate his commitment to teaching and research at SPPH; his contribution has been to my benefit as it has been for many others.”

SPPH Senior Administrator Virginia Anthony said Dr. Sheps was always generous with his time with students, staff and faculty, and was quick to acknowledge those who supported him and the department.
“I am pleased that Sam will still be in SPPH in his post-retirement appointment. His dedication to the education of the next generation is remarkable.”

PhD, MSc, and MHSc graduate education manager Beth Hensler said it was not possible to quantify the amount of wisdom and guidance she had gained from working with Dr. Sheps. Ms Hensler said throughout the five years she had worked with Dr. Sheps, she had always felt respected and listened to by a “calm leader, wise mind, and friend.”
“With the memory of an elephant, and a dry wit that cannot be matched, Sam always found a way to work through many ‘interesting’ and challenging situations professionally with a dash of humour.”

Dr. Sheps was doctoral student Sean Hardiman’s Master of Health Administration major paper advisor, Executive Training for Research Application (EXTRA) advisor, and initial PhD supervisor, bringing guidance, critical thought, knowledge and practicality, Mr Hardiman said.
“What I appreciated most about Sam as an advisor was his understanding of the history of BC’s health system and its constituent parts – he always seemed to know someone who had direct involvement in whatever it was I was curious about.”

“The number of people I met in my work in health services management who knew Sam, had worked with him, and who had wonderful things to say about their experience working with him were many.”
SPPH doctoral student Sean Hardiman

Dr. Sheps’ last day as Professor was August 31st. He will continue as Professor Emeritus. His retirement celebration occurs this week.

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Class of 2006

National Senior Director, Healthcare Cisco Canada

I was raised in a household of two specialist physician parents so healthcare was my whole life. I remember at 9 years old, my parents told me I’d make a great hospital administrator. I had no idea what that meant and looking back, I appreciate they wanted me to keep my options open.

I began my career as a nurse, working across a number of clinical areas. While I loved being at the bedside, I also wanted to make use of my business skills. My mind also saw the bigger broader scale of population health and that leadership and policy initiatives were my passion.

I discovered UBC’s MHA while already enrolled in the Master of Science in Nursing. I made the switch and immediately felt I found the right program that gave me formal training in healthcare and business. It gave me the winning combination of learning both in the classroom and on the ground. During the week, I was working for a non-profit healthcare organization as the director of clinical services. I was running over 50 clinics across BC, doing things like rewriting the governance policy and clinical operations manuals.

During my two years in the MHA, I literally applied what I learned the weekend before to my current job. It was a true translation of knowledge between my education and my day-to-day.

At Cisco, my background gives me a unique understanding to have conversations with individuals like chief medical officers and hospital administrators on how technology can advance the goals of their organization. I believe that many of the issues we are facing in healthcare today can be improved by technology: telehealth, intelligent information systems, comprehensive and accessible electronic health records, collaboration tools and more. Again, being able to speak the language of healthcare to apply strategies and tools from the business sector allows me to make a positive contribution to the healthcare space.

Having worked in public and private sector, as well as internationally for the WHO, I often get asked about the MHA vs the MBA. I often tell people that the MHA is the right marriage for someone who wants to be in healthcare and is interested in leadership roles and the business of healthcare. If it’s healthcare that you love, the MHA is the right path to take.

“Literally millions of Canadians report that they are unable to take their medicines as prescribed because of the out-of-pocket costs associated with purchasing them.”
Professor Steve Morgan

Professor Steve Morgan

“Such windows of national policy opportunity are open for only a short time, however – the time to act is now before the window closes or is closed by those with financial interests in the status quo.”
Professor Steve Morgan

Nandini Maharaj has been awarded the Social Sciences and Humanities Research Council (SSHRC) Doctoral Fellowship, as well as an Affiliated Fellowship through the Faculty of Graduate and Postdoctoral Studies.

An Interdisciplinary Studies Graduate Program doctoral student whose home department is the School of Population and Public Health, Ms. Maharaj took up the 24-month SSHRC Doctoral Fellowship in May, and this month took up the 12-month Affiliated Fellowship.

