CHECK AGAINST DELIVERY

Remarks for
Dr. David Butler-Jones, Chief Public Health Officer
at the

Conference on Emergency Preparedness and Safety for Municipalities

Ottawa
January 16, 2007, 12:30PM

• It's a pleasure and privilege to be here today. And it's good to see such a varied group of individuals coming together to discuss how we can best support municipalities, communities -- and each other -- in planning and preparing for emergencies.

• Having first responders, decision-makers, health professionals, administrators … everyone in the same room like this illustrates how far we've come in our view of emergency planning. 

• We're hopefully getting past the traditional silo versus stove pipes approaches.  During a crisis is not the time to figure things out and get to know the players and roles.

• This is vitally important. As the Chinese proverb says, it's the wise ones who dig their wells before they are thirsty.

• Public health and emergencies happen locally. Though sometimes in many localities at once, whether it's a province-wide disaster … or nation-wide… or a global epidemic or an isolated, local outbreak -- it's happening locally. It's going to be local firefighters, police, health professionals, and municipal governments dealing with it.

• But what's important is that they're not responding alone.

• For instance, if there's a small outbreak of salmonella at a picnic, local public health officials will work with local hospitals, local government, local business, etc, to respond and resolve.

• But if that localized event grows, and spreads, either geographically or in intensity, beyond the capacity of the community to deal with it - then that community may turn to the province or territory for assistance, or if in multiple localities knowing the connections can help in control strategies -- eg Pulsenet.

• In turn, if the problem exceeds the province or territory's capacity, or if it's a highly complex or mysterious outbreak or infection or across jurisdictions, the federal government can be called upon.

• Each level of government must be value added.  Local responses to any emergency must be coordinated and connected.  It's about timely, appropriate application of expertise and resources no matter where the problems.

• Lincoln - The role of government is to do for people what can't do for themselves.

• This kind of system, characterized by a tight network and honest communication between jurisdictions and sectors is absolutely vital to Canadian emergency management. And not just in emergencies, but at all times -- such networks and relationships are vital pillars in the public infrastructure of Canada.

• Just a few years ago, the SARS outbreak taught us some important lessons in how we manage public health crises. Some things worked really well. Health professionals, some at great personal cost, were heroic under pressure. Nationally, our labs worked well and rapidly to identify the virus.

• But in other areas, we were found wanting. The outbreak highlighted nature's inventiveness and unpredictability. It reminded us that in an era when we can cross continents and oceans in mere hours, that the next infectious outbreak is really just a plane ride away.  And it reminded us how the fear of contagion can profoundly affect politics and economics.

• The 2003 report on the outbreak: Learning From SARS - Renewal of Public Health in Canada identified a number of areas in the public health system that needed improvement - ideas recently reinforced by the Campbell report.  

• For example, capacity, preparation and response was not uniform across communities, cities, and provinces… communications and cooperation between jurisdictions, and between sectors, needed to be improved … political and public health leadership had to be strengthened, and clear decision lines needed to be laid out … and surge capacity had to be enhanced, and public health infrastructure in Canada simply needed to be strengthened.

• What had happened is that we had grown complacent in our views of public health. It seems to be human nature, and it is very ancient.  There is an old saying: “When the Israelites remembered God they prospered, and when they prospered they forgot God.”  This is not so much an issue of religion as it is that when we as people, as a society, figure out what works, we do well. But unfortunately when we do well we often forget the fundamentals of what got us here.

• SARS showed us that we were forgetting some of the basics of public health.

• So one of the outcomes of the 2003 report on the outbreak was the creation of the Public Health Agency of Canada in 2004.

• But much more than just response to an infectious disease outbreak, the Agency helps strengthen the Government and the broader systems ability to protect the broader health and safety of Canadians … and it's a focal point to lead efforts in the advancement of public health - here in Canada, and internationally.

• Another outcome of SARS was the establishment in 2005 of the Pan-Canadian Public Health Network.

• The Public Health Network is a new way for different levels of government and experts to work together to improve public health in Canada. … it assists in the sharing of  knowledge and best practices between jurisdictions…it facilitates communications and development of public health strategies … it helps us enhance surge capacity and prepare for emergencies … and it also addresses everyday public health issues in Canada.  

