Reforming Health Protection and Promotion in Canada: Time to Act
IMMUNIZATION AND CHRONIC DISEASE PREVENTION
(…) the shift in mortality and morbidity profiles away from communicable diseases to chronic non-communicable diseases create(s) challenges for public health practice.[1]
In its October 2002 report (Recommendations for Reform), the Committee recommended that the federal government contribute $125 million annually to a national chronic disease prevention strategy.[2] In this chapter, we repeat our call for such a nationwide strategy. Also in this chapter, we strongly support the recommendation of the Naylor Advisory Committee to develop a national immunization program.
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4.1 Chronic Disease Prevention
Chronic diseases are the leading cause of death and disability in Canada and account for the largest proportion of the economic burden of illness. In Recommendations for Reform, the Committee indicated that about two thirds of total deaths in Canada are due to the following chronic diseases: cardiovascular disease (heart and stroke), cancer, chronic obstructive lung disease (bronchitis and emphysema) and diabetes. More specifically:
- Cardiovascular diseases, including coronary artery disease and stroke, are responsible for 38% of all deaths among Canadians each year, and are one of the leading reasons for hospitalization;
- Cancer is the second most important cause of death in Canada, responsible for 29% of all deaths each year, and accounting for almost one third of potential years of life lost.
- Chronic obstructive lung disease is the fifth most common cause of death in Canada and is the only cause of death that is increasing in prevalence. Asthma is the most common chronic respiratory disease of children; it is the leading cause of hospital admission and school absenteeism among children in Canada.
- Over one million Canadians live with diabetes. It is a major cause of coronary heart disease and a leading cause of blindness and limb amputations. Among Aboriginal Canadians, the prevalence of diabetes is three times as high as among other Canadians. In total, diabetes accounts annually for about 25,000 potential years of life lost.[3]
In Recommendations for Reform, the Committee also stressed that many chronic diseases are preventable to a very large extent. Moreover, many chronic diseases often share common causes. More precisely, poor diet, lack of exercise, smoking, stress and excessive alcohol intake – all lifestyle issues – are recognized as the leading social/behavioural risk factors for these diseases. These risk factors are also often associated with other physical and psychological states that elevate the risk of chronic disease – including overweight or obesity, high blood pressure or hypertension, high blood cholesterol or hypercholesterolemia, and glucose intolerance or diabetes. If reduced or eliminated, these common lifestyle risk factors would greatly lessen the prevalence and economic burden of chronic diseases.
The fact that the vast majority of Canadians are exposed to one or more of these common risk factors suggests that the overall health status of the population could be substantially improved by a stronger focus on chronic disease prevention, in parallel with controlling infectious diseases. There are currently diverse initiatives by some national health organizations, provincial governments and the federal government which focus on chronic disease prevention. However, as the Committee noted in Recommendations for Reform, these initiatives require much better integration and coordination.
For these reasons, the Committee recommended that the federal government take the lead role to initiate a national chronic disease prevention strategy. We felt that, while the federal government should act as a leader, it would be important to collaborate with provincial/territorial governments, the private sector, and the voluntary health sector partners in the development of this strategy.
In addition, the Committee enumerated in Recommendations for Reform the elements that should comprise the national chronic disease prevention strategy, including: public education efforts, mass media programs, policy development and programs, integrated research agenda and improved surveillance and monitoring systems for chronic diseases and their associated risk fa ctors.
The Committee believes that the Health Protection and Promotion Agency recommended in Chapter Two of this report would be well-suited to lead this strategy. This is consistent with the observations of the Naylor Advisory Committee which recommends the establishment of a national public health strategy along with a public health partnerships program, to be led by the new agency, and that would address both infectious and chronic diseases.
Therefore, the Committee recommends that:
The Health Protection and Promotion Agency, in collaboration with the provinces and territories and in consultation with major stakeholders (including the Chronic Disease Prevention Alliance of Canada) implement a National Chronic Disease Prevention Strategy.