Her doctoral research is investigating how people experience the human-companion animal relationship as they are recovering from and living with cancer, and will explore the meaning and significance of this relationship to their cancer journey. From a healthcare perspective, it could help researchers learn about people’s daily experiences as they are living with cancer, how important pets are to them, and how health care providers could better support this relationship.

But it is not just how a pet might affect people’s health – she looks at the mutual relationship between companion animals and people, and has found through interviews for her research that people living with cancer value how their pets make them feel and want to do whatever they can to give their pets a good life.

“They get so much from their pets, they want to give back.”
Doctoral student Nandini Maharaj

This impact is something to which Ms. Maharaj can relate. She is pictured with her dog, Dally, who she says is integral to her research, helping her to learn about these relationships, and who checks in on her while she is working. Dally has had a number of health issues in recent years, and Ms Maharaj says she is continually inspired by his resilience. He has been properly acknowledged – Ms. Maharaj says she has thanked Dally in each of her published articles. “This is a forever relationship.”

The Fellowships come in the fourth year of her doctorate and while the funding has been a boost to her spirits, she says the awards have reinforced her resolve to pursue research on the human-companion animal bond regardless.

Her Master’s research, completed with the Counselling Psychology program in the Department of Educational and Counselling Psychology, and Special Education, focused on how people described their relationship with their dog and how both people and dogs contributed to developing an enduring and meaningful relationship.

Ms. Maharaj is slated to complete her PhD next year.

New breast screening methods should be pursued, a case study has said.

Published this month in BMJ Case Reports, the case study examined a patient who developed a haematoma, or blood clot, after a mammogram, the second such case the authors had seen. After complaining of pain, screening clinic staff advised her to take analgesics. Three months after this procedure, the patient was diagnosed with an aggressive cancer in the injury area, and she died four years later.

The case study concluded that the patient’s concerns were not appropriately addressed, and questioned how often postmammography pain was discounted. School of Population and Public Health clinical associate professor, and one of the authors of the case study, Dr. Stephen Hoption Cann, said judging from women who had contacted the authors, he suspected this was under-reported. “Many women report prolonged pain after compression mammography that lasts months, sometimes longer. This may be due to the development of a hematoma or an injury to the nerves.”

The case study concludes that newer technologies for breast cancer screening that require less compression should be considered, as evidence supporting their efficacy is reported, and prolonged pain after mammography should be monitored and evaluated. Dr. Hoption Cann said such technology, such as 3D ultrasound and 3D tomography, exists and is currently being evaluated. “There are of course costs to its introduction, but the pain many women endure during mammography has been swept under the rug. They are told to take tranquilizers or pain medication beforehand so that they may better tolerate the pain, rather than saying, ‘Maybe there is a better way to do this’.”

The case study suggests that further research should occur on two fronts, Dr. Hoption Cann said; how common is prolonged pain following compression mammography and what are the underlying causes; and what influence compression has on the growth dynamics of a tumor.

A spokeswoman for the Canadian Breast Cancer Foundation encouraged women to speak with their technologist during the mammogram if they experience pain and to schedule their appointment within 10 days of their last period, when some women find their breasts are less sensitive.
She noted, “Many women experience varying levels of pain/discomfort during mammography. It is important to note that a sufficient amount of compression is required during a mammogram – for reducing the breast thickness to optimize the image quality and minimize the amount of radiation needed.”

Existing technologies that involve less compression are sometimes used in conjunction with or as a follow up to a mammogram in women known to be at increased risk for breast cancer, she said, but these technologies are not suitable for screening average risk women without symptoms as they are prone to a much higher rate of false positives.
 
Mammography continues to be the current gold standard for breast cancer screening, the spokeswoman said.

According to the B.C. Cancer Agency website, the effectiveness of screening mammography has been established by several large clinical trials across the world, which found a relative risk reduction of breast cancer deaths of between 15-25% for women aged 50-69. “Of eight randomized control trials for screening mammography, seven showed that screening mammography is beneficial.”

