PROVINCE OF BRITISH COLUMBIA Sixty-eighth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH Department of Health Services and Hospital Insurance YEAR ENDED DECEMBER 31 1964 1 Office of the Minister of Health Services and Hospital Insurance Victoria, B.C., January 21, 1965. To Major-General the Honourable George Randolph Pearkes, V.C., P.C., C.B., D.S.O., M.C., Lieutenant-Governor of the Province of British Columbia. May it please Your Honour: The undersigned respectfully submits the Sixty-eighth Annual Report of the Public Health Services of British Columbia for the year ended December 31, 1964. Department of Health Services and Hospital Insurance (Health Branch), Victoria, B.C., January 21, 1965. The Honourable Eric Martin, Minister of Health Services and Hospital Insurance, Victoria, B.C. Sir,—I have the honour to submit the Sixty-eighth Annual Report of the Public Health Services of British Columbia for the year ended December 31,1964. The Department of Health Services and Hospital Insurance consists of three branches—the Health Branch, the Branch of Mental Health Services, and the British Columbia Hospital Insurance Service. Each of these is headed by a Deputy Minister under the jurisdiction of the Minister of Health Services and Hospital Insurance. The chart on the other side of this page deals only with the Health Branch. For convenience of administration, the Health Branch is divided into three Bureaux. The Deputy Minister of Health and the Bureaux Directors form the central policy-making and planning group. The divisions within the Bureaux provide consultative and special services. The general aims of the Deputy Minister with his headquarters staff are to foster the development of local health services, to provide advice and guidance to those local health services, and to provide special services which cannot, for economic or other reasons, be established on the local level. Included in these are the special services provided by the Divisions of Tuberculosis Control, Venereal Disease Control, Laboratories, Vital Statistics, Public Health Engineering, Public Health Edu- Direct services to the people in their communities, homes, schools, and places of business are provided by " local public health personnel." These fall into two broad groups. In the metropolitan areas of Greater Vancouver and Greater Victoria they are members of the city and municipal health departments, which, in these two cases, do not come under the direct jurisdiction of the Health Branch. (However, they co-operate closely with the Health Branch and, through it, receive substantial financial assistance with services from the Provincial and Federal Governments.) Throughout the remainder of the Province the " local public health personnel" are members of the health units (local health departments), which are under the jurisdiction of the Health Branch. A health unit is defined as a modern local health department staffed by full- time public health trained personnel serving one or more population centres and the rural areas adjacent to them. Outside the two metropolitan areas mentioned above, there are 18 such health units covering the Province from the International Boundary to the Prince Rupert-Peace River areas. TABLE OF CONTENTS General Statemen Bureau of Administration.... Division of Vital Statistics Division of Public Health Education- Accounting Division Bureau of Local Health Services Bureau of Special Preventive and Treatment Services- Division of Tuberculosis Control Division of Venereal Disease Control Division of Laboratories Division of Occupational Health Registry and Rehabilitation Services Sixty-eighth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH Department of Health Services and Hospital Insurance YEAR ENDED DECEMBER 31, 1964 The Health Branch, as an integral section of the Department of Health Services and Hospital Insurance, is charged primarily with the protection of the public health of the Province. In pursuit of this goal it is required to develop, supervise, and direct a broad range of services in the interests of prevention of ill health and the encouragement of positive health. This Report relates the significant tasks involved in that objective. THE PROVINCE AND ITS PEOPLE The number of people in the Province has been gaining at an increasingly rapid rate since the 1961 Census. In 1962, 30,000 people were added to the population, in 1963, 36,000, and in 1964, 43,000, a proportionate increase of almost 7 per cent within three years. The 1964 mid-year figure of 1,738,000 is very nearly twice the 1942 figure of 870,000. Indications are that the growth rate is continuing at a high level. As the birth rate is declining, it can be assumed that immigration must be a major factor in the population growth. In actual fact, the number of births has shown a consistently downward trend since the record high of 1960, when a rate of 25.0 per 1,000 population was created by the birth of 40,116 babies. Preliminary figures indicate that in 1964 a rate of 20.7 was recorded, the lowest in the last 20 years. This may seem curious in a world that is experiencing a population explosion. It has been customary to assume that the reduced mortality from disease had been responsible for a rapidly rising world population and consequent overcrowding. This is true for the developing countries in which dramatic decreases in the death rates have not been accompanied by corresponding declines in the birth rates. In the economically advanced countries, however, the birth rates and the death rates had reached moderately low levels some years ago, and the recent declines in both these rates have not greatly affected the rate of natural increase. In this Province the general mortality rate has been gradually declining since the high of 11.1 in 1943, and reached close to a record low of 8.9 per 1,000 population in 1963. In 1964, available figures establish a rate of 9.2, a very slight increase. Marriages were maintained in a frequency approximately the same as for the last year, with a rate of 6.9 per 1,000 population, thus coinciding exactly with the rate of the previous year. This is not particularly significant, except that it is considerably below the peak rate of 12.5 established in 1941 and, of course, that it is a factor in the lower birth rate currently being experienced. The preliminary infant mortality rate per 1,000 live births this year was 23.1, a slight decline from the 1963 figure. It appears that the number of maternal deaths occurring in 1964 will be a record low, preliminary figures showing that only four occurred for the year. 1 PUBLIC HEALTH SERVICES REPORT, 1 Twenty years ago there were 50 such deaths recorded, and when it is realized thatB the number of births then was about half the number now, the significance of thisB decline becomes even more apparent. There was a slight increase in the total number of deaths, which led to the establishment of a crude death rate per 1,000 population of 9.2. The rate of deaths 1 from diseases of the heart was 353.9 per 100,000 population in 1964, the highest I point for some years and well above the 1963 rate of 334.2. Malignancies re- 1 corded a considerably higher than usual rate of death at 163.8 per 100,000 popu-1 lation, the highest ever registered. The 1963 rate was 156.4. The conditions I referred to commonly as strokes or apoplexy also recorded a higher rate of deaths this year than last with a rate of 99.8, the third successive year of increase. While not quite equivalent to the low figure of a year ago, the accidental death I rate for 1964 was only a little higher, there having been 63.6 accidental deaths per I 100,000 population in 1964 as compared to 62.4 for the previous year. The ] proportions of accidental deaths ascribed to the various specific causes were not ] greatly changed. Thirty-six per cent of these deaths resulted from motor-vehicle 1 accidents, while 16 per cent resulted from falls and 9 per cent from r. Drownings created 12 per cent of the accidental deaths, and fires w factor in loss of life in 5 per cent of the accidental deaths. There is little reason for pride in the record in venereal diseases. British ] Columbia achieved notable success in reducing the high incidence of venereal disease during the war and post-war years. Now there is a reversal in a field which in most parts of the continent was all too complacently considered under control. Infectious syphilis involved 56 cases in 1960, 64 cases in 1961, 183 cases in 1962, 280 cases in 1963, and 304 in 1964. The incidence of gonorrhoea, which attained a record low in 1955, has been climbing slowly until the last two years, when there was a sudden dramatic upsurge, with 5,012 cases in 1963 and 5,816 in 1964. This means that gonorrhoea has attained a record high, while the incidence of infectious syphilis was the highest recorded since 1947. While the greatest increase is in the 20-39-year age-group, nevertheless the rate in the younger age-groups is increasing also. The incidence is not occurring uniformly throughout the Province, as is evidenced in the following table:— GENERAL STATEMENT Gonorrhcea Infectious Syphilis Number Rate Number Rate East Kootena- I gi I w^fc^. — ?„°_h ny^8™ fil Upper Fraser 's'S Upper Wand ~ ~ J 27~_1 5,816 334.6 304 This reveals the highest incidence to be occurring in the northern areas of the Province, in the Cariboo, Skeena, Peace River, and Northern Interior Health Units in so far as gonorrhoea is concerned, with an unexplainable high rate of infectious syphilis for the South Central Health Unit. When these diseases were at a former peak, there was a concerted effort by medical, legal, law-enforcement, church, and public health groups in a case-finding, contact-tracing, treatment, law-enforcement, and educational drive. This produced beneficial results. Then penicillin came into popular use and the efforts were relaxed, because of reliance on the efficacy of a drug as the perfect control agent. This position must now be re-examined. Penicillin has not lost its effectiveness, but the social attitudes of the community may have changed. What can be done about it? Certainly, the health profession cannot be expected to supply the complete solution; it can only deal with one factor of a much more complicated situation. Each community will have to marshal its ests on the more general social issues. Concurrent with the rise in venereal- ise rates, there is a consistently increasing illegitimacy rate. Numbers and Rates of Illegitimate Births, British Columbia, 1960-64 1960 .. 1961 .. 1962 1963 .. 1964 _ 2,673 2,680 2,804 . 3,079 . 3,3601 66.6 69.5 73.5 It must be recorded that these figures relate to illegitimate births to both single and married women, and that illegitimacy is not necessarily confined to unmarried mothers. The table is a further reflection of an unfavourable trend in social morality, justifying a community examination into social trends among the population. q 12 PUBLIC HEALTH SERVICES After a year of complete freedom from paralytic poliomyelitis, one severe case j occurred this year in a non-vaccinated middle-aged male, emphasizing that this I disease will arise in a community unless immunization is maintained. During the 1 year the oral poliomyelitis vaccine programme was completed, and everyone j throughout the Province has now had an opportunity to avail themselves of three I doses of Sabin vaccine. Just under 500,000 people, amounting to about 30 per cent 1 of the total population of the Province, accepted immunization, while more than 75 1 per cent of school-aged children have now been given protection. It has not yet been j decided how frequently a reinforcing dose of this vaccine will be necessary, but the maintenance of a community immunity status will become a feature of the routine j immunization programme for the future. Infectious hepatitis appears to be on the wane, as indeed it is all over North i America. In 1962 there were 1,889 cases reported, while last year the total had dropped to 1,736, and for this year a further reduction to 1,054 is recorded. It is j felt that the reporting of clinical cases of this disease is fairly good because of the j physicians' awareness that it was assuming epidemic proportions, and because the Health Branch makes free gamma globulin available to family contacts. At this time a Province-wide study is being carried out to determine the optimum dose of this relatively scarce and expensive prophylactic. Five cases of typhoid fever were diagnosed this year, which remains slightly below the average for the past years. Most cases occurred due to the presence of healthy carriers who can excrete this organism intermittently for years. Few, if any, cases occur now in this country from contaminated milk or water, and every year one or two more healthy carriers are located, these people generally being unaware of their unfortunate ability to spread typhoid fever. The incidence of bacillary dysentery, which has caused considerable concern over the past four or five years, decreased in 1964. There were 131 reported cases of bacillary dysentery, which may be contrasted to 169 in 1963 and 1,192 in 1960. There were no cases of diphtheria reported in the Province this year, and the incidence of healthy carriers, recognized from throat swabs taken at random, has not increased, as is the case in certain of the Prairie Provinces. Immunization in this field nevertheless must be maintained. Botulism caused one death in 1964. As in the past, this resulted from the eating of fermented salmon roe, a traditional native Indian delicacy. Fortunately this food was confined to family groups rather than to a large group, in which a much more serious situation might have resulted. Scarlet fever and streptococcal sore throat infections seem to appear in cyclic outbreaks. The relatively high incidence arose in 1950 with well over 4,000 cases, but since then there has been a steady decline to 969 cases for this year. Fortunately in recent years this infection has been relatively low in severity, but one danger remains in that a proportion of the children who contract the infection may develop rheumatic fever complications with resultant heart damage. For that reason a rheumatic fever prophylaxis programme was introduced in 1958 and has been continued. At the moment there are 1,200 children being carried on this programme. A careful study of the recurrences while under prophylaxis indicates that the failure rate approximates 3.7 per cent, which is similar to the rate in one of the most carefully controlled programmes on the continent carried out in New York City. There is little doubt that the programme obtains results in prevention of cardiac damage among this group, allowing them to attain maturity in as healthful physical state as possible. Dentally the health status of the people of the Province, and especially the children, is far from ideal. For example, the average 7-year-old child has been GENERAL STATEMENT Q 13 I shown to have 6 of his 20 deciduous teeth attacked by decay, and for close to 40 per I cent of this age-group no adequate treatment of these decayed teeth has been under- I taken. As the child increases in age, the number of decayed teeth is increased, and I in