Windsor Roundtable Report

April 16th 2004

In Windsor the Minister of State met approximately 20 local public health stakeholders.

1. Regarding a Mandate for a Public Health Agency of Canada:

Broad Scope

• Mandate must go beyond infectious diseases to include:
  • Determinants of health
  • Prevention of chronic diseases
  • Health promotion, and
  • Research.
  • We have lost basic knowledge about biological systems, how they work, and how to make decisions according to these systems. The Agency should incorporate principles of biological science and systems in public health policies and programs.
  • Consider using the Agency to review the activities of other departments that impact public health, using a public health lens to review policies of other departments.
• Citizen / Stakeholder Engagement
  • Public health policies and programs must be relevant and responsive to the needs of the local community. Therefore, citizens and stakeholders must be involved in decision making.
  • If local communities are left out of decision making because of systemic flaws, public health objectives will not be achieved.

2. Regarding Operational Strategies for a Public Health Agency of Canada:

Collaboration, Cooperation and Communication

• Intergovernmental cooperation is paramount and must include municipal governments.
• Public health emergencies occur at the local level, and the response requires assistance from and coordination with provincial and federal governments. Therefore, the Agency must support and reinforce the work of local public health units.
• Establish clear communication mechanisms between federal, provincial and municipal governments. Ensure these communications reach the front lines of public health and other sectors, for example, home care, educational institutions, etc.
• The most influential determinants of health are outside of the health care system, for example, income, housing, education, etc. Intra-Ministerial and Inter-Ministerial cooperation, across and within sectors, is key.
• Address gaps in the current system by seeking the perspectives of "difficult to serve", rural, traditionally marginalized, and / or not well served populations, for example, intellectual disabilities, mental illness. These populations may require targeted approaches as "mainstream" programs tend not to work.
• Demand for home care services is growing, yet this sector is often overlooked. Include considerations for this sector in policy development, communications, etc. The Agency should support and implement initiatives that promote home based services over institutionalization.
• Pharmacists are key partners in public health. They are the most accessible health professional and have trusting relationships with their clients. Pharmacists play an important role in health promotion, patient education, and as an "early warning system".

Agency Activities

• The Agency should conduct international surveillance and communicate findings to local public health units in a timely manner. It should also identify national "hot zones" for infectious diseases.
• The Agency should identify the desirable features of a successful public health system.
• Examine / build upon successful models, for example, community health centres.
• Set national guidelines / standards for public health practice, infection control, especially fit testing of masks, and education / training to ensure consistency in communities across the province.
• The Agency should provide a forum for communication, information sharing and learning. It could serve as a national clearinghouse.
• The Agency should offer training support to local public health units.

Chronic Diseases

• The human burden and economic impact of chronic diseases, including mental health and intellectual disabilities, are huge. A healthy population is best able to fight infectious diseases. The Agency should establish a chronic disease strategy.

3. Investments

• Public health is a local issue, albeit with national implications. Therefore, the national interest is best served by investing in, and supporting, robust local public health capacity.
• Investments must reach and be felt at local levels. Concern that federal transfers to the province will not be dispersed to local levels (applies to more than health funding). Support for targeted public health investments.
• Target investments to traditionally overlooked populations such as those with intellectual disabilities and mental illness. Those with multiple diagnoses are especially in need.
• Consideration should be given to outbreak costs. Students and educational institutions should not be expected to bear the costs of outbreaks.
• Access to transportation is a key determinant of health, especially in rural communities. Consider targeted investments to support transportation subsidies for those with physical and intellectual disabilities.

4. Public Health Issues

• Local Considerations
  • Windsor / Essex County is one of the country’s most unique jurisdictions, and has unique public health needs. Windsor is Canada’s largest metropolitan centre next to the U.S, and is the 8th largest city in North America. The international border poses both risks and opportunities, for example, involvement in U.S committees, etc.
  • Essex is home to small rural communities which suffer many of the same access problems as the north.
• Global Issues
  • About 30 new diseases have emerged over the last 30 years, for example, AIDS, West Nile Virus, SARS, etc. This trend is likely to continue. SARS provided learning and improvement opportunities.

5. Chief Public Health Officer:

• Choose the Chief Public Health Officer carefully, one who is credible and well respected.