The family physician and the public health perspective: Opportunities for improved health of family practice patient populations

Christopher Sikora; David Johnson

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Re: advocacy and Industrial Wind Turbines IWT
Karen L. Rideout

Published on: 17 April 2010
advocacy and Industrial Wind Turbines IWT
Richard Denton

Published on: 02 January 2010
The Family Physician as patient advocate
Roy D Jeffery

Published on: 01 December 2009

Published on: (17 April 2010)

Re: advocacy and Industrial Wind Turbines IWT
Karen L. Rideout, Knowledge Translation Scientist
Other Contributors:
I would like to clarify Dr. Denton’s statement regarding Dr. Ray Copes’ and my support (or lack thereof) for wind turbines. Dr. Copes and I co-authored a report for the National Collaborating Centre for Environmental Health (http://www.ncceh.ca/en/ncceh_reviews/other/wind_turbines) in which we review the evidence relating to the potential for...
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I would like to clarify Dr. Denton’s statement regarding Dr. Ray Copes’ and my support (or lack thereof) for wind turbines. Dr. Copes and I co-authored a report for the National Collaborating Centre for Environmental Health (http://www.ncceh.ca/en/ncceh_reviews/other/wind_turbines) in which we review the evidence relating to the potential for human health effects from living near wind turbines. The review was an evidence review, and not intended to advocate for or against wind turbine developments. Neither of us would characterize our views as being ‘for’ or ‘against’ wind turbines.

In our report, we find a lack of evidence in support of direct health impacts from noise, electromagnetic fields, or shadow flicker. We did, however, find some evidence that sleep disruption or annoyance may be associated with living near wind turbines. We also describe potential risks of injury from structural failure or falling ice.

There is a need for further study to assess any potential health effects relating to low levels of low frequency sound, as well as to measure impacts of wind turbine sound on sleep physiology. In assessing wind turbine sound, it is important to distinguish between the sound power level (a rating of sound produced at the source) and the ambient sound pressure level, which is what people experience in theirs homes or in the community. It would be helpful to have more measurements of actual ambient noise levels around wind turbine developments (i.e., where people live) in order to determine whether they are within WHO or other guidelines for community noise.

Karen Rideout, MSc
Knowledge Translation Scientist, National Collaborating Centre for Environmental Health

Ray Copes, MD
Director, Environmental and Occupational Health, Ontario Agency for Health Protection and Promotion
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Competing Interests: None declared.
Published on: (2 January 2010)

advocacy and Industrial Wind Turbines IWT
Richard Denton, family physician
Dear Roy: good to hear from you. I strongly agree with you that we family physicians need to advocate on behalf of our patients and this includes in areas of protecting them from environmental hazards. You make many claims about the harmful effects of Industrial Wind Turbines IWT but I have yet to see any Evidence Based Medicine articles on this. I am familiar with some of the literature, such as from Public Health Author...
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Dear Roy: good to hear from you. I strongly agree with you that we family physicians need to advocate on behalf of our patients and this includes in areas of protecting them from environmental hazards. You make many claims about the harmful effects of Industrial Wind Turbines IWT but I have yet to see any Evidence Based Medicine articles on this. I am familiar with some of the literature, such as from Public Health Authorities, MOH, and have also seen a reputiating article of the same. A Dr. Ray Copes is in favour of wind turbines, and Nina Pierpoint, and Karen Rideout are not. Dr. McMurtrie is also doing a report for the government? It seems that the problems of migraines, sleep deprivation, flickering, appearance to the sky line, have been documented in qualitative studies but for an energy source that has been around for many years, there is still little research on it. There has been some studies on death of small animals(bats) and birds. There have been improvements in the design of wind turbines in having the rotors downwind from the pole, etc. I thus agree with you that we need more research. The question is where to draw the line, at 500 m, 1 km or as you suggest, 2 km where these are built from human habitation. There is also the question of alternatives, coal fired generators, nuclear energy, etc and each of these has their problems. Thus, in looking at the big picture, least harm for as few people needs to be taken into consideration.
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Competing Interests: None declared.
Published on: (1 December 2009)

