A Public Health Wake-Up Call for Canada

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

This report describes the general idea of improving Canada?s public health (and in particular, infectious disease) infrastructure with emphasis on the idea of a national body or network to coordinate public health efforts and a Chief Public Health Officer to provide national leadership to public health efforts. The duties and financing of a new national body have yet to be determined but it is likely that all three levels of government and all hospitals would be affected.

Purpose of health policy or idea

• This report describes the general idea of improving Canada's public health (and in particular, infectious disease) infrastructure with emphasis on the idea of a national body or network to coordinate public health efforts and a Chief Public Health Officer to provide national leadership to public health efforts.
• Since the federal, provincial and municipal governments are all currently involved in the funding and delivery of public health (to different degrees in different provinces), all three levels of government would be affected by a new organisation.  Providers (institutional and individual) would be affected.  Due to the population-wide nature of public health programs, all Canadians would potentially be affected as well.
• The financing of a new national organisation has yet to be determined. Potentially, financial incentives could be built into the policy in the form of earmarked intergovernmental transfers or payments to providers.

Main points

Main objectives

Nationally-coordinated public health infrastructure.

Type of incentives

Potentially both financial and non-financial.

Groups affected

All three levels of government (federal, provincial, municipal), Providers, The Canadian public

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

This policy if implemented would dramatically change the delivery and management of public health services in Canada. Since the detailed policy discussions have not yet begun, the degree of controversy involved remains unclear.

 

Political and economic background

• At the time of our last survey round in February 2003, public health officials in Canada were gearing up to combat West Nile disease, a potentially fatal mosquito-born illness that infected about 100 Canadians during the previous summer.  
• These preparations were being made by a public health community that has expressed long-standing concerns that Canada's public health infrastructure is underfunded, even relative to the health care system at large.  Because the public health system tends to be invisible to the general public (except in times of crisis), investments in public health infrastructure have been low on governments' lists of priorities. Experts were warning that the public health system was too stretched to handle both the increasing burden of chronic illness and preparations for emerging infectious diseases. 
• A few short weeks later in March 2003, SARS arrived in Canada infecting health care workers, closing hospitals and dominating news headlines.  In late April, the World Health Organisation issued an advisory against non-essential travel to Toronto. This was a major blow to the economy of Toronto and the country as a whole. Forty-four people died of SARS in Toronto making it the hardest hit area outside of Asia. 
• Early on in the outbreaks, it was evident that there were organisational difficulties hampering the tracking and management of cases, the tracing of contacts, communication with front-line health care workers and the sharing of information between the multiple agencies dealing with SARS. In the wake of the crisis, three expert committees were appointed (one by the federal government and two by the Ontario provincial government).
• Though SARS was the instigator for the committees, the idea of a nationally coordinated infrastructure would have major implications for public health in general, especially disease surveillance and control.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

• The main purpose of the idea is to develop a national strategy on public health and to increase funding for public health infrastructure.  While personal or clinical health services are controlled by the 10 provincial governments, this decentralisation is seen as impractical for infectious disease control. A clarification of federal, provincial and local roles is needed followed by greater investments in human resources and information technology. The establishment of a national co-ordinating body at arms-length from government would help to depoliticize public health decision-making.
• The scientific community has been the primary proponent of nationally coordinated public health. In addition to the appointment of the aforementioned expert committees, the idea was also endorsed by an ad hoc Committee on the Future of Public Health in Canada, organised by the national health research granting agency. So while this policy idea is not a new one, Canada's recent SARS crisis has put our public health infrastructure in the spotlight.

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

• The idea of a nationally coordinated public health infrastructure has most recently been proposed by the first of the three expert committees, which reported in early October 2003. The committee - chaired by Dr David Naylor, Dean of Medicine at the University of Toronto - recommended a stand-alone national public health body and an increase in funding for public health in general.  The federal Minister of Health (who appointed the committee) has expressed the government's support for a national public health body.
• Health professional groups like the Canadian Medical Association and the Canadian Nurses Association have supported the recommendations of the expert committee.
• The most likely arena for conflict on this policy issue will be the intergovernmental negotiations, which have not yet begun and will be tracked in future surveys. The expert committee has recommended that both the federal and provincial levels of government increase their public health funding.

Influences in policy making and legislation

The expert committee report stated the need for legislative changes to support a coordinated public health system. No legislation has been drafted to date. Moreover, it is not clear how these recommendations relate to the federal Health Ministry's initiative on health protection legislative renewal, which has been underway for five years.

Adoption and implementation

See expert opinion below.

Expected outcome

• This policy idea requires agreement and co-ordinated action from both the federal and provincial levels of government. We must therefore address the first and perennial question in intergovernmental health policy development:  will it ever be implemented? Despite the strong recommendation of the expert community, apparent agreement from health care providers and the current high public profile of public health issues, discussions of intergovernmental responsibility and funding have yet to begin and are usually long and complex. 
• Moreover, this process will have to compete for money and attention with the nascent reform process in the health care system (i.e., personal or clinical health services as opposed to population-level services). The latter process stems from a Royal Commission that reported not even a year ago. Reforms addressing a long list of health care issues - including health human resources, home care and medical equipment, to name but a few - are currently making their way through the intergovernmental machinery. As broad as this health care reform process is, there is very little overlap with public health as this was not a prominent issue last year. 
•  If improvements in public health infrastructure can be implemented, they should, as preventative services, reduce the burden on the health care system.  But this impact will likely be long-term and difficult to measure.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

At this stage, there are too few details to comment on the impact of the policy.

 

References

Sources of Information

For general information on SARS in Canada and the Report of the National Advisory Committee on SARS and Public Health (October 2003):

www.sars.gc.ca

Information on Health Canada's Health Protection Legislative Renewal:

http://renewal.hc-sc.gc.ca

Author/s and/or contributors to this survey

Cathy Fooks and Lisa Maslove

Empfohlene Zitierweise für diesen Online-Artikel:

Cathy Fooks and Lisa Maslove. "A Public Health Wake-Up Call for Canada". Health Policy Monitor, 24/10/2003. Available at http://www.hpm.org/survey/ca/b2/1