Advocacy Timeline

"For several decades, there was nothing else like it in the country; and when several other provinces began their own programs, the Alberta Medical Association’s model was frequently the one they followed."¹

For over 70 years, dedicated Alberta doctors, nurses and other caregivers worked to improve the health and safety of pregnant women and newborn babies in the province, volunteering on three successive committees:

• Committee on Maternal Welfare (formed in 1936).
• Committee on Perinatal Mortality (formed in 1954).
• Committee on Reproductive Care (formed in 1984).

Impact

Over the 70 years, the committees confronted every issue involving reproductive health, regardless of controversy, such as the Alberta hereditary disease program, female genital mutilation, birth weight, contraceptives and teenage sexuality.

The committees studied maternal, perinatal and neonatal mortality to identify issues for practice and system improvements in obstetrical and newborn care.

They advocated for legalized medical abortions, midwifery practice, stillbirth investigations, breastfeeding support and regionalization of care for high-risk mothers and babies.

All three committees also collected a storehouse of information about pregnancies and maternal and infant health. As a result, Alberta has one of the most complete and accurate databases on pregnancy and maternal health in the world and impressively low rates of maternal and infant death and illness.

Note:

1. Alberta Medical Association Committee on Reproductive Care: A Celebration of 70 Years of Vision and Action

Physicians were constant and vocal advocates for child safety seat legislation throughout the 1970s and 1980s — until legislation was finally passed in 1987.

In addition to almost yearly appeals to government for legislation, the AMA promoted public awareness by:

• Producing a poster for doctors’ offices. 
• Distributing five 30-second public-service announcements to Alberta TV stations. 
• Partnering with Safeway to print the safety seat message on paper grocery bags.   

Impact

[Car Seat Image]

The AMA’s advocacy efforts reflected the priority of the issue for its physician members. When motor vehicle collisions involve children, physicians see the toll in injuries and fatalities.

The AMA’s sustained advocacy kept this gap in preventative safety measures before legislators and the public.

Before Alberta’s law, motor vehicle collisions were a leading cause of death for children under four. Using a child safety seat properly remains one of the most effective injury prevention measures.

Thanks largely to advocacy efforts by the medical profession and the support of patients, seat-belt legislation became law in Alberta in July 1987.

Undeterred by the Alberta government’s unwillingness to act on the issue (despite sound evidence that seat belts saved lives), the AMA launched its "Your name could save a life" petition in late 1986.

Physicians across Alberta (who placed the petition in their office) and partner organizations gathered more than 62,000 signatures – results that clearly showed public support for a law.

The AMA President and President-Elect of that time, Dr. Richard Kennedy and Dr. Ruth Collins-Nakai, delivered signed petitions to the Minister of Transportation in December 1986.

By the mid-1970s, although some 16 countries and two Canadian provinces had seat-belt legislation, the Alberta government had ignored initial AMA calls for a seat-belt law.

Throughout the late 1970s and 1980s, the AMA continued to press almost annually for seat-belt legislation. The Alberta government finally passed its law in 1987, one of the last two provinces in Canada to mandate compulsory seat-belt use.

Impact

According to Transport Canada, in 2009-10 Alberta had a 92% compliance rate for seat-belt use.

Seat belts save about 1,000 lives per year in Canada. As well, using a seat belt reduces the chance of being injured at all or of receiving a severe injury (source: Alberta Occupant Restraint Program).

As an indirect benefit, these safety measures also reduce health care system costs.

Throughout its history, the AMA has spoken out publicly on the health consequences of tobacco use and the need for tobacco reduction and smoke-free environments.

Highlights of some important AMA actions chronicle the scope and scale of the issue in addressing one of Alberta’s leading causes of preventable serious illness and death.

1980s

• Advocated to eliminate smoking on aircraft (a federal ban was enacted).
• Urged Alberta newspapers/magazines to voluntarily remove tobacco product advertising.
• Presented AMA awards to pharmacies and hospital gift shops voluntarily discontinuing the sale of tobacco products.
• Assisted physicians to make personal presentations to school boards asking for smoke-free school policies, resulting in six school divisions declaring themselves smoke-free.
• Asked the provincial government to implement substantial increases in tobacco taxes.
• Encouraged provincial legislation to prohibit sales to minors and increase fines for infractions; provincial legislation to make restaurants smoke-free; and provincial government policy to make all government workplaces smoke-free.

