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Do I Need my Flu Shot? * cough * cough *

   Have you ever woken up with a terrible cough? A runny nose that will not stop dripping? A general feeling of being “under the weather”? According to the World Health Organization (2018), commonly referred to as WHO, “seasonal influenza is characterized by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose.” For some, these symptoms may last less than a week without requiring medical attention but for others, influenza can lead to severe and debilitating illness and potentially death (World Health Organization [WHO], 2018).

   While the statistics may change from year to year depending on the severity of the flu strain, an average of 23,000 laboratory confirmed cases are reported annually to the FluWatch program, Canada’s national surveillance system for monitoring influenza (Ministry of Health and Long-Term Care [MOHLTC], 2018). This number is projected to be even higher due to the number of cases that may go unreported as some may choose to not seek medical assistance (MOHLTC, 2018). The Ministry of Health and Long-Term Care estimates that there are 12,200 hospitalizations due to influenza each year and an overwhelming 3,500 deaths in Canada annually (MOHLTC, 2018).

   Everyday prevention such as proper and frequent hand hygiene, coughing and sneezing into your elbow, and staying home when feeling unwell, or avoiding those who are ill are all positive steps to take to protect yourself against getting the flu (Centres for Disease Control and Prevention [CDC], 2020). However, the Centre for Disease Control has stated that, “getting a flu vaccine each year is the best way to prevent the flu” (2020). The flu vaccine works by causing your body to generate antibodies against the viruses present in the vaccine (Mayo Clinic, 2019). This is why getting your flu shot each year can help minimize the risk of catching the influenza virus.

   A common misconception is that getting the flu vaccination once will suffice; however, genetic mutations arise constantly among the influenza virus, making it important for individuals to get their flu shot annually to have the best chance of protection (Fukuda, & Kieny, 2006). It is difficult to determine its exact effectiveness, however, researchers have estimated that the 2019 flu shot is 40%-60% effective at reducing the risk of influenza (Centers for Disease Control and Prevention [CDC], 2019). Vaccinations work to prevent the spread of influenza by protecting individuals directly and by protecting populations indirectly through herd immunity (Logan et al., 2018). Herd immunity is the idea that when a certain percentage of a population is vaccinated, the rate of transmission is reduced (Logan et al., 2018). This is why it is important that the maximum amount of people who can receive the flu vaccine do so.

   Ontario currently has a Universal Influenza Immunization Program (UIIP) in place (Ministry of Health & Ministry of Long-Term Care [MOH & MOLTC], n.d.). This program is intended to provide the flu shot, free of charge, to individuals who are over the age of six months and live, work or go to school in Ontario (MOH & MOLTC, n.d.).

   While it is important for all eligible individuals to get immunized, we believe that targeting children would be the most effective method to protecting the health of the population. Children are often associated with being efficient spreaders of the influenza virus to the population through their school and home lives (Zeltser, 2009). A study determined that by immunizing children through the flu shot, there was a decreased school absenteeism for the immunized child in addition to their siblings (King et al., 2006). Furthermore, immunizing children was significantly correlated with decreased illness and work absenteeism among the parents (King et al., 2006). Ensuring that children are receiving their flu shot annually can effectively prevent influenza complications of the child and individuals in close proximity as well.

   Children spend a significant portion of their day in a school environment, making it the perfect target for policy implementation. Currently, in Ontario under the Immunization of School Pupils Act students must either have received their vaccinations or have appropriate medical or religious exemption (Ministry of Health and Long Term Care [MOHLTC], 2015). Failing to do so may result in suspension (MOHLTC, 2015). Likewise, if there is an outbreak or an outbreak is reasonably foreseeable, the school is required to suspend any child who has not received their vaccinations (MOHLTC, 2015). However, influenza is not included on the list of mandatory vaccinations.

   Including the influenza vaccination on the Immunization of School Pupils Act could be problematic as it would not be ideal to remove children from school every time there is an imminent threat of an outbreak (Schnirring, 2008). Rather, a policy should look to set up vaccination clinics at school as a way to increase the rate of vaccination among the younger population. A randomized trial including over 40 elementary schools revealed that when implementing school-located influenza vaccination clinics they were able to increase the total rate of vaccination from 47.4% to 54.1% (Szilagyi et al., 2016). This modest, yet important increase can open the doors to potential policy implementations surrounding influenza vaccinations in schools.