It recommends that women aged 50 to 74 without a family history of breast cancer get a mammogram every two years. Women aged 40 to 49 and over 74 without a family history of breast cancer should talk to their doctor about the benefits and limitations of mammography.

Healthcare coverage, access to contraception, and child mortality rates have improved since the Millennium Development Goals were adopted in 2000, according to new research involving School of Population and Public Health (SPPH) faculty.

Published yesterday (September 21) in The Lancet, the research measured 188 countries’ progress towards 11 health-related Sustainable Development Goals (SDG) adopted by the United Nations General Assembly in September 2015, by analyzing 33 health-related indicators from 1990 to 2015 using the Global Burden of Diseases, Injuries, and Risk Factors Study 2015. These indicators included under-five and neonatal mortality rates, under-five stunting, wasting, and overweight, and met need with modern contraception. The research also provided analysis of changes in indicators since 2000, to give an idea of possible future trajectories.

The Global Burden of Disease Collaboration, which includes Professors Carolyn Gotay and Michael Brauer, is coordinated by the Institute for Health Metrics and Evaluation. It created an index (SDG index) to rank the countries, compiling scores out of 100 (the best observed value over the time period) for each indicator to produce an overall ranking. These rankings show which nations are closest to achieving the SDG targets, the Institute says.

The median score was 59 in 2015, with Iceland coming out on top at 85, Canada in at ninth with 81, the USA in at 28th with 75, and the Central African Republic the lowest at 20.

The study found that countries’ performance in the childhood overweight indicator “considerably” worsened. Socio-demographic index, which measures income per capita, average educational level and total fertility rate, was highly predictive of the overall health-related SDG index, highlighting the general importance of income, education, and fertility, the authors said, but was a poor predictor of indicators such as intimate partner violence and mortality due to war.
“This highlights that a focus on increasing income and education and decreasing fertility alone will likely not be sufficient to meet the SDGs.”

The research also found that fewer people are dying from air pollution. Research co-author, and Professor Michael Brauer, said these results showed some signs of progress for deaths related to air pollution.

“Yet a major challenge remains to ensure healthy air for the majority of the world’s population.”
Professor Michael Brauer

The paper provided possible case studies for understanding the drivers of progress on achieving SDGs, identifying countries with the largest improvement in the SDG index from 2000 to 2015, separated by SDI information into quintiles. These countries were Timor-Leste among low SDI countries; Tajikistan among low-middle SDI countries; Colombia among middle SDI countries; Taiwan among middle-high SDI countries; and Iceland among high SDI countries. These countries had “implemented a range of policies and interventions that may have contributed to their progress”.

Photo credit: GBD 2015 SDG Collaborators

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Canadian College of Health Leaders (CCHL) BC Lower Mainland Chapter and Emerging Health Leaders are pleased to offer a mentorship program for 2016-17.

This fall, CCHL’s BC Lower Mainland Mentorship Committee will be launching a personalized matching program to match local future health care leaders with senior executives.

The mentorship program will be kicked off with the CCHL/EHL Mentorship Networking & Membership Appreciation event on Thursday, October 20th, 2016 at the UBC Golf Club, with guest speaker Karin Olson, Chief Operating Officer, Vancouver Coastal Health.

• Mentors are defined as experienced health care professionals, with more than 7 years of health care related work experience. Mentors are not required to be CCHL members.
• Mentees are defined as students currently within a health-related leadership program (such as the MHA, MBA, EMBA programs) or working professionals within their first 5 years of work experience in a health care sector.
• Mentees must be either EHL or CCHL members. Matching will be based on interests, geography, and mentoring goals.
• Participants are asked to commit to 2-3 hours per month, between October 2016 and June 2017.
• Matches will be notified by October 14, 2016.

 
MHA students interested in participating as a mentee must fill out the application form by Friday, September 30, 2016.

Writer: Shannon Pidlubny

After media coverage of Professor Kay Teschke’s research on cycling crashes on streetcar or train tracks, SPPH got an update from Dr. Teschke about the response to her research and her future work in this area.

