Impact of a Labour Disruption Affecting Local Public Health on the Incidence of Chlamydia Infections in Toronto

Abstract

IntroductionLabour disruptions that interrupt services can be a natural experiment to examine the effect of halting a program. A five-week municipal labour disruption in Toronto during the summer of 2009 provided an opportunity to investigate the impact of reduced sexual health services.MethodsWe examined the incidence of reported chlamydia in Toronto during the five years (2004–2008) preceding the labour disruption and during the periods just before, during, and after the labour disruption. Comparisons of actual reports for 2009 were made to immediately adjacent periods around the labour disruption, to historical trends and to forecasted rates. Interrupted time series analysis was used to test for significant differences in the trend of reported chlamydia incidence.ResultsThere was no significant difference in the trend of reported chlamydia incidence around the time of the strike. However, there was a small but significant increase in the incidence of reported chlamydia, particularly among females under 25 years old immediately following the labour disruption. The reported incidence for this group was higher than would be expected based on annual increases and projected seasonal trends.ConclusionsThere was a small increase in incidence of reported cases of chlamydia for certain groups that went beyond what is expected during the time immediately following the labour disruption. While causation cannot be implied from our ecological study, public health services may play a role in the control of sexually transmitted infections, even in the short-term. This underscores the need for future work to understand whether the changes observed can be attributed to the absence of these services.

The impact of strike action on patient morbidity: A systematic literature review

“…The quality of the 13 remaining papers varied. Four studies scored well, scoring six or above 12‐15 . Several studies scored relatively low on this scale, with five papers scoring three or less 16‐20 .…”

“…Four studies scored well, scoring six or above. 12 , 13 , 14 , 15 Several studies scored relatively low on this scale, with five papers scoring three or less. 16 , 17 , 18 , 19 , 20 The remainder of these studies fell somewhere between, scoring four or five.…”

“…One final and more recent study also reported more mixed results, exploring the impact of a strike on sexual health services. 14 This study used population data to examine the incidence of reported chlamydia in Toronto during strike and non‐strike periods. This strike lasted 36 days, with 5 of the 95 staff continuing to work to provide care for those with more acute needs.…”

Impact of healthcare strikes on patient mortality: a protocol for a systematic review and meta-analysis of observational studies

“…Given the pressing concerns about patient well-being during strike action, an outcome that has received particular attention is patient mortality, with a number of studies measuring patient mortality in-hospital/clinics and in populations/communities during strike action. To a lesser extent, a number of other patient outcomes have been examined in light of strike action, from immunisation rates 12 to chlamydia rates 13 for example.…”

The Impact of Health Workers' Strikes on Health Outcomes and Health Service Utilization in Low- and Middle-Income Countries: A Systematic Review

“…2 A study of a 36day municipal workers' strike in Toronto, which included employees of the Toronto Public Health Department and led to the closure of all eleven sexual and reproductive health clinics, found a small but significant increase in chlamydia cases immediately after the strike. 3 In low and middle-income countries (LMIC) with different disease burdens and access to and quality of health services, it is possible that strikes by health workers pose different risks to patients compared to HIC. [4][5][6] A recent review of the characteristics and frequency of health workers' strikes between 2009 and 2018 in 31 low-income countries identified 70 strikes across 23 countries that totaled 875 lost working days, with a median number of 77•5 working days lost per year.…”