Canada’s public health system is stretched “dangerously thin”

Canada’s top doctor is urging the federal government to strengthen the country’s public health system to keep up with evolving threats, including the rapid spread of the Omicron variant of SARS-CoV-2.

The COVID-19 pandemic has been a “stress test” for Canada’s public health system, according to chief public health officer Dr. Theresa Tam.

“Incredibly, it rose to the occasion, but at a serious cost,” she told reporters at a recent press conference. “Our public health system has been stretched dangerously thin and it is in need of critical reinforcements.”

In a report to Parliament, Tam warned that Canada’s public health system “lacks the necessary resources and tools to carry out its critical work, and is the subject of ‘boom and bust’ funding cycles that leave us ill-prepared in the face of new threats.”

The report outlines four areas for urgent action: shoring up the public health workforce, closing information gaps, modernizing public health governance and accountability, and ensuring stable and consistent funding.

Heavy demands on medical care during the pandemic threaten to overshadow “equally critical” strains on the public health workforce, according to the report. Many public health professionals have been working night and day for nearly two years and reports of burnout are increasing.

The report recommends building surge capacity, supporting on-the-job training, and updating public health competencies to include skills like countering disinformation and translating evidence into policy options.

Important gaps in Canada’s public health surveillance and data systems have also hindered Canada’s pandemic response, Tam reported. “There are still unacceptable delays in getting the right data to inform public health decision-making.”

The report calls on the government to establish an interoperable system that links and pools health data from various sources, and to integrate early-warning systems into decision-making.

The report also recommends that the government clarify the core role of public health — something that Tam said is often “not fully understood,” leading to inconsistencies in services, funding, and accountability.

“Public health is the outbreak that did not happen, the traumatic injury that did not occur, and the opioid overdose that was avoided,” Tam said. “We must change the way we think about and value health in our country so that we come to value prevention and wellness the way we value medical treatments and care.”

The report calls for the development of a pan-Canadian public health mandate with clear priorities and outcomes tied to funding commitments that can be measured and reported back to Canadians.

Governments should also increase permanent funding to support the new mandate, according to the report. However, “it is unclear what an appropriately financed system should look like in Canada.”

Before the pandemic, just under 6% of all health spending in Canada went to public health — a share that Tam warned may be “insufficient and vulnerable to cuts.”