What has been the response been to your research, published in BMC Health in July?

The article has been shared on Twitter in places such as England and Germany, and in Portland and Seattle, from city planners to engineers.

The majority of the responses have been from Toronto. The findings were not a surprise for cycling advocates, or for those working in emergency rooms, who see the aftermath of cyclists getting into crashes on streetcar tracks.

I have also been contacted by an engineer and city planner who has been involved in designing new cycling infrastructure in Surrey who said that the research helped to reinforce what the City has already planned for, including incorporating cycling infrastructure into the Light Rail Transit project with design features that minimized cyclists from interacting with the tracks.

What should city planners consider when planning bike paths across streetcar tracks?

Professor Kay Teschke

When designing new infrastructure for cyclists, the safest routes are those in which bikes lanes are separated from traffic and streetcars. In cities with streetcars or trams, dedicated rights of way, or separated bike lanes, allow people to cycle without interference from tracks. Having separated bike lanes also means not having crashes with motorized vehicles.

In terms of cost, even the most expensive bike path is less expensive than building new roads for cars and is less expensive to maintain.

Could your study demonstrate the importance of population health measures?

Surveys have found that people are more motivated to use their bikes to commute, or for pleasure and exercise, when the infrastructure is in place.

Having separated bike lanes is primary prevention – it prevents injury from happening in the first place. But it also demonstrates primary prevention of chronic illness, and obesity, because having infrastructure, such as separated bike lanes, promotes cycling and exercise. Riding next to traffic is a deterrent for many people, especially women and families.

Are you planning other research projects in this area?

I am currently looking at Vancouver and Montreal census data to determine if people are more likely to use their bikes to cycle to work based on the number and type of bike paths in their community. I may also look at ICBC data to examine cycling injuries at traffic circles.

Is infrastructure the future of cycling?

When municipalities put in great cycling infrastructure it can solve problems that are much more difficult to deal with by trying to educate every individual cyclist and driver. For example, cyclists are often injured when they crash into a car door. To reduce ‘dooring,’ municipalities either have to work to change the behavior of the driver of the car, the behavior of the cyclist, or both. But instead, if municipalities put in protected bike lanes then those crashes will not happen. Great cycling infrastructure prevents catastrophes from the mistakes people make.

Photo credit: Ken Ohrn

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Working with a public health physician almost 25 years ago set Associate Professor Amee Manges on her path to specialize in molecular epidemiology. “I thought, ‘This is great. You can really make a difference in the world.’”

A love of science helped push Dr. Manges towards the field, as it allows people to adapt tools and techniques from basic science to answer questions relevant to the health of populations, such as why some people become seriously ill from a bacterial infection while others do not.

Dr. Manges’ work looks at how microorganisms living in the gut affect people’s health, an emerging field that needs more investment, she says. The tools molecular epidemiology is developing, such as bio measurements, and sequencing of metabolites, gives researchers the ability to measure and delve into the origins of disease and risk, speeding up progress in developing prevention techniques. An example of recent work in animal studies was the investigation of the gut-brain connection, where research suggested bacterial metabolites could access the brain and influence mood, raising questions about how this might change standard mental health epidemiology, should it be found to occur in humans, Dr. Manges said.

A highlight of Dr. Manges’ career has been the SHINE trial, looking into child health and development in Zimbabwe. Slated for completion in 2017, the project looks at stunting in children and aims to test whether a combination of nutrition, and water sanitation and hygiene, can improve the growth of infants. Her work involves measuring the microbiota in babies and mothers, as changes in the functioning of this community of organisms could be important to how babies grow.

“As a public health study, you couldn’t work on a better project. Everyone comes into this field thinking you’re going to make life better for people, and here’s a study that has the chance to help babies grow and reach their full cognitive potential.”
Associate Professor Amee Manges

Having completed her Master of Public Health (MPH), and then PhD, at the University of California, Berkeley, Dr. Manges has been the SPPH MPH program director for about four years, and says she still cries at every graduation ceremony, thinking about the potential in that moment, and how many choices her students face. It is one of the best programs on offer thanks to its connections to public health practice in the province, Dr. Manges says.

