THIS IS A HEALTH ISSUE

Re: Drug use 'our biggest challenge,' July 25.

Each of us knows how difficult it is to change the behaviour of
others. Physicians and other health-care providers struggle with this
as we try to help patients to change.

Research has shown that people go through five stages of behaviour
change: precontemplation, contemplation, preparation, action, and
maintenance. Once we know where someone is on this pathway to change,
activities can be tailored to encourage people toward sustainable change.

Health professionals involved in the City of Ottawa's crack-kit
program understand that most addicts are at the precontemplation
stage where addicts are unable, uninterested, or unwilling to change
their behaviour. Small steps like speaking with an outreach worker,
using safer crack kits, smoking and not injecting, all of these are
behaviour changes that in time could increase the likelihood that
some addicts will progress toward the action stage and enter into a
drug rehabilitation program.

Harm-reduction programs recognize that behaviour change is difficult
and that it is necessary to prevent future serious medical problems
as patients take the small incremental steps towards better health.

Dr. David Salisbury, Ottawa's medical officer of health, and the
other professionals who work in drug rehabilitation understand this
model of behaviour change. Ottawa council members would do well to
understand this model in guiding their decisions.

Unlike other cities, we do not have an independent board of health.
Ottawa councillors act as our board of health. In their role as
health board members, councillors need to shift their vision away
from their political agenda and examine complex public health issues.
They must learn that it takes time to see the results of investments
in prevention.

Ottawa councillors must also ensure that Dr. Salisbury can be
independent of city politics and can fulfill the goals of health
promotion, harm reduction, and disease prevention. In this way,
councillors can be a credible, accountable board of health.

Lee Donohue, MD, Ottawa,

President, Academy of Medicine Ottawa