Public health on the installment plan

Hoping to dispel impressions that the federal government was imprudent with taxpayers' dollars during the sponsorship scandal, Finance Minister Ralph Goodale unveiled a 2004–5 federal budget that provides relatively modest new monies to improve Canada's public health system.

The new Public Health Agency will absorb the functions of, and $404-million in funding from, Health Canada's Population and Public Health Branch, while receiving an additional $165 million over 2 years for operations, including administrative costs associated with its creation.

That falls well short of the $1.65 billion over 5 years in new monies that the National Advisory Committee on SARS and Public Health, headed by University of Toronto Dean of Medicine Dr. David Naylor, recommended be pumped into the system.

Still, Naylor was enthusiastic. “Absent an agency that is operational and a chief public health officer in place to help guide its mandate, this is a very important beginning.” His opinion was echoed by the CMA.

Goodale stressed that the new outlays are but a “first installment” and the issue of financing will be revisited once a comprehensive public health plan is developed. The agency's broad goal is to increase public health capacity for chronic disease, emergency preparedness and infectious disease.

As it stands, the $165 million will be divided among 5 priorities: emergency response capacity; disease surveillance; the creation of regional centres of excellence on communicable disease epidemiology; capital upgrades at the National Microbiology Laboratory in Winnipeg and the Laboratory for Foodborne Zoonoses in Guelph; and improving international collaboration.

Health Canada officials projected the bulk of the new monies will go to human resources, particularly training the next generation of public health professionals through fellowships, community-based apprenticeships and other initiatives.

It's not known where the agency's offices will be located, but Dr. Carolyn Bennett, Minister of State for Public Health, says it will be up and running by late May, when Canada's new public health officer is slated to be hired (see page 1425).

After a decade of cost containment, the agency is “a miracle for those toiling in public health,” Bennett said at a media conference. “We've learned lessons from SARS but we have a lot to learn about using modern technology and working together.”

She called for an end to the “tyranny of the acute. The sustainability of the system is about decreasing the demand side.”

The budget also included funding for 3 provincial public health initatives. They will receive $300 million over 3 years to standardize immunization of children and youth against 5 diseases: meningococcal infection, pneumococcal infection, chicken pox, pertussis and influenza.

The provinces will also be given $100 million over 3 years to redress deficiencies in front-line public health infrastructure. Health Canada officials noted some provinces lack even a single isolation unit.

And finally, the provinces will receive $100 million to buy software and hardware for disease surveillance systems in service of the Canada Health Infoway quest to improve health data collections.

While those are good starts, a comprehensive strategy is still wanting, argued Coalition for Active Living Chief Operating Officer Steve Grundy. “There has to be significant new investments in nutrition, tobacco control, immunization and physical activity if we're really going to make progress on public health.” — Wayne Kondro, Ottawa