Toronto Roundtable Report

In Toronto, the Minister of State met approximately 53 Ontario 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 requires the authority, capacity, expertise and resources (financial and human) to engage in relevant partnerships with other levels of governments, local public health providers, and stakeholders through a pan-Canadian network;
• The Agency's mandate must be comprehensive, respecting the principles of population health and social inclusion. A full list of mandates would include:
  • Health promotion;
  • Chronic & infectious disease prevention and control;
  • Emergency response;
  • Public education;
  • Comprehensive, "real time" surveillance;
  • Research;
  • Education and training;
  • International / global public health; and, a
  • National public health strategy.
• The Agency must be responsive to multiple health needs, including those specific to:
  • Women;
  • Children / youth;
  • First Nations;
  • Official language groups; and
  • Cultural minority groups.
• The Agency and its counterparts in other orders of government need to agree on clear roles for emergency situations;
• The Agency should set national standards and objectives for Canada, including a national immunization program:
  • Provincial and territorial governments would then decide how to implement theses standards and meet objectives; and,
  • Standards must be flexible enough to allow public health providers on the front lines to meet local needs.
• Canadians need to be involved in the Agency's functions and in determining public health priorities. This engagement could include citizen participation on an advisory council.

2. Regarding Operational Strategies for a Public Health Agency

An Agency should consider:

• The United Kingdom's experience in integrating primary health care with public health services.

Leveraging Canadian Professionals:

• The Agency should establish a "Canadian Reserve" - a cadre of health professionals with multi-jurisdictional licensure to create new "surge capacity" for emergency response;
• The Agency should provide front line public health workers with meaningful opportunities to advise on development of a public health strategy; and,
• The Agency should leverage the widest range of health professionals for public health mandates, by ensuring their training and maximizing scope of practice. For example, empowering pharmacists to provide immunizations.

More robust forms of collaboration within, among, and beyond governments:

• Need to improve direct collaboration with municipal governments and local service providers;
• Agency should strengthen health collaboration among federal government departments, and with business, voluntary and recreation organizations outside of government;
• Agency should help spur better collaboration within the health sector, among:
  • Hospitals;
  • Public health units; and.
  • Community providers.
• To do this, the Agency should use mechanisms and organizations already in place, including the Canadian Public Health Association and the Community Health Nurses Association of Canada.

Measurement:

• The Agency must establish a comprehensive system to measure progress in health and well-being of the population and to assist in setting and goals. These goals might include the abolishment of food banks, and the reinstatement of Canada atop the United Nations list of most livable countries; and,
• The health education sector needs to be strengthened by creating national standards for public health curricula across the country.

3. Investments

Participants urged an Agency to focus on the following priority investments:
Communications / I.T.:

• Agency needs to invest in a rapid, real time, "two-way" communication system that links the Agency and front line public health providers.
• Funding Environment:
• Focus should be on sustainable public health funding;
• A portion of the transfer to the provinces and territories should be earmarked exclusively for public health and linked funding to national objectives; and,
• Within public health, funding should be targeted, for example, to school health programs and "well-baby visit" programs.

4. Public Health Issues

Participants also raised concerns about specific public health issues:
First Nations Communities:

• There is concern that sun-setting programs in Aboriginal communities retain funding;
• First Nations communities are not prepared for public health emergencies, and public health service is non-existent in some communities where care is treatment-oriented; and,
• Revocation of the Indian Health Regulations removed the legislative framework that protected the health of First Nations.
• Francophone Communities:
• About half of Franco-Ontarians do not have access to health services in their mother tongue; and,
• Agency should ensure better overall collaboration / networking with Official Language Minority Communities to facilitate integration of their needs in planning public health services.

5. Chief Public Health Officer

• The Chief Public Health Officer (CPHO) should be "arm's length" from government:
  • Role should be similar to that of the Auditor General, reporting annually to Parliament; and,
  • The CPHO should have a fixed term that would transcend the 4-5 year mandate of any particular government.
• The selection process for the CPHO must be transparent:
  • The CPHO should be internationally credible, because one duty would entail building international partnerships;
  • The CPHO also needs to instill confidence among Canadians, by providing leadership during emergencies; and,
  • The CPHO should be an advocate for public health issues - particularly in the face of funding debates versus health care priorities.
• The Agency will also need "deputy chiefs" within the Agency to champion each of the core functions of public health including:
  • Population health assessment;
  • Health surveillance;
  • Health promotion;
  • Disease and injury prevention; and,
  • Health protection.
• There is also a real need for public health nursing leadership at federal, provincial, and municipal levels.