1990s

• Urged the Alberta government to mandate Alberta Alcohol & Drug Abuse Commission (AADAC) to provide smoking cessation programs.
• Asked for the removal of tobacco products in all pharmacies.
• Continued to press for higher tobacco taxes, with funds raised dedicated to health care.
• Asked the provincial government to make all public places and workplaces smoke-free.
• Partnered in Capital Health’s "Smoke-Free Homes" pilot project in Edmonton.

2000 onwards

• Asked for legislation to ban promotion and display of tobacco products in places where children and young adults are allowed.
• Continued to press the Alberta government to enact legislation for smoke-free public places.
• In the absence of provincial legislation, supported physicians to make a presentation at public hearings by municipal councils for local smoke-free bylaws.
• Partnered with Health Canada and others in "Teaming Up for Tobacco-free Kids" educating grade 6 students on the harms of tobacco use.
• Developed a parent handout for physicians to use to promote not smoking in cars with kids.
• AMA has served on the province’s tobacco reduction advisory committee since it was formed in 2003 (now the Provincial Advisory Committee on Tobacco).

Impact

Physicians know first-hand how tobacco use impacts Albertans’ health. In speaking on physicians’ behalf, the AMA has been proactive and brought a credible and influential voice to efforts to combat tobacco use.

An innovative AMA initiative – the "New Year’s Baby Car Safety Seat" program – made sure the first baby born in hospitals in Alberta’s seven major cities/regional centers had a safe ride home.

A physician in each of the seven communities presented the car seat to the New Year’s baby’s parents at the hospital.

This program was a natural extension of the AMA’s advocacy for legislation and public education about the importance of child safety seats.

The safety seat program began when there was no legislation and continued for several years after Alberta’s seat belt/child safety seat law came into force in July 1987.

After 1987, the program’s focus shifted to reminding parents to install a seat properly and use it only as recommended.

The AMA program had support from Dorel Co. Ltd., which donated the car seats as a public service. 

Impact

For more than 10 years, Alberta physicians sponsored the "New Year’s Baby Car Safety Seat" to underscore to new parents – and to Albertans overall – that car safety seats save children’s lives.

Now, with legislation and enforcement, buckling a child into a car safety seat is the accepted norm for children and adults.

About the project

By examining every area of maternal and infant health, the AMA’s Reproductive Care Committee sailed into turbulent social and political waters of the 1980s and 1990s, tackling many controversial issues, such as:

• HIV/AIDS.
• Birth control.
• High rates of teen pregnancy and sexually transmitted diseases.
• Education for physicians about teen sexuality.
• Universal sex education.

Beyond advocating for sex education in schools (a move that influenced a provincial policy change in 1989), in 1991, the AMA went directly to the public, issuing a bright poster to alert teens that doctors were available for counseling on sex and contraceptives.

Physicians received a booklet called Go Ahead … Ask Me: Physician Guide to Teen Sexuality Counselling that helped them prepare for teenagers’ problems and questions.

Impact

The initiative brought a sharp reaction from some parents who believed that any sexuality counseling done without their knowledge was a violation of their rights and those of their children.

Newspapers were flooded with protest letters, especially in rural Alberta.

But the complaints became more muted as Albertans absorbed the shocking fact that provincial rates of teen pregnancy and disease were among the highest in the country.

All of this work by the Reproductive Care Committee (e.g., pressure on government to introduce sex education in schools, its work on teen pregnancy and birth control and the campaign targeting physicians) provoked a major shift in public attitudes.

(Source: A Celebration of 70 Years of Vision and Action [2005])

Injuries to children and a tragic Alberta playground fatality in 1992 led to an AMA partnership with Alberta Safe Kids to develop a resource kit on removing playground hazards.

Other partners and sponsors included Alberta Community Development, the Sport Medicine Council of Canada, the Sturgeon Health Unit, PlayWorks and the St. Albert Rotary Club.