the average 15-year-old there are nearly 12 of the 28 permanent teeth exhibiting I dental caries. In this same age-group, 17 per cent of the children were noted to have I disease of the gums and 35 per cent to have " severe " malocclusion to the degree I that they were in obvious need of orthodontic treatment. Prevention of dental dis- [ ease is the only rational solution—research the only hopeful approach. Conven- I tional methods of repair require unobtainable numbers of dentists. Neither this nor [ other countries of the world can hope to provide enough dentists to control dental disease by therapeutic measures alone. ENVIRONMENTAL POLLUTION Public health has traditionally concerned itself with the tangible causes and I effects of disease but it is fast becaming clear that other potential hazards to man are arising from our technological advance, which is promoting a variety of changes in ! our environment. Some are good; some may be even harmful. In any event, as a Health Branch it becomes necessary to become better informed on the effects of air pollution, water pollution, pesticide exposure, and ionizing radiation, which are the predominant hazards presenting themselves at the moment. In the matter of air pollution, at least in so far as British Columbia is concerned, there are not enough facts to make completely rational decisions on it as a factor in health. Nobody has ever proved that long-time exposure to air pollution can cause disability or chronic illness. However, it may a cumulative effect in encouraging lung disease. Industrially the Province is yet a comparatively young society, but exposure to air contaminants is creating obnoxious discomfort to some communities. Each of us breathes in about 15,000 quarts of air per day; that is about 55 pounds—8 to 10 times as much as our intake of water and food combined. Everyone in our modern civilization contributes to air pollution. There is no such thing as a small amount of air pollution. Perfectly clean air is unobtainable, but cleaner air is definitely obtainable. Clean air costs money; dirty air costs more. Action toward control is probably justified. Some moves have begun. Comparative studies of respiratory conditions in heavily exposed and moderately exposed populations e being undertaken. The latest addition to air pollution is radioactive fallout, which is merely one factor in the total problem of ionizing radiation. Investigations of risk to community health have become a major activity of the Division of Occupational Health. This Division checks on X-radiation sources, control of radioisotopes, film monitoring, and radioactive fallout. Understandably it is this latter item of fallout that arouses the greatest amount of public interest, and yet it is but a minor item of radiation exposure. Probably the effects are small compared with those from automobile and industrial exhausts. Anyway, there is not much that can be done about radioactive fallout but live with it; it is an international matter which can only be settled internationally. Nevertheless, it is an item on which information must be maintained. The actual monitoring and reporting on radioactive fallout is handled by the Radiation Protection Division at Ottawa, which employs experienced physicists and technical personnel best able to advise on this highly specialized subject. In then- view, fallout must be kept in proper perspective with all other forms of radiation exposures. Measurements of fallout reached peaks in the spring of 1963 and then gradually decreased. However, the recent testing of the first Chinese nuclear weapon revived concern. Fresh fission materials were detected in Canada within q 14 PUBLIC HEALTH SERVICES REPORT, 1964 three days after the Chinese blast, but within a couple of weeks the values were 1 settling down again. Reports on the situation become available monthly and are j carefully reviewed. From time to time there have been suggestions that the Province | should embark on a Provincial monitoring radiation service, but it does appear that j this would be needless duplication in a highly technical field that seems to be adequately monitored now by a well-qualified staff within the National department. While air pollution is attracting some interest, the matter of water pollution is 3 becoming increasingly important. Some years ago a Pollution Control Board was j set up with the objective of controlling the amount of industrial and domestic con- j tamination escaping into the surface waters of the Prov'nce. The role of the Health ] Branch in these activities has been to provide the public health engineering service, ] and this has been increasing year by year in keeping with the industrial growth within ] the Province. Another possible threat arises through the ever-increasing use of pesticides. ! Like other elements that influence man's environment, they have both real values and potential hazards. The challenge in their use is to ensure an adequate supply of safe, wholesome, nutritious food, and sanitary living conditions free from pest-borne ] diseases, and at the same time prevent hazards to the health of man and animals. Pesticides are a modern necessity. In this Province there is no concrete evidence of human harm from pesticides to any degree; there has been the occasional toxicity to a handler, and some reports of fish kills in spraying to eliminate pests or protect crops or control forest diseases. The use of pesticides is a subject vital to a number of Government departments—Forests, Fisheries, Agriculture, Recreation and Conservation, as well as Health. From them an interdepartmental committee was set up several years ago to examine the situation in British Columbia. That committee advanced some recommendations, one of which deals with more regulatory controls over the sale of the products. In any event, maintenance of vigilance in this field seems justified. HALL COMMISSION ON HEALTH SERVICES The Royal Commission on Health Services was appointed in June, 1961, specifically to determine the existing facilities and the future needs in health services for the people of Canada, the resources necessary to such services, and to recommend such measures as would ensure the best possible health care being available to all Canadians. Almost three years later the first volume of the report of the findings was released. Volume 1 of the Royal Commission on Health Services contains 885 pages and is a valuable summation of the situation relative to health care throughout the country. The report analyses the basic concepts involved in the health-care field and supplies 200 recommendations under three major headings dealing with (1) health-services; (2) health personnel, facilities and research; and (3) financing and priorities. The report was issued in late May, and a Ministerial conference was convened in Ottawa to discuss its content in mid-July. It was obvious from the meeting that no Province had had sufficient time to review and analyse the report, and it was proposed that a future Ministerial conference be convened, some six months later. There was also an indication that there was a second volume of the report to be released, and it was queried whether a true analysis of the first volume could be undertaken until the contents of the second volume became known. That additional volume is still awaited. In the meantime, analytical studies of the report and the recommendations it contained are under review. r GENERAL STATEMENT Q 15 ACKNOWLEDGMENTS In the large field of public health, not all services are provided by official health | departments. Other departments of government, professional groups, and voluntary agencies all make a significant contribution to the general health of the Province, and this Department gratefully acknowledges the excellent co-operation and the full support it has received from these many agencies. Finally, the Department would like to acknowledge the very major contribution : provided by the clerical staff; without their considerable assistance, Departmental routines would become chaotic, while policies, programmes, and services would grind to a halt through lack of capable office operations. This was never more clearly brought to attention than with the retirement of Miss Alison Chrow, who had been the senior clerk with the Health Branch for a period of 45 years. When she started, the Health Branch consisted of two individuals—a Provincial Health Officer and herself. She watched it grow and in many ways guided the growth. She served under three Deputy Ministers and, as every good secretary does, prompted them on administration matters coming to her attention. The Department benefited from her years of service, her knowledge of its early beginnings, and her advice in many areas. The Department owes her much and is pleased to acknowledge in gratitude her contribution to the health services of this Province. 1 q i6 PUBLIC HEALTH SERVICES REPORT, 1964 REPORT OF THE BUREAU OF ADMINISTRATION The Bureau of Administration consists of the general offices in the Health Branch headquarters, the Division of Vital Statistics, and the Division of Public Health Education. (The relationship is shown in the chart at the front of this Annual Report.) The headquarters and these two Divisions are concerned with programmes and procedures throughout the Health Branch as a whole. Their activities lend support to those of all other divisions and services. The Directors of the Divisions of Vital Statistics and Public Health Education have prepared reports which appear elsewhere in this volume. This section of the Report deals with administrative and organizational matters which are of general interest in the Health Branch's operations. ORGANIZATION AND STAFF As predicted in last year's Annual Report, the Health Branch assumed operational control of the Provincial Infirmaries (which had been under the jurisdiction of the British Columbia Hospital Insurance Service since 1949) on May 1, 1964. For many years the Provincial Infirmaries have consisted of two branches in or near Vancouver—the Marpole Infirmary and the Allco Infirmary, both operated by the Provincial Government. In addition, some infirmary patients have been accommodated in Mount St. Mary Hospital, operated by the Sisters of Saint Ann in Victoria. In the latter part of May, the Provincial Infirmary at Allco was closed and its patients transferred to Pearson Hospital. Marpole Infirmary was continued in operation temporarily because of the need to provide an activity wing at Pearson Hospital before the Marpole Infirmary patients could be given adequate care there. At the year's end, planning of the activity room was well advanced. It was hoped that the wing would be completed by July, 1965. Approximately 35 infirmary patients continued to be accommodated in Mount St. Mary Hospital. In the Local Health Services organization, the new Coast-Garibaldi Health Unit was established, with headquarters at Powell River. The new unit consists of the former Gibsons-Howe Sound service and part of the Upper Island Health Unit. There were no other major organizational changes during the year. The following list shows the various parts (divisions, offices, clinics, etc.) of the Health Branch with their locations and the approximate numbers of persons employed at the end of the year:— Health Branch headquarters (Victoria), Legislative Buildings, Victoria 39 Health Branch office (Vancouver), 828 West 10th Avenue, Vancouver 3 3 Division of Vital Statistics— Headquarters and Victoria office, Legislative Buildings, Victoria 62 Vancouver office, 828 West 10th Avenue, Vancouver 16 Division of Tuberculosis Control— Headquarters, 2647 Willow Street, Vancouver 13 . Willow Chest Centre, 2647 Willow Street, Vancouver..... 111 Pearson Hospital, 700 West 57th Avenue, Vancouver— 151 Poliomyelitis Pavilion, 700 West 57th Avenue, Vancouver 53 Pearson Infirmary, 700 West 57th Avenue, Vancouver _ 11 ADMINISTRATION Division of Tuberculosis Control—Continued Marpole Infirmary, Hudson and Marine Drive, Vancou- Victoria and Island Chest Clinic, 1902 Fort Street, Vic- New Westminster Stationary Clinic, Sixth and Cameron, New Westminster- Travelling Clinics, 2647 Willow Street, Vancouver Survey programme, 2647 Willow Street, Vancouver Division of Laboratories— Headquarters and Vancouver Laboratory, 828 West 10th Avenue, Vancouver. Nelson Branch Laboratory, Kootenay Lake General Hospital Victoria Branch Laboratory, Royal Jubilee Hospital1 Division of Venereal Disease Control— Headquarters and Vancouver clinic, 828 West 10th Avenue, Vancouver Victoria clinic New Westminster clinic .» Local Public Health Services (health units)— East Kootenay, Cranbrook Selkirk, Nelson _ West Kootenay, Trail North Okanagan, Vernon. South Okanagan, Kelowna _ South Central, Kamloops Upper Fraser Valley, Chilliwack 1^ *^ North Fraser, Mission- Boundary, Cloverdalc Simon Fraser, New Westminster Coast-Garibaldi, Powell River__ ^Z_," ' ■"' . Central Vancouver Island, Nanaimo— Upper Island, Courtenay Cariboo, Williams Lake._ Skeena, Prince Rupert Peace River, Dawson Creek Northern Interior, Prince George "I 'UBLIC HEALTH SERVICES REPORT, 1964 The total number, 1,105, was 84 more than that reported at the end of 1963. Most of the increase was due to the transfer of the employees of the Provincial Infirmaries from the British Columbia Hospital Insurance Service to the Health 1 Branch. (Offsetting this to some extent was a drop in the number of employees I required for the care of tuberculosis patients at Pearson Hospital.) There _ also part-time employees in many of the places listed. These totalled the equivalent of approximately 65 full-time employees. The greatest staff problem was the recruiting and retaining of qualified physicians to serve as health unit directors in local health services. Throughout the year there was an average of three vacancies among the 22 positions. Although it was possible to fill most of the public health nursing positions, this group presents other staffing difficulties. The turnover is higher than it should be, and the positions could be kept filled only by employing some nurses not trained in public health. The subsequent training of these nurses, as usual, produced its owr problems of transfers and temporary replacements. TRAINING mpleted postgraduate training I a diploma or master's degree in one of the public health specialties. Funds from National Health Grants v used to help defray the costs, and, in accordance with long-standing policy, the I trainees were required to sign agreements to serve with the Health Branch for specified periods following completion of training. The types of training, universities or other training centres (in parenthese and numbers trained were as follows:— Completed training— Diploma in Public Health Nursing (British Columbia, 6; McGill, 2; Western Ontario, 1) 9 Nursing Administration and Supervision (Toronto) 2 Diploma in Public Health (Toronto) .... 3 Master of Public Health—Statistics (Minnesota) ... 1 Commenced training— Diploma in Public Health Nursing (British Columbia, 11; McGill, 1; Western Ontario, 1) ..... 13 Nursing Supervision and Administration (Toronto) 1 Master of Public Health Nursing (Pittsburgh) 1 Diploma in Public Health (Toronto) _.. 