• The Network Council includes representatives from the provinces and territories and Federal Government. And  the various experts and issue committees bring together expertise on a range of Public Health Issues reporting to the conference of Deputy Ministers where I sit and through them to the conference of Ministers on policy and other matters.

• It also is effective in addressing on-going public health challenges and in helping lay the groundwork in preparing for emergencies - at the program and planning levels and it will be effective during a public health crisis when leadership and communication is most valuable.

• And coming back to what I was saying about public health and emergencies being, at their cores, local -- the Public Health Network is helping to do ensure effective coordination between local, provincial, territorial, federal, and international players.

• Specifically, in terms of emergency preparedness, the Public Health Network Council is advised by an Emergency Preparedness and Response Expert Group - it's one of many groups on a variety of public health issues to advise the council.

• While terrorism and pandemics are obviously and necessarily priorities, it maintains an all-hazards approach in its work.  The various threats from emerging disease to natural disasters to  bio-terrorism have much planning and response in common. And given that all emergencies are a bit unpredictable, we need to be in a position to respond to whatever nature or humans throw at us. Its work can generally be grouped into six main clusters:

  • Leadership and coordination
  • Surge capacity
  • Training and education
  • Surveillance and detection infrastructure
  • Supplies
  • Communications

• As one of its priorities, the expert group is mapping current health emergency management capacities in Canada -- this means it is in the process of outlining what we understood of jurisdictional roles and responsibilities, existing emergency resources like the National Emergency Stockpile System, and the identification of non-government activities and services.

• In short, a document of this kind will help us identify where gaps, and points of clarification exist in our national health emergency management systems, how we fill those gaps, what our next steps are, and how we can do a better job of engaging and strengthening the roles of non-government and professional health sectors.

• The Expert Group also developed the National Framework for Health Emergency Management, which provides guidelines for the development of a more integrated and comprehensive emergency management systems within Canada.

• Essentially, this Framework allows for a consistent and coordinated approach to the development of programs across jurisdictions in Canada.

• Another of the Expert Group's main priorities moving forward has been the Development of a Memorandum of Understanding on Mutual Aid - in the Public Health emergencies this is an agreement for assisting with  surge capacity of communities and jurisdictions.

• What this Agreement will do is facilitate the exchange of human resources, supplies and equipment between jurisdictions during emergencies. 

• All jurisdictions are building their capacity. But different areas have different strengths and different resources. This Agreement recognizes that if a community's disaster threshold is exceeded - if a disaster puts a community's needs beyond it's means and ability to cope --  it needs timely access to additional resources.

• So it's simply a mechanism for governments to provide and receive assistance from one another - in a timely and efficient manner. We hope this will be completed and implemented later this year.

• Of course, on top of all this, training and development will remain an emergency management priority for every level of government - it's an essential component of any effective plan.

• In addition, FPT health ministers also supported an agreement on information sharing in Public Health emergencies.  To ensure we can better control outbreak across borders.

• In matters of public health I often say it's not about identifying what expertise we need … I'd like to know at the end of the day what expertise we don't need to succeed.  In hockey, you can never have enough goaltending, in baseball you can never have enough pitching.  In emergency preparedness and response, it is a team sport. Just as in sport, here no one player can do it on their own, there is simply no expertise we can do without.

• This includes the important contributions that can be brought in an emergency by the non-governmental and voluntary sectors. We've seen what organizations like the Red Cross or St. John's Ambulance can bring to the table in a time of crisis.  But also local organizations from churches to rotary and community groups can be an important source of space, or expertise or volunteers.

• And so the Public Health Agency's of Canada Centre for Emergency Preparedness and Response and Office of the Voluntary Sector have supported NGOs in developing a framework to enhance the capacity of volunteers to respond to emergencies.

• One aspect of direct response and medical assistance that the Public Health Agency of Canada of Canada can provide in times of crisis is through the establishment of the National Office of Health Emergency Response Teams - or NOHERT. 

• NOHERT is currently in the process of developing teams that in the future -- and on request from governments in Canada -- would give us a nationwide capability to provide emergency health assistance in crisis situations. 