The kit offered a step-by-step approach to assessing playground safety as well as a checklist and templates for avoiding common hazards.

Two editions of "Removing Playground Hazards for Our Children’s Sake" were released: one in 1994 and a second in 1996.

For more information:

Read "Kids are worth it: AMA’s efforts to make playgrounds safer will reduce injuries" >>

Impact

About 3,000 copies of this user-friendly playground safety resource were distributed. Orders came mostly from Alberta but also from all parts of Canada as well as from the US, England and Australia.

Society was changing with the onslaught of more virulent sexually transmitted infections (STIs), especially HIV.

In 1994, the AMA’s Reproductive Care Committee took the lead in a joint project ("It Takes Two: The Condom and Pill") of the Alberta Medical Association (AMA), Canadian Medical Association and Health Canada.

The goal was to encourage physicians to counsel women using the pill or other forms of birth control about the importance of using condoms as protection against HIV and other STIs.

The project provided pamphlets and printed materials, including a poster for physicians’ offices.

While women sat in the waiting room, they completed a risk assessment sheet. They then received a guide on women’s risk of HIV and STIs, an instruction sheet on how to use a condom and free condoms.

Impact

Overall, the project’s evaluation results indicated strong support for the effectiveness of the "Condom & Pill" material as well as for the physician discussion.

The project was effective with a geographically diverse population as well as with various specialty groups.

The tourist industries, especially those in Banff and Jasper, also welcomed the project and posted information and provided materials for their employees.

Despite the project’s success, in the end, a source of funding was not found to sustain the "Condom & Pill" project in Alberta beyond 1996.

(Sources: A Celebration of 70 Years of Vision and Action [2005] and An Overview of "It Takes Two" – Condom & Pill Project [1997])

Developing a screening program

In 1997, a committee co-chaired by the Alberta Medical Association (AMA) and Alberta Health, was formed to develop an HIV screening in pregnancy program.

At that time, in Canada, about 25% of infants born to HIV-positive women acquired HIV from their mother. There was no way to accurately know which pregnant women would transmit the virus.

Based on the committee’s work (which included validating recommendations with stakeholders and focus groups), in early 1998, Alberta Health announced that HIV testing would become part of routine prenatal care later that year.

The key objective was to reduce HIV infection by perinatal transmission. With early detection of HIV, a pregnant woman could receive antiviral drugs that benefited the health of both mother and child and reduced the risk of passing the virus to the infant by about 70%.

Routine prenatal HIV testing began in Alberta in September 1998 as an "opt out" program.

The AMA, Alberta Health and Health Canada also developed educational materials about the program for physicians and for pregnant women. A formal evaluation of the new program was completed in 2001.

The AMA partnered with Alberta Health and others in a public awareness campaign using the Edmonton Space Science Centre’s HIV mobile exhibit, which traveled throughout the province.

Impact

According to A Celebration of 70 Years of Vision and Action (an historical account of the AMA’s Reproductive Care Committee), within a short time, 97% of women giving birth in Alberta were being tested for HIV.

Routine prenatal HIV testing has both improved the lives of HIV-positive mothers and the lives of their children.

In 2000, the AMA partnered with Health Canada to test an innovative workshop to help physicians learn about the cultural environment in which they provide care to aboriginal patients.

Called "Journey to Understanding," the workshop was created by an AMA-Health Canada working group led by an aboriginal physician.

The sold-out workshop was unique. In a Nakoda Lodge on the Stoney Reserve near Calgary, physicians participated in sessions with aboriginal speakers, breakout groups in teepees with joint aboriginal and non-aboriginal facilitators and cultural activities such as traditional dances, a sweat lodge and a guided nature walk.

Read "Journey to understanding: First Nations culture and health issues" >>

Impact

Evaluation results and participant and facilitator feedback were very positive.

Although the AMA’s role was to establish the feasibility and value of the innovative concept, the AMA is not mandated or funded to be a provider of regular continuing medical education.

Unfortunately, despite the success of "Journey to Understanding," no other organization has stepped forward to plan future events.

When children are apprehended, they may have conditions that require ongoing medical attention or may have been in traumatic situations that impact their health.