The National Chronic Disease Prevention Strategy build on current initiatives through better integration and coordination.
The Health Protection and Promotion Agency contribute $125 million annually to the National Chronic Disease Prevention Strategy. Funding for the Strategy should be part of the Agency’s flow through transfers program designed to strengthen local and regional health protection and promotion capacity.
Specific goals and objectives should be set under the National Chronic Disease Prevention Strategy. The outcomes of the strategy should be evaluated against these goals and objectives on a regular basis and reports of any such evaluation made public.
During the early 1900s, infectious diseases were the leading cause of death worldwide. Now, as a result of health protection measures – such as immunization, sanitation, public health education and better living conditions – infectious diseases cause less than 5% of all deaths in Canada. This accomplishment places health protection measures, and in particular immunization, among the greatest achievements in health care of the 20th century.
Immunization is a central activity of health protection and promotion and a very cost-effective illness prevention measure, protecting millions of children and adults from contracting debilitating, disabling and sometimes fatal infectious diseases. Immunization has been responsible for the eradication of some vaccine-preventable diseases such as poliomyelitis and smallpox.
The Naylor Advisory Committee reviewed a range of documents dating back to the 1990s and found substantial diversity among the provinces and territories in publicly-funded programs and legislation pertaining to immunization and vaccination. The Naylor report also notes concerns with respect to the growing price of vaccines, safety issues with some vaccines, inequity of access to some vaccines (particularly newer ones), and uneven electronic recording of immunizations.
In recent years, proposals have been made for the development of a national immunization program with the goal of securing guaranteed delivery of vaccines across the country at the lowest possible prices through public purchasing. In its February 2003 budget, the federal government announced that it would provide $45 million over five years “to assist in the pursuit of a national immunization strategy”.[4]
However, according to the Naylor report, the newly announced $45 million is “nowhere near sufficient to catalyze a national immunization strategy.”[5] The Naylor Advisory Committee estimates that no less than $100 million annually should be earmarked for a major reinvigoration of the national immunization strategy. Moreover, the Naylor report suggests that these earmarked funds should be transferred to a single purchasing body (e.g., Public Works and Government Services Canada). This would strengthen the buying power of the purchaser of these vaccines. Earmarked funds should be used to purchase only agreed-upon vaccines, particularly new vaccines for which there are gaps in public coverage. This funding should also serve to support a consolidated information system to track vaccinations and immunization coverage. The Naylor report recommends that the federal government invest the necessary $100 million annually beginning within the next twelve to eighteen months.
The Committee strongly supports these recommendations. We believe that a national immunization program requires strong federal leadership, along with workable federal/provincial/territorial collaboration. The Committee recognizes that there will be those who would say that since immunization is a provincial responsibility, any immunization program should be the exclusive responsibility of the provinces.
The Committee passionately disagrees with this position. There are several reasons for this, the most important of which is that infectious diseases do not respect provincial or national boundaries. Second, although new vaccines are not cheap, a national program of vaccine purchase will dramatically reduce the cost per unit.[6] Third, vaccines are most cost-effective when they are delivered through large scale programs.
Therefore, the Committee reiterates the recommendation of the Naylor Advisory Committee that:
The federal government, through the Health Protection and Promotion Agency, invest $100 million annually beginning within the next 12 to 18 months for the realization of a National Immunization Program whereby the federal government would purchase agreed-upon new vaccines to meet provincial and territorial needs, support a consolidated information system to track vaccinations and immunization coverage and track Vaccine-Associated Adverse Events through increased funding for surveillance and a mandatory reporting requirement, and provide funding for research on possible long-term adverse effects of vaccines.
CHAPTER FIVE:
FINANCING REFORM: AN INCREMENTAL APPROACH
Canada’s ability to contain an outbreak is only as strong as the weakest jurisdiction in the chain of disease control and health protection.[7]
The report of the National Advisory Committee on SARS and Public Health was published in early October. The Committee shares the view of all witnesses that the federal government must not let this report languish on the shelf. At the conclusion of their meeting in Halifax on September 4, 2003, all federal, provincial and territorial Ministers of Health agreed to make the enhancement of health protection activities across the country a top priority. The Committee strongly believes that the federal government must develop a plan to respond to the Naylor report recommendations in order to create a strong and well-resourced health protection and promotion infrastructure with adequate surge capacity and sufficient highly qualified professionals.
