Government & Medicine

Dr Bennett: round peg in a round hole

Could this be the start of something big?

By Hugh W Coulthart

Dr Carolyn Bennett

Among the congratulatory emails Dr Carolyn Bennett received following her appointment as federal Minister of Public Health, her favourite read, "Amazing, you're a round peg in a round hole!" Dr Bennett took it as a compliment. "It's like a custom- made job," she says. "It combines everything I care about."

She may not end up in the job for long -- she too has "heard the rumour" that Prime Minister Martin is likely to call a general election as early as April -- but that doesn't diminish her enthusiasm. When it happens she'll run for re-election in her Toronto riding of St Paul's.

In the meantime, the mandate of her job is fairly narrow: the junior public health portfolio was created for the specific purpose of filling the gaps in Canada's public health apparatus exposed by the SARS crisis. The federal government has stated its intention to adopt the recommendations of Dr Naylor's report into the crisis.

The Naylor report suggests the creation of a Canadian Agency for Public Health (CAPH) to be headed by a chief public health officer who would work with the provinces and territories to develop and implement a pan-Canadian public health strategy. A network for communicable disease control linking all federal, provincial and territorial activities in infectious disease surveillance, prevention and management would also be established. Though the agency's aspirations are clear, when it will happen is less obvious. So far the CAPH and its leader exist only on paper -- and Mr Martin's government has yet to put its money where its mouth is.

That said, Dr Bennett is more than glowing about CAPH's prospects. The Naylor report is an "excellent blueprint," she says. "We've ended up with all the constellations coming together. It's unfortunate that it came because of SARS," she continues, "but I think that because of SARS and infectious diseases like West Nile and now the avian flu, and flu in general, Canadians have really got behind this, with huge support from the provinces and territories." Bennett sincerely hopes that her office will provide an example of how all jurisdictions in Canada can work together. "I think that public health is the one place where we can show Canadians that the squabbling has stopped and that the cooperation begins."

Show me the money -- later
When sceptics suggest that there will be no change without new funding, Dr Bennett counters by saying she'd "be embarrassed to be asking for dollars before I'd done my homework."

Her homework begins with the design of CAPH. "A lot of it is about a dialogue with the provinces to see what they've already got that we'll build on," she says. "What exists now? What are the gaps? Then we'll cost it out and see what extra money we need to ask for. It's clearly a priority of this government, or I wouldn't have this job."

But there are a lot of ifs. If the Martin government does call an early election -- and survives it -- and if he continues to share Dr Bennett's view of public health management, some speculate that her present job could be combined within the ministry of health portfolio and she could find herself with Pierre Pettigrew's job. In this scenario Mr Pettigrew would most likely move on to foreign affairs and international trade.

But Dr Bennett is playing her cards close to her chest, and gives no indication that she anticipates, or even aspires to, a place closer to the head of the cabinet table. All the same, she wouldn't deny that a physician is a peg of just the right shape to slot into the role of Minister of Health.

She believes strongly that it's physicians who have made real change in public health. Indeed some directly inspired her, like Dr Julio Frenk, current Minister of Health in Mexico, and Dr Gro Harlem Brundtland, former prime minister of Norway and, more recently, director general of the World Health Organization.

The reason she thinks doctors often succeed in government is that "physicians are very big on results." She contrasts that with what she calls governments' "old way of looking at things, where you boast about the input, you boast about how much you've spent on something and say, 'We don't care a whole bunch about outcome...,' the assumption being we've spent all this money on the problem so it must be solved." Dr Bennett stands with the likes of Dr Brundtland and Dr Frenk who ask, "Fine, but what results did we get for the money we spent?'

When it comes to CAPH, Canadians will be watching, with the same question on their lips.