   It is time we look to influenza-related policies to help protect the population as a whole. Previous policies have been implemented surrounding healthcare professionals and immunizations. London Health Sciences Centre (LHSC) has made it mandatory for students to receive influenza vaccinations while in placement (London Health Sciences Centre [LHSC], n.d.). Additionally, they have explored potentially implementing a ‘vaccinate or mask’ policy to encourage front line staff to get their immunizations or to wear a mask while providing care (Lupton, 2018). Overall, influenza has proven to be extremely dangerous, and even deadly. Policies are needed to help encourage and enable individuals to get the flu vaccination each year to prevent the virus from spreading amongst the population.

Blog Post by Madelyn DaSilva, HELP Lab Practicum Student, 4th year Faculty of Health Sciences & Justine Dryburgh, 3rd year Facullty of Health Sciences, March 2, 2020

References:
Centers for Disease Control and Prevention [CDC]. (2020). Influenza (flu.) How well flu vaccines work. Retrieved from https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm

Centers for Disease Control and Prevention [CDC]. (2019). Influenza (flu). What you need to know for 2019-20. Retrieved from https://www.cdc.gov/flu/season/faq-flu-season-2019-2020.htm#anchor_1568639330820

Fukuda, K., & Kieny, M. (2006). Different approaches to influenza vaccination. The New England Journal of Medicine, 355, 2586-2587. doi: 10.1056/NEJMe068257

King, J., Stoddard, J., Gaglani, M., Moore, K., Magder, L., McClure, E., . . . Neuzil, K. (2006). Effectiveness of school-based influenza vaccination. The New England Journal of Medicine, 355(24), 2523–2532. doi: 10.1056/NEJMoa055414

Logan, J., Nederhoff, D., Koch, B., Griffith, B., Wolfson, J., Awan, F. A., & Basta, N. E. (2018). ‘What have you HEARD about the HERD?’ Does education about local influenza vaccination coverage and herd immunity affect willingness to vaccinate?. Vaccine36(28), 4118-4125.

London Health Sciences Centre [LHSC]. (n.d.). Student affairs, non-medical: Health requirements. Retrieved from https://www.lhsc.on.ca/student-affairs-non-medical/health-requirements

Lupton, A. (2018). ‘Vaccinate or mask’ ruling prompts London hospitals to review policies. CBC News. Retrieved from https://www.cbc.ca/news/canada/london/vaccinate-or-maks-1.4818607

Mayo Clinic. (2019). Flu shot: your best bet for avoiding influenza. Retrieved from: https://www.mayoclinic.org/diseases-conditions/flu/in-depth/flu-shots/art-20048000

Ministry of Health and Long-Term Care [MOHLTC]. (2015). Vaccines for children at school. Retrieved from: https://www.ontario.ca/page/vaccines-children-school

Ministry of Health and Long-Term Care [MOHLTC]. (2018). 2018-2019 Universal influenza immunization program. Retrieved from: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/docs/flu_uiip_HCP_QA_2018-19.pdf

Ministry of Health & Ministry of Long-Term Care [MOH & MOLTC]. (n.d.). 2019/2020

Universal influenza immunization program (UIIP). Retrieved from: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/

Schnirring, L. (2008). Experts weigh advisability of school-based flu shots. Center for infectious Disease Research and Policy. Retrieved from http://www.cidrap.umn.edu/news-perspective/2008/11/experts-weigh-advisability-school-based-flu-shots

Szilagyi, P., Schaffer, S., Rand, C., Vincelli, P., Eagan, A., Goldstein, N.,… Humiston, S. (2016). School-located influenza vaccinations: A randomized trial. Pediatrics, 138(5). doi: https://doi.org/10.1542/peds.2016-1746

World Health Organization [WHO]. (2018). Influenza (seasonal). Retrieved from https://www-who-int.proxy1.lib.uwo.ca/en/news-room/fact-sheets/detail/influenza-(seasonal)

Zeltser, M. (2009). Influenza vaccination: Financial burden or public health solution? Biotechnology healthcare, 6(4), 29-31. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799097/?tool=pmcentrez&report=abstract

 

Reflecting on Lessons Learned from Past Public Health Emergencies

   On January 30, 2020, the World Health Organization (WHO) declared the 2019 global outbreak of the coronavirus disease (COVID-19), which originated in Wuhan, China, to be a public health emergency of international concern (PHEIC) (WHO, 2020c). By doing so, the WHO defined this viral outbreak as an “extraordinary event” that threatens the global public health of its member countries through the international spread of disease, and potentially requires a coordinated international response (International Health Regulations (2005): Third Edition, 2016). 