The AMA has worked with the provincial ministry on issues such as:

• Challenges in arranging medical examinations soon after children are taken into government care.
• Concerns about a ministry policy change that reduced the standard of care for an at-risk population by increasing the length of time before an apprehended child must be examined by a physician.
• System changes to improve children’s access to physicians and to ensure that physicians receive the child’s previous medical history.

Impact

This work is ongoing. The AMA’s Section of Pediatrics has worked with the ministry and Alberta Health Services since 2011 to develop a more integrated, collaborative care model to better serve the health needs of these children.

The "Pediatrics for Kids in Care (P-KIC)" model is now in place in larger urban centers – P-KIC Calgary and P-KIC Edmonton are formalized programs for medical assessment of children in care, championed by Alberta pediatricians. The intent is to expand the model across the province over time.

The Alberta Medical Association endorses the Canadian Medical Association position that there are no medical circumstances that justify exemption from wearing a seat belt.

The AMA saw the Alberta law allowing seat belt exemptions for medical reasons as a traffic safety issue for Albertans. The AMA released its own position statement in 2002 to guide physicians and the public.

Despite being aware of the medical profession’s opposition to medical exemptions, the provincial 2003 Vehicle Equipment Regulation still allowed them.

Impact

The AMA updated its position paper in 2003 to reflect the new regulation, but the AMA’s position remains unchanged to this day. Seat belts save lives, and there are no medical circumstances that justify exemption from wearing a seat belt.

View the AMA’s "Medical Exemptions from Seat Belt Use" resource

Other useful resources

• Alberta Occupant Restraint Program
• Transport Canada for car seat safety information (search "car seats").
• Canadian Medical Association Driver's Guide (for ordering information).

Childhood obesity is a major health issue with long-term physical health and possible mental health consequences.

A 2010 Alberta Health Services report¹ calculated that 22% of Alberta children and youth are overweight or obese.

AMA advocacy has been longstanding:

• Advocating for regular physical activity in schools (and congratulating the minister when the government mandated 30 minutes of Daily Physical Activity (DPA) in schools in 2003).
• Advocating for school policies for healthier food choices (in vending machines or snacks).
• In 2007, urging the Edmonton Public School Board to vote yes to a motion to eliminate junk food in all of its schools.
• Encouraging physicians to assess children’s BMI (body mass index) for age annually through the use of growth charts and providing practice tools to support doing this.

Impact

By speaking out on behalf of physicians collectively, the AMA has highlighted the importance of this complex health issue and of public policy measures that help to promote change.

Note 1: Based on 2004 data, the most reliable data available.

The AMA endorses the recommendations of the Canadian Pediatric Society (CPS ), which are based on research and injury data . Key recommendations include the following:

• No child or youth under 16 years of age should operate an ATV regardless of the ATV’s size.
• A child should only be carried as a passenger on an ATV that is designed and approved for more than one person.
• Anyone on an ATV should wear a helmet and protective equipment.

There were 185 ATV-related deaths in Alberta from 2002-2013 - an average of 16 per year.

The AMA has urged the Alberta government to enact legislation consistent with the Canadian Pediatric Society recommendations.

Impact

Despite the toll to children, the Alberta government has not adopted CPS recommendations for minimum operating age, mandatory safety training for children or mandatory helmet use.

Alberta’s Off-Highway Vehicle Regulation sets no age restrictions for ATV users other than making it illegal for someone younger than 14 years old to drive an ATV on highways or to operate an ATV on public property without having an adult passenger (18+) supervising.

The Alberta government has not enacted legislation making helmet use mandatory for the general population. This is in spite of the fact that the government has included provisions in the Occupational Health and Safety Code that require adults using ATVs in work settings to wear helmets.

Note 1: Alberta Centre for Injury Control & Research.

Anyone who participates in a sport involving speed and possible body impact risks head injury.

Helmets that meet acceptable standards can reduce the risk and severity of skiing or snowboarding injuries. Yet helmets for alpine sports imported into or manufactured in Canada are not required under law to meet any recognized safety standard.

In 2006, the AMA advocated for provincial legislation to require all recreational alpine skiers and snowboarders to wear helmets.

