CASE 15: When the Midnight Train is the First of Many: Dealing with Irregular and Unsafe Railway Crossings in the City of London

While visiting a local school, the mayor of London was asked a simple question by a grade three student: “why aren’t there flashing light barriers at all railway crossings that are close to the places where children play?” The mayor did not have an answer to this question or the many other questions that went along with it, but he knew something needed to be done. But what? And by whom? Rail crossings in London are typically prone to risk. In Canada, only 17% of all 17,000 railway crossings have gates, and the primary purpose of these gates is to control motor vehicles. London residents remain frustrated by the delays caused at rail crossings on busy commuter roads. Residents are also concerned about the lack of safety mechanisms at smaller, low-traffic streets. Trains fall into a jurisdictional triangle. Many organizations, local municipalities, and provincial and federal ministries are involved in building and overseeing railways. All parties must work collaboratively to improve safety on the more than 17,000 rail crossings across the country. Decisions about how to move forward with this issue are complex and require mass consultation from government agencies such as Transport Canada and from railroad companies such as Canadian National Railway, Canadian Pacific Railway, and VIA Rail Canada. Pedestrians need to be educated about the dangers of crossing railway tracks. Railway police often give presentations to children and educate them about the risks associated with public rail crossings and trespassing on railway property. In recent years, the number of railway police officers has declined. Cities such as London are no longer able to have police at rail sites. Something needs to change in the City of London and the surrounding area to improve rail safety and prevent further tragedies. Operation Lifesaver believes more education and awareness will help. Community members are pushing for the installation of more active systems but spending more money on rail safety is not always politically favourable. What needs to be done, and by whom, remains uncertain. With so many organizations and groups involved, it is difficult to determine who should ultimately be responsible for this dilemma. Because the reality of train safety in London is not changing, the need to address the concerns about this issue is essential. Unfortunately, London has several dangerous rail crossings that lack gates or other physical barriers to block the crossing. The main concern is the safety of pedestrians at these sites

Case 16 : When the Midnight Train is the first of many: Dealing with Irregular and Unsafe Railway Crossings in the City of London

While visiting a local school, the mayor of London was asked a simple question by a grade three student: “why aren’t there flashing light barriers at all railway crossings that are close to the places where children play?” The mayor did not have an answer to this question or the many other questions that went along with it, but he knew something needed to be done. But what? And by whom? Rail crossings in London are typically prone to risk. In Canada, only 17% of all 17,000 railway crossings have gates, and the primary purpose of these gates is to control motor vehicles. London residents remain frustrated by the delays caused at rail crossings on busy commuter roads. Residents are also concerned about the lack of safety mechanisms at smaller, low-traffic streets. Trains fall into a jurisdictional triangle. Many organizations, local municipalities, and provincial and federal ministries are involved in building and overseeing railways. All parties must work collaboratively to improve safety on the more than 17,000 rail crossings across the country. Decisions about how to move forward with this issue are complex and require mass consultation from government agencies such as Transport Canada and from railroad companies such as Canadian National Railway, Canadian Pacific Railway, and VIA Rail Canada. Pedestrians need to be educated about the dangers of crossing railway tracks. Railway police often give presentations to children and educate them about the risks associated with public rail crossings and trespassing on railway property. In recent years, the number of railway police officers has declined. Cities such as London are no longer able to have police at rail sites. Something needs to change in the City of London and the surrounding area to improve rail safety and prevent further tragedies. Operation Lifesaver believes more education and awareness will help. Community members are pushing for the installation of more active systems but spending more money on rail safety is not always politically favourable. What needs to be done, and by whom, remains uncertain. With so many organizations and groups involved, it is difficult to determine who should ultimately be responsible for this dilemma. Because the reality of train safety in London is not changing, the need to address the concerns about this issue is essential. Unfortunately, London has several dangerous rail crossings that lack gates or other physical barriers to block the crossing. The main concern is the safety of pedestrians at these sites

Case 3 : “School, Interrupted”

Due to the fact that there is currently no national youth mental health strategy, each jurisdiction is faced with managing and preventing mental health issues in their communities. Through school-based mental health interventions public health professionals have the potential to impact a large portion of youth in their community in a setting with which youth are already familiar. Susan Miller, a health promoter with the Great Lakes Public Health Unit, has been tasked with making recommendations about what type of mental health intervention should be implemented in the local elementary and high schools. The main objective of this mental health intervention will be to enhance protective factors among youth as well as to decrease the risk factors that can lead to developing further mental health issues in adulthood

CASE 14: Hiring a Competent Health Promoter: Can Competency Statements Help?