2 In addition, it was again possible to provide some members of the Health Branch staff with relatively short-term training. National Health Grants helped t< defray these costs also. The courses and numbers attending were as follows:— I Public Health Administration (University of California). 1 Public Health Refresher Course (University of TorontcO'il-J ._ 1 Workshop on Fluorescent Antibody Techniques (Washington State Department of Health, Seattle, Wash.).... 1 Research Conference in Pulmonary Diseases (Veterans' Administration—Armed Forces, Cincinnati, Ohio) ___uj;_. 1 Air Pollution Courses (Robert A. Taft Sanitary Engineering Centre, Cincinnati, Ohio) 1 School Guidance and Counselling Services (University of Victoria) 1 Biostatistics and Statistical Methods in Epidemiology (University of North Carolina) 1 ADMINISTRATION Q 19 Problems of the School Age Child (University of Washington) 2 Special Instruction in Virology (Laboratory of Hygiene, Ottawa) 1 Special Instruction in Computer Programming (Biology Branch, Atomic Energy of Canada, Chalk River, Ont.) 1 Psychiatric Nursing (Provincial Mental Hospital) 10 The Public Health Institute was again held at the University of British Columbia in May. This provided training for the field staff of the Health Branch. In I addition to speakers drawn from the Health Branch staff and the University of I British Columbia, there were two guest speakers—Dr. F. Burns Roth, Professor I and Head of the Department of Hospital Administration, University of Toronto, | and Dr. H. B. Newcombe, Head of the Biology Branch, Atomic Energy of Canada [ Limited, Chalk River, Ont. ACCOMMODATIONS For some time there has been a pressing need for more offices and stockroom space for the Health Branch services housed in the Legislative Buildings in Victoria. [ During the year, many discussions were held with the Deputy Minister of Public [ Works and his staff, who made great efforts to improve the situation. At the end of the year, it appeared that a reasonable, although not ideal, solution had been [ found. Through the Department of Public Works, rented space was provided in 1 the " Mc & Mc Building " on Government Street. By the end of December the I necessary renovations were well advanced, and it was anticipated that the Health Branch's central stockroom and the Division of Vital Statistics' records stored at the vault on Topaz Avenue would be transferred to the new accommodations early in February. The Department of Public Works also indicated that in all probability an old house on Superior Street would be made available to the Health Branch. It was planned to place the Division of Public Health Education, including the Health Branch library, in this house as soon as certain modest renovations could be made. The space vacated by the stockroom and the Division of Public Health Education will now be converted into much-needed offices. The advantages of these changes were felt to be the provision of additional space, the provision of improved working conditions for some employees who had been occupying substandard offices, and the consolidation of some services which had been scattered. The obvious disadvantage seemed to be the physical separation of two services (the stockroom and the Division of Public Health Education) from the Health Branch's central group of offices in the Legislative Buildings. ACCIDENT PREVENTION Since 1962 the Provincial Government has conducted an accident-prevention programme in which the principal officer has been the Co-ordinator of Accident Prevention, a member of the staff of the Civil Service Commission. Within the Health Branch, the co-ordination of the programme has been the responsibility of the Director of Administration. Since July, 1963, " 12-month rolling averages " have been calculated for the disabling-injury frequency rate per million man-hours. During the period July, 1963, to February, 1964, the Health Branch's record improved steadily. After a short period with no change, the rate rose slightly and remained almost constant from May to October, 1964, when it stood at 8.6 disabling injuries per million man-hours, as compared with a rate of 21.7 for the Provincial Government service as a whole. In the Health Branch, great emphasis has been placed upon creating an " accident awareness " in all employees. An important factor has been the insistence on a formal discussion between the injured employee q 20 PUBLIC HEALTH SERVICES REPORT, 1964 and the supervisor to determine the cause of each accident and to suggest ways of j preventing recurrences. In the Division of Tuberculosis Control, where most of the 1 accidents in the Health Branch occur, an accident-prevention committee was established under the chairmanship of the Assistant Administrator. This committee, j through its regular formal meetings, instituted other measures which have apparently done much to improve the situation. Notwithstanding these efforts, it has proven very difficult to reduce the number ; of accidents below two or three each month. Although these are fortunately generally minor in nature, they cause the rate to be 8 to 10 disabling injuries per million man-hours. During the year the Health Branch purchased several sets of slides dealing with seemg-habis in driving. Plans were made to use these in improving the driving habits of the staff of Local Health Services, in which there are some 330 employees who drive cars. The Motor-vehicle Branch indicated a willingness to participate by helping with the driving instruction of newcomers to the Local Health Services staff throughout the Province. It is hoped that the programme will be started early in the new year. RECIPROCAL AGREEMENTS (TUBERCULOSIS) The agreements with Alberta, Manitoba, and Ontario continued at $10 per diem and with Saskatchewan and Quebec at $8 per diem. For varying lengths of time during the year (December 1, 1963, to November 30, 1964), nine British Columbia cases were hospitalized in other Provinces. The distribution Was as follows: Total for Accounts Alberta ^ br ,*t.........»_jant- 6 $6,810 Saskatchewan Manitoba _.... 1 1,280 Ontario 4% .._ kr-.. 2 1,440 Totals 9 $9,530 The number from other Provinces who r during the same 12-month period totalled nit follows:— Quebec - _ 2 2,110 2,380 3,208 Totals 9 $10,858 It is noted that the total amount paid out by British Columbia was almost offset by the total amount received. VITAL STATISTICS REPORT OF THE DIVISION OF VITAL STATISTICS The responsibilities of the Division of Vital Statistics fall into two broad I categories—one relating to the operation of the civil registration system, the other [ to the provision of a centralized biostatistical service to the Health Branch, the Mental Health Services Branch, and to other health agencies. Included in the I former is the administration of the Vital Statistics Act, the Marriage Act, the Change \ of Name Act, and certain sections of the Wills Act. REGISTRATION SERVICES Administration of the Vital Statistics Act The major part of the Division's administrative duties stem from the Vital Statistics Act. This Act prescribes the registration requirements for all births, stillbirths, marriages, deaths, adoptions, and divorces that take place within the Province and regulates the issuance of certificates and other forms of certifications from the registrations which are filed. The Act also controls the circumstances under which registrations may be amended to reflect adoption, legitimation, or changes of given name, or to rectify errors or omissions on registrations. The registration of vital events proceeded in a very satisfactory manner during 1964, with no serious problems being evident. Compliance of the public with registration requirements was excellent, there being only a small number of delinquent registrations outstanding at the end of the year. The majority of these related to illegitimate births in situations where the local registrars had been unsuccessful in tracing the mother. The Division has continued to enjoy outstanding co-operation from the hospitals of the Province in matters relating to vital statistics registration. Hospitals have been prompt in submitting the monthly returns of birth required by the Vital Statistics Act, and most hospitals have agreed to distribute blank birth registration forms and instructions to the mothers of newborn infants during their hospital stay. Likewise, hospitals, have rendered valuable assistance in the completion of the nonmedical items on the Physician's Notice of Live Birth or Stillbirth and in ensuring the prompt dispatch of these notices to the local District Registrars of Births, Deaths, and Marriages. During the year a revision of the Physician's Notice of Live Birth or Stillbirth was undertaken, and the revised form will come into use on January 1, 1965. This is the first major revision of the form since 1951, when the several items of medical significance were first incorporated into it. Since that date these notices have constituted a valuable source of statistical data for use in connection with analyses of births, stillbirths, infant deaths, and congenital malformations. The revised form incorporates a number of improvements which have been recommended by physicians specializing in child and maternal care. Administration of the Marriage Act The Marriage Act prescribes the legal requirements which must be observed in connection with the solemnization of marriage, the legal qualifications of individuals to marry, and the authorization of ministers and clergymen and of Marriage Commissioners to perform the marriage ceremony. Under this Act the Division of Vital Statistics is required to license ministers and clergymen of established religious q 22 PUBLIC HEALTH SERVICES REPORT, 1964 denominations who desire the authority to solemnize marriage. It is also the ] responsibility of the Division to appoint Issuers of Marriage Licences throughout j the Province and to supervise their work. As at December 31, 1964, there were 171 Civil Marriage Commissioners in j the Province and 41 persons authorized to issue marriage licences. There were also 2,222 ministers and clergymen, representing 139 autonomous religious bodies, authorized to solemnize marriage in the Province. During the year, 246 clergymen were vested with the authority to solemnize marriage, while 254 licences were cancelled due to transfer out of the Province or due to death. In addition, 56 temporary licences were issued to non-resident clergymen who were ministering in the Province for brief periods only. There were two new religious denominations registered under the Marriage Act during the year. Administration of the Change of Name Act The Change of Name Act provides a means whereby persons may change either their given names or their surnames upon meeting certain requirements set forth in the Act. The Act expressly forbids any changes of name which are not made in accordance with its provisions, although it exempts changes of name resulting from marriage, adoption, or legitimation, or changes in the given name of a child made under the Vital Statistics Act and prior to the child's 12th birthday. Five hundred and twenty-one legal changes of name were granted during 1964, this being the largest number in any one year since the Change of Name Act was enacted in 1940. Certification of Particulars of Adopted Children For many years a very unsatisfactory situation has existed for children adopted in this Province but who were born in certain other countries in which the registration practices will not permit the issuance of a birth certificate in the adopted name. This Division has frequently been urged to issue a birth certificate based on the adoption record, in spite of the fact that the child was not born in this Province. However, this suggestion is quite unacceptable since it is a widely recognized principle of vital statistics registration that certificates should be issued only by the Province or country in which the birth occurred. Unfortunately the policy adhered to by the countries in question has forced many persons into the embarrassing position of having to reveal their adopted status in order to explain their inability to produce a birth certificate in their present name. This problem was further discussed with the Deputy Attorney-General and the Superintendent of Child Welfare, and it was agreed that some relief might be afforded to a person in this predicament if he could be issued with a simple statement showing his name by adoption, his date of birth and place of birth, and certifying that such information is on record in the files of this Division. A form of statement was therefore drafted for this purpose and placed into use during 1964. Before such a statement is issued, the Division must be in receipt of an official copy of the Court Order of Adoption and the copy of the original birth certificate which formed part of the documentation presented to the Court in connection with the adoption proceedings, and these two documents are permanently retained in the files of the Division. While a statement as outlined above is clearly of lesser value than an official birth certificate, and is likely unacceptable for certain purposes, it nevertheless VITAL STATISTICS Q 23 appears to meet many of the less formal requirements for evidence of date of birth and place of birth. Registry of Wills Notices The Division maintains, under the Wills Act, a Registry of Wills Notices. This registry makes it possible for a testator to file with the Division a notice stating that he has executed a will and stating the location where the will is deposited. The filing of a notice respecting a will is not mandatory, but this action is available to all persons who wish to ensure that information which will lead to the discovery of their wills will be readily available upon their deaths. The Courts require that a search be made of the wills notices on file in this registry before they will proceed with an application for probate of a will. For the second year in succession, the number of new notices filed exceeded 11,000. At the end of 1964 there were over 100,000 wills notices on file with the Division. Volume of Registrations and Certifications The volume of registrations received in 1964 was approximately 2 per cent higher than that for 1963, while the volume of certifications issued was greater by 1 per cent. Revenue collected by the central office increased by approximately 3 per cent. Preliminary counts of the more important registration services rendered by the Division in 1964 are as follows:— Registrations accepted— Birth registrations ___ 37,430 Death registrations 16,054 Marriage registrations J jJBfi 12,307 Stillbirth registrations 484 Adoption orders 1,689 Divorce orders "P* -___! 