Government & Medicine

'First installments' make lasting impressions

Public health officials lick their lips with promise of more from the Grits' coffers. All the premiers have to lick is their wounds

By Susan Usher

All the hoopla from the 'Premiers for Health' ad campaign didn't exactly bear fruit if the federal budget announced on March 23 is anything to go by. The provinces didn't get an increase on the $2 billion in additional transfer payments already promised last year when they signed the health accord with the feds. On the other hand, Canada's public health crisis received unprecedented attention, with public health programs getting a very respectable cash injection. Well at least someone's happy.

As the premiers expressed their outrage, Finance Minister Ralph Goodale's announcement was greeted enthusiastically by the public health community, who'd frankly not been expecting much. "This is wonderful news," says Dr Eleanor Wilson, CEO of the Canadian Public Health Association. "In a budget that doesn't have a lot of handouts, we captured a fair amount." She's also encouraged by Mr Goodale's reference to the new spending as 'the first installment.' "They don't seem to be treating this as one-time money," says Dr Wilson.

SARS WAKE-UP CALL
Public health has long been perceived as the softer � and cheaper � side of healthcare. Not anymore. SARS showed us just how scary, difficult and expensive public health emergencies could be, and just how high the stakes are � and how important it is to keep Canada's name off that damnable WHO's list of hot spots.

The budget pledges seem to be a direct response to recommendations made in last October's report on the SARS outbreak, written by Dr David Naylor and members of the National Advisory Committee on SARS and Public Health. The committee found that public health was dangerously compromised by a lack of clearly defined authority and coordinated response in different jurisdictions, variable capacities between regions, and a shortage of resources to handle public health emergencies. The report advocated a transfer of responsibility from Health Canada to a new Canada Public Health Agency, and appointment of a Public Health Officer to oversee it and take responsibility for fixing some long-standing weaknesses.

This budget looks like it'll make those recommendations a reality. Part of Health Canada's current mandate � notably the population and public health branch � will be transferred, along with the $400 million that goes with it, to form the core of the new Canada Public Health Agency. The agency, which previously existed only as a theoretical entity, will be responsible for detecting outbreaks, mobilizing resources to control infectious and chronic diseases, coordinating with the US Center for Disease Control and the WHO, and lead national public health response during emergencies. An additional $165 million allocated in the budget will be used to expand laboratory capacity and establish emergency response teams. "We now live in a more vulnerable world, where disease can be spread from one end of the globe to the other in just a matter of hours," Mr Goodale said in his budget speech. "As a result, we face new challenges to our public health systems."

SHOT IN THE ARM
Immunization, also mentioned in Dr Naylor's report, gets a much needed budget top-up, promising a boost for the poor immunization infrastructure that has frustrated past attempts at improvements. "Many, many organizations have been lobbying for years for a pan-Canadian immunization strategy that would create a level playing field for all provinces," says Dr Wilson. "Now maybe we can start getting vaccines in people's arms in a consistent way."

The new investment should even out coverage of some of the newer vaccines for kids across the country. Some provinces have already added immunization for meningococcal and pneumococcal infections, chicken pox, adolescent pertussis, and influenza to their routine immunization schedules, but in others parents still have to pay for them.

Lucille Auffrey, Executive Director of the Canadian Nurses Association, applauds the investment in immunization, but thinks it's long overdue. "To think that Canada, which was at one time seen as a leader in this area, is now 16th among OECD countries in immunization," she says.

She's also less than pleased with the budget's treatment of healthcare human resource issues. "We've been positioning the need for a health and human resources national vision, an institute of some kind that would look at across-the-board planning for doctors, nurses, therapists, etc, in a comprehensive fashion," says Ms Auffrey. "The absence of any support there is distressing."

Additional reporting by
Hugh W Coulthart