Good morning, Mr. Chair and committee members. Thank you for the invitation to present to you today.
First, I want to acknowledge that I am joining today's meeting from the ancestral and unceded territory of the Algonquin Anishinabe peoples. The Canadian Public Health Association is committed to working with first nations, Inuit and Métis people and their governments in realizing meaningful truth and reconciliation.
I will begin by expressing our support and gratitude for the efforts of everyone involved in the Canadian response to COVID-19. Throughout this extraordinary situation, people from all walks of life in this country are showing their true grit.
With my time today, I will tell you about how our system has learned from previous responses and how we need to continue to adjust and improve.
This country needs a public health system that can provide a national perspective while supporting the provinces, territories and indigenous peoples with the skills, tools and equipment necessary to meet the demands of this and future disaster or pandemic responses while reducing the burden on the acute care system.
Public health is defined as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society”. The core functions of public health systems in Canada include health protection, health surveillance, disease and injury prevention, population health assessment, health promotion and, of course, emergency preparedness and response.
I remind you of that today, because this pandemic has been a classic case study of that definition. From the start of this year, the Public Health Agency of Canada has been monitoring this outbreak, following the evidence and the growing body of knowledge about this novel coronavirus. The agency and public health officials across the country have been following, and contributing to, the science.
As COVID-19 continued to spread around the world, pandemic preparedness plans developed after SARS and H1N1 were refreshed, and the Canadian response began to be formulated. That response is guided by a set of principles embodied in existing pandemic preparedness plans and includes a number of commitments. First, all levels of government and stakeholders are collaborating to produce an effective and coordinated response. Second, decisions are based on the best available evidence. Third, the response to the pandemic is proportionate to the level of the threat at any given point in time. Finally, plans and actions are flexible and tailored to the situation, and evolve as new information becomes available.
Where the “art” of public health comes into play is in the decision-making process for interventions. While it may be tempting to look back and suggest that Canada should have closed its borders and implemented physical distancing measures as soon as the first travel-acquired case was identified in our country, the reality is that there would have been very little public support for those moves at that time. Low public support would have resulted in minimal adherence and a diminishment of support for any future interventions.
For the past few weeks, the message I have been repeating from the Canadian Public Health Association is that how we respond as individuals may be the single most important factor in how well we fare as a country. For both better and worse, this is playing out as we expected. Those who are heeding the advice of public health officials are helping to flatten the curve, while those who do not appreciate the seriousness of this situation continue to endanger others through their behaviour.
The intersection of public health guidance, civil liberties and human behaviour is always a tricky one to navigate. While there has been criticism of the incremental or proportionate approach adopted by public health officials and governments across this country, we believe that this was the most prudent way to navigate this intersection.
Public health officials and politicians alike began with requests for behaviour modification. These requests became appeals, which later became requirements and eventually enforceable requirements with penalties for non-compliance. At each juncture, the request for behaviour modification, be it frequent handwashing or physical distancing, was accompanied by the evidence that predicated that request. This process was and continues to be a perfect example of health promotion in action or the process of enabling people to increase control over and improve their health.
Public health officials across the country understand that if we want our population to change their behaviours, we cannot simply tell them to change. We have to empower them to make the decision for themselves. In times of a public health crisis, health promotion efforts can be hampered by the lack of resources or the time to get people on board and change their behaviours. It is in this situation that enforcement and penalties are reluctantly put into place to safeguard well-being.
It is important to note that there are many in our country who are not in a position to take control of their health or change their behaviours. They may live in crowded housing conditions, are homeless or living in shelters, or they do not have access to clean water. The negative impact of these pervasive social determinants of health are intensified during a public health emergency.
Of course, the Canadian response to COVID-19 to date has amplified some of the perpetual challenges of our federated model and the delegation of authority for health to the provinces and territories. This delegation of authority is a double-edged sword in that it allows provincial and territorial officials to develop responses that are honed to the specific circumstances of their jurisdictions. But in the case of a national public health emergency, it can create the perception that different jurisdictions are taking dissimilar approaches to the outbreak and the perception that there is a lack of coordination. Any differences in public health messaging can be seized upon by the public or the media as signs of disharmony, or worse, incompetence among public health officials.
COVID-19 has once again revealed the lack of surge capacity within our public health systems, mental health support systems, acute care systems and especially in the services available to many if not all indigenous communities. The requirements for testing and contact tracing have pushed public health personnel to the limit, even though all available resources have been redirected toward the COVID-19 response. This redirection of resources will inevitably have repercussions as other core public health functions will be set aside during this crisis.
The lack of surge capacity is directly linked to the chronic underfunding of public health services in Canada. While this issue is not currently within the purview of the federal government to rectify, we are encouraging the development of a legal, regulatory and financial framework in consultation with provincial, territorial and indigenous governments that would provide the Government of Canada with a mechanism to protect and promote the physical and mental well-being of people in Canada through population-based approaches. Such a mechanism will help facilitate the establishment of public health standards and the reasonable provision of public health programs and services. The purpose of this legal and regulatory package would be to provide a national framework of public health functions and activities to inform provincial and territorial activities, accompanied by a resource envelope to support their implementation.
COVID-19 has brought tremendous disruption, hardship and tragedy to the lives of many in our country. It has also resulted in an unprecedented level of scientific progress, non-partisan collaboration and a resolve to triumph over this deadly virus. While we continue to face significant challenges, we inevitably start planning for recovery. As we do so, we have an opportunity to take a longer view of pandemic preparedness with the understanding that COVID-19 will not be the last novel pathogen to disrupt our world and it will most likely not be the worst.
It has too often been the case that a year or two after a public health emergency, public health and political interest in public health wanes. Budgets that were temporarily enhanced are cut back to provide for the immediate needs of the acute care system.
I would ask that you keep one fact in mind as this committee considers recommendations for the future. Public health systems and services in this country are the front line of the health system. If you want to have sustainable acute care systems across the country, you need to have much more robust public health systems to prevent disease, prolong life and promote health both in times of crisis and during normal times.
Thank you.