1,636 Delayed registrations of birth 408 Wills notices I 11,475 81,483 Legal change of name 521 Legitimations of birth 163 Alterations of given name __._____a____.L_ 228 Certificates issued— Birth certificates 54,130 Death certificates 8,394 Marriage certificates 5,642 Baptismal certificates 8 Change of name certificates 723 Divorce certificates 312 Photographic copies of registrations 11,591 80,801 Searches of wills notices _____ 8,361 Non-revenue searches for Government departments 10,299 Central office revenue $102,551 1 q 24 PUBLIC HEALTH SERVICES REPORT, 1964 STATISTICAL RESPONSIBILITIES The statistical activities of the Division are directed toward the production I of a wide range of demographic statistics based upon the birth, death, and marriage j registrations filed in the Province, the production of several series of morbidity 1 statistics, and the production of administrative statistics relating to the programmes of the Health Branch, the Mental Health Services Branch, and other Government- ] supported health agencies. These activities include the processing of original rec- j ords using mechanical tabulation equipment, the drafting of statistical tables and reports, and the application of statistical methods in analysing the resultant data, j The Division is committed to a number of large-scale statistical undertakings which involve the preparation of extensive series of statistics on a continuing basis for the Division of Tuberculosis Control, the Division of Venereal Disease Control, the Division of Public Health Dentistry, the Division of Public Health Nursing, the Registry for Handicapped Children and Adults, the Mental Health Services Branch, ! the B.C. Government Employees Medical Services, the cytology service of the ] Vancouver General Hospital, the British Columbia Cancer Institute, and the G. F. ; Strong Rehabilitation Centre. The details of these statistical programmes have been outlined in previous Annual Reports, and although they constituted a major part of the statistical work of the Division during 1964, they will not be commented upon in this report except where new developments or unusual features warrant In addition to the foregoing, the Division carries out a number of utine assignments for various divisions and agencies. H|p VITAL STATISTICS Q 25 Much of the statistical data compiled appears in the annual reports of the I divisions and agencies mentioned above. The demographic statistics in the Province are published annually in a separate volume entitled " Vital Statistics for the Province of British Columbia." A series of vital statistics special reports is main- I tained to serve as a medium for releasing statistical data relating to special studies or projects which would not otherwise appear in print. Cancer Statistics The notification system for the reporting of new cases of malignant neoplasms [ has been the responsibility of the Division for many years, and during this time [ the Division has solicited the co-operation of private physicians, hospitals, and I treatment clinics in reporting all malignancies in an effort to obtain reliable statistics I on the incidence of this group of diseases. However, only limited success has been I achieved in obtaining reports on cases as they are diagnosed, with the result that a large proportion of cases of cancer have not become known to the Division until they have been located upon a scrutiny of death registration. Early in the year, with the co-operation of the British Columbia Division of the Canadian Medical Association and the British Columbia Hospitals Association, a special effort was \ made to encourage all hospitals in the Province to submit reports on newly diagnosed cases admitted to hospitals or diagnosed during hospital stay. While it is too early to assess the degree of success which has attended these efforts, the preliminary i results are encouraging. By the end of the year over 1,800 new malignancies had ; been reported directly from the hospitals throughout the Province. Dental Health Statistics During 1964 another in the series of community dental health surveys was completed in the northern part of the Province, and the examination reports processed by the Division. The analysis of data stemming from clinical dental examinations of two groups of children participating in a study designed to evaluate the caries-inhibiting effect of topical application of a fluoride phosphate solution was commenced during the year. The results of the subsequent statistical analysis will be available early in 1965. The Division also collaborated with the Division of Preventive Dentistry in another study involving the effects of a fluoride phosphate solution in a programme of supervised tooth-brushing. The results of the first phase of this study have been compiled, and the material will shortly be published in a dental journal. Two other technical articles were prepared jointly by the Division of Preventive Dentistry and the Division of Vital Statistics and published during 1964 in the journal of the Canadian Dental Association. These articles were " Relationships between Gingivitis and Other Dental Conditions " and " Indices Reflecting Demand for Dental Services in British Columbia, 1962." Tuberculosis Statistics The magnitude of the tuberculin-testing programme being carried out under " Operation Doorstep " has resulted in a heavy demand for tabulating service on the Mechanical Tabulation Section of the Division. During the year over 200,000 tuberculin-testing punch-card records were processed on the tabulating equipment, making this one of the most massive assignments handled by the Division. In addi- q 26 PUBLIC HEALTH SERVICES REPORT, 1964 tion to the statistical tables which were compiled from these punch-cards, alphabeti- ] cal lists of all persons tested were tabulated for use in the follow-up programme. In addition, special tabulations on tuberculin tests carried out in earlier years were j undertaken for research purposes. A diagnostic index of all known cases of significant non-tuberculous chest , conditions was prepared from the punch-card files for use in the Division of Tuber- ] culosis Control. This index, which supplements the annual alphabetic and numeric j indexes of all tuberculous and non-tuberculous cases known to the Division of Tuberculosis Control, provides a ready reference to the medical-history files of cases in specified diagnostic categories when these are required for special investiga- j tion or review. This diagnostic index will be updated periodically. Juvenile Delinquency Statistics During the year the first tabulations were prepared from the juvenile delinquency report forms which are processed by this Division. These reports are completed by Court officials throughout the Province respecting each juvenile delinquency case tried and are then submitted to the Attorney-General's Department. Certain items of information are coded in that Department prior to the forms . being forwarded to the Division of Vital Statistics. Sanitary Inspection Statistics During the year, assistance was given to the consultant sanitary inspector in developing procedures for obtaining statistics on the services carried out by the sanitary inspectors and on the distribution of time devoted to performing these services. Forms were developed and used on a trial basis in certain areas before being issued to all Provincial health units. Registry for Handicapped Children and Adults The Division of Vital Statistics has a major responsibility u the Registry for Handicapped Children and Adults. A senior research officer of the Division acts as administrator to the Registry, while a second research officer devotes considerable time to the statistical aspects of the Registry. The mechanical processing of the statistical data stemming from the Registry and the preparation of the annual statistical report is carried out by the Division. Administratively, the Registry is under the supervision of the Director of the Division of Registry and Rehabilitation, and a more detailed account of the Registry operation during 1964 appears in the report of that Division. Mental Health Statistics The Division co-operated with the Mental Health Services Branch in a detailed follow-up study of one month's admissions to Crease Clinic. Based on the information obtained in this study, a more comprehensive statistical summary record of each case was developed for use commencing April 1, 1965. This augmented statistical record will be processed by the Division of Vital Statistics in place of the more limited admission report which has been in use for many years. The significant feature of the new record is that it will make available for statistical analysis additional information respecting symptoms VITAL STATISTICS Q 27 Cytology Statistics The processing of the case reports of the cytology laboratory at the British I Columbia Cancer Institute has become a major undertaking for the Division in view I of the large numbers of women who are taking advantage of the cytological method I of screening for cancer of the cervix uteri. Over 160,000 records from this programme were handled during the year. In addition to the annual statistical tabulations prepared for the cytology I laboratory, the Division collaborated with the medical staff in preparing special I statistical analyses relating to a general evaluation of the screening programme and I its impact upon the incidence of cervical cancer in British Columbia. Estimates of I the average duration of the pre-invasive period in cervical cancer and of the percentage of pre-invasive cases that progressed to the invasive stage were made from [ the statistical material at hand. British Columbia is one of the few areas in the [ world which has accumulated sufficient statistical data for analyses of this type. Other Projects Questionnaires from a survey of smoking habits and attitudes amongst 8,000 school-children in the South Okanagan Health Unit were mechanically processed I by the Division during the year. Tables were prepared from the data and provided E to the director of the health unit. The records of a survey to determine the optimum dosage of gamma globulin ; for the prophylaxis of infectious hepatitis were also processed on punch-cards and [ statistical tables provided to the Director of Epidemiology. Plans were made for the Division to co-operate with the Faculty of Medicine of the University of British Columbia in a research study relating to deaths involving a diagnosis of emphysema. All such deaths occurring during 1965 will be investigated, and, with the concurrence of the British Columbia Division of the Canadian Medical Association, copies of the death registrations will be made available to the research team. Two other Provinces are participating in this study by providing copies of the relevant death registrations from their Provinces. The Division will assist in the coding aspects of this research project. During the year there appeared to be an increasing concern respecting the relatively high incidence of illegitimate births. In dealing with these inquiries, the desirability of differentiating between illegitimate births to unmarried mothers and illegitimate births to married mothers became apparent. Heretofore it has not been possible to identify all illegitimate births to married women, but changes in registration procedure brought about by the new Vital Statistics Act now make this possible. Accordingly, modifications were made in the coding and punching procedures to accommodate this refinement in the data. Assistance was given to the Division of Public Health Education in connection with two studies undertaken by that Division—namely, a study of attitudes toward dental health practices among adults and a survey of health knowledge among school-children. For both studies, punch-cards were used to analyse the resultant The Division continued to carry out the medical coding of all illnesses and disabilities reported on the medical examination of driver reports of the Motor- vehicle Branch. During 1964 the first group of punch-cards containing this information became available from the Motor-vehicle Branch, and these were tabulated within the Division to provide statistical information for the Director of Epidemiology. Q 28 PUBLIC HEALTH SERVICES REPORT, 1964 In addition to the activities mentioned above, the Division continued to carry out a number of other routine assignments in the statistical field. These included I the maintenance of the Province-wide notifiable-disease reporting system, the main- I tenance of the register of cases on the rheumatic fever prophylaxis programme, and I the processing of the records of the obstetrical discharge study and the study relat- 1 ing to the neurological development of the newborn infant. The latter two studies I are under the direction of the Faculty of Medicine of the University of British ] Columbia. The Division also provided a wide range of consultant service to other 1 divisions and to research workers in the medical field. EDUCATION REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION At the close of the year, the Division was staffed by the Director, a consultant I who is a specialist in in-service education of the field staff, a consultant in school I health education, and a public health education assistant who is concerned prim- I arily with photography and the preparation of audio-visual aids and written material. I Clerical and stockroom personnel are employed in the operation of the Health I Branch library and the facilities required for the ordering, stocking, and distribu- i tion of educational aids. The health educator for the Greater Vancouver Metropolitan Health Service, Mr. Alex Buller, completed his postgraduate training in public health at the Uni- I versity of California during the summer. At present the health education position [ for the Greater Victoria Metropolitan Board of Health remains vacant. SCHOOL HEALTH EDUCATION The consultant in school health education continued to work in the three areas | of, first, school health curriculum, in co-operation with the Department of Educa- [ tion; second, the provision of consultant services to personnel in the field, both public health and school; and, third, teacher-training, in co-operation with both the I University of British Columbia and the University of Victoria. In this latter regard, I discussions initiated in November of 1963 with the British Columbia Division of I the Canadian Medical Association, which has had a joint interest in the teaching of health in the schools, have resulted in the establishment of a sub-committee of the Medical Education Committee of the British Columbia Division. It was agreed with the British Columbia Division that in defining areas of responsibility the association will concentrate on advising and assisting the teacher-training institutions | with respect to the training of student teachers in the matter of health. The prime ■ responsibility for liaison with the Department of Education in the development of ' health curricula rests with the Health Branch, through the consultant in school health education. In this connection, two teaching units were prepared during .the j year for the Department of Education, one of which on posture is now being tried out on an experimental basis in two schools. A similar unit on venereal disease, suitable for the Grade X level, has been under discussion with one School Board | with the view to trying it out on an experimental basis, with the ultimate objective of | incorporating it, together with the posture unit and similar units whi^h have been ' d out on an experimental basis, into