   Declaring a PHEIC allows the WHO to expand its power to mobilize resources and coordinate international aid to support countries with weaker health systems and a significantly higher risk of being impacted by infectious disease; in turn, this curbs the spread of global outbreaks (Smith & Shelley, 2020).

   The creation of International Health Regulations regarding PHEICs occurred in 2005 as a response to the human losses suffered during the 2002-2003 SARS outbreak (Douglas & Staudenmaier, 2020). Since the term was coined in 2005, the WHO has declared six PHEICs: the H1N1 pandemic (2009-2010), West Africa's Ebola outbreak (2014-2016), the Polio outbreak (2014), the Zika virus (2016), the ongoing Ebola outbreak in the Democratic Republic of Congo (2019), and the current COVID-19 outbreak (Douglas & Staudenmaier, 2020; Smith & Shelley, 2020). 

   Addressing the emerging ethical and sociopolitical dilemmas associated with COVID-19 requires scientists, healthcare providers, and ethicists to look back at lessons learned from past public health emergencies. It is imperative to learn from past experiences in order to improve upon current healthcare systems and develop better emergency preparedness and response guidelines that reduce and prevent the spread of infectious diseases. Only by examining the successes and failures of the international community, in responding to previous PHEICs, can we determine how to effectively address current and future PHEICs and ultimately save more lives.

In theory, each pandemic experience has provided a unique “wake-up call” for health officials to improve upon guidelines for preparing and responding to global public health emergencies (Smith & Upshur, 2015). However, this article examines some of the main lessons “learned” (or not) from previous PHEICs and how they can be applied to address the current COVID-19 outbreak.

First Lesson: Transparency is Key

   Arguably the most important lesson learned from previous PHEICs is about transparency, as it is crucial for governments to promptly and openly report any cases of disease that have the potential to internationally spread (WHO, 2003). The 2003 SARS epidemic and the 2009-2010 Ebola outbreak particularly revealed the need to improve the communication of risks and precautionary guidelines to the general public and international community (Smith & Upshur, 2015). Effective communication has proven critical in gaining the public’s trust and reducing the health, economic, and psychosocial impacts of past PHEICs (WHO, 2003). However, a lack of transparency during the 2009-2010 Ebola outbreak exacerbated the spread of misinformation and created public panic, distrust, and paranoia, which resulted in people’s refusal to accept public health interventions (Smith & Upshur, 2015). 

   Unfortunately, China failed to apply this lesson of transparency with regards to the COVID-19 outbreak due to fear poor social and economic consequences. However, this came at the cost of human lives. The government was slow to report the first cases of COVID-19 to the international community and delayed its acceptance of foreign aid for over a month, during which the virus spread widely amongst the public (Favaro & Jones, 2020).

   Furthermore, the Chinese government actively took punitive measures to prevent healthcare providers from raising awareness of the outbreak. Wuhan ophthalmologist, Dr. Li Wenliang, was accused of “rumor-mongering” and committing “unlawful acts” for warning his colleagues and the general public about the novel coronavirus strain circulating among his patients (Xiong & Gan, 2020). Sadly, Dr. Wenliang eventually contracted the virus while providing medical care and succumbed to it himself, which sparked public outrage (Moritsugu, 2020). Thus, the initial lack of transparency during the COVID-19 outbreak reveals a clear need for Chinese health officials to participate in community engagement to rebuild the public’s trust in order to effectively respond to the PHEIC (Upshur & Smith, 2015).

Second Lesson: The Lesson Not Learned

   Unfortunately, efforts to address the COVID-19 outbreak thus far and reflections on the past reveal a common lesson: we fail to truly learn from previous public health emergencies and their tribulations. In truth, it is more accurate to say that many valuable lessons from past PHEICs have been “identified” in the literature, rather than “learned” and put into practice by governments and organizations (Smith & Upshur, 2015). In fact, Executive Director of the WHO’s Health Emergencies Programme, Dr. Michael Ryan, admitted: “We don’t tend to learn the lessons from (outbreak) response… Or at least, we don’t tend to implement the lessons that we’ve learned” (Favaro & Jones, 2020).

