Canadian Public Health Association calls for new federal powers over public health spending

OTTAWA-As the COVID-19 outbreak ramps up, the Canadian Public Health Association is issuing a call for more federal power to direct national spending on public health.

Ian Culbert, executive director of the Canadian Public Health Association, is scheduled to speak to the Commons health committee Thursday, and says he will outline the association's concerns, which he says are not a criticism of the Public Health Agency of Canada.

In an interview with the Star, Culbert says that agency, and Dr. Theresa Tam, the chief public health officer, are doing exactly what the agency and its officials were supposed to do: coordinate the national response. Provinces and territories have responsibility for frontline health care delivery and Culbert says the association's proposal is not aimed at wresting that away.

But Culbert said public health capacity across the country is stretched too thin because in the past decade, all provinces have "reorganized" their health systems and in eight of the 10, "public health came out on the losing end."

Other health needs - specifically personal or acute care services - get prioritized by politicians under pressure to reduce wait times and deal with an aging population, and "public health becomes integrated into bigger systems. Especially provinces that have regional health authorities."

He said Ontario is the one province that doesn't have regional health authorities and still has local health units that are tied to municipalities.

Culbert says the acute care system "keeps taking up more and more of our GDP every year. Well the only way you stop that is you stop the going into the health care system: you do that by keeping people healthy, and you do that by implementing public health care interventions."

The association is calling for a new legal and regulatory framework, separate from the Canada Health Act, "so that standards can be the same across the country, things like vaccination schedules can be harmonized, that we can have unified reporting of data, that there can be even greater connectivity between provinces and territories."

"I think that there is absolutely an opportunity presented by COVID-19, because we know this isn't going to be the last time this happens, to rethink the federal government's role when it comes to delivering public health services across this country."

Overall health spending is rising, increasing by about 4 per cent last year, and taking up a bigger chunk of provincial budgets. The Canadian Institute for Health Information said last year that Canada's total health spending was expected to reach $264 billion in 2019, or $7,068 per Canadian.

Yet it is notoriously difficult to nail down how much is directed towards public health. Different provinces define it differently.

The 2003 SARS report, led by Dr. David Naylor, said public health costs are "modest - perhaps 2 to 3 per cent of health spending" depending on how one accounts for it. After SARS that changed, but things have slid backwards in the last 10 years, Culbert said.

He said it's time Canada takes a hard look at where the gaps are and beefs up federal oversight and control specifically to protect public health.

"When you look at the overall cost of COVID-19, we will have no choice but to look at new ways of doing things," he said. "We will come through this, we will pay a heavy price in human terms, in terms of our health system and our economic systems, and the recovery will be slow but we need to start thinking about what does recovery look like to us. And I don't believe we can afford to go back to the status quo."

Culbert said the federal public health agency reacted swiftly to the viral outbreak from the first of January, since it was first reported to the World Health Organization.

"They have been connecting with public health officials in all the provinces and territories. They have been pulling the science together. They have been preparing the government and the politicians to make difficult decisions. And they've been giving them ammunition."

But he said the challenges are around "some of the structural pieces that the very unsexy things that really cost a lot of money, but nobody ever sees and we hope we never have to use but find ourselves using today, like the national stockpile, the idea of surge capacity within the system, to be able to have a workforce at the Public Health Agency of Canada that no matter what file you happen to be working on you have the basic skills" to contribute to the national response to the outbreak.

Tonda MacCharles is an Ottawa-based reporter covering federal politics. Follow her on Twitter: @tondamacc