Vancouver Roundtable Report

In Vancouver, the Minister of State met approximately 27 BC and Yukon 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

• Mandate should go beyond just disease - needs to be a holistic response to all the risk factors in a community, including lifestyle;
• Within its disease mandate, the mandate should be about both Infectious Disease and Chronic Disease. It can't just be focused on infectious disease outbreaks;
• The Agency should be tied to academic teaching and research centres:
  • So that it can assist in training public health professionals; and,
  • So that it can integrate public health-related research into public health practice.
• A federal Agency needs to enhance - rather than seek to replace - provincial and territorial public health agencies. "Enhancement" can mean that the federal Agency provides national leadership in public health;
• A federal Agency should be involved in the following functions:
  • Policy development;
  • Regulation;
  • Research;
  • Community action;
  • Collect and disseminate best practices; and,
  • Collect and disseminate hard data.
• Some suggested that an Agency should also be involved in regulating firearms and tobacco.

2. Regarding Operational Strategies for a Public Health Agency

An Agency should consider:

• Building its strategy around unique Canadian strengths:
  • Expertise in information technology;
  • Understanding the link between health status and social-economic-environmental determinants of health;
  • Strength in health research; and,
  • All of these can work in as core pillars of a Canadian public health system.
• Setting specific Public Health goals:
  • BC is currently setting public health goals; and,
  • The Olympics may be an opportunity to set national public health goals.
• Linking public health to social justice:
  • A federal Agency should focus specifically on the links between health status and poverty and, more broadly, with other determinants of social justice.
• Pursuing a gender based approach to public health:
  • In many areas, an Agency would be most effective if it acknowledges the links between gender and public health risks - and develops strategies that account for issues of specific relevance to women or specific relevance to men.
• Integrating existing public health programs across governments:
  • The new federal Agency should act as a catalyst for integrating the many public health programs that already exist in the Population and Public Health Branch of Health Canada, along with provincial and territorial public health agencies;
  • These programs need to be integrated on a national level between governments and between the various departments within each government; and,
  • The current "stovepipe" between all these efforts is hindering progress in public health.
• Transferring First Nations health programs to First Nations:
  • Community representatives note that "where First Nations have control of a program, the program moves ahead";
  • Transferring control would enable better coordination between federal, provincial, territorial and community governments; and,
  • BC Chiefs wanted to transfer environmental health services to First Nations control.
• Chronic Disease Prevention in Schools:
  • Agency could launch a new era in primary prevention, by focusing on school populations; and,
  • Not enough data available regarding key drivers of children's health - namely, nutrition and physical activity.
• Addressing the psychological determinants of health:
  • There is increasing support for managing the social and environmental determinants of health; and,
  • But, psychological issues also frame the health status of Canadians.
• Linking commercial Olympic sponsorships to a fitness or diet promotion:
  • 2010 Olympics are an opportunity for Canada to require event sponsors from food businesses to support public promotion of healthy diet and activity in their ad and sponsorship package; and,
  • Olympics are also a chance to set significant public health goals for Canada.
• Building a Network of public health Centres across Canada:
  • Canada would benefit from a network of public health centres of excellence across the country, allowing a focus on specific health issues and allowing the government to leverage existing strengths in many different parts of the country.

3. Investments

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

• Information Technology:
  • Without this, the Agency could not generate the data to form effective public health strategies;
  • Currently, we can't get a coherent picture of the health status of Canada's population;
• We do not even know how many public health delivery points exist in Canada, because the system has been re-organized so many times;
• Canada would benefit from development of electronic health records; and,
• An Agency has to be able to collect hard data on public health determinants, like obesity, and diet.
• Public Health Human Resources:
  • The Federal Agency and the broader national public health strategy will fail without appropriate investment in staff and knowledge management;
  • Investments in public health staff take a very long time, and have been dismantled in recent years; and,
  • Staff has to come to local level.
• Funding of local health authorities:
  • Federal funding of local health authorities should not be targeted on specific national programs, because local authorities will know what they need to invest in.
• Northern Health:
  • SARS preparation revealed that a single suspected SARS case could "overwhelm" the Yukon health system, as one example; and,
  • Too few immediately available staff for infectious and chronic disease management.
• Diet Information:
  • Diet is key in preventing disease;
  • But, Canada lacks good data on diet in the population; and,
  • In order to build effective public health policies relating to diet, especially in the face of overwhelming advertising from food companies, Canada needs to invest in collecting data on Canadians' eating habits.

4. Public Health Issues

Participants also raised concerns about specific public health issues:

• Cancer Control:
  • The launch of a federal Agency is an opportunity for Canada to implement a Cancer Control Strategy;
  • The strategy could involve a national centre for cancer control;
  • Cancer control strategy would focus on four elements:
• Better surveillance, for earlier diagnosis;
• Prevention;
• Treatment; and
• Support.
  • Cancer prevention could contribute to prevention of other chronic diseases, like diabetes and cardiovascular disease.
• BC First Nations Public Health Issues:
  • Injury prevention;
  • Early childhood health:
• Dollars invested in early childhood development create major benefits in adulthood; and,
• Investments in childcare allow parents to remain in and enter workforce after the birth of a new child.
  • Safe environmental systems:
• Some communities face such risks as unsafe drinking water and toxic mould in houses.
  • Policies affecting First Nations public health status need to be better integrated:
• Different governments, and different departments within governments, are responsible for many of the key health determinants in First Nations communities, such as environmental systems; and,
• These jurisdictional divisions create significant, unnecessary risks for the health status of many communities.
  • Public health budgets on reserve tend to be siphoned off to acute care needs; and,
  • Transfer of some mandates from the First Nations and Inuit Health Branch of Health Canada to local communities appears to be going well.
• Disabled Canadians:
  • Many Canadians with disabilities face particular public health problems, because their bodies may deteriorate faster than normal; and,
  • Moreover, Aboriginal Canadians with disabilities tend to "fall in the cracks" between jurisdictions and lack appropriate support.
• Substance Abuse:
  • There is a paradigm shift away from considering substance abuse as a disease affecting an individual, towards considering it as public health issue - in which certain populations face specific population risks, and which can be addressed at the population level;
  • Fetal Alcohol Syndrome is one example of a substance abuse problem that can be understood as a public health issue that can be addressed at the population level; and,
  • A federal Agency can take the lead against FAS by building national awareness, identifying and promoting best practices and monitoring progress.

5. Chief Public Health Officer

Participants also advised the Minister to ensure that the CPHO be a national spokesperson for public health, and be a national voice in times of emergency:

• Should be a non-political figure who can be trusted to advise Canadians on health and science in a straightforward, easily understandable manner.