   Simply put, we lack the depth of understanding needed to truly learn lessons from the past and apply them in preventing, responding to, and recovering from ongoing and future public health emergencies. Learning the identified lessons requires a critical analysis of past PHEICs that moves beyond determining where and how emergency preparedness and response patterns proved ineffective (Smith & Upshur, 2015). Instead, we must comprehend what factors contributed to or exacerbated the ineffectiveness of global health action during PHEICs, and examine the moral failures reflected from our inability to translate lessons “learned” into policy and practice (Smith & Upshur, 2015).

   To address the need for guidance in ethically applying lessons learned from previous PHEICs, the WHO is piloting a Public Health Emergency Ethics Preparedness and Response Network (PHEEPR). This network will aim to provide ongoing "coordinated and contextual ethics support” during public health emergencies, thus aiding governments and health professionals in ethical decision-making (WHO, 2020b). Furthermore, the PHEEPR will conduct research to improve global preparedness for future PHEICs and address unsettled ethical dilemmas from previous outbreaks (WHO, 2020b). With the COVID-19 outbreak’s re-opening of unsettled debates regarding the ethical justification of forced quarantine, the PHEEPR’s guidance will especially be needed.

Third Lesson: Global Solidarity

   The third lesson, reinforced with each viral outbreak, is that global solidarity is imperative for effectively responding to and curbing the spread of PHEICs. Since the 2003 SARS outbreak, it has become clear that researchers and public health experts from around the world must set aside their individual interests and unite to openly share their data across borders and collectively aid countries in responding to global outbreaks (WHO, 2003). Data sharing is morally promoted by ethicists because it maximizes the social benefits of research and promotes the public health good for all (Langat et al., 2011). Furthermore, the effectiveness of disease surveillance and emergency response systems is dependent on the strength of collaboration between countries and their distribution of resources (Smith & Upshur, 2015).

   Currently, there is an urgent need for governments to collaboratively take measures to curb the spread of the COVID-19 outbreak. As of February 23, there have been 78,811 confirmed cases and 2,619 deaths of COVID-19 in at least 28 countries around the world (WHO, 2020a; Yeung, Marsh, & John, 2020). Despite the virus’ relatively low death rate of 2%, COVID-19’s rapid transmission around the world is concerning and the WHO’s Director-General, Dr. Tedros Adhanom Ghebreyesus, urges the global health community to seize the narrowing “window of opportunity” to contain this outbreak (Reuters, 2020; WHO, 2020d). A Global Outbreak Alert and Response Network team of leading epidemiologists, clinicians, and outbreak control officials has been deployed to China to collectively improve our understanding of the outbreak (WHO, 2020d). However, only time will tell if past lessons on international collaboration are effectively applied to stop the spread of COVID-19.

Blog Post by Nagham Hashem, HELP Lab Practicum Student, 4th year Faculty of Health Sciences 
February 27, 2020

Learn More/Additional Resources:
Smith, M. J., & Upshur, R. E. (2015). Ebola and Learning Lessons from Moral Failures: Who Cares about Ethics? Public Health Ethics, 8(3), 305-318. doi:10.1093/phe/phv028

WHO. (2020, February 23-a). Coronavirus disease 2019 (COVID-19) Situation Report – 34. Retrieved from https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200223-sitrep-34-covid-19.pdf?sfvrsn=44ff8fd3_2

WHO. (2020, January 26-b). Piloting the PHEEPR Network (Public Health Emergency Ethics Preparedness and Response). Retrieved from World Health Organization: https://www.who.int/news-room/detail/26-01-2020-piloting-the-pheepr-network

References:
Douglas, E., & Staudenmaier, R. (2020, January 30). What constitutes an international public health emergency? Retrieved from Deutsch Welle News: https://www.dw.com/en/what-constitutes-an-international-public-health-emergency/a-52114823

Favaro, A., & Jones, A. M. (2020, February 17). Is COVID-19 spreading because we didn't heed the lessons of previous viral outbreaks? Retrieved from CTV News: https://www.ctvnews.ca/health/is-covid-19-spreading-because-we-didn-t-heed-the-lessons-of-previous-viral-outbreaks-1.4816167

