The power to speak
Medical officers of health have special responsibilities and powers in the Canadian health system. Although they work for municipal, provincial and federal governments, many have the authority to speak out about health risks without having to get approval from elected officials.
Federal law, for example, gives Canada’s Chief Public Health Officer, Dr. Theresa Tam, the specific authority to “communicate with the public … for the purpose of providing information or seeking their views about public health issues.” This authority continues even during an election period, when the rest of the public service is under ‘caretaker’ restrictions.
The advice of one Medical Officer of Health is worth noting. The combined advice of all 14 has even greater significance.
Senior MOHs from the provinces, territories and federal system work together through the Council of Chief Medical Officers of Health. This council has spoken out about vaping twice this year – first on April 11 and then again exactly six months later, on Friday October 11.
Comparing these two statements allows us to see how these physician leaders have deepened their understanding of the vaping problem and how they have changed their recommended approach to managing it.
A much-needed statement in April.
Vaping products were legalized in Canada in late spring of 2018, and it was not long before parents, teachers and communities were coming to grips with this new form of drug use. By late winter, the federal government was signalling that it was open to changing the law, but in a cautious way.
In April the Council of Chief MOH seemed willing to speak of the problem with more urgency than Ministers of Health were expressing. “We are seeing an alarming number of youth vaping in Canada,” their statement read. “We cannot allow a new generation of Canadians to become dependent on nicotine and develop long-term risks to their health. We all have a role to play in protecting our youth..”
(How welcome this was for those who had been urging parliament to fix the problems with the federal law before the election, or even calling on the Minister of Finance to shoehorn an amendment into the Budget Bill.)
A strong stand in October.
Only 10 days before the federal election, the Council issued its second statement on vaping. This time, its analysis of the problem had deepened and its call for action was more focused on regulators. In this statement, the Council goes much further than it did in April, and acknowledges for the first time that:
- vaping is a gateway to tobacco use
- independent of tobacco use, vaping causes new public health challenges
- vapers inhale cancer-causing chemicals
- the compounds used in vaping products which are safe to eat (i.e. glycerol) may not be safe to inhale
- Canadians should refrain from using e-cigarettes or vaping products
- vaping is not recommended for pregnant women or adults who do not currently use tobacco products.
- laws on vaping products should include plain packaging, health warnings and regulations on the marketing and sale of products and flavurings.
Just as noteworthy were the ideas contained in the April statement which were dropped this month:
- switching comipletely to vaping is a less harmful alternative to smoking.
- putting the onus on youth, adults and health educators to manage the problem of youth vaping before putting the responsibility on government.
In its October statement, the Council of Chief Medical Officers of Health is now calling for the same policy changes as health groups have been promoting since the introduction of S-5, the parliamentary bill which became the new Tobacco and Vaping Products Act. Its warnings against using vaping products are stronger and clearer than those currently communicated to the public by Health Canada. It has moved away from encouraging smokers to switch to vaping to one of encouraging vapers to quit.
Let’s just hope that health ministers and ministries are listening!