Immediate action must be taken. However, this requires federal leadership as well as substantial federal funding. One of the lessons the Committee drew from its examination of other countries studied in preparation of this report is that central government funding and leadership are vital to optimal programming, uniform standards and equity of services across the country. This chapter focuses on how much additional federal government funding is needed in Canada, and when it is needed.
5.1 Federal Government Spending Recommended in the Naylor Report
According to the Naylor report, a sound, responsive, effective and timely health protection and promotion infrastructure in Canada would require an investment by the federal government totalling approximately $1 billion per year by fiscal year 2007-2008. As shown in the table below, this sum would consist of an existing federal spending of some $300 million and an additional federal spending of $700 million.
The existing $300 million would be transferred from Health Canada to the proposed new agency described in Chapter Two. This existing funding is currently used by the department for the purpose of health protection and promotion and covers, for the most part, the core functions of the Population and Public Health Branch (PPHB).
The Naylor report estimates that an additional investment by the federal government is needed to revitalize health protection and promotion in Canada. It recommends that this additional federal spending increase gradually over the next few years to reach $700 million by fiscal year 2007-2008. In the view of the Naylor Advisory Committee, this is not an unrealistic amount: “This is what F/P/T governments currently spend on personal health services in Canada between Monday and Wednesday in a single week.”[8] In addition, when he appeared before the Committee, Dr. Naylor stressed that, under the circumstances, it is a minimum prudent investment to make. The Committee feels that it is especially true when compared to the cost in lives, illnesses and economic impact of less-than optimal health protection actions (e.g. impact of SARS in Toronto).
THE
NAYLOR ADVISORY COMMITTEE:
FEDERAL
GOVERNMENT SPENDING RECOMMENDATIONS
| Initiative |
Funding (Millions of Dollars) |
Proposed Timeframe |
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| New |
Existing |
||
| New National Agency:
|
$200 |
$300 |
The $200 million level is to be reached over the next 3 to 5 years |
| Flow Through Transfers for Local and Regional Capacity (protection, promotion and prevention of both infectious and chronic diseases) |
$300 |
Public Health Partnerships Program: Funding would rise over the next 2-3 years to reach $300 million annually |
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| Flow Through Transfers for Communicable Disease Surveillance |
$100 |
Would start immediately at a lower level and then rise over the next 2-3 years |
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| Immunization |
$100 |
To be accomplished within the next 12 to 18 months. |
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| Total |
$700 |
$300 |
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Source: Report of the National Advisory Committee on SARS and Public Health.
Of this $700 million amount, some $200 million is to be allocated to the new agency for expanded core functions. In particular, it is to be used for the following purposes: enhancing national disease surveillance systems ($15 million); developing a national public health strategy ($5 million); improving health emergency preparedness and response ($10 million); creating epidemic response teams and strengthening surge capacity ($10 million); establishing a new network for communicable disease control ($50 million); expanding human resources ($25 million); bolstering research funding ($25 million); enhancing protection and promotion in the fields of environmental health, mental health and injury prevention ($30 million). These amounts, which actually total some $170 million in additional annual federal funding, would gradually increase to $200 million annually over the next three to five years.
The other $500 million in additional federal funding is recommended to cover the following areas: earmarked flow through transfers to strengthen local and regional health protection and promotion capacity ($300 million); flow through transfers to enhance communicable disease surveillance ($100 million); and funding for a national immunization strategy ($100 million).
As the Naylor report clearly points out, not all additional federal funding needs to be new. Some of the additional federal investment it recommends could be obtained from programs and initiatives that already exist (e.g. Canada Health Infoway Inc., Human Resources and Development Canada, etc.).