• We also operate the National Emergency Stockpile System with depots across the country.  We have portable hospitals, shelter, water purification, medical and other supplies.  International presence in emergencies that has responded to Katrina, the Tsunami and countless forest fires and other events in Canada.

• Now, one of the most important things we can talk about today is community resiliency. By community resiliency, we mean considering a community's vulnerabilities and ability to respond to and recover from disasters and emergencies.

• What we were reminded of time and again through events like the Tsunami, Katrina, or even SARS - is that these are not academic exercises. It is literally about the people who's lives are affected. Specifically, who are the most vulnerable that will be affected in an emergency, but just as important, who can be engaged to help us strengthen our communities and to help us reduce vulnerability in between the crises.  It is no coincidence that the hardest hit communities, whether in a hurricane or tsunamis, are also the poorest and most vulnerable.

• That's why in December, the National Forum on Emergency Preparedness and Response, supported by the Public Health Agency of Canada, brought together both government and non-government stakeholders to discuss building community resiliency in Canada.

• And why we focus on finding ways to address the underlying health of populations to prevent problems and to improve the ability to respond rather than just waiting for ill health or crises to prompt actions - a pro-active role.

• And that's why in February, the Agency, along with partners, will be hosting an international workshop on emergency preparedness and seniors.

• We have to be sure that vulnerable populations have a prominent place in our planning processes. We need to consider that in an emergency, there are going to be groups that can't necessarily look after themselves.

• So it's important that every community has the knowledge - somewhere -- of where people who lack self-mobility may be located, so that first responders can act appropriately.

• The alternative? Consider the staggering number of deaths during the heat wave in Western Europe in August, 2003 - and specifically in Paris. Thousands of vulnerable seniors died.

• There was a severe breakdown in communication between all levels of government, public health officials, and hospitals. In many cases these vulnerable individuals, suffering from a lack of mobility were not accounted for, or simply weren't informed of their options.

• There were, of course, many different contributing factors - not the least of which were the facts that France was not accustomed to such intense heat and so most homes were not equipped with air conditioning. But again we should not have to remind ourselves that nature is full of surprises

• Because we know that a relatively simple mechanism to ensure vulnerable individuals are considered in emergency planning, and we have a means of getting information out to them, could have cut the number of fatalities.

• Here again we see the importance of clear decision lines, of early involvement of others, of engaging different populations in planning, of rapid and honest communication - and simply, of planning, dialogue, and testing. 

• Testing, because the most effective plans can be rendered useless if they haven't been tested.

• In think it was Eisenhower that said plans are useless - it is the planning that is essential.

• And finally dialogue because, and I can't say this enough, because we all need to know our roles, our responsibilities, and to know each other - before the crisis.

• I always encourage physicians to get to know their local medical officers of health and vice versa. They're a gateway to the broader public health system that connects them provincially to their chief medical officers of health … federally, the Public Health Agency of Canada as well as to key decision-makers through the Public Health Network …  and to Canada's advanced and capable laboratory network …  and internationally through the World Health Organization and our other networks

• I'm glad we're here with each other.  We want to know the key players in an emergency before the crisis hits because we're not going to have time to figure it out in the middle of an emergency.

• We need to know each other so that we're comfortable getting on a phone with each other as soon as it's needed…or sending emails to each other. We need this as part of the most effective possible public health network, that's going to get us successfully through an emergency.  There is no substitute for being able to talk directly with other key players in solving problems.

• And if we have those systems, and networks, and connections set up beforehand, we're going to be that much better prepared to assess threats, to make the right decisions, and to avoid either over- or under-reacting to any given threat.

• Without a doubt, we have a lot of work ahead of us, and conferences like these that bring us together and strengthen the ties between us - in a very direct and personal way - I believe, are of great importance.

• As I said it is a team sport.  Henry Van Dyke: “Use what talents you possess for the woods would be very silent if the only birds who sang were those who sang best.”.

• Finally there is no room for complacency for as Mark Twain said, “even when we're on the right track, if we're not moving, we'll get run over.”

• Thank you.