The Family Physician as patient advocate
Roy D Jeffery, MD, FCFP
In their article entitled “The family physician and the public health perspective”, Sikora and Johnson identify three scenarios where the benefits of incorporating public health elements into practice are made clear. They remind us that the Canadian advisory Committee on Public Health 2001 identified 6 key domains of public health practice, the first three being “health protection” (taking action to protect individuals...
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In their article entitled “The family physician and the public health perspective”, Sikora and Johnson identify three scenarios where the benefits of incorporating public health elements into practice are made clear. They remind us that the Canadian advisory Committee on Public Health 2001 identified 6 key domains of public health practice, the first three being “health protection” (taking action to protect individuals against health and safety risks), “health surveillance” (identifying health events of concern through the collection, integration, analysis and interpretation of data with the dissemination of results to the appropriate people and organizations), and “disease and injury prevention” (developing interventions to reduce the likelihood or progression of disease). (1)
I would like to suggest another important role for family physicians in the domain of public health. That is to advocate for the victims of environmental illness. Currently in Ontario and indeed in jurisdictions across Canada and abroad the public health system seems to be struggling to come up with a sensible response to the growing public health phenomena associated with industrial wind turbines (IWT). In the light of increasing numbers of victims in every jurisdiction of the province where IWT’s have been built in close proximity to human habitation, we would have expected a recognition from the public health authorities that more in depth surveillance and precautionary measures were appropriate. Rather than a process based on the above key domains of surveillance, protection and prevention the response seems to have been characterized by political posturing related to government and corporate agendas around “green energy”. I wonder if the victims of industrial turbines were experiencing the side effects of a new experimental drug whether the authorities would have as much difficulty coming to the realization that data collection was appropriate. In addition I suspect that if monitoring was in place and a rash of new and serious syndromic illness developed shortly after the introduction of a new drug to a community, the response would not be “there is as yet no proof, more studies are needed before taking action”. Rather our public health officials would move immediately to protect the health and safety of the citizens by withdrawing the new experimental drug.
In the case of IWT’s we have a new and rapidly evolving technology. Turbines are now 40 stories tall and sweep an area greater than the size of a jumbo jet. They emit an effect well known to cause illness (noise at a variety of frequencies including ultra low frequencies).(2) Although industry data indicates that most IWT’s now emit over 106 dB at the source, little is known about how the various frequencies of sound diffuse through the environment. Computer generated sound modeling has been shown to be highly inaccurate. Further officials in the Ministry of the Environment for Ontario have admitted that they lack the technology to monitor compliance with noise guidelines. A rapidly increasing number of people living in the shadow of turbines are describing a well defined syndromic illness which subsides when they leave the area and redevelops when they return. Many people have had devastating effects on their health largely mediated through sleep deprivation. I believe it is desirable for family physicians who are working in the affected areas to advocate for their patients (even for those who are facing the threat of health effects from improper placement of IWT’s). Family physicians can ask some of the following questions. Why are the public health agencies not collecting data on health effects? Why are some officials insisting that the syndrome does not even exist? Rather than calling for a moratorium on new IWT installations less than 2 km from human habitation to ensure that many more people are not injured, why is our Ministry of Health calling for more research and study?
Family physicians can advocate for a public health agency which bases its policy on the precautionary principle. In the case of IWT’s this would involve immediately setting up an unbiased database for monitoring health and safety effects and ensuring that no new IWT’s are built within 2 km of human habitation, schools and gathering places. In this role of patient advocacy family physicians would certainly be a “resource to their community” and a “major partner in disease prevention, surveillance and promotion in Canada.”
Roy Jeffery MD,FCFP Little Current, Ontario
1. Advisory Committee on Population Health, Public Health Agency of Canada; 2001 2. Night Noise Guidelines for Europe, World Health Organization; 2007
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Competing Interests: None declared.