(2016). International Health Regulations (2005): Third Edition. Geneva: World Health Organization. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/246107/9789241580496-eng.pdf;jsessionid=7D2D30D8507D7EC790F228F8E00AAD0F?sequence=1

Langat, P., Pisartchik, D., Silva, D., Bernard, C., Olsen, K., Smith, M., . . . Upshur, R. (2011). Is There a Duty to Share? Ethics of Sharing Research Data in the Context of Public Health Emergencies. Public Health Ethics, 4(1), 4-11. doi:10.1093/phe/phr005

Moritsugu, K. (2020, February 6). Chinese doctor who sounded the alarm about the coronavirus dies. Retrieved from CTV News: https://www.ctvnews.ca/health/chinese-doctor-who-sounded-the-alarm-about-the-coronavirus-dies-1.4799956

Reuters, T. (2020, February 21). 'Window of opportunity' to contain coronavirus is now, health officials say. Retrieved from CBC: https://www.cbc.ca/news/world/coronavirus-covid19-feb-21-1.5470987

Smith, M. J., & Upshur, R. E. (2015). Ebola and Learning Lessons from Moral Failures: Who Cares about Ethics? Public Health Ethics, 8(3), 305-318. doi:10.1093/phe/phv028

Smith, M., & Shelley, J. (2020, February 3). What the coronavirus emergency declaration means for Canada. Retrieved from Western News: https://news.westernu.ca/2020/02/what-the-coronavirus-emergency-declaration-means-for-canada/

WHO. (2003). Chapter 5: SARS: Lessons From a New Disease. Retrieved from The World Health Report: https://www.who.int/whr/2003/chapter5/en/index5.html

WHO. (2020, February 23-a). Coronavirus disease 2019 (COVID-19) Situation Report – 34. Retrieved from https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200223-sitrep-34-covid-19.pdf?sfvrsn=44ff8fd3_2

WHO. (2020, January 26-b). Piloting the PHEEPR Network (Public Health Emergency Ethics Preparedness and Response). Retrieved from World Health Organization: https://www.who.int/news-room/detail/26-01-2020-piloting-the-pheepr-network

WHO. (2020, January 30-c). Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Retrieved from https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)

WHO. (2020, February 19-d). WHO Director-General's opening remarks at the mission briefing on COVID-19. Retrieved from https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19

Xiong, Y., & Gan, N. (2020, February 5). This Chinese doctor tried to save lives, but was silenced. Now he has coronavirus. Retrieved from CTV News: https://www.ctvnews.ca/health/this-chinese-doctor-tried-to-save-lives-but-was-silenced-now-he-has-coronavirus-1.4797913

Yeung, J., Marsh, J., & John, T. (2020, February 24). Coronavirus cases surge in Italy, Iran, South Korea. Retrieved from CNN: https://edition.cnn.com/asia/live-news/coronavirus-outbreak-02-24-20-hnk-intl/index.html

HELP Lab Intro Blog Post

   Welcome health ethics, law and policy enthusiasts! We are the Health Ethics, Law & Policy Lab, commonly known as the HELP Lab, a new interdisciplinary research lab at Western University. We bring together researchers and trainees across multiple faculties. Our goal is to tackle challenges in health ethics, health law, and health policy using an interdisciplinary approach. The HELP Lab facilitates collaborative and transformative research through the expertise of individuals and groups across Western University's campus and other institutions. Together as a lab, we examine a large range of topics in ethics, law and policy, and the roles they play to impact health. From medical cannabis to ethical considerations of global epidemics, our lab explores a large variety of topics on a local, provincial, national, and global scale.

   We envision a bright future for this blog! Its purpose is to give undergraduate students and graduate students a platform to discuss health ethics, law and policy related issues that matter to them. It is a platform to promote and facilitate meaningful discussion in the field. It is our hope that this blog will grow to become an avenue for current and upcoming professionals in health ethics, law and policy to share their experiences and contribute to the discourse on these topics. We encourage all students at every stage in their academic careers to contribute to the blog. The goal of the blog is to inspire students and professionals alike to consider the effects of health ethics, law and policy in the world around us.