a revised health curriculum which the Department of Education is proposing to develop within the near future. Frequent consultations were made at the request of the field staff during the year, particularly in the area of sex education and venereal-disease education.' In addition, two studies were carried out in the field—one in the Boundary Health Unit relating to a health-knowledge test directed at the Grade X level; the second, conducted in the Upper Island Health Unit, centred on an analysis of the extent to which teachers felt selected health pamphlets were of use to them in the classroom. SMOKING AND HEALTH As a result of the Federal-Provincial Conference_on Smoking and Health held in Ottawa in November of 1963, two technical advisory committees were established to advise the Federal Government on research and educational measures that might Q 30 PUBLIC HEALTH SERVICES REPORT, 1964 be undertaken on a nation-w.de basis. The Director was appointed to the Com-1 mittee on Health Education and attended two meetings in Ottawa during the year, at which time priorities were established and measures undertaken to develop a I co-ordinated educational programme on a national basis. In this Province a measure I of co-ordination had been achieved as the result of a meeting to which representa- f tives of voluntary health agencies, the British Columbia Division of the Canadian Medical Association, and the Non-smokers' Association of Canada were invited ir order to determine the role that each agency not only was playing, but also could ] play, in educating groups with respect to the hazards of cigarette smoking. Since 1 that meeting in April, approaches have been made to other Provincial bodies, such 1 as the Pharmaceutical Association, Registered Nurses' Association, the British ] Columbia Teachers' Federation, and other health and education groups, with a view to exploring their respective roles within a comprehensive programme of I health education regarding the hazards of smoking. Copies of the information kit I containing materials selected and reprinted by the Department of National Health I and Welfare, together with teaching guides prepared by this Division specifically I for use in Grades V, VIII, and X, were issued to schools throughout the Province | at the commencement of the academic year. AUDIO-VISUAL AIDS AND WRITTEN MATERIALS Of the 64 films and filmstrips previewed during the year 10 films and 3 strips ] were added as new titles to the Division's visual-education library. An additional | 38 prints of existing films and 4 of filmstrips were purchased in order to meet the increased demand on the library's facilities. During the year confirmed film bookings increased by 13 per cent over those for 1963. A considerable number of colour transparencies and black-and-white j photographs were taken throughout the year. While these were taken I primarily to enlarge the library of I visual materials operated by the Division for health unit displays, I many were taken specifically for an exhibit on the subject of venereal disease prepared by the Health Branch for showing at the British Columbia Medical Association's motherhood display at the Pacific National Exhibition in Vancouver. In addition, colour transparencies were prepared to replace existing black-and-white photographs at the year-round Departmental exhibit at the Pacific National Exhibition. PUBLIC HEALTH EDUCATION Q 31 I One poster for use in the venereal-disease control programme was completed Iby the end of the year, and another was under preparation. Both are directed at Ehe high-risk groups. IN-SERVICE EDUCATION I In January some 70 public health inspectors, including representatives from Ithe Greater Vancouver and Greater Victoria health departments, attended an [intensive one-week training session designed to acquaint them with new concepts lin the fields of sewage disposal, air pollution, occupational health, and common- Icarrier inspection. The Division provided considerable assistance to the Sanitation IService in both the planning and organization of this course. For the second consecutive year the Annual Public Health Institute was held Ion the campus of the University of British Columbia in Vancouver, utilizing on- Icampus residences for the housing of the staff and classrooms for both general and [sectional meetings. This year'two guest speakers from outside the Province were (invited to participate. The first of these was Dr. F. Burns Roth, Professor and [Head of the Department of Hospital Administration at the School of Hygiene, j University of Toronto, who in two talks discussed principles of administration and [the need for co-ordination of health resources within the community. The second [speaker was Dr. H. B. Newcombe, Head of the Biology Branch at the plant of [Atomic Energy of Canada Limited at Chalk River, who reviewed the relationship between genetics and public health practice. The balance of the four-day pro- [ gramme consisted of speakers drawn largely from Health Branch staff and the i University of British Columbia. SURVEYS AND RESEARCH It was mentioned in the report for 1963 that a methodology was being designed for the collection and analysis of base-line data on public health knowledge, attitudes, and habits with respect to commonly recommended health practices. At the conclusion of 1963 such a methodology was developed as an instrument which could be used in any part of the Province to collect information on various sets of health practices—child rearing, nutrition, dental, etc. During the first three months of 1964, residents of the Trail area of the West Kootenay Health Unit were interviewed to determine their knowledge, attitudes, and habits with respect to four dental health practices as they apply primarily to children —namely, oral hygiene, dietary practices, visits to a dentist, and use of fluorides (water, supplements, and topical application). From tabulations prepared, appraisal of the data collected has revealed to the health unit the level of knowledge, attitudes, and habits that actually exist within a community and whether or not they are as recommended by the health unit staff. Further analysis of the data has also indicated to the health unit staff specific areas of dental health practice, or groups of persons in the community, in which education emphasis appears to be necessary. PUBLIC HEALTH SERVICES REPORT, 1 REPORT OF THE ACCOUNTING DIVISION For the Period April 1, 1963, to March 31, 1964 A gross amount of $8,841,972 was spent on public health services by the ■ Health Branch during the fiscal year 1963/64. To provide the many services, such as administration, nursing, public health engineering, sanitation, and other health services, required a staff of over 1,000 permanent and temporary employees. The total payroll was $5,193,865, or 58.74 per cent of the gross Health Branch expenditure. Personnel in the course of their duties were required to do a considerable amount of travelling, which amounted to an expenditure of $341,150. A great deal of travelling was incurred in the operation of Government and privately owned vehicles, which travelled 2,443,726 miles. The tuberculosis institutions of Willow Chest Centre and Pearson Hospital provided 73,528 patient-days' care during the fiscal year at a per capita per diem rate of $19.28. The Poliomyelitis Pavilion situated at the Pearson Hospital provided 11,531 patient-days' care during the fiscal year at a per capita per diem rate of $27.89. The comparison table of public health services gross expenditure shows an increase of $642,287 in expenditure between the fiscal years 1962/63 and 1963/64. Approximately one-third of this increase is due to salary revisions granted Government employees. The Division of Tuberculosis Control, while reflecting an increased expenditure over the previous fiscal year of 1.4 per cent, nevertheless continues to decline in percentage of expenditure in relation to the total Health Branch expenditure. To meet the demands of growing communities, local health services continue to expand, resulting in an increase in expenditure of 8.7 per cent over the previous fiscal year. The group of expenditures headed " Cancer, arthritis, rehabilitation, research, etc." has increased 12.2 per cent over the fiscal year 1962/63. The increase is due to greater expenditure in cancer control, professional training, research, and larger grants to health agencies. The poliomyelitis section of expenditure has increased $46,925 or 12.3 per cent. This increase reflects the oral and Salk vaccine campaign carried out during the fiscal year. The balance of services shown in the comparison table reflects increased expenditures, largely due to salary increases granted employees during the fiscal Comparison Table of Public Health Services Gross Expenditure for the Fiscal Years 1961/62 to 1963/64 Gross Expenditure Vt°SSSS^T 196J/62 | 1962/63 1963/6* 1961/62 ,962/63! 1963/64 Division of Tuberculosis Control 1 12 031829 ii n I 23 3 l as SStSSSSS^^ DMsioS of WtSauito LOCAL HEALTH SERVICES REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES In order to provide knowledgeable support and consultation to local health I services in the field, those personnel in central office who tend to be specialists in I a given area of public health must keep themselves informed of the activities of their I colleagues and of the Bureau as a whole. For this reason the Bureau report is I presented as a whole, summarizing the work of the Divisions of Public Health I Nursing, Preventive Dentistry, Epidemiology, Public Health Engineering, and the I Nutrition Service. Each year one particular aspect of the activities of the Bureau is highlighted; I this year it is the turn of the sanitation services. SANITATION PROGRAMME The public health inspectors as members of the public health team are located in the 18 health units throughout the Province, being responsible directly to the I Medical Health Officer for the implementation of the sanitation programme. The traditional role of the public health inspector has undergone drastic changes in an attempt to meet ever-increasing demands within the scope of community health. The main techniques used in dealing with the public are those of education and persuasion, with enforcement used only as a last resort. The following presents a few highlights of the health inspectors' work. PUBLIC HEALTH SERVICES REPORT, 1964 SANITAJUPN SERVICES #' ..*,« m. W/A * 30 I coi^ftijhjty. he^lff^;t^ey|; reach out to serve all the people of B.C. 1 LOCAL HEALTH Food Sanitation The food industry is a large one, with almost 15 per cent of the work force in I British Columbia employed in the production, processing, and distribution of food. I For this reason alone it is of considerable importance. In the five-year period 1958 to 1963, the tourist income in British Columbia increased by over 40 per cent. The I restaurant industry caters to many thousands of tourists a year, with rapid multiplication in the number of eating and drinking places. Both residents and tourists [ are quick to notice poor standards, and, in turn, these tend to colour their impressions of | Beautiful British Columbia." The public depends upon the food i industry to serve safe and wholesome food in clean premises, and both look to the 1 public health inspector to see that high standards of sanitation are maintained. This he does by regular inspection of food premises and by continued education of food-handlers both on the job and through training courses. All food-handling ' premises, including bakeries, bottling plants, groceries, butcher-shops, and food- processing plants, are inspected under the authority of the Health Act and local by-laws. Up-to-date by-laws to regulate food establishments were recently adopted by several municipalities in the Lower Fraser Valley. q 36 PUBLIC HEALTH SERVICES REPORT, 1964 School Health Programme Each year the public health inspectors carry out environmental inspections of the schools within their health unit jurisdiction. Section 109 of the Public Schools Act requires, among other duties, that the school Medical Health Officer examine j the school buildings and surroundings, and that he submit his recommendations -j to the Board of School Trustees. A copy of the completed report on every school is forwarded to the Board prior to December so that any necessary expenditures \ may be included in the budget under preparation. During 1962/63 four health ■ units completed evaluation studies of school construction and environment. The j purpose of these studies, on which reports were available in 1964, was to determine : the effectiveness of the present school inspection programme, to recommend changes i in the school building manual, and to consider what further contributions could be . \ made by health unit staff. Subdivisions Rapid development within the Province has accelerated land subdivision beyond areas serviced by sewers and water. In some areas this has created serious sanitation problems, with unsuitable soil conditions interfering with the adequate functioning of septic tanks to the extent that correction is costly and on occasion wells within close proximity have been contaminated. Because of these and other problems, approving officers now refer all proposed subdivisions to the Medical Health Officer for approval, with specific reference to provision of safe water and adequate sewage disposal. The old adage " an ounce of prevention is worth a pound of cure " will pay dividends to the householder, benefit the municipality, and help to make British Columbia a healthier place in which to live. Occupational Health As an example of activities in this field, public health inspectors carry out surveys of the carbon monoxide content of air in commercial and Government garages. Approximately 95 per cent are satisfactory, and in the remaining 5 per cent action is taken to correct any problem and avoid the danger of carbon monoxide poisoning. Readings have also been taken in food-packing plants, with particular attention being paid to the operation of gasoline-operated fork lifts. In co-operation with the Department of Labour, plant sanitation in other industrial establishments has been checked, and potential health hazards in the form of dust, vapours, gases, and mists have been identified. Improved methods of ventilation are necessary to resolve these problems. The public health inspector is capable of doing a good job in the field of industrial hygiene and enjoys the advantage of being able to obtain medical and engineering advice from within the Health Branch as and when problems of a more technical nature are involved. Control of Water Supplies Protection of public and private water supplies is an important day-to-day function. Routine sampling to determine bacteriological quality is carried out on all public water systems. Residents served by private supplies in the more rural parts of the Province are encouraged to seek the advice of the public health inspector to ensure the safety of their well water. Swimming-pools The swimming-pool standards were revised this year to upgrade and "-'" '■• their operation with respect to sanitation and safety. These standards, LOCAL HEALTH SERVICES Q 37 