Demoting Chief Public Health Officer more about politics than promoting health
A version of this commentary appeared in the Toronto Star, the Vancouver Province and the Hamilton Spectator
He will no longer hold a deputy minister rank, he will have no direct line to the federal minister of health, he will be subservient to a bureaucratic agency president and he will have no secure public funding.
The new Chief Public Health Officer has said he is in favour of this plan, as shrugging off managerial oversight for the Public Health Agency will free him to provide scientific advice. That may be so, but will anybody be listening? Will he even be allowed to speak?
We seem to have forgotten the harsh lessons of SARS. It was just 11 years ago when the World Health Organization slapped Toronto with a travel advisory, costing the city $2 billion and 28,000 jobs. This was not because of the number of SARS cases (similar in number to Singapore, which had no such advisory) but because Ottawa did not have a public health leader who could effectively coordinate with the provinces and communicate the outbreak’s status to other countries.
SARS shone a light on the enormous hurdles that Canada’s version of federalism – with provinces largely in charge of their own health dollars and direction — poses to effective country-wide pandemic responses. Significant change was needed and proposed, including the establishment of the Chief Public Health Officer and the Public Health Agency of Canada. The idea was that new structures and an empowered Chief Public Health Officer could forge a new vision for Canadian public health, ensuring collaboration and cooperation across provinces and territories.
The key was building trust: provinces and their public health departments needed a guarantee that the federal government’s public health pronouncements were based on scientific principles rather than political talking points.
Despite reforms, results have been patchy. Auditor General reports year over year have raised concerns that we have not yet achieved satisfactory progress on many measures, including information sharing across the country. Interestingly, it is the Auditor General who has shone a light on these concerns and not the Chief Public Health Officer. Why is that the case?
Science has never actually been allowed to trump government politicking; the Chief Public Health Officer was made an officer of government instead of an officer of Parliament, thereby preventing him from exercising full independence like our Auditor General, the Official Languages Commissioner and the Privacy Commissioner. That was a mistake. But at least he was given some independent powers to speak to Canadians and a mandate to engage in public activities and citizen dialogue. Even these limited powers, unfortunately, are slated for removal in the proposed legislation.
Demotion and politicization of the Chief Public Health Officer is a wrong-headed move. It seems to be linked more to the public gagging of our government scientists than about promoting health or the public good. With an Ebola outbreak raging in West Africa, this is not the right time to be weakening our national public health infrastructure. This change makes us far less prepared for Ebola and other diseases like it.
More than likely the omnibus budget bill will go ahead and we will be left to regret its folly in the wake of another harsh public health lesson — which may play out on the international stage, as in the case of SARS. After some hand-wringing — and undoubtedly several Commissions and reports — we will return to this inevitable conclusion: the Chief Public Health Officer of Canada needs to be independent of federal and provincial governments.
Someone needs to speak public health truth to power on behalf of all Canadians. We are all less safe without it.
Colleen M. Flood is a Professor of Law at the University of Ottawa and an expert advisor with EvidenceNetwork.ca. Steven J. Hoffman is an Assistant Professor of Law and Director of the Global Strategy Lab at the University of Ottawa and a Visiting Assistant Professor of Global Health at Harvard University.
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