In 2009, when Health Canada asked for public input on whether to federally regulate standards for skiing or snowboarding helmets, the AMA asked for mandatory – not voluntary – standards (as well as regulatory measures to monitor and enforce compliance).

Impact

Provincially, the Alberta government has said it does not support legislating mandatory helmet use for recreational skiers or snowboarders and prefers education and public awareness.

Federally, Health Canada still does not require alpine sport helmets to meet the Canadian Standards Association’s 2008 Recreational Alpine Skiing and Snowboarding Helmets standard Z263.1 or any other internationally recognized standard. This is despite the fact that all ice hockey helmets imported or sold in Canada must meet the relevant CSA standard for hockey helmets.

Community treatment orders are a way to ensure that patients with mental illness living in the community comply with essential treatment.

The government introduced amendments to the Mental Health Act in 2007, proposing a legal framework for community treatment orders.

The AMA supported these but also drew the ministry’s attention to important issues to address in developing regulations and policy. The AMA provided expert medical advice while the regulations were being drafted.

Impact

With input from relevant specialist groups, the AMA ensured that patient care and professional issues informed government decisions on how community treatment orders would be implemented.

Distracted driving causes collisions and injuries (and new technologies such as cellphones can worsen this problem).

The AMA has a long record of working to reduce distracted driving:

• Giving in-kind support to a 2006 documentary, "Sudden Stop" (made available to schools and health authorities):
• Read "Alberta documentary exposes reckless driving epidemic" in the AMA’s Alberta Doctors’ Digest
• In 2007, calling for provincial action to address distracted driving, especially cellphone use.
• Submitting a brief to the legislature standing committee reviewing Bill 16, "Traffic Safety (Distracted Driving) Amendment Act," (and advocating for a ban of both hand-held and hands-free devices while driving).
• Commending the government for legislation passed in 2010 banning hand-held devices and urging future amendments to extend the ban to hands-free devices.
• Becoming a supporter of Students for Cellphone-free Driving (SCFD) (which educates young Albertans on the risks of distracted driving).

Impact

AMA efforts helped persuade legislators to pass Bill 16. Then health minister Ron Liepert publicly said that he had moved from opposing to supporting the bill because of the medical profession’s advocacy.

University of Alberta medical students founded Students for Cellphone-free Driving in 2009. With help from an AMA Emerging Leaders in Health Promotion grant, University of Calgary medical students recently established their own branch.

Both branches help to reduce distracted driving among young drivers by delivering educational presentations to high school students around the province:
For more information about the project, read "Ban the tech: Pass the tech"

In 2008, the AMA and the University of Alberta’s Alberta Centre for Injury Control and Research (ACICR) joined forces as founding partners of the "Finding Balance: Prevent a fall before it happens" campaign. 
At the time, seniors’ falls were a neglected health promotion issue even though one in three seniors in Alberta falls each year (and the resulting injuries can seriously affect their quality of life).

Impact

The campaign brings public attention to the issue (especially during November — Seniors’ falls prevention month) and focuses on simple steps that seniors living in the community can take.
The AMA remained a major sponsor of "Finding Balance" for four years (2008-11) to help it build a solid footing.

Since then, the campaign continues under the capable leadership of ACICR, and the AMA is no longer directly involved but remains a firm supporter of Finding Balance’s efforts to reduce seniors’ falls.

Find out more

The AMA supports:

• Banning access to tanning facilities by children and youths under 18, and
• Introducing regulations that require health warnings for tanning facilities.

The World Health Organization (WHO) has declared artificial UV rays to be a known human carcinogen. The health risks of artificial tanning have also prompted bans in other Canadian and international jurisdictions.

Impact

The AMA has formally asked the Minister of Health to introduce legislation and has also joined the Indoor Tanning Is Out Coalition (a coalition of health-based organizations working together for effective legislation to protect young Albertans).