and supplied by the Health Branch, have been favourably received and are in constant use as a guide by individual operators. Public swimming-pools are inspected regularly during the bathing season to maintain bacteriological standards and to record chlorine residual, water clarity, and other pertinent information. Sewage Disposal Adequate sewage disposal plays an important part in the control of com- I municable disease. Many problems arise in areas not served by municipal sewerage I systems due to septic-tank failures occasioned by inadequate maintenance, faulty I design, or poor soil conditions. Public health inspectors devote considerable time I to the abatement of such nuisances, to the approving of new installations, and in * undertaking " sanitary surveys " to assess the extent of a community problem. > Survey information on sewage-disposal problems has assisted many municipalities : to obtain public sewerage systems. Saturation of the soil with septic-tank effluent [ is a common problem in growing suburban areas. Although he is not responsible [ for the engineering details of design and operation, the public health inspector is . responsible for the routine inspection of public sewerage systems to ensure that satisfactory operation is maintained. This aspect of his work is co-ordinated with that of the consultant engineers from the Division of Public Health Engineering. In areas under the jurisdiction of the Pollution-control Board an with new outfalls, the public health inspector, through his Medical Health Officer, may be requested by the Board to see that the proposed outfall point has been q 38 PUBLIC HEALTH SERVICES REPORT, 1964 posted, to take samples, and to advise as to other uses of the water that might be I affected by the proposed outfall. Such uses include provision for drinking purposes, for swimming, or for shellfish propagation. To a great extent the Pollution-control Board is dependent upon the local Medical Health Officers and their inspectors for local assistance and knowledge. Due to the network of health units blanketing the Province, this information can be readily obtained. Tourist Accommodation Increased tourism throughout British Columbia has resulted in the mushrooming of tent and trailer camps. Community planning regulations require approval by the Medical Health Officer of plans for water and sewage- and garbage-disposal I facilities. Recommended standards have been prepared by the Health Branch and are presently used as a guide. Again it should be recognized that this aspect of the public health inspector's work will make or mar many a tourist's holiday in British 5 Columbia. PATTERNS OF DISEASE Except in the field of VENEREAL DISEASE, British Columbia has been singularly free of major outbreaks of communicable disease during the year. There ) were 5,816 cases of GONORRHOEA reported to the Health Branch this year, and 1 this is the largest number ever recorded in this Province. It should be appreciated j that only a proportion of cases are notified to the local Medical Health Officers, and for this reason the total number of cases that actually occurred would be far larger. This gives some idea of the problem facing health authorities. Infectious SYPHILIS i was reported on 304 occasions, which is somewhat less than the increase shown last year, when 280 cases were notified, but still demonstrates that in spite of increased efforts to locate and treat the carriers of this disease, no reduction in over-all incidence has been effected. One immediate result of this outbreak has been the marked increase in the work load of many health units in tracing and bringing to treatment all the sexual contacts of those infected by both gonorrhoea and syphilis. In this regard, visits by public health nurses totalled 8,413, to represent a 39-per-cent increase over last year. This has required an increase in staff in one health unit which has had a particularly heavy work load thrust upon it, while in others staff have had to be diverted from other duties. ■ After a year of complete freedom from PARALYTIC POLIOMYELITIS, one severe case occurred this year on Vancouver Island in a non-vaccinated middle- aged male. This underlines repeated statements that poliomyelitis vaccine will only protect those who have had an adequate course, and that this disease can still occur in a community despite the fact that the majority of people in the community are vacc'nated. During the latter part of the year the oral poliomyelitis vaccine programme was completed, and everyone throughout the Province has now had an opportunity of receiving three doses of Sabin vaccine. Just under 500,000 people, or 30 per cent of the total population of the Province, have taken advantage of this programme, and more than 75 per cent of school-age children have been protected It has not yet been decided how frequently a reinforcing dose of the vaccine should I be given, but this will be incorporated into the routine immunization programme of the Health Branch in the years to come. For the last few years, small outbreaks of BOTULISM, to result in one or t fatalities each, have occurred annually along our northern coast. These have resulted I from the eating of salmon eggs prepared and preserved in the manner peculiar to I the native Indian population. This year was no exception, and, despite an intensive I 1 PUBLIC HEALTH SERVICES REPORT, 1964 education effort, fish eggs prepared in the traditional manner were again the cause. ] Fortunately the toxicity of the eggs was discovered early enough to prevent their ■ being used for a feast. Two years ago a very serious outbreak of DIARRHOEA OF THE NEWBORN occurred on the east coast of Canada, resulting in many deaths. This condition was shown to have been caused by an organism called Escherichia coli. Since that time a very careful watch has been kept of the number and nature of such cases reported in British Columbia. This year there were 52 cases of this disease diagnosed among infants, compared with 27 the year before and 19 in 1962. These cases were scattered widely throughout the Province, so that, although the total incidence has risen, there is no concentration of cases in any one area. Once again there were no cases of DIPHTHERIA reported in the Province this year, and the incidence of healthy carriers, recognized from throat swabs taken at random, has not increased, as is the case in certain of the Prairie Provinces. The incidence of BACILLARY DYSENTERY, which has caused considerable concern over the past four or five years, decreased in 1964. There were 131 reported cases of bacillary dysentery, which may be contrasted with 169 in 1963 and 1,192 in 1960. The number of cases of dysentery for which the cause could not be identified despite intensive laboratory investigation remained at the 300 mark, where it has stood for the past four years. Food poisoning due to STAPHYLOCOCCAL intoxication or SALMONELLA infection was not so prevalent this year. Two hundred and twenty-nine cases were reported, contrasting with 354 in 1963 and 556 in 1962. The highest number ever recorded in British Columbia was 724 in 1960. INFECTIOUS HEPATITIS also appears to be on the wane, as indeed it is all over North America. In 1962 there were 1,889 cases reported, while last year the total had dropped to 1,736, and for this year a further reduction to 1,054 is recorded. It is felt that the reporting of clinical cases of this disease is fairly good because of the physicians' awareness that it was assuming epidemic proportions, and because the Health Branch makes free gamma globulin available to family contacts. At this time a Province-wide study is being carried out to determine the optimum dose of this relatively scarce and expensive prophylactic. The Province has been singularly free of ASEPTIC MENINGITIS this year. Very few of the usual causative organisms, such as the poliomyelitis, ECHO, or coxsackie viruses, were isolated from the 37 reported cases. There were 11 cases of MENINGOCOCCAL (SPINAL) MENINGITIS reported, which is approximately the same as in the past few years. Although modern antibiotic treatment has removed much of the terror from this disease, small outbreaks still occur and call for prompt and energetic action. A recent American outbreak, for example, has involved several hundred people. SCARLET FEVER and STREPTOCOCCAL THROAT INFECTIONS wax and wane over long periods of time. The relatively high incidence of this disease in 1950, when well over 4,000 cases were reported, has been followed by a steady decline this year to 969 cases. In the 1920's scarlet fever was a very serious and often lethal communicable disease. More recently it has become relatively mild, but one danger remains in that a proportion of children who have this disease go on to develop rheumatic heart disease and all the complications that can occur from that condition. Five cases of TYPHOID FEVER were diagnosed this year, which remains slightly below the average for the past five years. Most cases occur due to the r LOCAL HEALTH SERVICES | presence of healthy carriers who can excrete this organism intermittently for years. I Few, if any, cases occur now in this country from contaminated milk or water, and I every year one or two more healthy carriers are located, these people generally being I quite unaware of their unfortunate ability to spread typhoid fever. WHOOPING-COUGH was far less prevalent this year, only 180 cases with I one death being reported, which compares very favourably with an average of 603 | cases for the preceding five years. It is interesting to note that whooping-cough I still causes some 25 to 30 deaths each year in Canada, generally in infants under [ the age of 1 year. The RHEUMATIC FEVER prophylaxis programme introduced in 1958 con- [ tinues to increase slightly, and the number of children presently carried on the | programme has reached 1,200. A careful study of the recurrences while under prophylaxis shows that the failure rate is approximately 3.7 per cent, which is simi- l lar to the rate shown in one of the most carefully controlled programmes on the <■ continent carried out at the Irvington Clinic in New York City. As far as possible, every effort is made to limit the number of children on the programme to only those who have had a very definite case of rheumatic fever. Each year in one region of this Province the practising dentists together with the Division of Preventive Dentistry examine some 1,300 school-children. Results of these surveys show differences between the DENTAL HEALTH status of children of different regions of the Province and, over a span of years, in the same region. Children in the northern health units were examined in 1960 and again in 1964. In this period a marked improvement in their state of dental health is apparent. The percentage of children with no defects-—that is, not in need of any form of dental treatment—has improved twofold. Also doubled is the percentage of children not in need of treatment for dental decay. The percentages of children with abnormal gingival conditions (diseases of the gums) and with abnormal occlusion (incorrect bite) have also significantly decreased. The average caries attack rate for children of all ages for deciduous and permanent teeth has decreased from 9.5 to 8.2 teeth per child. It is of interest to note that of all the children examined in this survey, some 40 per cent resided in communities which have commenced fluoridation during the past nine years. In these communities the full benefit of this public health measure on the dental health of these children will not be demonstrated for another seven or more years. At the present time, and in spite of the improvements reported above, the average dental health status of the children of this area and indeed of the whole Province is a matter of the most grave concern. For example, this survey showed the average 7-year-old to have 6 of his 20 deciduous teeth attacked by decay, and for close to 40 per cent of this age-group no adequate treatment of their decayed deciduous teeth had been provided. This survey also showed the average 15-year- old to have nearly 12 of his 28 permanent teeth attacked by decay. Of these 12 teeth, 5 had been restored (filled), five had open carious lesions, and 2 had either been extracted or likely would be extracted. Of these young teen-age children, 17 per cent were noted to have disease of the gums and 35 per cent to have severe malocclusion to the degree that they were in obvious need of orthodontic treatment. The tragedy is that today dental research has clearly shown that dental caries, which is the major oral disease and contributes to gingival disease and malocclusion, is a controllable, if not entirely preventable, disease. Water fluoridation has been proven effective and safe. Currently 11 communities in British Columbia benefit by water fluoridation—approximately 4 per cent of the total population of the Province. In addition, equipment is under installation at Squamish and Williams Lake. In "1 PUBLIC HEALTH SERVICES REPORT, 1 plebiscites held at the year's end, the following communities voted in favour of commencing this important public health measure: Golden, Kimberley, Chapman | Camp, Marysville, North Kamloops, Port Moody, and Terrace. Another rather specialized programme is that developed for POISON CONTROL purposes. Approximately 1,000 cases of accidental poisoning were re- 1 ported to the Health Branch, and it is our feeling that this represents about half the I number of cases that were treated in hospital emergency departments throughout J the Province during the year. Again aspirin and aspirin compounds were respon- 1 sible for over 30 per cent of the poisonings reported. There were five deaths in j children under 15 years during 1964. It was interesting to note that three children 1 were poisoned with the insecticide Parathion, two of whom were severely ill, one 1 being comatose for a period of about 18 hours. The source of the pesticide was 1 identified and found to result from the contamination of sheets which were sold to j a second-hand dealer by an insurance company, whose property they became when 1 they were rejected by a department store due to discoloration. Investigation re- 1 vealed that the sheets were contaminated by a leaking barrel of Parathion, probably ] while in transit to this Province. In keeping with the trend which has taken place over the past few years ! whereby more and more patients with TUBERCULOSIS are being treated at home j rather than being admitted to institutions, the public health nurses made 12,333 j visits to tuberculosis patients and their contacts. Within the same programme a total of 21,535 tuberculin tests was done to include the routine testing of Grade II I pupils. It is planned to discontinue routine testing of a selected grade during the j coming year because of the low incidence of cases found in most areas. Where the j need is demonstrated to exist, such routine testing will be continued. It should be recognized that the mass community surveys will continue to be done approximately j every five years, and in this way a close surveillance will be maintained of the incidence of tuberculosis throughout the Province. Health