Public Health in Canada: Costs, Challenges, and Achievements

1. PUBLIC HEALTH AGENCY of CANADA L’AGENCE DE SANTÉ PUBLIQUE du CANADA ANDSOOHA Annual General Meeting Dr. David Mowat, Deputy Chief Public Health Officer October 5th, 2005

3. COSTS - SARS • Tourism $200-$350M • Lost jobs 5250 • Airline industry $220M • Tax revenue $161M • Non-tourism retail sales $380M • Provincial health system >$1B • Deferred medical care • Exhausted health workers

4. The Naylor Report

5. Recent History • Blood – Krever Enquiry • Walkerton, North Battleford • Capacity Report of ACPH • Chronic Diseases

6. The Current State • Emerging and re-emerging diseases • Global travel and trade • Bioterrorism • Food & water-borne disease • Obesity, diabetes, syphilis • Persistent inequities • “The preventable goes unprevented”

7. HIV/AIDS Legionnaire’s VTEC + HUS SARS Hepatitis C H5NI Influenza Rabies TSEs ARO New, Emerging & Re-Emerging Diseases

8. Reported Infectious Syphilis Rates in Canada by sex, 1993 – 2002* *Data for 2002 are preliminary and changes are anticipated Source: Sexual Health and STI Section, Community Acquired Infections Division, Health Canada 2003

9. Public Health • the organized efforts by society to protect, promote and restore the health of the entire population

10. A properly structured and functioning public health system will contribute to: • Improved levels of health status of the population and decreased health disparities • Decreased burden on the personal health services system and thereby contribute to its sustainability • Improved preparedness and response capacity for health emergencies

11. Public Health in the Background • semantic confusion • long-term perspective • probabilistic outcomes • negative outcomes • diffuse vs. concentrated interest • weak links to academia • F/P/T issues • complexity • funding • voice

12. PH in Canada - Overview • Provincial/territorial mandate to protect the public’s health and deliver public health services. • public health activities in each jurisdiction governed by public health act (or equivalent) and regulations, and by other specific legislation. • Planning, programming and delivery of services devolved to regional/local structures. • elected/appointed boards responsible for planning and delivery of all health services.

13. Governance • 3 patterns: • Regional health authorities/districts • responsible for all health services (the most common pattern). • Regional/district boards • responsible for public health and other community services. • Quasi-municipal (Ontario) • Responsible for public health and other community services - serving single or multiple municipalities, with boards appointed by both municipality and province. • Provincial only (small jurisdictions)

14. Governance (2) • Aboriginal populations • Public health services provided by: • FNIHB • or • a variety of contracted arrangements (transferred communities)

15. Legal Basis • Department of Health Act • Acts for food, drugs, pesticides, radiation • Quarantine Act, Importation of Human Pathogens Act • P/T privacy legislation, PIPEDA

16. Federal Roles • “own jurisdiction” – e.g. Quarantine, aboriginal • national leadership • highly specialized services • efficiencies of scale • “naturally” national issues, e.g. HHR • surge capacity • International

17. Federal Strategy • 2004 and 2005 Budgets • Agency & CPHO • Pan-Canadian Public Health Network

18. Funding Agency: $404m existing $80/85m additional 2004 & on $60m p.a. additional 2005 & on One-time: $300m immunization $100m public health, general $100m Infoway

19. The Response (2) the new Public Health Agency of Canada Prime Minister Paul Martin launched the new Agency on September 24th, 2004 • Dr. David Butler-Jones appointed Chief Public Health Officer (CPHO) • Headquartered in Winnipeg and Ottawa, with offices across Canada

20. Federal Health Portfolio Minister of Health Minister of State, Public Health Deputy Minister of Health CPHO President, CIHR Health Canada Public Health Agency of Canada Canadian Institute of Health Research

21. PHAC Organization Dr. David Butler-Jones Chief Public Health Officer Health Promotion and Chronic Disease Prevention Public Health Practice and Regional Operations Corporate Services Infectious Disease and Emergency Preparedness Jim Harlick ADM Dr. Paul Gully Deputy CPHO Dr. Sylvie Stachenko Deputy CPHO Dr. David Mowat Deputy CPHO

22. Infectious Disease and Emergency Preparedness Centre for Infectious Disease Prevention and Control Dr. Frank Plummer/Bersabel Ephrem Centre for Emergency Preparedness and Response Dr. Ron St. John National Microbiology Laboratory Dr. Frank Plummer Laboratory for Foodborne Zoonoses Dr. Mohamed Karmali Canadian Science Centre for Human and Animal Health

23. Health Promotion and Chronic Disease Prevention Centre for Health Promotion Claude Rocan Centre for Chronic Disease Prevention and Control Dr. Greg Taylor (A) WHO collaborating centre for chronic disease policy Dr. Clarence Clotty

24. Public Health Practice and Regional Operations Office of Public Health Practice Dr. David Mowat (A) Regional Offices Gary Ledoux

25. Infrastructure (as in Naylor Report) • Renewing laboratory infrastructure • Building Research Capacity • PHAC • Pan-Canadian Public Health Network • Clarifying Legislative & Regulatory Context • Information & Knowledge Systems • Renewing Human Resources

26. Evidence-based decision-making • expansion of research related to public health • synthesis • identification of research gaps • knowledge translation & exchange • more research on KTE • all require more people and more skills

27. National Collaborating Centre Program • determinants • policy & risk management • tools & methodologies • infectious diseases • environment • aboriginal

28. Workforce Issues • Naylor report Learning from SARS (chp. 7 on health human resources) • Unfilled positions in many PH occupations • Existing PH staff need skills upgrading • Insufficient number of new graduates • Aging workforce, uneven distribution, etc. • Prior emphasis on research only • Increased demand

29. “No attempt to improve public health will succeed that does not recognize the fundamental importance of providing and maintaining in every local health agency across Canada an adequate staff of highly skilled and motivated public health professionals” The Naylor Report 2003

30. Gaps • non-thesis masters • practice-based education • faculty with experience in practice • access & flexibility • cross-disciplinary education • continuing professional development • exposure of students

31. New & Expanded Federal Programs • Canadian Field Epidemiology Program • Skills Enhancement Program • Competencies & HHR planning • Community medicine residency funding • Scholarship Program

32. Competencies A Foundation Piece used for: planning job specification educational development curriculum development

33. Pan-Canadian Public Health Network • New way of working with provinces and territories on public health • Key mechanism for national collaboration • Will bring together experts/officials from all jurisdictions • Facilitate national approaches to public health policy and planning

34. Pan Canadian Public Health Network Proposed Initial Structure Issue Groups Issue Group ( 13 ) Expert Groups (permanent expertise) Issue Group ( 3 ) Communicable Disease Control Emergency Preparedness & Response Issue Group ( 1 ) Canadian Public Health Laboratory FPT Conference of Deputy Ministers of Health Council FPT members (14) Surveillance and Information Issue Group ( 2 ) Is accountable to Non-Communicable Disease & Injury Prevention & Control Issue Group ( 5 ) Health Promotion Task Groups (time limited) Issue Group ( 4 ) Task Group ( #) indicates number of Issue Groups In development To be developed/ or aligned Existing

35. Pan-Canadian Public Health Strategy • Goals • Specific health targets • Benchmarks for progress • Collaborative mechanisms to maximize pace of progress • Collaborate with all departments, jurisdictions and stakeholders

36. Conclusion • Canada’s Public Health Agency…an important step towards making Canadians “the healthiest population in a healthier world”.