Manitoba Roundtable Report

In Winnipeg, the Minister of State met approximately 16 Manitoba public health stakeholders.
They advised the Minister to consider the following factors in building a Public Health Agency of Canada.

1. Regarding a Mandate for a Public Health Agency

• The Agency should focus on ensuring ongoing cooperation between public health jurisdictions, as well as horizontal and vertical integration:
  • Its work needs to be cross-functional (with other departments of the federal government) and cross-jurisdictional (with other orders of government - provinces, territories and local authorities).
• The Agency must consider resource distribution and capacity required for a network of national and provincial public health systems;
• The Agency cannot just focus on infectious disease outbreaks:
  • It needs to focus equally on chronic disease, health promotion, and long term issues that cause morbidity and mortality.
• The Agency needs to focus on closing the gap between Canada's healthiest populations and those populations most at risk; and,
• The Agency must be guided by national goals with appropriate indicators.

2. Regarding Operational Strategies for a Public Health Agency

An Agency should consider:

Referring to the Naylor Advisory Committee description of public health functions, as a guide:

• Focussing on First Nations public health:
  • Risk that First Nations concerns fall between the cracks between different jurisdictions;
  • Need to manage inter-jurisdictional issues to ensure that First Nations receive adequate attention and focus;
  • Ensure greater systems collaboration, as opposed to reliance on collaboration between individuals;
  • Consideration of First Nations comprehensive view of health, including economic and social issues;
  • Role of First Nations in planning as well as role in new arrangements to be developed; and,
  • Agency work based on an understanding of the vulnerability of aboriginal groups and the broader context regarding jurisdictional issues.
• A northern public health strategy:
  • Creating a system that links northern territories to specific provinces in public health (e.g. Manitoba and Nunavut); and,
  • The Agency could provide leadership in building public health staff in the north.
• Special protection for public health programming in an environment in which expenses for non-insured health benefits are increasing dramatically;
• Co-locating epidemiologists and laboratory scientists for the effective management of disease:
  • The scientists who know how a disease is spreading in a community must be in the same place as those who know how a disease operates on a molecular level.
• Mechanisms to work closely with, and flow information to, primary care physicians and nurses;
• Gender analyses of health policy:
  • Health policies tend to affect women and men differently.
• Not over-emphasizing health promotion alone:
  • Promotion strategies tend to assume that all Canadians have the ability to make health choices. However, many do not have adequate resources, or live too remotely, to have access to a true range of healthy choices; and,
  • Hence, promotion strategies risk widening the health gap between rich and poor.
• Making decisions in the context of population health and primary health care:
  • Engage poverty activists;
  • Balance care and prevention related planning and activities; and,
  • Engage all parts of the health system, including those traditionally considered outside of the public health system but who play public health roles (e.g. other health care providers, teachers, social workers, etc.).

3. Investments

Participants urged an Agency to focus on the following priority investments:

• Adequate public health staff at all levels of service:
  • Public health nurses, in particular, are often diverted away from public health work to acute health care work; and,
  • Protect existing funding for public health and health care, because an increasing portion of health services appears to be uninsured.
• Post-graduate training in public health and capacity building:
  • Address knowledge gaps regarding public health;
  • Media training;
  • Virtual learning to enhance skills of practitioners wherever they may be situated; and,
  • Enhance national capacity and also make the best use of existing capacity.
• More applied public health research:
  • To determine which community practices work, and which ones fail, on a scientific basis.
• More studies and focus on the health of Francophone minority populations:
  • Francophone minority populations often appear to have higher rates of chronic disease than surrounding populations; and,
  • Access for French speaking Canadians.
• Funding of implementation of existing strategies.

4. Public Health Issues

Participants also raised concerns about specific public health issues:

• Northern communities are seeing a rise in tuberculosis and diabetes; and,
• Public health issues addressed by the Agency must include:
  • Chronic disease (i.e. proposal for Chronic Disease Alliance of Manitoba);
  • Injury and accident prevention;
  • Mental-health issues and self-inflicted harm;
  • Environmental health; and,
  • Tobacco use.

5. Chief Public Health Officer

• Should be capable of speaking directly with the public, so that politicians are not the only ones with a public voice on health policy.