Montreal Roundtable Report

In Montreal, the Minister of State met approximately 30 Quebec 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

Federal involvement in public health should not duplicate existing initiatives by provinces, but rather enable efforts to be coordinated and knowledge developed and shared.

• Some participants suggested a comprehensive mandate including promotion, prevention, protection and monitoring - for the combination of infectious disease and chronic disease;
• Others suggested a very focused mandate limited to crisis management or areas already under federal jurisdiction;
• In either case, an Agency has to take an approach that incorporates determinants of health, such as income and education and environmental determinants of health, like water, air and soil quality;
• The Agency's creation could be an opportunity to give Canada a unifying public health project like those developed in other northern countries;
• The Agency should be mandated to evaluate the public health impacts of the broad range of federal government policies, or introduce a mechanism by which federal departments and agencies evaluate health risks of proposed policies;
• The Agency should foster inter-provincial solidarity in crisis management;
• The Agency should be apolitical and report directly to Parliament;
• The Agency should not come under the authority of a minister of health who also has responsibilities for therapeutic programs, since therapy tends to drain resources from public health;
• The Agency has to play a key international role in surveillance, coordinating initiatives and sharing knowledge; and,
• Transparency and accountability are essential.

2. Regarding Operational Strategies for a Public Health Agency

An Agency should consider:

• Targeting problems of mental health and public health effects of social alienation;
• Creating a more ambitious prevention policy, including hygiene and mental health issues, and stressing the personal responsibility that citizens have for preventing disease;
• Managing distinct and non-mainstream approaches to vulnerable and isolated populations, including close working relationships with community service groups;
• Keeping an ongoing inventory of current initiatives and resources devoted to public health has to be developed - in order to identify and publicize effective and ineffective approaches;
• Working to ensure provincial and territorial participation in federal initiatives;
• Amending the legal framework, so that information can be shared between jurisdictions;
• Remaining flexible to deploy programs into different kinds of communities. Ongoing citizen engagement is also critical;
• Ensuring that it does not bend to pre-established programs limiting the scope of its intervention. It should, rather, be an autonomous Agency that acts according to needs; and,
• Aiming for good health for everyone, with early initiatives in schools that promote physical activity, healthy eating, basic hygiene, etc.

3. Investments

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

• Strengthen Canada's capacity to monitor public health threats, transfer information among jurisdictions and train public health staff;
• Network existing public health staff who specialize in similar areas across the country;
• Document human resources management practices in public health;
• Provide resources at the local level to adopt initiatives, provide long-term support for communities and strengthen networking at the local level;
• Build on existing networks, structures and expertise, rather than creating redundant structures and programs;
• Include in those networks close liaison with universities, including veterinary schools;
• Document and address problems relating to the training, recruitment and retention of public health workers; and,
• Ensure, through the Federal Government, that every province has the basic infrastructure and sufficient resources for public health.

4. Public Health Issues

Participants also raised concerns about specific public health issues:

• Cancer, diabetes and HIV/AIDS should be prioritized for prevention strategies;
• Mental health and hygiene strategies would assist in public prevention of disease; and,
• Public health standards should also cover occupational health and safety.

5. Chief Public Health Officer

• The Chief Public Health Officer needs to ensure that messages broadcast in the media during crisis situations are consistent and relevant.