Furthermore, the Naylor Advisory Committee assumes that provincial and territorial governments will also increase their contribution to health protection and promotion over the next several years in order to put in place a strong national infrastructure which is supported by all levels of government.
The Naylor report also comments on the Grants and Contributions Program (G&C) currently managed by PPHB. Under the G&C program, which has an annual budget of some $200 million, PPHB funds projects are undertaken by non-government organizations (NGOs) across the country. These projects cover a range of issues from communicable and non-communicable diseases to wellness and healthy living/aging. Although many of these projects are valuable in that they clearly help to achieve the policy objectives of PPHB, the Naylor Advisory Committee heard mixed views on the value of the existing G&C program with respect to the policy objectives and mandate of PPHB. Concerns were also raised with respect to the politicization of the program and the magnitude of transfers to some NGOs. Perhaps more importantly, the September 2001 report of the Auditor General noted problems in the project management process of the G&C program.
For these reasons, the report of the Naylor Advisory Committee recommends that the G&C program be reviewed and that the use of the grants and contributions be very clearly aligned with the mandate and objectives of the proposed new agency. In addition, the Naylor report suggests that the funding of the G&C program be incorporated into the budget of the new agency.
When Dr. Naylor appeared before the Committee, he stated that the first funding priority for the federal government should be to prepare for this winter’s respiratory virus season. As such, the first step would be to develop a set of directives, guidelines and protocols with respect to SARS for the use of hospitals, health professionals and front-line personnel. In Dr. Naylor’s view, this would help prevent false SARS alarms that could be quite devastating.
The second priority, according to Dr. Naylor’s testimony, would be twofold: to undertake the establishment of the new agency, while at the same time developing a much better surveillance system for infectious diseases with improved coordination among governments and institutions. The development of a network for communicable disease control would be his third priority. In the longer term, a legislative review will have to be undertaken with the goal of harmonizing and improving federal and provincial health emergency legislation.
5.2 Federal Government Spending Recommended by the Committee
However, the Committee believes that this investment must be made in a fiscally responsible manner. Accordingly, additional federal funding for the purpose of health protection and health promotion should, whenever possible, come from existing sources. In addition, we believe that relevant funding from the current G&C program at PPHB should be incorporated into the budget of the new Health Protection and Promotion Agency. This would provide the Agency with substantial additional funding from existing federal spending. We also concur with the Naylor Advisory Committee that the G&C program should be very carefully reviewed to ensure that only those projects with good value-for-money and which clearly further the policy objectives of the new agency should continue to receive federal funding.
Therefore, the Committee recommends that:
Between now and the end of 2004, priority for federal spending on health protection and promotion should be given to the following twelve (12) initiatives:
· The establishment of the Transitional Health Protection and Promotion Board which should eventually lead to the creation of the Health Protection and Promotion Agency (3 months);
· The creation of the Health Protection and Promotion Agency by Order-in-Council before the end of the current fiscal year (4 months);
· The development of directives, guidelines and testing protocols to assist health professionals, hospitals and laboratories in preparation for the next respiratory virus season (3 months);
· Initial investment to facilitate immediate preparedness for a possible return of SARS during the winter season of respiratory illnesses (3 to 6 months);
· Further investment in infectious disease surveillance and control with the view of enhancing surveillance capacity at the local and regional level initially (12 months);
· F/P/T review of the capacity and protocols of public health laboratories to respond effectively and collaboratively to the next serious infectious disease outbreak (12 months);
· Meeting of the F/P/T Conference of Deputy Ministers of Health to initiate discussions on a new network for communicable disease control (3 months);
· As a first step, increasing enrolment in existing university and community college programs in the field of health protection and promotion; then, undertaking the establishment of the Virtual School of Public Health (12 months);
· National Immunization Program (12 months);
· Begin F/P/T negotiations on the creation of the Health Alert System (12 months);
· Initiate negotiations with Canada Health Infoway Inc. to set up appropriate information technology to improve both surveillance and communication systems (12 months);
· Initiate transfer of physical and human resources from the Population and Public Health Branch to the Health Protection and Promotion Agency (12 months).
