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Preventable Deaths

Five for fighting, three to six for mumps: Controlling disease outbreaks in the NHL (Part 1)


Editorial note: This piece was co-written by Atif Kukaswadia, PhD, and Ary Maharaj, M.Ed. Atif is a writer for the Public Health Perspectives blog on the PLOS network, and Ary is a writer for Silver Seven, an SBNation blog about the Ottawa Senators hockey team. This piece is being cross-published on both platforms. Enjoy!

INTRODUCTION

When we think of places for disease outbreaks, a few examples quickly come to mind: classrooms, college dorms, crowded trains. Another suggestion? The confines of the National Hockey League, where players are surrounded by literal blood, sweat, and tears. When you watch a hockey game, you’ll routinely see players spitting, swapping saliva through the sharing of water bottles, sweating — either through playing the game, using the same towel to dry themselves off, or rubbing their sweaty glove in another player’s face during a scrum. Add to this the intense travel and training schedule, along with the close quarters players are in between games, and this means that, among other things, the NHL is a breeding grounds for illness, even rare ones that do not generally permeate the public sphere.

 

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2017: What can we expect?

Following up from the end of last year, I thought it would be fun to predict what I think the next 12 months will have in store for us. So lets get to it!

1. Repeal of the Affordable Care Act

President Trump has already made it clear that this is one of his first priorities when he assumes office. The groundwork was already laid with the combination of the Senate passing a budget measure that was supported by Congress, and this week Trump issued an executive order to start rolling back the ACA. Now, the ACA is not without fault as we’ve discussed before; premiums have increased for many users, and the lack of true, universal coverage means many who don’t need coverage would rather pay the penalty than enrol. But repealing it without a replacement could be a disaster for many Americans. The Washington Post estimates that the repeal will kill more than 43,000 annually (based on this study in the NEJM). The impacts will be felt beyond the healthcare system though, with evidence from California suggesting that such a move could affect everyone involved with the health industry ranging from hospitals, food, and transportation services that all work together to provide patient care. Estimates from this study suggest up to 209,000 people would lose their jobs, and it would cost California over $20 billion dollars. It remains to be seen what replacement is offered, but the transition between the two is one that needs to navigated delicately.

 

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The only way to save Obamacare is to expand it

The Affordable Care Act was a landmark piece of legislation for the United States. While most other G-20 countries already have some form of universal healthcare (either through a single payer system, or mandatory insurance coverage), the US was one of the few countries that did not have one. Arguably, however, it didn’t go far enough, and therein lies its biggest problem.

One of the key provisions in Obamacare was that insurers could not deny coverage based on pre-existing conditions. This was a hugely important for those with serious or chronic illnesses, who would normally be denied coverage. For example, diabetes can cost someone approximately $7900 a year in direct medical expenses, which is a hefty sum if you don’t have insurance coverage. Obamacare mandating that these individuals, and others with similar conditions, have to be able to purchase coverage, is an excellent step forward. However, the business of insurance relies on those who enrol but do not require services subsidising those who enrol and do. In terms of healthcare, this would be low risk people paying and not using services, ensuring high-risk individuals are able to access services. As you can imagine, there is very little incentive for low risk individuals to enrol; a phenomena known as “adverse selection.”

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Which diseases do we get to “fight”?

About two weeks ago, the Hospital for Sick Children, also known as SickKids, launched their new ad campaign. For those who aren’t from Canada, SickKids is based in Toronto, Ontario, is the second largest children’s hospital in the world, and does some truly amazing and inspiring work. I highly recommend watching the ad, as the messaging and production quality is absolutely amazing. The imagery and symbolism is strong, and shows these children as fighters who will vanquish their foes. It shares more in common in terms of tone and imagery with NBA and NFL commercials than typical hospital advertisements.

I have mixed feelings on this ad campaign. On the one hand, it is meant to provide a strong, motivational message to children undergoing treatment, and to help raise funds for the SickKids Foundation. In this, it is wildly successful, with an ad that has been viewed almost half a million times (as of this writing), and one that has sparked lots of discussion. However, while the ad is motivational and empowering, it is not without fault.

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Is plain cigarette packaging just smoke and mirrors?

The Marlboro Man is one of the most iconic advertising images from the 20th century. The cowboy, depicted in some rustic setting, was single-handedly responsible for turning Marlboro’s annual sales from $5 billion a year to over $20 billion a year in the two years after the campaign was introduced. Since the success of that campaign, anti-smoking activists have tried several different ways to limit cigarette advertising. The latest salvo comes in the form of last week’s WHO statement on plain packaging, where they recommended plain packing as part of “comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.” Plain packing standardizes how cigarettes are sold, keeping the picture health warnings, but making the brand names, pack size, colour scheme all identical to limit their appeal.

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Basic Income: A radical idea for eliminating poverty

The Watson Arts Centre in Dauphin, Manitoba (photo from Wikipedia)
The Watson Arts Centre in Dauphin, Manitoba (photo from Wikipedia)

I imagine most of my readers have never heard of Dauphin, Manitoba. A small, farming community in Canada, Dauphin is a town that was part of an experiment back in the 1970s. The “mincome” project was launched in 1974, and offered everyone a minimum income. Unfortunately, the project was shut down in 1979 with a change in the government, and so the effects weren’t long term enough. The purpose of the mincome project was to see what would happen if a “top up” was offered to everyone. Dr. Evelyn Forget has been studying records from those years, and following up on people to see how it impacted their life. Would people stop working? Would there be higher rates of employment? How would people respond?

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Bullet Points: This article has no waiting period

In December of 2012, I was asked my thoughts on the Sandy Hook shooting on Twitter, and if I was going to write about it through a public health lens. I said no – I didn’t want to weigh in so soon, and I didn’t really know where to start. Sandy Hook capped off a year where 130,437 people were shot by firearms. Of these, 31,672 people died, with almost 60% listed as suicides. Since that exchange, there have been several more mass shootings (defined as 4 or more fatalities in one instance – not including the shooter), and I kept surfing the internet to explore the arguments on both sides of the gun control debate. As pointed out by Kathleen Bachynski over on The 2×2 Project’s series on gun violence, aptly titled “Fully Loaded“, if “measles or mumps killed 31,672 people a year, we would undoubtedly consider the situation to be a public health emergency.”

Smith_&_Wesson_Model_29_retouched
The Smith & Wesson Model 29 became a classic after the Dirty Harry movies starring Clint Eastwood were released

The issue is, I’m not inherently against owning firearms. Sure, I don’t understand it, and it makes little to no sense to me how owning a gun makes you feel safer given how every other country in the Western world doesn’t and they seem to be getting along just fine, but that’s not the point. Many gun owners own firearms for self-defence, but use them mainly for fun and recreation – shooting targets and hunting are two of the major uses. More importantly though, Americans don’t want to give up their firearms, and that attitude isn’t going away any time soon: Anyone who thinks advocating for a universal ban on firearms in the US is wasting their time.

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