Buried in the current omnibus budget bill being studied by Parliament is a plan to demote the Chief Public Health Officer of Canada. He will no longer hold a deputy minister rank, he will have no direct line to the federal minister of health, he will be subservient to a bureaucratic agency president and he will have no secure public funding.
The new Chief Public Health Officer has said he is in favour of this plan, as shrugging off managerial oversight for the Public Health Agency will free him to provide scientific advice. That may be so, but will anybody be listening? Will he even be allowed to speak?
We seem to have forgotten the harsh lessons of SARS. It was just 11 years ago when the World Health Organization slapped Toronto with a travel advisory, costing the city $2 billion and 28,000 jobs. This was not because of the number of SARS cases (similar in number to Singapore, which had no such advisory) but because Ottawa did not have a public health leader who could effectively coordinate with the provinces and communicate the outbreak's status to other countries.
SARS shone a light on the enormous hurdles that Canada's version of federalism -- with provinces largely in charge of their own health dollars and direction -- poses to effective country-wide pandemic responses. Significant change was needed and proposed, including the establishment of the Chief Public Health Officer and the Public Health Agency of Canada. The idea was that new structures and an empowered Chief Public Health Officer could forge a new vision for Canadian public health, ensuring collaboration and cooperation across provinces and territories.
The key was building trust: provinces and their public health departments needed a guarantee that the federal government's public health pronouncements were based on scientific principles rather than political talking points.
Despite reforms, results have been patchy. Auditor General reports year over year have raised concerns that we have not yet achieved satisfactory progress on many measures, including information sharing across the country. Interestingly, it is the Auditor General who has shone a light on these concerns and not the Chief Public Health Officer. Why is that the case?
Science has never actually been allowed to trump government politicking; the Chief Public Health Officer was made an officer of government instead of an officer of Parliament, thereby preventing him from exercising full independence like our Auditor General, the Official Languages Commissioner and the Privacy Commissioner. That was a mistake. But at least he was given some independent powers to speak to Canadians and a mandate to engage in public activities and citizen dialogue. Even these limited powers, unfortunately, are slated for removal in the proposed legislation.
Demotion and politicization of the Chief Public Health Officer is a wrong-headed move. It seems to be linked more to the public gagging of our government scientists than about promoting health or the public good. With an Ebola outbreak raging in West Africa, this is not the right time to be weakening our national public health infrastructure. This change makes us far less prepared for Ebola and other diseases like it.
More than likely the omnibus budget bill will go ahead and we will be left to regret its folly in the wake of another harsh public health lesson -- which may play out on the international stage, as in the case of SARS. After some hand-wringing -- and undoubtedly several Commissions and reports -- we will return to this inevitable conclusion: the Chief Public Health Officer of Canada needs to be independent of federal and provincial governments.
Someone needs to speak public health truth to power on behalf of all Canadians. We are all less safe without it.
Colleen M. Flood is a Professor of Law at the University of Ottawa and an expert advisor with EvidenceNetwork.ca. Steven J. Hoffman is an Assistant Professor of Law and Director of the Global Strategy Lab at the University of Ottawa and a Visiting Assistant Professor of Global Health at Harvard University.
The Survivors: Portraits Of Liberians Who Recovered From Ebola
James and Tamah Mulbah(01 of10)
Open Image ModalEbola survivor James Mulbah, 2, stands with his mother, Tamah Mulbah, 28, who also recovered from Ebola in the low-risk section of the Doctors Without Borders Ebola treatment center, after a survivors' meeting on October 16, 2014 in Paynesville, Liberia. (credit:John Moore via Getty Images)
Benetha Coleman(02 of10)
Open Image ModalEbola survivor Benetha Coleman, 24, stands in the low-risk section of the Doctors Without Borders Ebola treatment center after attending a survivors' meeting on October 16, 2014 in Paynesville, Liberia. She said that her husband and two children died due to the disease. (credit:John Moore via Getty Images)
Jeremra Cooper(03 of10)
Open Image ModalEbola survivor Jeremra Cooper, 16, wipes his face from the heat while in the low-risk section of the Doctors Without Borders Ebola treatment center on October 16, 2014 in Paynesville, Liberia. The 8th grade student said he lost six family members to the Ebola epidemic before coming down sick with the disease himself and being sent to the MSF center, where he recovered after one month. (credit:John Moore via Getty Images)
Zaizay Mulbah and Mark Jerry(04 of10)
Open Image ModalEbola survivors Zaizay Mulbah, 34, and Mark Jerry, 30, right, stand together before their shifts as nurse's assistants at the Doctors Without Borders Ebola treatment center on October 12, 2014 in Paynesville, Liberia. Jerry was a money changer and Mulbah a delivery driver before they caught the disease and went to the center, where they recovered. Doctors Without Borders hired them afterward to counsel and comfort others stricken by the disease. (credit:John Moore via Getty Images)
Eric Forkpa(05 of10)
Open Image ModalEbola survivor Eric Forkpa, 23, stands in the low-risk section of the Doctors Without Borders Ebola treatment center after meeting with fellow survivors on October 16, 2014 in Paynesville, Liberia. The college student, who is majoring in civil engineering, said he thinks he caught Ebola while caring for his sick uncle, who died of the disease. He spent 18 days at the center recovering from the virus. (credit:John Moore via Getty Images)
Emanuel Jolo(06 of10)
Open Image ModalEbola survivor Emanuel Jolo, 19, stands in the low-risk section of the Doctors Without Borders Ebola treatment center after a survivors' meeting on October 16, 2014 in Paynesville, Liberia. The high school student lost six family members and believes he caught the disease while washing the body of his father, who died of Ebola. (credit:John Moore via Getty Images)
Sontay Massaley(07 of10)
Open Image ModalEbola survivor Sontay Massaley, 37, smiles upon her release from the Doctors Without Borders Ebola treatment center on October 12, 2014 in Paynesville, Liberia. Massaley, who spent 8 days recovering from the disease in the center, said she worked as a vendor in a market before contracting the virus. (credit:John Moore via Getty Images)
Victoria Masah(08 of10)
Open Image ModalEbola survivor Victoria Masah, 28, stands in the low-risk section of the Doctors Without Borders Ebola treatment center on October 16, 2014 in Paynesville, Liberia. She said her husband and two children died of Ebola. (credit:John Moore via Getty Images)
Abrahim Quota(09 of10)
Open Image ModalEbola survivor Abrahim Quota, 5, stands outside the JFK Ebola treatment center after recovering from the disease on October 13, 2014 in Monrovia, Liberia. He had arrived at the treatment center 10 days before with his parents, who both died there from the virus. The Ministry of Health was to deliver him home after his release to live with relatives. (credit:John Moore via Getty Images)
Lassana Jabeteh(10 of10)
Open Image ModalEbola survivor Lassana Jabeteh, 36, smiles before his shift as a nurse's assistant at the Doctors Without Borders Ebola treatment center on October 12, 2014 in Paynesville, Liberia. He said that he previously worked as a taxi driver and that he thinks he caught Ebola when he transported a sick policeman who vomited in his car on the way to the hospital. Doctors Without Borders hired Jabeteh after he recovered in their treatment center and he now counsels and comforts others stricken by the disease. (credit:John Moore via Getty Images)