This set of recommendations clearly points to the need to make health protection and promotion the priority of the next federal budget.
Table 1
Summary
of the Committee’s Action Programme
| Within 3 months |
Within 6 months |
Within 12 months |
|
| Infectious disease surveillance and control |
· Prepare for the next respiratory virus season · F/P/T Meeting on a new communicable disease control network |
· Investment to facilitate immediate preparedness for a possible return of SARS |
· Further investment to enhance capacity at the local and regional level |
| Health Protection and Promotion Agency |
· Establish the Transitional Health Protection and Promotion Board |
· Create the Health Protection and Promotion Agency by Order-in-Council by the end of the current fiscal year (March 31, 2004) |
· Initiate transfer of physical and human resources from the Population and Public Health Branch to the Health Protection and Promotion Agency |
| Other Programs and Infrastructure |
· Increase enrolment in existing university and community college programs in the field of health protection and promotion |
· Establish the National Immunization Program · Create the Health Alert System · F/P/T review of public health laboratories · Initiate negotiations with Canada Health Infoway Inc. · Undertake the establishment of the Virtual School of Public Health |
Throughout this report, the Committee has indicated that it wholeheartedly supports nearly all the recommendations in the Naylor report. Moreover, many of these recommendations are essentially the same as those contained in a federal government inquiry ten years ago and were also recapitulated in an F/P/T working group report seven years ago. Witnesses also expressed strong support for the findings and recommendations of the Naylor report. The Committee strongly believes that the time for study is over and the time for action has arrived.
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This is why, at the end of Chapter Five, the Committee put forward a precise timetable – a critical path – for the implementation of the key recommendations in the Naylor report. We believe that all of these measures can be implemented without the approval of any other government within the proposed timeframe.
Despite widespread agreement on the need to move quickly to implement these recommendations, the Committee is aware that there are, nevertheless, barriers that might impede progress. For example:
· There may well be resistance to decreasing the size of Health Canada by moving the Population and Public Health Branch, and all of its employees and budget, into an arm’s length agency. Similar human resource concerns were initially experienced with the creation of the Canadian Food Inspection Agency but were finally overcome.
· In spite of the international obligations of the federal government, some officials and politicians could be reluctant to support the deployment of federal employees across the country for disease surveillance purposes, based on the view that data collection is a provincial or local government issue. We believe that the deployment of federal epidemiologists or other public health professionals can allow for a swift, coordinated action when necessary without compromising provincial governments’ roles and responsibilities.
· Organizations that currently receive funding under the Grants and Contributions Program of the Population and Public Health Branch may be upset if their grants/contributions are reduced or eliminated entirely, as the new agency tries to maximize the value it gets for the grant money it disburses.
· There will be individuals in the research community who may be unhappy with having the agency contract out specific research projects, rather than allocating the money through CIHR.
All of this potential disagreement with the measures that the Committee proposes the federal government adopt before the end of 2004 can easily be overcome if the federal government believes, as strongly as the Committee does, that the time for action is now. The essential ingredient that is required is decisive political leadership.
If the federal government fails to implement the proposed measures, then Canadians will have no choice but to conclude that the federal government is incapable of making, or is unwilling to make, the prevention of illness amongst Canadians – through the implementation of a vigorous health protection and promotion program – as much of a priority as taking care of Canadians who are already sick. Thus, by the end of next year, Canadians will be able to judge for themselves how high a priority the federal government places on the recommendations of the Naylor report and on health protection and promotion.
Late in the fall of 2004, the Committee intends to ask the Minister of Health to appear at a public hearing in order to report to the Committee, and more importantly to Canadians, on what the federal government has done with respect to implementing the Committee’s recommended action steps for 2004.
LIST OF RECOMMENDATIONS BY CHAPTER
The Committee recommends that:
CHAPTER TWO:
A new agency, to be called the Health Protection and Promotion Agency (HPPA), be created, and that it be headed by the Chief Health Protection and Promotion Officer of Canada (CHPPO). The HPPA would be a legislated service agency that reports to the federal Minister of Health.