Teaching at SPPH has also led to some fond memories, including witnessing students who are struggling with a topic at the start of the term surpass all expectations through hard work and connecting with peers.

“They absolutely shine.”
Associate Professor Amee Manges

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Professor Carolyn Gotay accepts the award from Dr. Dermot Kelleher

School of Population and Public Health (SPPH) faculty and staff were recognized at the Faculty of Medicine awards reception, with an Applegarth Staff Service Award and three Distinguished Achievement Awards.

The Faculty of Medicine Distinguished Achievement Awards are given to individuals whose performance during the last assessment year was particularly meritorious. The reception was held on 5th October and the awards were presented by the Dean, Dr. Dermot Kelleher.

Professor Carolyn Gotay accepted a Distinguished Achievement Award for Service to the University and Community in recognition of significant contributions to local, national, or international communities aimed at improved health outcomes of the population. Dr. Gotay’s long career in cancer prevention and control research includes leadership roles in academia and in the community. Dr. Gotay said being able to contribute to the University and community organizations was one of the most rewarding aspects of her work, and she appreciated being recognized for this.

Associate Professor Eugenia Oviedo-Joekes accepted a Distinguished Achievement Award for Excellence in Clinical or Applied Research in recognition of outstanding clinical or applied research and scholarly contributions.

Dr. Oviedo-Joekes and Dr. Gotay

Dr. Oviedo-Joekes is also a research scientist in the Centre for Health Outcomes and Evaluation Sciences (CHEOS), a Michael Smith Foundation for Health Research Scholar, and a CIHR New Investigator. Dr. Oviedo-Joekes said the award was important because it recognized the work that the School and the Faculty of Medicine had been doing for many years, in partnership with Providence Health Care, which had demonstrated that treatment with injectable opioids in supervised settings kept patients safe and provided daily opportunities for comprehensive care.

“This award shows the Faculty of Medicine’s concern for an important minority of the most vulnerable and underserved members of our communities struggling with heroin dependence.”
Associate Professor Eugenia Oviedo-Joekes

Dr. Martin Schechter

Professor Martin Schechter, who received a Distinguished Achievement Award for Overall Excellence – Senior Faculty in recognition of outstanding contributions in the areas of research, education, and service, was not able to attend the reception, but said he was deeply honoured to receive the award. Dr. Schechter is Founding Director of SPPH, where he also holds a Tier I Canada Research Chair in HIV/AIDS and Urban Population Health. He is co-Director of the UBC Centre for Excellence in Indigenous Health, Founding Director of the Canadian HIV Trials Network, and Founding Director of the British Columbia Centre for Excellence in HIV/AIDS.

“There is no greater recognition than ones you receive from your peers. I am extremely grateful.”
Professor Martin Schechter

From left: Dr. Derek Applegarth, Winona Kent and Dr. Dermot Kelleher

“Part of the wonderful thing about this job is that I’m always improving and learning new things, and I’m allowed to be innovative and creative as part of problem-solving.”
MSc, PhD and MHSc Programs Assistant Winona Kent

Ms. Kent said she had had a wonderful manager over the past five years who had encouraged her to work with an independent mind and trusted her to undertake increasing responsibilities. Ms. Kent said she was proud to receive the award, which recognized her years of work at SPPH, and ability to step in and provide support, knowledge and assistance when needed.

Congratulations to all our award winners!

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Research by School of Population and Public Health (SPPH) alumnus and faculty has concluded that the impact of physician incentives on mental health care has been “modest”, and it is time to explore other approaches.

Published in September in Medical Care, the study looked at linked health data for eligible B.C. residents diagnosed with major depression between January 2005 and December 2012, divided into monthly cohorts, and tracked their use of mental health services for 12 months following initial diagnosis.

