Canada's public health system beset by problems: report

An unpublished report obtained by CMAJ indicates that Canada's public health infrastructure may be overwhelmed if it faces more than one major public health crisis at once (see page 1245). The report was completed in September 2000, a year before the possibility of major public health threats was raised by the Sept. 11 terrorist attacks in the US and 4 months after a contaminated water supply claimed 7 lives in Walkerton, Ont.

“There appears to be agreement that only one crisis can be managed at a time,” it says.

The 65-page report, prepared for the Federal, Provincial and Territorial Advisory Committee on Population Health, was never made public. CMAJ's initial informal request for a copy, made to Health Canada, was denied. A formal request for the report was then made on CMAJ's behalf by access-to-information specialist Ken Rubin on Aug. 17, 2001, but a response is still pending. However, a copy was obtained from another source. Among the conclusions and observations spelled out in the report:

· “When key informants from outside the public health system were asked if Canada has an effective, integrated public health system, only 1 of 37 respondents responded affirmatively.”

· “There appear to be significant disparities between ‘have’ and ‘have not’ provinces and regions in their capacity to address public health issues.”

· “In many jurisdictions, resources for organized public health have been curtailed, diverted or not replenished.”

· Some respondents reported “that given recent program and staff reductions, responding to a prolonged crisis or more than one urgent issue at a time would severely tax their resources and capabilities.”

· “Although there have been many accomplishments, there is the huge potential for the Walkerton water contamination to happen anywhere and in particular in our remote and isolated communities.”

· Sixty percent of senior public health officials interviewed said public health policies are being set without reference to specific data.

· There is growing concern about a lack of resources to combat long-term public health issues such as obesity and diabetes, but less concern about capacity to cope with one-off problems such as specific environmental disasters. “There is near consensus that the reported lack of attention to longer-term health promotion and disease- and injury-prevention strategies are increasing threats to health and sustainability of the health care delivery system.”

· “There are vacancies in a number of critical provincial and territorial positions and among regional medical officers of health that are difficult to fill. Factors contributing to these vacancies include low salaries, difficulties in recruiting professionals for remote and Northern areas and competition for limited numbers of qualified personnel.”

· “Walkerton was a wake-up call.”

· “We need champions for the essential role of public health within the health system, champions who can describe what it is and how it complements other parts of the system.”

These conclusions were based on 38 telephone interviews, online and mailed surveys completed by 260 respondents, and 15 conference calls. Most of the respondents were senior public health officials from across the country, but researchers, public health advocates and Aboriginals were also consulted.— Patrick Sullivan, CMAJ