Sudbury Roundtable Report

April 13, 2004

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

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

Broad Scope

• The mandate must be comprehensive, extending beyond infectious diseases to include chronic diseases and health promotion, and addressing the full range of health determinants. There was concern with the notion of a "phased in" approach, ie, one that focuses on infectious diseases first, other issues second, because of the risk that the other phases will never come.
• Clearly define public health and articulate how the Agency's mandate will fit within this definition. Define the core functions of public health, and establish national consensus. Consider those identified in the CIHR report: population health assessment, health surveillance, health promotion, disease and injury prevention, and health protection.
• Ensure that the full range of government policies and programs support public health objectives by applying a public health "lens" to policy decision making across all departments.

Accountability and Citizen / Stakeholder Engagement

• The Agency must be accountable to Canadians, and decision making must be transparent. This can be accomplished by:
  • Developing a balanced scorecard / "report card" for public health;
  • Encouraging citizens to participate in the Agency's governance through membership on its board, with outside expertise provided through advisory committees of health professionals and other experts; and,
  • Ensuring that responsibilities to the Canadian public, other levels of government and in international fora are well articulated.
• The Agency should also engage Canadians by:
  • Encompassing principles of social inclusion;
  • Going beyond elected representatives;
  • Involving citizens in its design; and,
  • Learning from experts who currently engage citizens, such as grass roots coalition groups.

Regional Considerations

• Ensure the Agency addresses regional inequities in health status. Areas of greatest need are those with decreased access to resources and capacity, for example, the north.

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

Communication

• Communication is paramount; it must be:
  • Clear and consistent to be credible (SARS was cited as an example where messaging was confusing and sometimes contradictory);
  • Delivered through multiple channels (do not rely only on technology) in order to facilitate widest possible dissemination; and,
  • Timely, this includes French language translation of communications (written and oral) for Official Language Minority Communities.
• Make better use of the media to communicate. Ensure messages get to sometimes difficult to reach groups (ie, seniors).

Collaboration and Integration

• Intergovernmental cooperation is key, extend the concept beyond federal - provincial - territorial to include municipal governments.
• Involvement of local public health units is paramount, especially in program and service delivery.
• Pharmacists are the most accessible health professional - more Canadians enter pharmacies than any other health care institution in the country - and they need to be engaged. Pharmacists can play three important roles:
  • Advisors, informing policy makers of community needs, the effectiveness of initiatives, etc;
  • Conduits, delivering PH services and education; and,
  • Sentinels, signalling emerging community symptoms.
• Establish partnerships with municipal social planning councils.
• Ensure activities impacting public health are vertically and horizontally integrated among all sectors, including:
  • All other levels of government;
  • Non-governmental organizations (NGOs);
  • Other government departments (beyond health); and,
  • Stakeholders.

Agency Activities

• Set national public health standards and guidelines to ensure equity, reduce duplication and make better use of limited resources.
• Once the core functions of public health have been identified (see section on "Broad Scope" above), identify the specific competencies needed by the Agency and public health professionals to guide public health education, research and practice.
• The Agency should assess the strengths and weaknesses of the current system. Build upon existing innovation, expertise and success. Local examples include the Northern Ontario Medical School, the Public Health Research Education & Development (PHRED) Program and the Northern Ontario Child Consortium.
• Implement Canada's Drug Strategy.

3. Investments:

Funding Mechanisms

• Ensure that adequate resources are provided to fund public health at all three levels of government.
• While municipalities are willing to stay engaged in supporting / promoting the public health of its citizens, they would like to revise the current 50-50 cost sharing funding formula so that the full municipal public health budget is absorbed by the province.
• Target investments to traditionally overlooked areas such as addiction services, harm reduction, mental health, etc.

4. Public Health Issues:

• "Northern factors" that impact the health of the population include small communities spread over large distances, weather, and disparities in resources, compared to larger southern centres. These factors exacerbate the inequity and access issues facing northern Ontarians. Lack of services in language of choice also impedes access.
• The most effective way to improve the health of the population is to integrate the population health approach with individual health care. This is the principle underlying the World Health Organization's Unity for Health declaration.
• Focus on the determinants of health to improve population health, they are more influential than health promotion efforts targeting lifestyle.