   Our three Co-Directors are Dr. Maxwell Smith, Dr. Shannon Sibbald, and Dr. Jacob Shelley. Accompanying them, we have a dedicated team of students ranging from undergraduate to PhD candidates in the fields of health studies, law, philosophy, kinesiology, and health and rehabilitation sciences. Together, we work to produce useful research findings that support policies, professional practice, and programs aimed at providing real-world benefit and enhance the provision of high-quality care for Canadians.

   Here at the HELP Lab, we are open to diverse opinions and challenging subjects from all students and faculty regardless of discipline (as long as it is within the scope of the HELP Lab!). While certain topics in health ethics, law, and policy can certainly become controversial, it is our intent to create a safe space on this blog for discussion, free of discrimination and hate.

   We hope you will find the HELP Lab blog useful in furthering your understanding of, and participation in the ever-changing discourse on health ethics, law and policy. We look forward to starting this discussion and hearing your insights on all things health ethics, law and policy-related! If you have any questions or would like to learn more about the HELP Lab, email us at helplab@uwo.ca.

February 4, 2020

Western Smoke-Free Policy 

   New to the 2019/2020 school year, Western University has become a smoke-free campus. What does this mean exactly? Smoking traditional tobacco cigarettes, cannabis, and vaping is prohibited from being done on Western property. This policy is aimed to protect the health all individuals on campus. This policy has been in the works since 2015 when Western surveyed more than 40,000 students, staff and faculty members, and it was found that an overwhelming amount of responders wanted Western to become smoke-free. Why is this important? Smoking can have serious health implications not only for the individual, but also puts those around them at risk through the dangers of second hand smoke. It was estimated that second-hand smoke can increase your risk of developing heart diseases by 25-30% and well as lung cancer by 20-30% among so many other dangers (City of Toronto, n.d.). This policy was implemented with the goal of protecting the health of all individuals on campus.

   The Western survey was followed by meetings with group representatives from students, staff and faculty to discuss the future of smoking on campus. In early 2017, the Advisory Committee on Future of Smoking at Western was established and they proposed a phased in approach of the policy beginning in January of 2018. The goal was to implement a total smoke, vape and tobacco-free policy by July 1st, 2019. The first implementation phase asked people who smoked to stay 10 meters away from all campus buildings. Following the success of this phase, on July 1st, 2018 six designated smoking areas on campus were created, which meant that the rest of campus were now smoke-free spaces. On July 1st of 2019, the policy had reached its overall objective of becoming completely smoke, vape and tobacco free on campus. If someone wanted to smoke, they would be required to move to a City of London owned street on the outskirts of campus. In addition to the new policy, the STOP program has been created in partnership with the Middlesex London Health Unit to help the cessation of smoking. The STOP program has been run every single month since May of 2018. This confidential workshops have received excellent feedback with smoking cessation for those who want to quit.

   There are some important exemptions to the smoke-free policy, such Indigenous peoples’ rights to use traditional medicines. As the policy states, “This exemption is in alignment with Indigenous peoples’ distinct rights to observe their cultural and ceremonial practices on campus” (Western University, n.d.). It is important for the policy to recognize the rights of Indigenous peoples on campus.

   Currently, the policy is being enforced by the Smoke Free Campus Ambassadors who are responsible for increasing awareness regarding the policy on campus. This group of students and alongside various community members work in teams of two to encourage those who chose to smoke to use appropriate areas.

   This policy is beneficial to the entire Western community. It is designed to protect all individuals on campus from the dangers of being exposed to second hand smoke. Western is making significant progress to ensuring the overall health of all staff, students and faculty. We hope to see this policy continue to be respected in the future.

   Let’s clear the air together!

Blog Post by Madelyn DaSilva, HELP Lab Practicum Student, 4th year Faculty of Health Sciences 
February 4, 2020

Learn More/Additional Resources:
Want to learn more about the Smoke-Free campus policy, check out https://www.uwo.ca/hr/safety/wellness/clear_the_air/index.html

References:
City of Toronto. (n.d.) Second-hand smoke and the law. Retrieved from https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/live-tobacco-free/second-hand-smoke-and-the-law/

Western University. (n.d.) Policy 1.16- Policy on smoking, vaping & tobacco use. Retrieved from https://www.uwo.ca/univsec/pdf/policies_procedures/section1/mapp116.pdf