Public health is shrinking at all levels of government. Public health plays an integral role in keeping our population healthy. However, it is decreasing in importance and more frequently placed in competition with other health services. This dismemberment has taken place most overtly, and most recently, in the province of New Brunswick. The prognosis is not positive for public heatlh across Canada. A number of public health doctors have described the division as risking that which is a primary objective of public health work: citizen health and safety.
The role of public health in Canada
The aim of public health is to reduce the burden of disease. The public health approach extends beyond the health system. Public health officials work to impact physical, policy, social and economic environments in order to address socio-economic inequities and inequities that increase risk and vulnerability.
The approach to public health in Canada was weakened before the SARS crisis in 2003. Shortly after the SARS outbreak, the Naylor report highlighted the disarray of Canada’s public health system. This resulted in the creation of the Public Health Agency of Canada and the investment in resources and systems for public health across the country, all of which is now being reversed in many provinces.
Funding for public health has decreased in Canada. Nova Scotia has among the lowest funding in the country at 1.5% of healthcare spending in 2010/2011. In British Columbia, funding was decreased between 2012/13 and 2015/16. However, it is not only the lack of funding that is cause for concern. Public health is being brought into the auspices of health authorities across the country. It is being integrated with primary and community care, which could result in further diversion. Finally, with public health being dismembered, there is an erosion of the essential independence of the Medical Officers of Health and their advocacy capabilities, an important part of the office.
In January of 2016, Ontario Minister of Health, Dr. Eric Hoskins, created a panel comprised of health sector officials to study the province’s public health system, including its structure and leadership. The panel recommended decreasing the number of health units in the province from 36 to 14. A former Medical Officer of Health had suggested this kind of amalgamation could be beneficial. The acting Medical Officer of Health for Hastings and Prince Edward Counties said the concept would not likely be implemented in the near future and did not anticipate there would be cost savings. He suggested that the amalgamation could result in jeopardizing the work of the public health force.
Although action has yet to be taken in Ontario, there have been major reforms in New Brunswick. At the end of August, the then Minister of Health, Victor Boudreau, announced that the province was restructuring the office of the Chief Medical Officer of Health, moving important daily operations to other departments. Public health practice and population health will be moved under the auspices of the Department of Social Development. Public health and agri-food inspectors will now be looked after by the Department of Justice and Public safety. Finally, the Healthy Environments Branch of the department will be integrated into the Department of Environment and Local Government.
The government cited the goals of improved collaboration and the aim of pooling together similar professional sets of expertise within government as reasons for the move. However, since the announcement, health officials in the province have expressed concern. It has been publicly criticized by nurses, a hospital network, seniors, a former health minister, and the official languages commissioner. Green Party Leader, David Coon, described the division as a “cynical, self-serving move”. A former Chief Medical Officer of Health has said this will result in more bureaucratic hoops to jump through, something there isn’t time for when in crisis.
Investing in public health
A recent estimate suggests that medical care accounts for only 10-20% of health outcomes. Most of the health spending in Canada goes towards this 10-20%, which will only continue to burden the provinces. Public health work is dedicated to reducing this burden. Investing in bublic health is essential for the sustainability of our health system.
CBC News. New splintered public health system in N.B. will hurt, former top doctor says, (18 September 2017).
Hendry, L. Merger doubtful, The Intelligencer (6 September 2017).
Pruss, V. Province restructures Office of Chief Medical Officer of Health, CBC News (31 August 2017).
Silcox, B. New health minister acknowledges controversial files, CBC News (6 September 2017).