Saraz Frasier has been the manager of Special Programs and Healthy Communities at her health unit for the past five years. She is a true trailblazer within her organization. Saraz has helped transform her team into an innovative, progressive, and health equity-driven team. This team is responsible for promoting health, planning, conducting, and implementing health initiatives and health programs, working with community partners, developing policy, and reducing disparities within the community. Saraz has recently been tasked with hiring a new health promoter for her Healthy Communities team. This new hire will help lead Saraz’s team in health promotion and help plan special health programs. She is determined to find a candidate who will understand and contribute to her team’s current dynamic, work ethic, and equity-related priorities, and to the organization’s vision and desired culture change. The top three candidates were already interviewed this past week. Saraz now needs to decide who the best person is for this position. As she is thinking about finding a reliable way to evaluate and compare the three excellent candidates, Saraz opens her email only to find a webinar on the Pan-Canadian Health Promoter Competencies. It’s a sign! She will use the Competencies to evaluate and compare her three candidates in order to hire the best person for the job. The Pan-Canadian Health Promoter Competencies outline the skills, knowledge, and abilities that health promoters should possess to fulfill their mandate efficiently and adequately (Health Promotion Canada, 2015). These Competencies serve as a framework upon which health promoters, and others who work within health promotion, can base their work and practice their skills in targeting health, health equity, and the social determinants of health (Health Promotion Canada, 2015). Saraz can strategically use these competency statements to create a profile of the perfect candidate for the position, based on the skills, abilities, and knowledge that she requires, and then compare the three qualified candidates to this profile. The candidate who best reflects the Health Promoter Competencies and Saraz’s ideal candidate profile must be chosen soon, as these skills are required to undertake the type of work conducted by the exemplar Healthy Communities team at Saraz’s health unit. All three of Saraz’s candidates are competent, skilled, and knowledgeable. Saraz is looking for an innovative leader who possesses the required education and experience, and understands and values the complexities involved in public health. Saraz has to take one last look at her candidates, using the ideal candidate profile she has developed based on the Competencies, to determine who is most likely to best fulfill her expectations of a competent health promoter

Case 12 : Policy Meets Practice – People Who Inject Drugs (PWID)

Dr. Silverman is the Chief of Infectious Diseases at London Health Sciences Centre (LHSC) and St. Joseph’s Health Care in London, Ontario. He is concerned about the increasing prevalence of people who inject drugs (PWID) in London, and the risk to PWID of bacterial infections due to contamination (e.g., improperly or unsterilized injection equipment, skin not being sterilized before injection). Of primary concern is the risk of infective endocarditis (IE), an infection in a patient’s heart. Treatment for IE entails antibiotics administered through the intravenous (IV) route. IE is generally treated through home care; in London, the South West Community Care Access Centre (CCAC) is responsible for delivering home care. To treat IE at home, a patient would need a peripherally inserted central catheter (a PICC-line) and assistance from a CCAC nurse to administer the antibiotics. This option, however, is not viable for some patients, including those who fall under the category of PWID or who may not have a fixed address. In the case of PWID, the PICC-line, in effect, becomes a “highway” for injecting other drugs; in instances where a patient may not have secure housing or be homeless, the CCAC nurse may not be able to track down the individual. When a patient in one of these situations is being treated for IE, it puts the care team in a difficult position. The alternatives to home care are hospital admittance or no treatment at all, neither of which are ideal solutions. Dr. Silverman is currently in this position, as he must decide on a treatment plan for Mr. W., a patient who has IE, has struggled with drug addiction (the likely cause of his IE), and who does not have stable housing. In making his decision, Dr. Silverman has included on Mr. W.’s care team two other physicians from LHSC, a representative from the CCAC, and the managing director of London CAReS, a community-based housing-first organization. The care team must determine the best treatment plan for Mr. W

CASE 9: Gun Violence: A Public Health Issue?

Gun violence is a growing concern in the City of Toronto. The number of injuries and fatalities related to firearm incidents has been increasing at an alarming rate over the past six or seven years. The Stop The Bleed program is a secondary injury prevention program aimed at training laypeople how to respond during critical incidents to prevent fatal outcomes caused by massive bleeding. Along with the Centre for Injury Prevention at Sunnybrook Hospital, Sarah Smith, a registered nurse working in the hospital’s emergency department, has been given the opportunity to collaborate with multiple stakeholders, including the Black Creek Community Health Centre and the City of Toronto, to pilot a Stop The Bleed expansion program in the city’s at-risk communities. Sarah is aware that several complex variables intertwine to comprise this public health issue and she knows that a multifaceted approach is needed to try to stop deaths resulting from gun violence entirely. However, to determine whether the program expansion is feasible, Sarah must complete a comprehensive planning process that considers the facilitators and barriers to program implementation, including the stigmatization of at-risk communities