The research used six indicators to measure the impact of the physician incentives, which took effect in 2008 and were intended to recognize the investment in time and skill such patients require in GPs, and to improve patient care, according to the GPSC. The six indicators included minimally adequate antidepressant therapy [MAAT], defined as 84 or more days of AT, and minimally adequate counseling/psychotherapy [MACP], defined as four or more CP sessions.

Lead author Dr. Joseph Puyat

The research found that five years after the incentives were introduced, the percentage of people who received at least one session of CP increased by 3.3 percentage points and the percentage of people who received AT decreased by 4.5 percentage points.

The percentage of people who received MACP rose 1.8 percentage points, a “surprisingly low” impact over time, suggesting other barriers to receiving MACP than financial disincentives, the authors said.

The percentage of people who received MAAT dropped by 2.2 percentage points five years after the incentives were introduced, a finding that the authors did not expect and which they suggested could be due to physician incentives discouraging the provision of non-incentivized services.

The authors concluded that physician incentives had a modest impact on mental health care.

Lead author Dr. Joseph Puyat, an SPPH alumnus, said the research showed it was time to explore other approaches to addressing that gap in mental health care. While there had been an impact, it would not have a substantial effect in closing this gap, he said.

“I think it’s about time that other evidence based interventions be explored at the population level.”
Dr. Joseph Puyat

Other interventions currently being investigated include team-based and collaborative care models, he said. Physicians were already overloaded and might not have the time to do the work required. “We can only stretch physicians to a certain extent.”

Professor Arminée Kazanjian

“Adding a few fee items to the list of what GPs can be paid for some additional time for patients with MDD will not address a major structural issue: ease of access for younger and older patients to multidisciplinary health professionals for counseling /psychotherapy and adequate follow-up.”
Professor Arminée Kazanjian

SPPH Associate Professor Hubert Wong is also a co-author of the article.

Photo credit: iStock

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Click here to view the embedded video.

New resources are targeting UBC students for cancer prevention, providing advice and tips about lifestyle choices that could help prevent cancer.

About half of cancers potentially could be prevented, according to the Centre of Excellence in Cancer Prevention, based in the School of Population and Public Health at UBC.

Centre researchers and staff have developed ‘Cancer Prevention 101’, six online modules providing advice about lifestyle choices that can help prevent cancer, such as healthy eating (‘Try to limit red meat, and avoid processed meats’), exercise (‘At least 150 minutes of moderate activity per week can help reduce your risk of colon, breast, and uterine cancers’) and alcohol consumption (‘Try to find healthy outlets to cope with stress, such as going for a walk, or doing yoga’).

Education director Melissa Ashman

The modules target UBC students, providing tips specifically for those at the Vancouver campus, such as places to buy fresh vegetables (UBC Farm Markets) and links to UBC Health Services’ stress busting advice, as well as quizzes, videos, and links to further information, such as the Canadian Cancer Society.

The content is evidence-based, and collates some well-known – in cancer prevention circles – facts, presenting them in a student-friendly way, said Centre education director Melissa Ashman.

University could be a time of great change, and a period when students formed habits for a lifetime, she said. “Healthy habits adopted in university could prevent cancer in the long term, and while change can be hard, the modules have been designed to provide easy options for taking small steps.”

“It’s never too early or too late to start thinking about preventing cancer.”
Education director Melissa Ashman

Professor Carolyn Gotay

“These videos provide users with tools that can help to reverse these trends and prevent cancer in the future.”
Professor Carolyn Gotay

The modules were user-tested six students at the Vancouver campus and six at the Okanagan campus. Angelica Leon, a Master of Science student at the School of Population and Public Health, provided feedback on the modules in late July, and said they provided useful information in an engaging way, with enough information to get the facts without boring readers.

Mrs. Leon said students were making decisions for themselves about lifestyles, and it was important that these were smart decisions when it came to subjects such as healthy eating.
“It’s really important to start making these decisions young.”

Another tester was doctoral student Molly Sweeney Magee, who said the modules were a good way to start encouraging students to think about their habits now, and how these could affect their future cancer risks.
“Any reminder is helpful as well, to try to be healthy and be cognizant of future cancer risk.”