The CHPPO be appointed by the federal Minister of Health and be a health professional.
The Minister also appoint a Health Protection and Promotion Board that would receive regular reports from the CHPPO and function as the Board of the HPPA. The Health Protection and Promotion Board should be chaired by someone other than the CHPPO.
In order to ensure sustained input from the provinces and territories, and to provide the HPPA with the best possible scientific advice, that an Advisory Council be created composed of the Chief Medical Officers from the provinces and territories. The advisory council should also contribute to working out a comprehensive human resource strategy by the HPPA.
The mandate of the HPPA should include the following:
(a) Work with provincial and territorial authorities to articulate a coherent long-term vision for health protection and promotion in Canada, and develop a plan to realize this vision;
(b) Partner with already existing provincial bodies (such as the B.C. Centre for Disease Control and the Quebec National Institute of Public Health) and help stimulate the development of similar comprehensive initiatives in regions of the country where they do not yet exist;
(c) Ensure that Canada meets all its international health protection obligations;
(d) Enhance disease surveillance and control in Canada;
(e) Direct federal efforts to be prepared for any health emergency and work closely with P/T authorities to ensure that there is adequate capacity in all regions of the country;
(f) Direct federal activity designed to improve all aspects of health protection and promotion infrastructure across the country;
(g) Actively promote the health of Canadians, and, in particular, design and implement a National Chronic Disease Prevention Strategy as well as a National Immunization Program.
A Transitional Health Protection and Promotion Board for the Health Protection and Promotion Agency be struck as quickly as possible, through Order in Council if necessary. The Transitional Health Protection and Promotion Board would be charged with setting up the HPPA. The HHPA should come into being before the end of the current fiscal year (March 31, 2004). It would be authorized to work with Health Canada in order to transfer resources and staff from the current Population and Public Health Branch of Health Canada that would serve as the initial core of the HPPA. The Transitional Health Protection and Promotion Board would begin the search for appropriate candidates to head the HPPA and would make a recommendation to the Minister in this regard.
CHAPTER THREE:
The federal government should establish, under the aegis of the new Health Protection and Promotion Agency, a Communicable Disease Control Fund, that would be used to assist the provinces and territories in building up their disease surveillance and control capacity. Money from this fund should begin flowing immediately and be directed to preparing for the coming influenza season.
Work should begin immediately on building up existing F/P/T infrastructure with the goal of establishing a comprehensive network that would link disease surveillance and control activities across all jurisdictions.
The new Health Protection and Promotion Agency should make infectious disease surveillance a top priority and work closely with the new F/P/T network to build capacity. It should also work to develop over a longer period a comprehensive, national disease surveillance system.
Urgent efforts should be directed towards reaching memoranda of understanding between the various levels of government on the business procedures and protocols that would allow for greater immediate collaboration on disease surveillance and control.
The federal government take responsibility for deploying federally-employed field epidemiologists to every region of the country, in sufficient numbers so that they can be effectively sent wherever they may be needed to assist in dealing with a health emergency.
The HHPA develop, as a priority, a Memorandum of Understanding with each province and territory on the implementation of a Health Alert System. As a first step, the reporting of infectious disease outbreaks should be agreed on immediately.
Human Resource Development Canada, as part of its human resources sector study of physicians and nurses in Canada, devote specific attention to the current and future needs of health professionals in the field of health protection and promotion.
The federal government take immediate action to encourage the development of on-the-job training programs to assist health professionals in acquiring the necessary skills pertaining to health protection.
The federal government, in collaboration with provincial and territorial governments and in consultation with universities and community colleges, initiate discussions on the creation of a Virtual School of Public Health.
The federal government, in collaboration with provincial and territorial governments, urgently undertake a review of the capacity and protocols needed by public health laboratories to respond effectively and collaboratively to the next serious infectious disease outbreak.
