Thank you.
Good afternoon, honourable members, and thank you for the invitation to appear before you today.
The COVID-19 pandemic has highlighted the limits of our health care and public health systems and resulted in governments considering the implementation of the Emergencies Act. We agree that the conditions to implement the Emergencies Act have not been met, for the reasons your previous witness has indicated.
From a public health perspective, the use of the Emergencies Act should be considered only as a last resort. Its use in response to an infectious disease outbreak can be forestalled by the appropriate funding and governance of Canada's public health systems.
The fact that the federal government has discussed with the provinces and territories the use of the Emergencies Act underscores the need to modernize the funding and governance of these systems. While the delivery of health services is the responsibility of the provinces and territories, the federal government has a responsibility for leadership, collaboration and international relations. The challenge is that the federal responsibilities are not well defined.
A further challenge is that the key components of a public health response, such as data sharing, are based on voluntary agreements that are not legally enforceable and do not result in the timely collection of the information necessary for an informed response. This situation must change if our country is to respond efficiently and effectively to future outbreaks.
In May 2019, CPHA published a background document and position statement on “Public Health in the Context of Health System Renewal in Canada”. That report includes a series of legislative, regulatory and policy-related recommendations to strengthen the capacity of Canada's public health systems to protect and promote the health of Canadians.
In February of this year, we published our “Review of Canada's Initial Response to the COVID-19 Pandemic”. In this review, we noted that the health portfolio operations centre was activated, and a special advisory committee was implemented as a means for developing guidance, facilitating communication, providing governance and coordinating FPT public health activities and responses. However, the challenge with implementing the work of these groups is the current delegation of authority for managing health services. This division results in barriers to achieving an effective, consistent national public health response.
While we need to respect provincial and territorial authorities, the varying approaches among neighbouring provinces demonstrate that steps are required to improve the consistency of the national response.
CPHA recommends the development of a more unified structure that provides a national approach to public health while respecting provincial and territorial responsibilities. This goal could be achieved through the development of federal legislation for public health, a Canada public health act with clear roles and responsibilities defined for all governments and stakeholders. Such legislation would require a national funding accord that incorporates performance measures for the delivery of public health services according to national standards.
The COVID-19 pandemic has demonstrated the strengths, resilience and weaknesses that exist within governments' collective abilities to protect those who live in Canada from a global pandemic, and the vital role of public health organizations in achieving that goal.
These organizations have a history of responding to infectious disease outbreaks with the skills, competencies and professionalism that are the hallmarks of public health. Following every outbreak response, efforts are made to look back at their actions and to learn from them so that the response can be improved for the next event.
In the time between outbreaks, however, political commitment to implementing the recommended changes and to funding public health systems appropriately wanes. The defunding of public health systems is an easy target, because they operate in the background, protecting and improving the health of Canadians and reducing health inequities. Unlike wait-lists for surgical procedures or MRIs, there isn't a public backlash when public health services are cut.
Emergency preparedness is only one of six core functions of public health, so the necessary investments in public health governance, infrastructure and human resources will be fully utilized across the remaining functions in between infectious disease outbreaks.
The COVID-19 pandemic has clearly demonstrated that we cannot afford to allow the status quo to continue with respect to the governance and funding of public health systems in this country. If a jurisdiction spends only 5% of its overall health budget on protecting and promoting the health of its citizens, it can come as no surprise that we have unsustainable growth in our acute care systems during normal times and they teeter on the brink of being overwhelmed during this third wave of this pandemic.
We did not learn the lessons from SARS. We failed to properly and fully implement the recommendations of the Naylor and Campbell reports.
Our proverbial chickens have come home to roost with COVID-19. The political will at all levels of government must be marshalled to reform public health governance and to ensure its appropriate funding if we are to be better prepared to address the next outbreak, and there most definitely will be a next outbreak.
Thank you.