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Archive for the ‘Child Health’ Category

“DO NOT USE” signs plastered all over school drinking fountains have a way of getting the chilling message across. For the past thirty years, those signs have appeared, periodically, on fountains in thousands of Canadian K-12 schools. Most of us walk by, unaware – until recently — of a simmering public health crisis.

What was a largely dormant issue has come back with a vengeance.  The November 4, 2019 release of the findings of the massive year-long Canadian investigation, spearheaded by the Institute for Investigative Journalism, has raised new concerns over exposure to lead in home tap water and school/daycare drinking water supplies.

The “Tainted Water” series of news reports were alarming because many in education had assumed it was behind us. The benchmarks changed in March of 2019 when federal health authorities reduced the acceptable levels of lead from 10 parts per billion (ppb) to 5 ppb. Out of 12,000 tests conducted since 2004, in 11 different Canadian cities, one-third – 33 per cent—exceed the new health. safety standard. The latest investigation, based upon some 260 water tests conducted in 32 cities and towns and validated in accredited labs showed that 39 per cent of samples, or two out of five, exceeded the 5 ppb guideline for healthy water.

The current health alarm is serious, but needs to be considered in proper North American context.  Three to four million American children were found to have toxic levels of lead in their blood back in the 1980s. Levels of contamination were far higher in those days. The U.S. EPA reported that thirty-three of the 47 states testing drinking water had levels exceeding the then acceptable standard of 20 ppb.  Back then, most people, including young children, were exposed to multiple environmental sources, including paint on old housing walls, drinking water, ambient air, dust, soil, and food, particularly canned goods.

The 1988 U.S. Lead Contamination Control Act imposed strict new regulations on American schools requiring them to clean up their act by testing drinking water, abandoning lead-lined water coolers, and remedying any contamination found in taps and water intake pipes. It faced stiff legal challenges and a great deal of non-compliance and was eventually struck down in 1996 by a federal appeals court.

The first real school drinking water scare did produce a ripple effect and reactive responses which reverberated in school districts, from province-to-province, across Canada. What survived was a 1991 EPA established standard that required periodic tests for lead and copper levels in public water systems virtually excluding schools and day cares drawing water from their own wells. While the limit was reduced to 15 ppb, it applied to municipal water feeds rather than internal sources of contamination. In the case of schools, most of the lead still originates in lead pipes, water-cooler linings, and in led metal fountains and taps.

Medical science has advanced significantly over the past three decades, but implementation of health regulations lags, especially when it comes to testing for lead contaminants in schools and daycares. Coast-to-coast, the Canadian investigators identified a patchwork of lead regulations, weak oversight, laxity in conducting tests, and the relative absence of regular testing of homes, schools or daycares drawing water from wells.

When Health Canada cut the acceptable level of lead levels in half, it sent provincial and school district authorities scrambling, particularly outside the major metropolitan centres,  The new regulation came with warnings that, even at concentrations as low as 5 ppb, high levels of exposure can damage the prefrontal cortex, cause prenatal growth abnormalities, and contribute to anti-social behaviour and child behavioural problems. It has also been identified as a risk factor for hypertension, chronic kidney disease and tremors in adults.

Thousands of Canadian children in schools and daycares are at risk of ingesting lead in drinking water and most were totally unaware of that until the release of the latest journalistic expose. Provincial authorities, with the possible exception of Ontario and British Columbia, are playing catch-up, compared to a number of American states more proactive in testing and public disclosure.

The EPA promotes its “3Ts” approach – Training, Testing and Taking Action, complete with home and school water quality testing kits.  Since August 2016, New York State has required all school districts and boards to “test all potable water outlets for lead contamination, to remediate contamination where found, and to notify parents of children and the public of the results.”

The 2016 public health crisis in Flint, Michigan, intimately connected with the toxicity of water did not seem to register up here in Canada. Periodic warnings were issued to no avail by provincial public servants, according to newly-released government documents obtained through formal freedom-of-information requests.

Cleaning-up school drinking water standards is back as a top education priority. Whether it will last in a system best by competing immediate demands for reduced class sizes, more resource supports, and improved working conditions remains to be seen. Deferred maintenance has a way of coming back to bite school systems.

*An earlier version of this commentary was published in The Chronicle Herald, November 16, 2019 

Why is lead still in school and daycare drinking water, thirty years after the initial revelations?  Was the 2019 lead in the water scare the result of Health Canada’s decision to dramatically reduce the acceptable standards? How effectively did school and day care authorities respond?  Without a nation-wide investigative report, how much would we have known about the extent of the problem? 

