Thank you for this opportunity to appear before you, both as chair of CPHA and as informed by my practice as a public health leader in Saskatchewan.
This committee has heard CPHA say on prior occasions that the vast majority of our health dollars within the country go to fund the treatment side of the system at ever-expanding cost, without a commensurate increase in people's health status. Public health, that part of the system that focuses on keeping people healthy and preventing disease, is relatively underresourced—less than 2% of the health budget in many jurisdictions.
In times of crisis, the public rightly expects a robust public health system, but between crises it seems less top of mind than waiting lists for surgery or other treatment or diagnostic services and often becomes vulnerable to budget cuts. As a result, we have in the country a patchwork of approaches to and variable investments in public health. We need strong federal leadership to bring forward the implementation of a coherent, coordinated, and consistent approach across the country to deal with issues such as immunization coverage, inspection rates, chronic disease prevention, injury prevention, etc.
The people on the front lines, my staff, the public health workforce, are the key element to building and maintaining public trust and confidence in the public health system. But this workforce isn't expanding at a rate that matches increased demand for service from the public, and it doesn't have sufficient surge capacity to respond in an effective and timely fashion to simultaneous public health emergencies and outbreaks. We need a pan-Canadian public health infrastructure action plan that includes as a key element the expansion and enhancement of the country's public health workforce.
CPHA has advocated for many years for increased investment in public health in the implementation of a population health-based approach to health sector human resource planning and allocation, and certainly some progress has been made of late; for example, the 2005 “Pan-Canadian Framework for Public Health Human Resources Planning”, the Pringle and Emerson report, and the Public Health Agency of Canada's April 2008 online resource Core Competencies for Public Health in Canada , and also the recent emergence of several schools of public health in Canada. But there hasn't been sufficient response to achieve the necessary improvements to public health capacity at the front line.
Although health care is a provincial responsibility, ensuring that a strong and unified public health system is in place across the country certainly should be a federal concern. We feel that the best way to guarantee public health capacity in times of crisis is to ensure that the public health system has a strengthened baseline capacity, working on enhanced disease and injury prevention, health promotion, and protection activities between crises.
CPHA's brief to the Standing Committee on Health, “Enhancing the Public Health Human Resource Infrastructure in Canada”, presents several recommendations that we encourage the committee to consider in its deliberations and final report to Parliament.
The pan-Canadian framework for the planning of public health resources exists. The challenge before us is to implement it now, with well-defined timelines and the achievement of key milestones and the definition of roles and responsibilities of key players.
We also need some minimum level of public health workforce investment across the country. CPHA also suggests a targeted investment approach through transfer payments that require a percentage of matching dollars from the provinces in order to ensure a stable level of funding for a public health system across the country. This mechanism has been used successfully before. The national immunization strategy is one example in which federal funds were targeted to certain immunizations deemed core for all Canadians, which in turn helped leverage provincial funding in support of this public health priority area.
We don't expect the federal government to do everything; it's a joint effort. But it does need leadership, championing, and stewardship, and it needs political commitment to get the job done. I can assure you that CPHA will do its part to support the enhancement, expansion, and further development of our country's public health workforce.
Thank you.