The federal government immediately initiate negotiations with Canada Health Infoway Inc. to set up appropriate information technology to improve both surveillance and communication systems.
The Health Protection and Promotion Agency play a leading role, along with international partners, in the detection of global emerging diseases and outbreaks, including by working to enhance the Global Public Health Intelligence Network.
The Health Protection and Promotion Agency promote greater engagement by Canada internationally in the field of emerging infectious diseases, and, in particular, initiate projects to build capacity for surveillance and outbreak management in developing countries.
The Health Protection and Promotion Agency be the institution responsible for direct communication with the World Health Organization, the US CDC, and other international organizations and jurisdictions. During outbreak situations, the Agency should work to maximize mutual learning by ensuring an effective liaison with international organizations and jurisdictions.
CHAPTER FOUR:
The Health Protection and Promotion Agency, in collaboration with the provinces and territories and in consultation with major stakeholders (including the Chronic Disease Prevention Alliance of Canada) implement a National Chronic Disease Prevention Strategy.
The National Chronic Disease Prevention Strategy build on current initiatives through better integration and coordination.
The Health Protection and Promotion Agency contribute $125 million annually to the National Chronic Disease Prevention Strategy. Funding for the Strategy should be part of the Agency’s flow through transfers program designed to strengthen local and regional health protection and promotion capacity.
Specific goals and objectives should be set under the National Chronic Disease Prevention Strategy. The outcomes of the strategy should be evaluated against these goals and objectives on a regular basis and reports of any such evaluation made public.
The federal government, through the Health Protection and Promotion Agency, invest $100 million annually beginning within the next 12 to 18 months for the realization of a National Immunization Program whereby the federal government would purchase agreed-upon new vaccines to meet provincial and territorial needs, support a consolidated information system to track vaccinations and immunization coverage and track Vaccine-Associated Adverse Events through increased funding for surveillance and a mandatory reporting requirement, and provide funding for research on possible long-term adverse effects of vaccines.
CHAPTER FIVE:
Between now and the end of 2004, priority for federal spending on health protection and promotion should be given to the following twelve (12) initiatives:
· The establishment of the Transitional Health Protection and Promotion Board which should eventually lead to the creation of the Health Protection and Promotion Agency (3 months);
· The creation of the Health Protection and Promotion Agency by Order-in-Council before the end of the current fiscal year (4 months);
· The development of directives, guidelines and testing protocols to assist health professionals, hospitals and laboratories in preparation for the next respiratory virus season (3 months);
· Initial investment to facilitate immediate preparedness for a possible return of SARS during the winter season of respiratory illnesses (3 to 6 months);
· Further investment in infectious disease surveillance and control with the view of enhancing surveillance capacity at the local and regional level initially (12 months);
· F/P/T review of the capacity and protocols of public health laboratories to respond effectively and collaboratively to the next serious infectious disease outbreak (12 months);
· Meeting of the F/P/T Conference of Deputy Ministers of Health to initiate discussions on a new network for communicable disease control (3 months);
· As a first step, increasing enrolment in existing university and community college programs in the field of health protection and promotion; then, undertaking the establishment of the Virtual School of Public Health (12 months);
· National Immunization Program (12 months);
· Begin F/P/T negotiations on the creation of the Health Alert System (12 months);
· Initiate negotiations with Canada Health Infoway Inc. to set up appropriate information technology to improve both surveillance and communication systems (12 months);
· Initiate transfer of physical and human resources from the Population and Public Health Branch to the Health Protection and Promotion Agency (12 months).
