Moving Forward from the COVID-19 Pandemic: 10 Opportunities for Strengthening Canada’s Public Health Systems
Executive summary
Executive summary
The widespread impact of the COVID-19 pandemic and the highly visible nature of the public health response have created a unique opening to take stock of the enduring challenges and novel opportunities facing Canada’s public health systems. We use the plural here intentionally as rather than a single national system, public health in Canada can be more accurately described as an amalgamation of multiple national, provincial, territorial, Indigenous, and local public health organizations and bodies. To leverage this opportunity, the Canadian Institutes of Health Research - Institute of Population and Public Health (CIHR-IPPH) convened a broad national dialogue with the public health community during Spring 2021 that identified key priorities and actions for building effective public health systems that are equipped to tackle ongoing and emerging threats and serve all Canadians. The dialogue sessions revealed that this is both a critical moment requiring systemic change and a time of great possibility for public health in Canada.
Participants highlighted several longstanding stresses on Canada’s public health systems that hindered the COVID-19 response and continue to weaken the capacity to tackle other urgent public health challenges, such as health equity and the effects of climate change. Although recognition of these systemic issues predates the COVID-19 crisis, the pandemic acutely demonstrated the unsustainability of the status quo and the need for a renewed focus on fundamental change across public health systems. Key challenges identified by dialogue participants include:
- Sector-wide failures to put equity at the core of public health and build systems that are anti-racist and anti-colonial, which leads public health governance, practice, research, and training to perpetuate structural inequities.
- Chronic underfunding of public health and public health research that inadequately supports the broad scope of public health needed to address social, structural, and ecological health determinants.
- An absence of national agreement on the scope and functions of public health systems across the country, which leaves the public health sector vulnerable to budget cuts and restructuring, paralleled by a lack of coherence in the public health and global health goals of Canada’s governments.
- Insufficient clarity regarding roles, responsibilities, and authority within governance structures, which weakens accountability, hinders coordination, and is complicated by the need for public health officials’ positions to balance the goals of independence and policy influence.
- A lack of surge capacity within public health systems, which impedes the ability to meet expanded human resource needs during crises and reduces opportunities to integrate community knowledge into emergency interventions.
- A widespread data and research gap regarding public health systems, workforces, and needs across Canada, which creates barriers to measuring, evaluating, and comparing different systems and approaches and stalls progress in addressing equity challenges.
- A lack of recognition of public health’s community focus among different orders of government, which sidelines the local expertise of practitioners who engage with communities on the frontlines in policy discussions.
- Inadequate structures for community participation and power-sharing in decision-making and research processes, which can result in public health interventions and knowledge outputs that are irrelevant and harmful.
- Weaknesses in communicating and targeting public health recommendations, which can lead to messaging that overlooks the circumstances of specific groups, fails to address mistrust of the system, and leaves individuals vulnerable to misinformation.
- Insufficient alignment and relationships among public health research, training, and practice communities, which hinders knowledge creation and mobilization on operational issues and creates a gap between research focus, training programs and system needs.
Although these challenges are not new, the unprecedented and whole-of-society nature of the COVID-19 pandemic and response has created an opening for systemic change at a time of rapid technological innovation, increased awareness of institutionalized racism, colonialism, and inequities, and expanded public engagement in public health decision-making processes. Dialogue sessions highlighted 10 interconnected opportunities and pathways to translate today’s unique context into system-wide action. In particular:
- 1. Advance equity
The growing awareness and efforts among some public health institutions to create equitable, anti-racist, and anti-colonial systems should be built on to establish long-term, well-resourced, and accountable strategies led by the knowledge and priorities of relevant communities.
- 2. Increase investment
The high profile of the public health system’s pandemic response should be leveraged to call for an increase in investment in public health and public health research that is stable over time.
- 3. Create governance structures
The collaboration across sectors that characterized the pandemic response has created a promising foundation and a crucial opportunity to entrench governance structures that support an intersectoral, Health in All Policies approach to addressing the determinants of health and health equity.
- 4. Align globally
The pandemic’s vivid illustration of the connections between local and global health should motivate the development of a long-term coherent plan that links Canada’s domestic public health goals and strategies with its global health policy and advocacy.
- 5. Define standards
The increased profile of public health, recognition of upstream and intersectoral contributions to health and health equity, and calls for urgent and coordinated action to address ongoing threats create an opportune window to define a coherent set of core functions and services for Canada’s public health systems.
- 6. Revisit core competencies
The pandemic response challenges that were experienced in areas such as emergency preparedness, public communications, and community relationships should motivate action to develop a modernized and strengthened set of competencies that accounts for future public health threats, system needs, and equity gaps.
- 7. Generate evidence
Building public health systems of the future will require better understanding how to plan, deliver, structure, and evaluate public health which must be based on context-specific research evidence and robust data.
- 8. Reinforce foundational resources
The pandemic’s lessons on the implications of inadequate surge capacity should translate into investment in the system’s ability to adapt and mobilize in times of need, including by strengthening data systems, building training-practice linkages, and investing in frontline community relationships that bring local knowledge into future emergency responses.
- 9. Strengthen community partnerships
The visible achievements of grassroots initiatives, co-planning approaches, and public engagement to inform equitable pandemic responses should lay the basis for long-term strategies to increase the participation and authority of those with local knowledge and lived experience in public health governance, planning, and implementation.
- 10. Link research and practice
The challenges of linking research, training, and practice before and during the pandemic – and the effectiveness of rapid initiatives to bring new data and knowledge into public health responses – should trigger efforts to expand and strengthen researcher-practitioner positions, embedded training programs and knowledge creation and mobilization networks.
At a time when urgent action is needed to address the health of our communities, country, and planet, the insights distilled in this document can provide a roadmap for thinking about target areas for increased investment and systemic change in the public health sector. Future decisions, however, should be informed by evidence and for many of the opportunities above more research is needed to understand how to tackle future challenges and improve health across populations. We hope that sharing what we heard will inspire the action needed to build a more robust and equitable future for public health in Canada.
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