St. Catharines Roundtable Report

April 15th, 2004

In St. Catharines, the Minister of State met approximately 20 local public health stakeholders.

1. Regarding a Mandate for a Public Health Agency of Canada:

The Agency must consider:

• Broad Scope
  • Utilization of a public health lens for all policy decision making, for example, infrastructure planning for environment, public health, transport, etc. Since all issues are interconnected, more responsibility can be shared by various departments at Cabinet.
  • Focus on the determinants of health in order to be broad and interdisciplinary in nature, including issues around child poverty; chronic disease amongst adults and children, for example, diabetes.
  • Focus on infection control and risk management with respect to ventilation systems, air purifiers, isolation facilities, must be a priority.
• Integration and Collaboration
  • Planning, developing, implementing and evaluating must occur within the context of federal-provincial-territorial relations and across various sectors. Integration and co-operation of many agencies is required
  • Standards must be developed within the context of federal-provincial-territorial relations and consensus must be reached.
• Accountability
  • All governments must be accountable for public health funding. In addition, to partnership in funding, clear protocols must be developed concerning the division of responsibilities when faced with public health threats.
  • The rules for intergovernmental cooperation with respect to public health are the same as for any other area involving shared responsibilities. This includes, clear roles, clear accountabilities and an agreed upon action plan (in advance) as to who does what.
  • Reporting back should be a dynamic process, for example, Web-based, collaborative, etc).
  • The Agency should be centralized and coordinated in order that the final common pathway leads to standardized information.
• Citizen / Stakeholder Engagement
  • The Agency must be transparent through consultations with committees, advocacy groups, communities and other key stakeholders, including providers and patients, through public hearings and online or mail-in questionnaires.
  • Accessing best practices through various means including the National Health Council, and/or posting information on a network or online. Furthermore, access to information must be easy.
  • Inclusivity must be transparent within the development of the Agency infrastructure.
• A Comprehensive Public health strategy would include:
  • Education and Communication of determinants of health and their impacts;
  • Terminology and Environmental Supports, for example, education about healthy eating must be concurrent with choices available in vending machines; and,
  • Policy/Legislative direction, for example, national wellness strategy needs to be integrated at all levels of government and community.

2. Regarding Operational Strategies For a Public Health Agency of Canada:

An Agency should consider:

• Utilization of Existing Resources
  • Current networks of students and communities. Students within universities in the field of public health who have existing links to community for purposes of education, promotion, surveillance, epidemiology, etc.
  • Current service providers, for example, nurses, nurse practitioners, etc.
  • Studies looking at health status in order to distinguish trends and determine implications and outcomes of those trends.

3. Investments:

Participants urged an Agency to focus on the following priority investments:

• Infrastructure
  • Strong infrastructure is required for evidence-based research and decision making.
  • Capital redevelopment program is required with respect to isolation units, proper ventilation, air purifiers, protective equipment, etc. within the context of infectious diseases.
• Common Language
  • Definitions of the words within the public health arena are different across sectors. Urgent need for common language to be developed across sectors, throughout the country.
• Information systems
  • Computer systems are required and important for the management of public health systems and processes. An electronic information and tracking system must be developed so as to be implemented quickly during emergencies. New policy is required around standardization of systems.
• Education
  • Internal education, for example, distance education for clinical upgrading, standardization of common language, impact analyses of interventions on that health status and health system data is required.
  • External education, for example, informing Canadians on how to effectively use health system by informing them where to go for what service, promoting behavioural changes through wellness.
• Funding Environment
  • Human Resource issues need to be addressed with respect to understaffing and over worked resources.

4. Public Health Issues:

Participants also raised concerns about specific public health issues, including:

• Ethics Issues surrounding rights vs. responsibilities. For example, should a health service provider have the right to refuse a flu shot, in the best interest of the general public? The Agency should advocate for all Canadians to be healthier.
• Public health needs of an aging population as this region has a high proportion of seniors - 2nd oldest population, behind Victoria, B.C.

Determinants of Health

• The Agency should have a clear leadership role within context of social and mental health sectors, and in advocating for all determinants of health, specifically, housing and poverty determinants.
• In order to aim for a healthy population, it is important to focus on and address all determinants of health within a public health context, as well as lifestyle and behavioural approaches to wellness, for example, stopping smoking.

Chronic Disease Prevention

• To curb cost burden of chronic disease, lifestyle strategies and management mechanisms of chronic disease prevention needs to be developed and integrated at all levels of government.

Refugee & Immigration Health Issues

• Human resource issues must be looked at by the Agency, since physicians who deal with refugee issues are scarce, for example, communicable diseases such as TB, malaria and other tropical diseases.
• The Agency should look at Interim Federal Health Program and at standards to make sure refugees have proper and cost-effective care. Care provision should be provided in various languages.
• Mental Health services for refugees are required within the context of Canada/U.S. border and international war victims.

5. Chief Public Health Officer (CPHO) and Leadership:

• Mandate of CPHO would include looking at capacities, needs, opportunities, actions, results, and reporting back.
• CPHO, like the Agency, must be in alignment with all sectors who are affected by public health, including income, education, environment, housing, transportation, etc.
• CPHO model of United States should be examined, for example, the Surgeon General. A similar opportunity may exist in Canada.
• Recommendation of a Chief Nursing Officer. Nurses and nurse practitioners must be involved.