Revamp Canada's public health system — and do it quickly: think-tank

In the wake of this year's SARS outbreak, Canada must act quickly to improve its public health infrastructure and develop a comprehensive system that may include a national institute of public health, experts have concluded. The consensus was reached at a think-tank sponsored by the Institute of Population and Public Health (IPPH), 1 of the 13 institutes within the Canadian Institutes of Health Research (CIHR).

Recent editorials and commentaries (CMAJ 2002;166[10]:1245;1282-3) and assessments of system capacity (CMAJ 2002;166[10]:1319) have highlighted concerns about Canada's ability to prevent, detect and respond to public health emergencies, and to deal with ongoing public health challenges such as obesity.

In 2002 the IPPH created a committee to study the future of public health in Canada. It examined models for funding and organizing public health systems in other countries and Quebec (Can J Public Health 2003;94:190-2). The findings were then discussed at the spring think-tank, which brought together researchers, politicians, public health and health system experts, and representatives from professional associations.

They concluded that there is an urgent need to address the public health system's infrastructure problems by clearly defining the system's essential functions and the roles, responsibilities, linkages and accountabilities at each level of government. These roles must be supported by consistent legislation and appropriate delivery structures, funding levels and information systems, as well as adequate staff.

The final consensus was that the SARS crisis highlighted the need for more public health system capacity and surge capability, as well as for a comprehensive communications strategy. Heavy emphasis was placed on improved national leadership, which could include a national institute of public health and a broader public health mandate for the National Health Council proposed by Roy Romanow.

The next steps needed are a more detailed analysis of system requirements and development of a network of public health system experts and organizations to ensure that a comprehensive public health system is eventually created. — Brent Moloughney, John Frank, Erica Di Ruggiero, CIHR