unit staffs assist in the planning, organization, and interpretation of the results of these surveys. In conjunction with the control of communicable disease in general, a large number of PROPHYLACTIC INJECTIONS and IMMUNIZATIONS are carried out each year, and, in addition, the public health nurses are involved in many home visits. It is interesting to note that some 6,360 injections of gamma globulin were given to the contacts of cases of infectious hepatitis, while 4,420 home visits were made within the communicable-disease control programme. Some idea of the staggering amount of work involved in the immunization programme can be obtained when one considers that a total of 571,634 children and adults received a complete series to protect them against smallpox and poliomyelitis, while a further 139,000 immunizations were given against other diseases to include typhoid and cholera. On the other hand, the communicable diseases represent only a small part of the over-all disease picture, and concern with the chronic diseases becomes ever more apparent from year to year. Such diseases include diseases of the cardiovascular and central nervous systems, diabetes, arthritis, cancer, and various blood conditions. Some 42,724 nursing visits were made during the year to provide care to almost 2,000 patients who required nursing as a result of these conditions. A few years ago in the field of MENTAL HEALTH almost all visits were related to children, but a gradual change in this picture is now apparent in that during the year 9,592 visits were made by public health nurses to people exper'encing some form of mental illness, and of this total 40 per cent concerned adults. In conclusion it might be added that the Director of the Division of Epidemiology is also a member of various committees concerned with accdent prevention, LOCAL HEALTH SERVICES Q 43 [to include the St. John Ambulance Highway First Aid Station Committee and the i Traffic Safety Committee of the British Columbia Division of the Canadian Medical [Association, and is employed as medical consultant to the Motor-vehicle Branch, I where he is presently involved in a long-term study of the effects of medical deficien- Icies and driving ability. Reported Communicable Diseases in British Columbia, 1960—64 (Including Indians) ADMINISTRATIVE CONSIDERATIONS It is iportant to recognize that the staff of the local health units under their respective health unit directors, although employed as Provincial Civil Servants, are nonetheless seconded upon appointment to their local municipalities and School Boards. However, it is important that an over-all standardization of service exist throughout the Province, and in this regard much of the detail in administration and personnel management is handled by staff in Central Office, Victoria. 1 PUBLIC HEALTH SERVICES REPORT, 1964 In keeping with the trend to extend mental health services at level, Health Branch personnel worked in close co-operation with Mental Health Ser- 1 vices' to extend the existing health centre in Trail as headquarters facilities for the 1 psychiatric team of the Kootenay Mental Health Clinic. Mental health clinics are 1 now in operation in the Okanagan, Vancouver Island, and Kootenay areas, and I facilities are presently under construction in Prince George for the development of I similar services to be offered to the Peace River and Northern Interior areas. To j date it would seem that these clinics are fulfilling their purpose, and although staff j shortages place a ceiling on the amount of psychiatric consultation, nonetheless by ; utilizing resource personnel in the community, such as the family physician, public \ health nurse, social welfare worker, Probation Officer, and others, a vastly improved 1 programme of prevention and treatment has been made available at the community 1 Public health nurses have continued to provide services to Indians on certain j reserves through agreement with the Medical Services Directorate, Department of National Health and Welfare. During the year a further exchange of service was arranged in the Lillooet and Lytton districts of the South Central Health Unit so that each service took on an adjacent population, thus reducing travel time for each nurse and providing a better service for both the white and Indian populations. Altogether approximately one-third of the 31,000 Indians living on reserves within the Province now receive routine public health nursing service from health unit personnel. The routine inspection of common carriers, formerly handled by the Engineering Division of the Department of National Health and Welfare, has now been assumed in part by the staff of the health units, to include the sanitation of railway yards and buildings, railway mobile work trains, airport ground facilities, B.C. Government ferries, privately operated ferries and dock facilities, In some areas, construction camps and Federal Government buildings are also included Ultimate legal responsibility for correction remains with Federal authorities. During the year, responsibility in the milk-sampling programme was transferred from this Department to the Department of Agriculture. The quality of milk produced in British Columbia over the years has improved, to reach a very high standard, and diseases formerly associated with unpasteurized milk have all but disappeared. A time study on the work of the public health inspector was carried out during the year and is to be repeated in the late spring of 1965. Results to date indicate the need for a limitation of time spent in indirect service in some areas, and it is anticipated that this time study will provide a sound base line from which a continuing programme can be developed in the years ahead. In addition, a policy and procedure manual was developed to acquaint the public health inspectors with the over-all sanitation programme. New multi-purpose inspection records have been introduced on a service-wide basis, to replace a multiplicity of forms formerly printed by health units. The programme of health centre construction continued with completion of health centres in West Vancouver, 100 Mile House, Sidney, Cloverdale, and Terrace, while others are under construction or in the planning stage in Rutland, Hope, Courtenay, Merritt, Alberni, Kamloops, Fruitvale, and Chetwynd. The need to extend existing health centres has been made apparent in Penticton and Salmon Arm, while plans are presently being prepared for the extension of the Chilliwack- Health Centre to house the mental health clinic team. LOCAL HEALTH SERVICES Q 45 In certain more remote areas of the Province, physicians are encouraged to I take up residence in outlying communities where they may provide service on a periodic schedule of visits to neighbouring communities which are not sufficiently I large in themselves to support a physician. Encouragement takes the form of a I grant-in-aid programme, and 18 physicians are presently in receipt of these grants. PERSONNEL The turnover among nursing and clerical staff during the year was approxi- \ mately as anticipated, but among medical health officers, dental officers, and public [ health inspectors it was somewhat greater than usual. Among Central Office staff, the promotion of the Assistant Director of the Division of Public Health Engineering | to head the Division resulted in a vacancy which was filled early in the year. In [ April a new position was created to meet the increased demands put upon the Division, but with the continued increase in the routine work load and with the additional very heavy demands made by the Pollution-control Board, it has not been possible within the limits of existing staff to provide adequate consultative services either to the health unit staffs in the field or in the work of pollution control. It is anticipated that certain measures will be taken to relieve the situation early in the coming year. During the year three health officers returned, having completed the course leading to the Diploma in Public Health at the University of Toronto, to take up positions as health unit directors in the Northern Interior and Peace River Health Units and in the new Coast-Garibaldi Health Unit with main office in Powell River. Two other physicians proceeded on course to obtain the Diploma in Public Health with the assistance of National Health Grants, and, in addition, three physicians were recruited to fill vacancies with the West Kootenay, Cariboo, and Boundary Health Units. Changes in the employment of physicians occurred in the Saanich and South Vancouver Island Health Unit and in the Cariboo, Central Vancouver Island, West Kootenay, Selkirk, North Okanagan, and Skeena Health Units. As mentioned above, continuing vacancies in the position of health unit director existed in four health units at the year's end. The resignation of a regional dental consultant to accept the appointment of Director, Dental Services Division, Department of Public Health and Welfare in Saskatchewan, created a second vacancy in the establishment of five regional dental consultants. Despite repeated advertisements, no suitable applications have been received, and it will be appreciated that without these positions being filled, effective dental health programmes cannot be carried out in 6 of the 18 health units in the Province. Changes in the employment of public health nurses have occurred due to the need for staff adjustments in local health services. During the year six full-time and five half-time public health nursing positions were added in an attempt to meet the very large additional demand for service, occasioned by population increase in certain areas of the Province, including Castlegar, Dawson Creek, Nanaimo, Kelowna, Chilliwack, Golden, Abbotsford, Campbell River, and Burns Lake. Recruitment involves provision of an active training and staff-development programme to enable suitably qualified nurses to fill the various positions. Eighty- nine per cent of the public health nursing field staff are fully qualified, while the remainder are temporary staff obtaining experience in the field before proceeding to university. Fourteen per cent have university degree preparation in public health nursing, with the remainder having a Diploma in Public Health Nursing. q 46 PUBLIC HEALTH SERVICES REPORT, 1964 An untimely loss was suffered through the death of Mrs. Jessica Field, senior nurse j in the Central Vancouver Island Health Unit. During the year the pattern of education and training of senior nursing staff j continued, with attendance of selected individuals at university to complete the ; Master of Public Health degree, subsidized under the National Health Grant training programme. In addition, a public health nursing consultant was thereby en- j abled to spend four months in study at the School of Public Health, University of ] California. In an effort to keep pace with changing concepts in the treatment and care of persons with emotional health problems, an attempt is being made to improve the background of public health nurses in mental health. During the year six public health nurses were given educational leave of absence, and National Health Grant assistance was obtained to enable them to enroll in the three-month affiliation programme at the Education Centre, Mental Health Services. One hundred and thirty-four public health nurses participated in a nine-month correspondence and discussion-group course arranged by the Department of Continuing Medical Education at the University of British Columbia entitled " The Scientific Method in Public Health Nursing." Fourteen research studies in public health nursing were submitted, and it is anticipated that other correspondence courses will be arranged. It should be appreciated that the health units themselves provide education and training facilities for student nurses with public health nurses on staff acting as field guides. During the year 24 nurses from the University of British Columbia and four from the University of Alberta had a month's field work, and 189 undergraduate nurses from six schools of nursing spent a week in observing public health. Some 37 students completing the practical nurse course at the Nanaimo Vocational School gained experience in Vancouver Island health units. In order to overcome staff shortages in the ranks of the public health inspectors and to meet the demand occasioned by population growth, industrial development, increased tourism, multiplicity of subdivisions, and the over-all industrial expansion, the policy of employing trainees for a 12-month period of in-service education, during which time they complete the correspondence course provided by the Canadian Public Health Association to obtain the required certification, was continued. Two persons were trained, and a further two were accepted for training during the latter part of the year. In January, 1964, 72 inspectors, including representatives from the Greater Vancouver and Greater Victoria health departments, attended an intensive one-week training course designed to acquaint them with new concepts in the fields of sewage disposal, air pollution, occupational health, and common-carrier inspection. The Health Branch is responsible for the development of Emergency Health Services planning, to include the training of selected individuals throughout the Province. Three courses were given during the year, beginning with one on " The Principles of Traumatic Surgery in Mass Casualty Care " at the University of British Columbia under the joint sponsorship of the Health Branch and the Department of Surgery, Faculty of Medicine. This was attended by over 40 practising physicians from all parts of the Province. Two hospital disaster institutes were held, in Nelson and Prince George respectively. These were attended by the hospital a<__ninistra- tive staffs of all hospitals in the areas concerned and were intended to induce these hospitals to develop disaster plans so that they might be ready to do their share in the event of a major community disaster. In addition, advanced treatment centres were exercised in Kamloops under the sponsorship of the local medical society and at Abbotsford under the direction of an interested militia commander. Individual hospital disaster plans were exercised at Nelson and Prince George in c LOCAL HEALTH SERVICES Q 47 I with the institutes being held there, and in addition St. Joseph's Hospital in Victoria and the Nanaimo General Hospital exercised their plans on their own initiative. Fourteen public health personnel attended intensive week-long courses at the Cana- [ dian Civil Defence College at Arnprior, to include four health unit directors, five I public health nurses, and five public health inspectors. In addition, the Director i of Emergency Health Services attended a Federal-Provincial Directors' Conference in the East and the Health Supplies Officer attended two week-long courses of ! instruction in the detailed management of the emergency hospitals and advanced treatment centres. During the year a series of meetings was held with the St. John Ambulance Association and the civil defence organization in an attempt to arrive at a more realistic policy in respect of first-aid training. It