The modules provided key information with links to extra information, which was a good balance, Ms. Sweeney Magee said.

To access the modules, click here.

The Clinical Systems Transformation (CST) Project is seeking a Jr. Business Analyst for an internship position in Spring 2017. Details are outlined in the evalutation-team-job-description.

Apply by October 23, 2016.

Start Date and Finish Date: January 3, 2017 to April 28, 2017
Pay Level: $20/hr
Hours: 37.5 hours/week; 8:30 AM to 4:30 PM
Duration of Position: 4 months
Application details: Resume, Cover Letter and Transcript
Position: Jr. Business Analyst, CST Project, Vancouver Coastal Health
Cover Letter Address: Zahra Hirji, HR Jr. Business Analyst

More information regarding CST and Career Opportunities are online.

Written by BC Children’s Hospital

Researchers have reassuring news for parents and caregivers: within four months of an injury, most children have recuperated and enjoy the same quality of life they did before they got hurt.

The researchers, including School of Population and Public Health (SPPH) faculty and students, followed children treated for injuries at BC Children’s Hospital for one year and found even children with severe injuries had largely returned to their pre-injury quality of life within four months. Very few of the children showed signs of post-traumatic stress disorder.

“Understandably, many parents worry about the long-term impact of injuries on a child’s wellbeing. Our research has good news. Children are resilient and rebound quickly from injuries, even serious ones,” says SPPH Associate Professor Dr. Mariana Brussoni, the senior author of the study in Health and Quality of Life Outcomes. Dr. Brussoni is an Investigator at BC Children’s Hospital, an agency of the Provincial Health Services Authority, and is also an Associate Professor in the Department of Pediatrics at the University of British Columbia and an Academic Scientist at the BC Injury Research & Prevention Unit.

The study included 204 children and infants ages 0 to 16 treated at BC Children’s Hospital for unintentional injuries ranging from cuts and broken bones to major trauma that required hospitalization. Children and their caregivers completed surveys at the time of treatment and at one, four to six, and 12 months post injury. These surveys measured health related quality of life (HRQoL), a holistic measure of wellbeing that encompasses physical, psychological and social aspects of health. The survey completed at the time of the injury served as a baseline measure of the child’s HRQoL before the injury occurred. The researchers noted limitations of the study: the sample is made up of 30 per cent of the eligible population and has a lower proportion of low-income families.

The researchers found that at four months post-injury, most children’s overall HRQoL score had returned to its baseline level. At one month post-injury, older children and children who were admitted into the hospital had lower HRQoL scores compared to other children in the study; however, these children recovered at a faster rate, and at the four month follow-up their HRQoL scores were comparable to younger children and children who were treated in the emergency room and released.
In Canada, more than 207,000 children are hospitalized for unintentional injuries every year and more than 3.3 million are treated in emergency departments. This work provides reassurance to families and doctors who may worry about the lasting effects of an injury on a child’s emotional health and quality of life.

This study can also inform the debate about the trade-off between the risks and benefits of a physically active lifestyle for children. “Serious injuries from physical and leisure activities are relatively rare,” says Dr. Brussoni. “This research shows that even when children do get injured, they recover quickly. Parents and caregivers should be aware of the possibility of injury and take steps to prevent unnecessary risks, but they need not place excessive limitations on a child’s activities or feel guilty when an injury does occur.”

Funding:
This research was supported by BC Children’s Hospital Foundation, Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.

