Stronger oversight for public health

Posted on August 24, 2009 in Health Debates – Opinion/Editorial – Stronger oversight for public health
August 24, 2009.

Canada has endured the ravages of SARS and the havoc wreaked by a listeriosis outbreak in recent years. Both episodes exposed the glaring shortcomings in our public health protection systems, notably the inability of federal and provincial authorities to seamlessly share information and resources – and act decisively.

Now, with many worried about the spectre of a future Swine flu pandemic, it’s worth asking if we have learned any of the painful lessons of the past. The evidence suggests we are lagging.

At root, Canada’s chief public health officer, Dr. David Butler-Jones, lacks the autonomy and clout he needs to fulfil his mission to protect the lives of Canadians. Indeed, there’s a very real risk that Canada’s public health watchdog won’t be able to provide a full measure of protection from pandemics and other threats.

Last week, the Canadian Medical Association Journal catalogued some of those gaps, arguing for a “health care czar” to deal with any H1N1 flu pandemic down the road.

Such a czar would go too far; it’s not a good fit in Canada’s complex constitutional setting. But the journal was correct in highlighting a public health gap that must be addressed.

The system’s weakness was painfully apparent in last summer’s bungled listeriosis crisis. Local public health agencies, provincial health ministries and federal health and agriculture officials were all involved in handling that outbreak, but no one assumed full responsibility.

Twenty-two people died. Some might well have been saved if a stronger federal health authority had produced a faster, more coherent response.

Failure to adequately monitor and disclose the deadly spread of SARS prompted the World Health Organization to warn against travelling to Canada in 2003. The Public Health Agency of Canada was established in the wake of that blunder to speak with an independent voice on health matters and take the lead in times of crisis.

But, fully six years after the SARS outbreak, this agency still depends on provinces and municipalities to provide data on an outbreak. Auditor General Sheila Fraser last year concluded that Canada’s national public health agency remained dependent on the goodwill of provinces and territories and, as a result, was “not assured of receiving timely, accurate and complete information.”

Yet today, long after the auditor general highlighted the problem, Ottawa still lacks a signed agreement with the provinces on sharing potentially life-saving public health information.

It wasn’t supposed to be this way. The national public health agency was originally envisioned as a broad, independent shield offering protection to all Canadians without political interference.

It has fallen short of that ideal. Rather than being free of the political process, Butler-Jones, the country’s first chief public health officer, is classed as a deputy minister serving the Minister of Health. 
Ostensibly, he has freedom to speak publicly on health matters and report on issues of concern. But it would be naive to expect Butler-Jones, or any future public health chief, to be oblivious to political pressure.

Against that backdrop, the Canadian Medical Association Journal called for a health care czar to handle the response to H1N1, with “executive powers across all jurisdictions,” including authority to transfer health care equipment, and personnel, from one part of the country to another.

But with responsibility for delivering health care falling under provincial jurisdiction, such a shift in responsibility disregards the country’s constitutional realities. Moreover, up until this point, the impact of the pandemic has been relatively mild. While it has taken more than 65 Canadian lives, even an average flu season can kill well over 4,000.

Rather than rushing ahead in a panic over H1N1, and turning to a czar, Ottawa would better protect Canadians by taking measured and careful steps toward boosting the power and autonomy of its chief public health officer.

And improving the mechanisms for federal-provincial co-operation – and decision-making – in times of crisis.

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