In addition to its political objective, the coalition sponsors public awareness events. Its educational work is supported by Alberta Health Services, which hosts an interactive website on the risks of indoor tanning:

Visit the Big Burn website

In March 2015 the Legislature passed the Skin Cancer Prevention (Artificial Tanning) Act intended to protect Albertans under the age of 18 and help inform Albertans about the health risks of ultraviolet artificial tanning so that they can make informed decisions.¹

Effective January 1, 2018, the Alberta government required all owners and employees to comply with this Act. To this effect, businesses providing artificial tanning services:

• Cannot provide ultraviolet (UV) artificial tanning services to minors
• Cannot advertise UV artificial tanning services to minors.
• Are required to post health warnings and age restrictions.
• Cannot have unsupervised self-service artificial tanning equipment in public places

Note:

1. www.health.alberta.ca/initiatives/artificial-tanning-act.html>

• View news release

Since 2013, the AMA Youth Run Club has been a partnership of the AMA and Ever Active Schools. As a school-based program, the AMA Youth Run Club has the following goals:

• To increase levels of physical activity among school-aged children and youth;
• To develop life-long healthy lifestyle habits;
• To decrease screen time;
• To educate, through School Health Advocacy Talks; and
• To develop youth leaders and school champions who will contribute to the sustainability of the program.

As the YRC continues to strive to help Alberta’s children and youth increase their activity levels and develop healthy living habits, its key priorities have evolved to include gender equity, Indigenous health, junior high and high school communities, and adapted sport and physical activities.

In support of gender equity, in fall 2017, the YRC launched GO! Run, (Girls Only!), to provide young girls with an environment where they can feel safe and confident as they participate in athletics. 18 Alberta schools – elementary, junior and senior high – host GO! Run clubs. Coached and managed by female teachers, GO! Run clubs are proving to be very popular with the students AND the teachers.

There are Youth Run Clubs and/or GO! Run clubs in 20 schools located in 10 Alberta First Nation School Authorities. Through the invaluable support of YRC Ambassador Rilee ManyBears, the Youth Run Club is able to develop long-lasting relationships with Indigenous schools and students.

Inclusive, adaptable, free and well-supported with leadership resources (including workshops and webinars), the AMA Youth Run Club overcomes barriers to physical activity for children and youth, and provides them with a sense of comradery and acceptance.

Five Years Strong!

From the AMA Youth Run Club’s start in 2013, with 233 schools and 17,000 students, to this spring’s participation rates of 524 schools and 26,000 students, growth has been strong and steady, with no signs of slowing down!

Comprehensive School Health (supported by the AMA Youth Run Club)

From 2014-2016, a representative of the AMA Health Issues Council worked alongside Ever Active Schools, as a member of the Alberta Health Services Comprehensive School Health Working Group.

The collaboration resulted in a video, jointly funded by the AMA, EAS and the Alberta School Boards Association, that explores the many ways in which the YRC aligns with the Comprehensive School Health commitment to "supporting improvements in students’ educational outcomes while addressing school health in a planned, integrated and holistic way." (Source: Pan-Canadian Joint Consortium for School Health)

Find out more about how the AMA Youth Run Club supports CSH.

Through our Health Issues Council, the AMA is helping future physicians to use their skills, enthusiasm and initiative to improve the health of others.

Our Emerging Leaders in Health Promotion grant supports medical students and resident physicians who want to champion a health promotion issue (leading a project in addition to their core medical studies).

Nurturing the creative ideas of the next generation of physicians, the grant gives them direct experience in influencing change and helps to build their leadership and advocacy skills.

Impact

Some of the more recent projects include: doctors fighting the opioid crisis by bringing helpful information in the form of a card game to the streets of Alberta, providing a summer camp overseen by physicians and medical health personnel for children with heart diseases and promoting physical activity for children with disabilities.

For information about these and other initiatives, visit Emerging Leaders in Health Promotion Grant page.

The AMA took a leadership role in advocating for reducing air pollution, using coal-fired power plant emissions as a starting focus, to improve Albertans’ health. The AMA’s Health Issues Council agrees with evidence that suggests that poor air quality is linked to a variety of health concerns and has put its support behind phasing out the use of coal power, a significant source of air pollution in Alberta. This in turn can prevent deaths and reduce the burden on the health care system.

As a result, the AMA, along with a number of local organizations, lobbied the government to make this become a priority. The Alberta government has since committed to phasing put coal pollution by 2030 under the Climate Leadership Plan.

For more information see www.alberta.ca/climate-coal-electricity.aspx>