has now been agreed that first-aid training courses will only be paid for by the civil defence organization when the candidate volunteers for a civil defence post where such training is needed, and that priority will be given to those volunteering to work in the Emergency Health Services. SERVICES AND PROGRAMMES Public Health Nursing* Public health nurses provide service on a generalized basis, directing their activities primarily toward the promotion of family health and giving service to all ages as required. This involves direct care, health instruction, counselling, planning, and organizing special care. Certain specific services have been selected for comment, as follows. Public health nurses offered group classes to EXPECTANT PARENTS in all the larger centres. Health-teaching at this time not only helps the mother prepare physically and emotionally for the new baby, but through group discussion focuses attention on basic mental health concepts directed toward improving family health practices. During the year 10,131 mothers and 1,751 fathers attended these classes, slightly fewer than last year, but the over-all birth rate was down correspondingly. Ten per cent of the mothers of new babies attended, and, what is more important, approximately one-third of all primipara took part in the classes. At this time the content, method of teaching, and length of each series of prenatal classes are under study, and it is expected that some reorganization will serve to increase their value. In addition, some 4,361 home visits were made to expectant mothers with special problems or who were unable to attend classes. Two per cent of the total nursing time was spent on this programme. Instruction is provided to parents of INFANT AND PRE-SCHOOL CHILDREN to help them meet the physical and emotional needs of their children. This is accomplished through home visits and by counselling at child health conferences. Public health nurses made 24,588 postnatal visits to new mothers and visited 21,857 new babies under the age of 6 weeks. This represents 95 per cent of all new babies. In addition, home visits to infants amounted to 16,320, and 35,601 visits were made to pre-school children. Child health conferences are made available at regular intervals in all centres of population so that mothers may bring their children to receive selected services, such as screening for hearing or vision defects, immunization, and the benefits of counselling and guidance. A total of 55,556 infants and 65,655 preschool children attended at child health conferences, and although this represents a slight reduction in the infant attendances compared to last year, this still represents q 48 PUBLIC HEALTH SERVICES REPORT, 1964 60 per cent of all infants. The infant and pre-school programme absorbs 13.6 per 1 cent of the public health nurse's time, compared to 18.3 per cent 10 years ago. The SCHOOL HEALTH PROGRAMME as adopted in 1.962 remains basically unchanged and has proved to be practical and effective. A complete review of 1 the programme is planned early in 1965, at which time consideration will be given 1 to studies conducted by the health units. Certain changes were implemented for the J school-year 1964/65 as a result of recommendations from the health units, such that public health nurses now assume responsibility for vision screening in those grades formerly screened by teachers, with the exception of Grade X. In this grade the arrangement of classes calls for special planning, and the " blitz " method is often used, with screening done by teachers for all Grade X classes simultaneously. The second change involves a number of teacher-nurse conferences. In the elementary 1 school the number of grades in which conferences are held has been reduced from seven to four, and as a result the nurses have been able to devote more time to follow-up of pupils referred by the teachers. Continued evaluation of this programme will undoubtedly result in further modification to meet changing situations and new concepts of service to the school-age child. The following tables give information for areas served by the Greater Vancouver and Greater Victoria Metropolitan Boards of Health and for the Provincial health units. Table I.—Number of Schools and Enrolment by Type of School, lune, 1964 Vancouver Victoria Remainder of Province Type of School H Enrolment Sc&C Enroltne, Sclols Enrolment Grp,"*0O'S~ M n I 32$1 1,034 2W9W KiSe^^-— _4„6 4^ Private Figures are given for the grade schools (public and priv children. In grade schools enr Greater Vancouver area, by 2, the remainder of the Province. first tin ate), pi lment I 851 in blic kinde as increas he Greats edinth r Victo n three types of schools— , and schools for retarded e past year by 5,804 in the da area, and by 10,233 in Table II.—Number of Pupils with Immunizations Up ti Grade I, September, 1963 Item Vancouver V-ria | g|g!| Total pupils enrolled 12,758 |§|f| 23 826 Diphtheria, pertussis, tetanus, and poliomyelitis 14,865(62.4%) 11 be noted that over 60 per cent of pupils are up to date in their i le time they enter Grade I. This figure is slightly higher than last year and LOCAL HEALTH SERVICES Q 49 I indicates an active immunization programme for pre-school children. All areas I continue to maintain a high immunization status for children in elementary and [ secondary schools. [ Table III.—Number of Pupils in All Grades with Immunizations Up to Date, June, 1964 Item Vancouver Victoria Rema ,tz°\ IZ^ZZZ'Zzzr- ._- llllli 30.605 ! iiii ll (84.2%) Table IV.—Number of School Medical Examinations (All Grades), 1963/64 The number of routine examinations in the Greater Vancouver a essentially the same as last year, but the number of " referral" s decreased by 3,373. In the Greater Victoria area there is a slight increase in both figures. The changing pattern of medical examination of school-children is evident in areas served by the Health Branch, where examinations by the school medical officer have decreased markedly and the number of school beginners examined by the family physician has increased by 1,138. The number of "referral" examinations by the school medical officer is less than half the 1963 figure. It seems probable that the increased availability of medical care has resulted in many children being referred by public health nurses direct to the family physician. This is particularly evident in the more heavily populated areas. Increased facilities, such as regional mental health clinics, speech clinics, and travelling clinics, may also have reduced the need for children to be seen by the school medical officer. Tab leV.—S ohool Health Programm e in Public Kindergartens 1964 Item Vancouver gg BBS Number of pup dsrefmdltc ~48 iff KSofpi; Vubncr^nursff^oS 88 (92.6%) Number of refe rralexamina ions by school medical officer... 8 The total enrolment in kindergartens operated by the Boards of School Trustees is 10,412, which is 25 per cent of the Grade I enrolment. A marked increase in enrolment has occurred this year in areas served by the Health Branch, where the number of pupils has .increased from 1,384 to 2,512. It is gratifying to note that q 50 PUBLIC HEALTH SERVICES REPORT, 1964 teacher-nurse conferences were held for 92.6 per cent of the divisions, a substantial § increase from last year. Considerable activity continued relative to SCHOOL HEALTH INSTRUC- ] TION in elementary and secondary schools. A test of health knowledge was pre- 1 pared and given to 1,739 students in Grade X in the Boundary Health Unit, this 1 study being planned as a device which might indicate whether students are familiar f with the course content and can apply their knowledge to simple health problems. Out of 100 items, scores ranged from 14 to 90, with a median of 55. It is interest- '. ing to note that the areas of least knowledge concerned the so-called health habits I relating to posture, care of teeth, problems of overweight, prevention of the common 1 cold, vitamins, and body elimination. Further work was done on teaching aids for j posture and smoking and the venereal diseases. Considerable liaison work h continued with all three universities and with the British Columbia Division of the ( Canadian Medical Association as progress is made toward an over-all revision, not only of the health education curriculum in schools, but also of the type of health- teaching offered to teachers in university. A survey of sex education practice in the schools revealed that the " menstrual hygiene " programme is very well accepted I throughout the Province, and that " changes of puberty for boys " is a programme j which is developing rapidly. Some 38 school districts (exclusive of the metropolitan areas) are providing a variety of programmes in sex education in secondary schools Public health nurses have continued to increase their activities in the field o MENTAL HEALTH, due largely to an increase in the psychiatric resources mad available in many Interior communities. More emphasis is being placed on _ tance to adults, and during the year 40 per cent of the visits were made to this group. A total of 9,592 home visits was made to persons with mental disturbances Two hundred patients were referred for follow-up on discharge from psychiai hospital or ward of a general hospital, and health unit staffs have been active both I in helping The Woodlands School with the assessment of children on their waiting list and in reorganization planning for retarded schools at the local level. In al, a total of 1,877 home visits was made on behalf of retarded children. The HOME CARE PROGRAMME has continued to become a basic of health unit operation as more areas have indicated their wish for such hom I nursing service to be provided. During the year the Upper Fraser Valley Healt Unit commenced home nursing service in the Matsqui-Sumas-Abbotsford area completed organization for the service to commence early in the new year in Chill wack. This means that 60 per cent of the population within the Provincial health units now receives home nursing through the local health units, and when the home nursing service of the Victorian Order of Nurses is added, as provided in the metro- politan health services of Vancouver and Victoria and in one or two other large centres, a total of 81 per cent of the population of the Province has home nursii service available. A five-year statistical study covering the period 1959-63, ii elusive, was completed in September to provide a detailed analysis of the home nursing programme over this period. It is of interest to note that in 1963 service was provided to a population of 441,390 in 39 communities, compared with 159,500 in 10 communities in 1959, an increase of 170 per cent within the five-year period. T The number of patients given service increased from 627 in 1959 to 1,737 in 1963, [ to represent an increase of 185 per cent. Some 12,225 visits were made in 195 , while in 1963 the number had risen to 36,350, to represent a 200-per-cent incre Certain figures remain much the same from year to year, to include age distribut with 71.4 per cent given care being over the age of 60, while the number of v per patient remains at an average of 21, with the total time per visit being approx - mately 30 minutes. On the other hand, there has been a very large increase ir LOCAL HEALTH SERVICES Q 51 I number of patients received into the home-care programme directly from hospital, increasing from 145 in 1959 to 518 in 1963, an increase of 257 per cent. This is probably a result of improved hospital liaison. The estimated number of hospital days saved per patient remains high, at 14.0 [in 1963. This represents a total of 3,464 acute hospital days, 15,037 chronic, and 5,813 days for other types of institution, for a total of 24,314 days, compared to 13,727 in 1959, an increase of 77 per cent. At an estimated $20 per day for an acute hospital bed, $12 per day for a chronic, and $7 for other institutional care, this represents a saving in institutional costs of $281,111. During 1964 some 42,724 visits were made, compared with 40,408 the previous year, an increase of 5 per cent. The health units continue to provide the most economical and efficient method of co-ordinating these home-care services, and two half-time consultant physiotherapists have been provided to give in-service education on rehabilitation nursing and to assist with the assessment and planning of home care for certain patients. One of the physiotherapists works with the staff in the Greater Victoria metropolitan area, including the Victorian Order of Nurses. The other serves in the Lower Fraser Valley area, including New Westminster. During the year the Manual of Home Nursing Care was revised, and a new and original section added on nursing rehabilitation exercises. The nursing staff have been active in assisting with other special programmes, such as speech and hearing, poison-control follow-up, special health educational projects, well-women's cancer clinics, etc. A programme whereby health consultation is provided to operators of boarding homes and nursing homes has commenced, with special interest being given toward food services. Altogether, public health nurses made 133,761 visits to homes and provided 721,291 services by telephone. Nutrition The people of British Columbia are fortunate to live in one of the few areas of the world where both an adequate amount and the right kinds of food are available. Without this, nutritional well-being is impossible, but even with it nutritional health cannot be guaranteed unless sensible attitudes toward food and a knowledge of the kind and amounts of food required are recognized in the home. The nutrition service contributes to this end by acting in a consultant capacity to public health personnel directly involved with the general public, to those involved with group feeding, to other Government departments, and finally to those concerned in any way with the dissemination of nutrition knowledge. A great deal of correspondence is carried out with small hospitals, and the Nutrition Consultant has visited 12 during the past year. Further time is spent in reviewing and advising on plans for hospital kitchens, and additional guidance is given to young people's camps, private schools, and hospitals. At the year's end a manual on food service for boarding homes neared completion. The Nutrition Consultant also acts on a committee of the British Columbia Dietetic Association which is working to develop a course at the vocational-school level for food supervisors in hospitals. Homemaker services and home nursing groups have requested and received talks on nutrition and meal planning. Preventive Dentistry dental services in the metropolitan areas continue to pay increasing attention to pre-school children, as shown in Table VI below. Of all Grade I pupils in the public schools of Greater Vancouver and Greater Victoria, by classroom examination 48.5 per cent did not appear to be in need of treatment for dental decay, 18.7 per cent were subsequently treated by their family dentist, and 25.1 per cent by the school dental clinics (Vancouver only). PUBLIC HEALTH SERVICES REPORT, 1964 Table VI.—Full-ti n British Columbia, H 111 Grade I Pupils School-year li. l (2) I £