Canada’s public health system is ‘dangerously thin’

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Canada’s top doctor urges the federal government to strengthen the country’s public health system to deal with evolving threats, including the rapid spread of the Omicron variant of SARS-CoV-2.

The COVID-19 pandemic has been a “stress test” for Canada’s public health system, according to Dr. Theresa Tam, Chief Public Health Officer.

“Incredibly, he rose to the occasion, but at a high cost,” she told reporters at a recent press conference. “Our public health system has been strained and it needs critical reinforcements.”

In a report to Parliament, Tam warned that Canada’s public health system “lacks the resources and tools to carry out its essential work and is subject to ‘boom and bust’ funding cycles that leave us unprepared for news of threats.”

The report outlines four areas for urgent action: strengthening the public health workforce, closing information gaps, modernizing public health governance and accountability, and ensuring stable and consistent funding.

According to the report, high demands for medical care during the pandemic threaten to overshadow “equally critical” strains on public health personnel. Many public health professionals have been working day and night for almost two years, and reports of burnout are mounting.

The report recommends building surge capacity, supporting in-service training, and updating public health skills to include skills such as countering misinformation and translating evidence into policy options.

Significant gaps in Canada’s public health surveillance and data systems have also hampered Canada’s response to the pandemic, Tam reported. “There are still unacceptable delays in getting the right data to inform public health decision-making.”

The report calls on the government to establish an interoperable system that links and consolidates health data from various sources, and to integrate early warning systems into decision-making.

The report also recommends that the government clarify the central role of public health – something Tam says is often “not fully understood”, leading to inconsistencies in services, funding and accountability.

“Public health is the epidemic that didn’t happen, the traumatic injury that didn’t happen, and the opioid overdose that was averted,” Tam said. “We need to change the way we think about and value health in our country so that we come to value prevention and wellness the same way we value medical treatment and care.

The report calls for the development of a pan-Canadian public health mandate with clear priorities and outcomes linked to funding commitments that can be measured and communicated to Canadians.

Governments should also increase permanent funding to support the new mandate, according to the report. However, “it is unclear what an appropriately funded system should look like in Canada.”

Before the pandemic, just under 6% of all health spending in Canada went to public health — a share that Tam says may be “insufficient and vulnerable to cuts.”

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