Key Collaborators:
• Dr. Mariana Brussoni: Investigator, BC Children’s Hospital; Associate Professor, Department of Pediatrics, School of Population and Public Health UBC; Academic Scientist, BC Injury Research & Prevention Unit
• Amy Schneeberg: UBC doctoral student supervised by Dr. Mariana Brussoni
• Takuro Ishikawa: UBC doctoral student supervised by Dr. Mariana Brussoni
• Sami Kruse: Researcher, BC Injury Research & Prevention Unit
• Erica Zallen: UBC medical student supervised by Dr. Mariana Brussoni
• Dr. Craig Mitton: Professor, School of Population and Public Health, UBC; Director, UBC Master of Health Administration; Senior Scientist, Centre for Clinical Epidemiology and Evaluation
• Dr. Julie Bettinger: Investigator, Vaccine Evaluation Centre, BC Children’s Hospital; Associate Professor, Division of Infectious and Immunological Diseases, Department of Pediatrics, UBC

Read more:
• Schneeberg A, Ishikawa T, Kruse S, Zallen E, Mitton C, Bettinger JA, Brussoni M. A longitudinal study on quality of life after injury in children. Health Qual Life Outcomes. 2016 Aug 26;14(1):120. doi: 10.1186/s12955-016-0523-6. PubMed PMID: 27561258; PubMed Central PMCID: PMC5000468.

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Hordes of flesh-eating zombies haven’t yet made the leap from the horror-movie screen to downtown city streets, but that hasn’t stopped two professors from the UBC school of population and public health from sharing tips on how to handle an invasion of the living dead.

Assistant professor Jennifer Gardy and professor David Patrick are taking part in a free public talk on October 21 to discuss how public health workers would diagnose, model and respond to a zombie virus. The talk is part of the school of population and public health’s Grand Round series and will feature faculty, students and guest speakers from UBC and the BC Centre for Disease Control.

Do zombies really exist and how likely is a zombie apocalypse?

JG: Absolutely! They’re just not the humanoid ones we recognize from movies. There are loads of zombie parasites out there in other species. While preparing for the rise of the undead is a little over the top, new diseases are emerging all the time, and thinking about how we’d prep for a zombie apocalypse is a great way of getting us thinking about more realistic disease scenarios, like a viral pandemic.

DP: In comparison, zombie behaviour is pretty unique, so we suspect that most emergency doctors would begin to ask questions. The difference with a zombie epidemic is the uncontrolled and aggressive behaviour of the zombie – that certainly increases the chances of transmission. This behaviour is reminiscent of animal and even human behaviour associated with rabies. The number of people that could be infected with a zombie virus would be highly dependent on the efficiency of transmission. Rabies is transmitted by a bite, but it’s not so efficient that it results in a giant epidemic in people.

How can the average citizen prepare for, and escape, a zombie attack?

DP: The first part of preparation is common to earthquakes and other disasters: make sure you have a survival kit. The more portable it is, like a loaded knapsack, the better.

In every other epidemic we’ve seen, infected people are not all running around exhibiting behaviour that would threaten others. So a zombie epidemic would raise a whole bunch of new ethical issues around our duty to the sick, the healthy, and the role of civil society in protecting itself. Movies aside, the medical imperative is clearly to get to the root of the problem, interrupt transmission, heal the sick, if possible, and protect the healthy. But we’d sure need to pay attention to building security!

How would we respond to an outbreak of the zombie virus?

JG: We use mathematical modelling techniques to understand how quickly a pathogen might spread – these same models are used in zombie movies when they’re showing the projected spread of the outbreak.

Remember that in any outbreak, rumours and misinformation will abound. Listen to public-health officials and heed their advice – you can trust that we’ll share everything we know with you.

Should you try and help an infected relative or friend?

DP: As long as this can be done while minimizing risk to yourself, it’s worth a try. The Ebola outbreak in West Africa, for example, could have been even worse. But people were able to put aside fear, employ rational measures for infection control, and care for the sick.

The ethical argument for sedating a zombie is pretty straightforward. As a physician I would sure want to know if I could protect others by isolating and, if necessary, sedating the zombie before I entertained vigilante solutions. “Any idiot can pump a shotgun” but a real healthcare worker is going to do what he or she can to preserve life.

What should you do if you get bitten by a zombie?

DP: Contribute to a natural history study or volunteer for a clinical trial.

‘The real public health science behind the zombie apocalypse’ will be held on October 21st at 9am in Michael Smith Laboratories, Room 102.