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Measles outbreaks in the spring of 2019 in the American Pacific Northwest and British Columbia were part of a global revival of an infectious disease that had already affected thousands in Asia, Africa and Eastern Europe. In the wake of that outbreak, the BC Ministry of Health under Adrian Dix acted to require all parents to provide local public health units with their child’s immunization record before beginning school in September 2019. Twelve measles cases in Saint John, New Brunswick, in June 2019, prompted the Chief Medical Officer of Health Dr. Jennifer Russell to intervene to protect as many as 2,000 people exposed to the disease, ordering up 20,000 more doses of MMR vaccine, protection against measles, mumps and rubella.

Lagging childhood immunization rates are emerging as a major public health concern.  Periodic outbreaks of measles and mumps have alerted the public to the fact that childhood diseases, once virtually eradicated by vaccines, are reappearing in and around schools.

Vaccines remain one of the safest and most effective tools we have to protect ourselves, our families and our communities from infectious diseases. Those are not my words, but those of the Public Health Agency of Canada. The current reality is that we are not meeting our national immunization goals and too many children as well as adults remain unprotected and liable to experience illnesses from vaccine-preventable diseases that can cause serious health complications, some of which carry a risk of death.

Each year in April Health Canada raises the alarm during National Immunization Awareness Week and education programs are announced in an attempt to raise vaccination rates. Our Chief Medical Officer of Health, Dr. Robert Strang, makes regular appeals, most recently in August of 2019, to encourage parents to keep their children’s immunization records up-to- date.

The current strategy is not working in Nova Scotia where only 71 per cent of 7- year-olds are immunized for measles and mumps, some 15 per cent lower than the national provincial average and ranking last among the provinces. In New Brunswick, where it’s considered a “crisis,” the measles and mumps coverage rate at age 7 is 92.3 per cent.

While provincial health and school authorities in New Brunswick, British Columbia and Ontario are tackling it head on, Alberta and Nova Scotia are still vacillating on how to improve its abysmal childhood immunization rates. While Health Minister Randy Delorey dithered, PC Leader Tim Houston introduced a private member’s bill to try to force the government’s hand.

Sparked by the spring 2019 measles scare in the Saint John region, New Brunswick Education Minister Dominic Cardy has championed legislation that would make vaccinations mandatory for children without medical exemptions in provincial schools and day cares.

Taking a proactive approach to combating the resurgence of childhood diseases is becoming common right across Canada. Three years ago, Ontario introduced stricter childhood vaccination regulations and in British Columbia legislation requires the reporting of immunization records. Ontario has far higher rates of reported childhood immunization at age 7 than Nova Scotia. Yet, since 2016, that province has required student vaccinations be up to date unless a parent or guardian can provide medical, religious or philosophical reasons why their child has not received a vaccine. Even when exemptions are granted, families are required to watch a 30-minute video on the importance of vaccines and then sign a document saying they viewed the presentation.

Public health authorities hold sway in Nova Scotia, unlike in New Brunswick, where a proactive Education Minister is leading the charge to meet childhood immunization targets so schools do not become sources of contagion.

Nova Scotia Health Minister Delorey may be deterred by fears of stirring-up the radical anti-vaxxers and setting back the cause. He should be taking his cue from New Brunswick’s courageous Education Minister. Confronting a posse of opponents, Cardy called out the group as conspiracy theorists who “influence, mislead and deceive” parents into thinking their children are at risk if they are vaccinated.

Prominent among the N.B. protesters were former Halifax chiropractor Dena Churchill who recently lost her licence to practice because of her anti-vax campaigning, and California pediatrician Dr. Bob Sears, a well-known anti-vax advocate funded by Vaccine Choice Canada.

Vaccine adverse reactions do happen, but, on balance, immunizing children prevents far worse harms caused by the unchecked spread of childhood infectious diseases. School attendance is compulsory and, in that context, so should immunization aimed at safeguarding children’s health.

Minister Cardy stood his ground defending his legislative changes aimed at achieving the goal of 95 per cent coverage. Growing anti-vaccination sentiment, he claimed, was being fed by social media, and threatened to discourage parents from vaccinating their children, reducing immunization rates below a critical threshold that allows a community to resist an outbreak.

Playing nice does not seem to be working at raising childhood immunization rates. Scare stories spread by anti-vaxxers should not go unchallenged. Claims that vaccines are harmful, in Cardy’s words, are “not supported in fact.” “If you believe in evidence-based decision-making, you have to look at the evidence and the evidence is incontrovertible.”

Childhood diseases such as measles, mumps, diphtheria, pertussis, and rubella can do great harm if left unchecked by regular vaccination. With childhood infectious diseases making a comeback, is now the time to be vacillating on child immunization? Does the school system have some responsibility to ensure that immunization rates are high enough to prevent mass outbreaks in the community?  Should it all fall on provincial and local health authorities? 

  • An earlier version of this research commentary appeared in The Chronicle Herald, October 31, 2019.

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