Erosion of public health capacity should be a matter of concern for all Canadians

Public health matters for society, and the benefits of prevention have been clearly demonstrated: a healthy population is a social good. Not having a disease or injury in the first place avoids much pain and suffering among patients and their families, as well as premature death. On top of this, there are significant economic benefits from prevention, both in avoided health care costs and in avoided loss of production, income, and tax revenue. Moreover, arguably, quality health care is not possible without a strong public health sector, which contributes in a significant way to all three goals of the “Triple Aim”, a widely-used set of overall goals for the health care system: improved population health, improved patient experience of care, and reduced per capita cost of health care. The Editorial Board of the Canadian Journal of Public Health is thus alarmed by the ongoing erosion of public health capacity in Canada. Those concerns have been expressed in these pages several times in recent years. Public health has been characterized as “under siege” and “under attack”. It has been argued that its weakening – characterized by downgrading the status of public health within governments and health authorities; eroding the independence of Medical Officers of Health; limiting the scope of public health by combining it with primary care; and decreasing funding – is a threat to both the health of the population and the sustainability of the health care system. Moreover, given public health’s work on the most basic determinants of health and its commitment to social equity, the erosion of capacity will likely disproportionately impact populations already experiencing unacceptable health disparities – for example, Indigenous populations, who continue to experience health inequities that are rooted in unaddressed basic public health challenges and shame Canada on the international stage. Public health continues to face challenges. Several further actions that erode public health capacity have occurred in just the few short months since our last editorial. At a national level, the Public Health Agency of Canada has backed away from one of the key reasons it was established – to address concerns about public health capacity in Canada – by eliminating both the Skills Online program and the practicum awards for MPH students established in 2013. This award had “provided over $1.8 M of funding to 17 institutions across Canada”. At the provincial level, the most serious attack on public health has occurred recently in New Brunswick, where the government fired the former Chief Public Health Officer (CPHO) last year for no discernible reason and has moved some 70 of the 110 staff out of the Ministry of Health, spreading them across three different ministries, thus disrupting the cohesiveness of the public health department and undermining its ability to address important public health issues. The reaction has been strong, with critical comments from public health professionals from across Canada in the local print media, on radio programs, and in open letters from the Canadian Network of Public Health Associations and the Public Health Physicians of Canada. Dr.WayneMcDonald, a former CPHO for New Brunswick, L’érosion des capacités en santé publique devrait préoccuper tous les Canadiens