APPENDIX B
LIST OF WITNESSES
(2nd Session, 37th Parliament)
| NAME |
ORGANIZATION |
DATE OF APPEARANCE |
| James Harlick, Assistant Deputy Minister |
Office of Critical Infrastructure Protection and Emergency Preparedness |
September 17, 2003 |
| Gary O’Bright, Director General of Operations |
Office of Critical Infrastructure Protection and Emergency Preparedness |
September 17, 2003 |
| Scott Broughton, Assistant Deputy Minister, Population and Public Health Branch |
Health Canada |
September 17, 2003 |
| Paul Gully, Senior Director General, Population and Public Health Branch |
Health Canada |
September 17, 2003 |
| David Mowat, Director, Centre for Surveillance Coordination |
Health Canada |
September 17, 2003 |
| Andrew Marsland, Acting Assistant General, Market and Industry Services Branch |
Agriculture and Agri-Food Canada |
September 18, 2003 |
| Gilles Lavoie, Senior Director General, Market and Industry Services Branch |
Agriculture and Agri-Food Canada |
September 18, 2003 |
| Judith Bossé, Vice-President, Science |
Canadian Food Inspection Agency |
September 18, 2003 |
| Dr. Karen Dodds, Director General, Food Directorate, Health Products and Food Branch |
Health Canada |
September 18, 2003 |
| Mohamed Karmali, Director General, Laboratory for Foodborne Zoonoses, Population and Public Health Branch |
Health Canada |
September 24, 2003* |
| Frank Plummer, Scientific Director, National Microbiology Laboratory |
Health Canada |
September 24, 2003* |
| Paul Kitching, Director, Winnipeg Laboratory |
Canadian Food Inspection Agency |
September 24, 2003* |
|
| Judith Bossé, Vice-President, Science |
Canadian Food Inspection Agency |
September 24, 2003 |
|
| Dr. David Butler-Jones, Former Chief Medical Officer for Saskatchewan |
As an individual |
September 25, 2003 |
|
| Dr. Colin D’Cunha, Commissioner of Health, Chief Medical Officer and Assistant Deputy Minister |
Ministry of Health and Long-Term Care Ontario |
September 25, 2003 |
|
| Dr. Richard Massé, Chief Executive Officer |
Institut national de santé publique du Québec |
September 25, 2003 |
|
| Ron Zapp, Provincial Executtive Officer |
British Columia Centre for Disease Control |
September 25, 2003 |
|
| Dr. Christian Mills, President |
Canadian Public Health Association |
October 1, 2003 |
|
Dr. Joseph Losos, Director, Institute of Population Health |
University of Ottawa |
October 1, 2003 |
|
| Dr. Elinor Wilson, Co-Chair |
Canadian Coalition for Public Health in the 21st Century |
October 2, 2003 |
|
| Dr. Maureen Law, Member |
Canadian Coalition for Public Health in the 21st Century |
October 2, 2003 |
|
| Rob Calnan, President |
Canadian Nurses Association |
October 8, 2003** |
|
| Lucille Auffrey, Executive Director |
Canadian Nurses Association |
October 8, 2003 |
|
| Dr. Sunil Patel, President |
Canadian Medical Association |
October 8, 2003 |
|
| Dr. Isra Levy, Director, Office for Public Health |
Canadian Medical Association |
October 8, 2003 |
|
| Bill Tholl, C.E.O. and Secretary General |
Canadian Medical Association |
October 8, 2003 |
|
| Dr. John Frank, Professor, Department of Public Health Science, Faculty of Medicine |
University of Toronto |
October 8, 2003 |
| Dr. David Naylor, Dean, Faculty of Medicine |
University of Toronto |
October 9, 2003 |
| Dr. James Hughes, Director, National Center for Infectious Diseases |
U.S. Centers for Disease Control and Prevention |
October 22, 2003 |
*
Fact-finding activity
**
Fact-finding activity and public hearing
OTHER WRITTEN SUBMISSIONS RECEIVED:
Ken Thomson, Chair, Hub Team
Duane Landals, BscAG, DVM, President,
Canadian Veterinary Medical Association
[1] Naylor report, p. 45.
[2] Chapter Thirteen, “Healthy Public Policy: Health Beyond Health Care”, Volume Six, Recommendations for Reform, October 2002.
[3] Mental illness and addiction are also important concerns as they account for the second cause of disability in this country. The Committee has undertaken a study on these issues and intends to release a report in 2004.