The Federal Strategy

A New Approach To Public Health In Canada

After the SARS outbreak in 2003, the Federal Minister of Health appointed Dr. David Naylor, Dean of the University of Toronto School of Medicine, to chair a Special Committee on SARS and Public Health to look at ways to improve Canada's public health system.

Following Dr. Naylor's report in September -- and following meetings between the federal, provincial and territorial governments -- we have started to shape a new federal approach Canada's public health system. It is based on three pillars:

1. Building a Federal Public Health Agency
2. Creating a Chief Public Health Officer (CPHO) for Canada
3. Building a Pan-Canadian Public Health Network

Before considering the questions on this Web site, we would like to give you the background on this issue.

In this section, you will find general information on:

1. The Definition of Public Health in Canada
2. How different levels of government currently share responsibility for public health
3. The three pillars of the new federal strategy for public health:
   Pillar 1. Building a Federal Public Health Agency of Canada
   Pillar 2. Creating a Chief Public Health Officer (CPHO) for Canada
   Pillar 3. Toward A Pan-Canadian Public Health Network

A) Defining "Public Health"

Health Care and Public Health

Most Canadians are familiar with our system of health care -- the system of hospitals, doctors, nurses and other professionals to whom we turn when we are sick or injured.

The public health system plays a different role: It is responsible for helping protect Canadians from injury and disease and for helping them stay healthy.

A good public health system means fewer people become sick or injured -- and more people can live longer, healthier lives.

What Are The Responsibilities Of A Public Health System?

Public health experts specify three responsibilities for a public health system:

1. Health Emergencies
   - preventing, discovering and responding to outbreaks of infectious disease -- like SARS or flu
   - working with national security agencies to respond to disasters, bioterrorism and other threats to Canada's health security
2. Chronic Disease and Injury Prevention
   - helping to prevent and manage chronic diseases -- like diabetes, cancers and mental illnesses
   - helping prevent injuries
3. Health Promotion
   - promoting good health
   - contributing to forming government policies that affect our health -- like policies on poverty, housing and the environment.

Who Delivers Public Health Services?

The public health system, like the health care system, involves doctors, nurses and a wide range of health professionals. But it involves many more people too, including:

• Provincial and territorial chief medical officers of health
• Local chief public health officers
• Community leaders
• Teachers and school principals
• Families
• Employers
• Aboriginal communities
• Multicultural communities
• Social organizations
• Sports and recreation clubs

B) How Federal, Provincial, Territorial and Local Governments Share Responsibility for Public Health

In Canada, all three orders of government share responsibility for public health policy.

• Local efforts are generally led by a Public Health Officer;
• Provincial and territorial efforts are led by Chief Medical Officers of Health; and,
• The federal effort is currently led by the Public Health Agency of Canada.

More specifically:

• Provinces and Territories have "front-line" responsibility for responding to public health emergencies in their jurisdictions;
• The federal government has responsibility for communicating with foreign governments and multilateral health agencies;
• All governments work together to monitor health threats; and,
• All governments are involved in some form of public health regulation and education.

The three orders of government also collaborate on setting public health policies.

Following SARS, both Dr. Naylor and a Senate committee have urged the federal provincial and territorial governments to deepen their collaboration - something the premiers, Prime Minister and health ministers have already begun to do.

By creating a federal Public Health Agency of Canada and a chief public officer of health for Canada, the federal government aims to "get its own house in order" - and collaborate more effectively with other governments.

Pillar 1. Building a Federal Public Health Agency

In response to the recommendations from Dr. Naylor and the Senate Committee, the federal government has proposed the creation of a federal public health agency of Canada that would:

• Be established by statute;
• Be linked, but separate from Health Canada;
• Be managed by a Chief Public Health Officer;
• Have appropriate advisory structures to provide for ongoing and timely expert advice from the medical, health and scientific communities, from community and advocacy groups, and from other related sectors; and
• Be accountable to the Minister of Health who would retain ultimate responsibility for matters of public health within the Health Canada portfolio and be accountable to Parliament for what is done in and by the Agency.

The Agency's work would focus on the following priorities:

• Support national readiness for public health threats, with particular emphasis on the adequacy of, and capacity to deploy, health professionals where and when they are needed in response to public health threats;
• Promote excellence in the management of public health in Canada and throughout the world; and
• Oversee federal efforts to:
  • Strengthen national capacity to identify and reduce risks to public health and
  • Develop, implement and assess policies and programs that help enable Canadians to live a healthier life.

Pillar 2. Creating a Chief Public Health Officer (CPHO) for Canada

The Chief Public Health Officer would:

• Manage and lead the Agency;
• Provide timely, objective and evidence-based advice to the Minister of Health on all matters pertaining to public health and national readiness for public health threats;
• Develop and implement policies, plans, programs and decisions approved by the Minister of Health to protect the health of Canadians;
• Interact with the public health community and with public health experts, both in Canada and internationally;
• Provide leadership in advancing Canada's interests in international agencies focussed on public health matters;
• Ensure the Agency carries out its tasks in accordance with its mandate; and
• Help coordinate national public health response to disasters and emergencies.

Pillar 3: Toward A Pan-Canadian Public Health Network

At the September 2003 Conference of Federal, Provincial and Territorial (FPT) Ministers of Health, Ministers acknowledged the need to:

"...make public health a top priority by improving public health infrastructure, and increasing institutional, provincial, territorial and federal capacity that builds on current strengths and successes across the country."

They also agreed to work collaboratively on such issues as:

• Clarifying roles and responsibilities for preventing and responding to public health threats, in a manner respectful of federal, provincial and territorial jurisdiction;
• Creating a national network of centres of public health science;
• Ensuring the adequacy of health human resources and strengthening capacity to respond to regional and national public health emergencies; and
• Enhancing national surveillance and information infrastructure.

To build on this consensus, federal, provincial and territorial governments are working toward the creation of a Pan-Canadian Public Health Network. This Network could initially complement and - if it proves effective - eventually subsume, certain of the existing mechanisms and arrangements for intergovernmental collaboration on public health matters. The Network could serve as a forum for:

• Promoting dialogue on public health issues;
• Coordinating responses to public health emergencies;
• Developing national public health strategies;
• Facilitating the development of national standards and agreements on issues such as resource and data sharing, accreditation of health professionals; and
• Encouraging the development of centres of public health expertise across the country.

The development of the new Public Health Agency of Canada must take account of this broader effort to strengthen and improve coordination across the public health system. Accordingly, in addition to an overall mandate to serve as a focal point within the federal government on public health matters, the new Agency will also be expected to make an important contribution to the development of an effective Pan-Canadian Public Health Network.