Municipal Partners Research Articles

Implementation of the Montreal Heat Response Plan During the 2010 Heat Wave

The objective of this paper is to describe Montreal's heat response plan and its application during the July 2010 heat wave.The Montreal heat response plan is designed to ensure the surveillance of weather and health indicators during the summer season and to coordinate actions to be undertaken during this period to reduce morbidity and mortality due to heat, particularly when weather thresholds are reached or an increase in health indicators is observed. It was developed to coordinate and apply intervention measures on the Island of Montreal and has been in effect since 2004.In the beginning of July 2010, Montreal experienced a heat wave that lasted 5 days. During this period, health indicators such as total mortality, prehospital emergency transports, calls to the health information line and hospital admissions were monitored by the Montreal public health surveillance system. The decision to implement emergency interventions and actions performed by regional and local public health and municipal partners (intervention level) was made following attainment of a predetermined weather threshold and increases in health indicators. The significant increase in daily observed mortality from all causes and in particular people dying at home or in the community prompted the Director of public health to conduct a chart review of all people deceased from July 5 to July 11, 2010 to determine cause of death and underlying health conditions.During the heat wave, there were 304 reported deaths from all causes in Montreal residents, of which 106 were probably or possibly heat-related. Major underlying health conditions in heat-related deaths included cardiovascular problems and mental health illness. Furthermore, in the case of people with mental illness who died during the heat wave, the chart review revealed that many were contacted 24 hours prior to their death by health care professionals, family members, neighbours or friends.Following the 2010 heat wave, the Montreal heat response plan and heat surveillance system were updated to include initiatives to better communicate preventive measures to the vulnerable populations and to intervene earlier during a heat wave.

Collaborating to Compete—The Governance Implications of Stakeholder Agendas at Mount Pulag National Park, the Philippines

Regional planning has long sought to manage places that extend across political boundaries. The international trend to decentralize governance and promote co-management of protected areas is consistent with emerging collaborative spatial planning theory (Healey, 1997, 1999, 2006), which suggests that through dialogue, parties assert multiple cultural perspectives, share knowledge, and forge shared landscape values as the basis of decisions. As a form of collaborative spatial planning, co-management specifies shared resource management power between national government and one or more local or indigenous communities. Both approaches assume decentralized governance systems. Although critics fault collaborative planning for glossing over historical and cultural contexts, and for ignoring power in decision making, few case studies ask why partners participate or how specific decentralized governance institutions affect plan implementation. This paper draws from a study of co-management at Mount Pulag National Park, the Philippines—a shared indigenous cultural landscape that was to be managed by a board representing multiple local, indigenous, and national jurisdictions. Tracing road decisions by two municipal partners, the paper summarizes how and why major stakeholders adopted and then circumvented protective policies by building duplicative road projects across fragile forests. In this context of changing indigenous rights, the same decentralization laws that enabled co-management also rewarded competition and strategic behavior that weakened the collaborative and fragmented the shared landscape. The case demonstrates the need to interrogate, rather than assume the benefits of decentralized governance and to study why stakeholders participate before relying on voluntary collaboration to manage regional landscapes. The initial version of this paper was presented to the 2006 annual meetings of the Association of Collegiate Schools of Planning, Fort Worth, Texas.

SARS: lessons learned from a provincial perspective.

To say that SARS was a unique threat, and one that challenged public health and the entire health system in Ontario could be viewed as somewhat of an understatement. Never had the modern public health or the health care system been put to such a test or been put under such pressure to respond as during the two phases of SARS outbreaks earlier this year. The very uniqueness and stress that the SARS outbreaks placed on our system inevitably revealed the weaknesses and the areas where change or fortification in our public health defenses was needed in order for us to meet successfully future challenges. In Ontario, public health services are delivered locally by 37 public health units. Funding for public health services in Ontario is based on a mixed model with municipal and provincial partners contributing to the funding. While funding is referred to as “50/50”, in actual fact, the Province matches the municipal contribution, and goes further. An additional 10-15% of funding is made available through the Community Reinvestment Fund to offset the increase in municipal costs over the base year. The total funding for the public health sector has gone up by 55% over 5 years. SARS provides an opportunity for a re-examination of the funding arrangement as some local health units have had difficulty in obtaining funding at the municipal level. The absence of surge capacity, locally, provincially and nationally, in public health infrastructure came to the forefront during the outbreak. While many individuals volunteered for the response, other public health functions that they were engaged in had to be put on the back burner. The area of public health human resources has been the subject of many studies since 2001. Creating extra capacity takes time as public health professionals take a few years to train. For instance, a fully qualified public health nurse takes 4 years to train, a public health inspector 4 years, a public health physician 5 years post graduation. Therefore aggressive investment and strategic planning is needed to meet public health human resource needs. A cadre of trained communicable disease investigators has to be nurtured and made available for deployment on an ongoing basis. Other public health professionals should be cross-trained in communicable disease management to create additional surge capacity. Epidemiological training is offered nationally through Health Canada. 1 During the outbreak, the immigrant health resources pool was used successfully. The vast majority of the two provincial rapid response teams assembled were international medical graduates at differing stages on the pathway to qualifying as physicians in Ontario/Canada. Some of these individuals are now considering public health as a career. In Ontario, the information technology system in place since the late 1980s was the Reportable Disease Information System (RDIS). 2 Nothing came of the efforts of a steering committee who undertook to modernize this system in the mid 1990s. The arrival of the integrated Public Health Information System (iPHIS) at the turn of the millennium aroused an interest in Ontario, and a formal commitment to its rollout was made in the spring of 2002. Implementation was planned for the spring of 2003 on a staggered basis. SARS challenged the planned start up. However, an iPHIS module was developed and used in April 2003 during the SARS outbreak. At the time of writing, British Columbia