Moving Forward from the COVID-19 Pandemic: 10 Opportunities for Strengthening Canada’s Public Health Systems
Section 3: What opportunities exist?

Section 3: What opportunities exist?

The public health challenges identified above are not new, and the COVID-19 crisis is only the latest stressor on the system. At the same time, the pandemic underscored the public health sector’s vulnerabilities in a highly visible, global, and whole-of-society way, which creates an opening for systemic change. This opening exists at a time of incredible advances in data and technology, greater awareness of institutionalized racism, colonialism, and inequities, and growing access to and involvement in public health information and decision-making processes by the public. Although the need for a more robust and equitable public health system has long been recognized, dialogue participants highlighted that today’s context provides unique opportunities and renewed momentum to achieve this goal. This section summarizes ten interconnected opportunities and actionable ideas that emerged across dialogue sessions.

Participants emphasized that despite the enormous amount of work that remains to move beyond public health systems that perpetuate colonialism, racism, and other forms of structural violence, it is vital to build on the heightened awareness and existing efforts among some institutions to create equitable, anti-racist, and anti-colonial systems of governance, practice, research, and training. We must also build on landmark documents such as the United Nations Declaration on the Rights of Indigenous Peoples in Canada (UNDRIP) and the final report of the Truth and Reconciliation Commission that provide roadmaps for more equitable and anti-colonial systems. Examples of existing initiatives that participants highlighted include strengthening capacity and competency in anti-racist approaches among public health staff, increasing the representativeness of public health teams from entry-level to senior leadership positions, applying a health equity lens to programming, engaging stakeholders to ensure services are meeting community needs, collecting race-based data and linking it to action, working with Indigenous communities on their self-determined priorities in areas like cancer care, and creating publishing guidelines regarding equitable and ethical research engagement with Indigenous communities. British Columbia’s establishment of a First Nations Health Authority and Council was also identified as a promising approach to health governance, delivery, and monitoring. Participants noted that funding bodies are implicated in inequities within the research system and should seize the opportunity to examine how their internal structures and policies perpetuate the status quo – including regarding how peer review is conducted, what types of knowledge are valued, and the criteria used to award grants. As dialogue sessions revealed, these challenges represent a steep hill, but different levers are available to reduce the incline. It is past time for the public health community and its partners to leverage all the pathways to action that are available to them.

Participants additionally emphasized that the COVID-19 pandemic has generated renewed urgency and a unique window to promote much-needed investment in increasing the public health system’s capacity to work across sectors to help address the upstream determinants of health, which is vital to respond to current and future threats and would translate into savings in health care and other sectors. The widespread impact of the pandemic brought unprecedented attention to public health, demonstrated the potential for public support for investment in this sector, and shed light on the system’s capacity to act and pivot when energy and resources are channeled towards it. The crisis also highlighted the ways in which social and structural determinants of health impact rates of illness and death – as well as what can be achieved when the system prioritizes the needs of groups who face conditions that put them at heightened risk. Leveraging this context to call for stable and long-term investment in addressing the social, structural, and ecological conditions that heighten vulnerability to public health threats and an increase in inter-disciplinary research on how to best address these determinants is not only wise, but essential to prevent another tragedy on (or exceeding) the scale of the COVID-19 pandemic. Making the most of this opportunity will also require efforts to increase public knowledge of public health’s remit beyond infectious disease.

Investment in upstream public health interventions should go hand in hand with intersectoral partnerships. Participants highlighted the importance of building on the large-scale coordination among sectors that occurred during the COVID-19 pandemic, the increased visibility of public health across ministries and departments, and public health’s contribution to key pandemic initiatives such as emergency income support programs. Combined with a growing global knowledge base about whole-of-government and Health in All Policies strategies, the visibility and collaboration across sectors that was spurred by the COVID-19 crisis has created an indispensable opportunity to entrench an intersectoral approach within governance structures. Owing to its fundamentally intersectoral focus, public health is particularly well-placed to play a convening role in bringing together different sectors that address the determinants of health and health equity, with the goal of tackling complex societal challenges more effectively.

The federal government’s approach to global health was also identified as due for a stronger intersectoral voice for public health, particularly as the COVID-19 pandemic has heightened recognition of the global nature of public health at different orders of government. The pandemic’s lessons about the ties between local and global health action and outcomes should serve as an impetus to link Canada’s domestic approach to public health with its global advocacy and participation in institutions like the World Health Organization (WHO). One strategy for achieving this involves the co-development of an integrated national plan that addresses both domestic and global health and engages global affairs and public health officials and stakeholders. Participants noted that this process could enhance intersectoral communication while streamlining the country’s approach to challenges of national and global relevance, including climate change. In pursuing this goal, Canadian governments could also benefit from linking their strategies to existing global agendas for cross-sectoral action, such as the Sustainable Development Goals.

Participants also highlighted that the pandemic response, and particularly the guidance issued by the National Advisory Committee on Immunization (NACI), indicated the potential for national coordination to promote coherence in public health approaches. Considering the current focus on public health, the opportunity to entrench the sector’s upstream and intersectoral functions, and the need for nationally coordinated action to address pressing challenges, this is a critical time to define a set of programs and services that Canada’s public health systems are expected to deliver. This effort should clarify the mandates of the federal, provincial/territorial, and local governments, in order to increase coordination and accountability. It should also define the public health system’s areas of compatibility and integration with – and specialization and differentiation from – other parts of the health and care sectors, including primary and acute care. Some participants supported the idea that a Canada Public Health Act would increase inter-jurisdictional coherence and protect public health budgets by enshrining a minimum set of expected public health activities (including in areas such as data sharing, programming, and surveillance) and conditioning funding on their delivery. Others questioned whether national legislation would achieve the desired coherence in light of the difficulty of securing agreement across orders of government, and cautioned that any legislative efforts must consider the experience of the Canada Health Act, which is only weakly conditional and has not been consistently enforced. Outside of legislative approaches, participants suggested enhancing cross-jurisdictional coherence through a national public health guidance body similar to NACI and by facilitating trans-local learning through cross-country networks of MOHs and program-level teams.

Defining essential functions for public health systems across Canada would also provide an opportunity for greater alignment between core competencies and system requirements. Dialogue sessions revealed agreement that the moment is ripe to refresh the country’s existing public health competencies, which have remained unchanged since 2008, and that this process should be linked to a stock-taking of anticipated needs. It is imperative that the lessons of the COVID-19 pandemic in areas ranging from emergency preparedness to public communications and community relationships translate into a strengthened set of competencies that account for current and future public health challenges, system needs, and equity gaps. As outlined in Section 2, participants mentioned a range of specific skills, literacy areas, and knowledge fields that should be considered in this process. One area that emerged as a particularly urgent focus of discussion in the context of the pandemic involved improving competencies in risk communication, public messaging, and combatting misinformation, including by leveraging novel digital and technological possibilities and community partnerships. A second key priority area involved strengthening competencies in anti-racism and anti-colonialism, including by developing a comprehensive set of competencies on Indigenous health, aligning with related calls to action from the Truth and Reconciliation Commission of Canada, and integrating a critical race theory lens.

Current public health challenges are occurring in the context of the proliferation of data sources (such as electronic medical records and social media), novel analytical tools (such as machine learning and artificial intelligence), emerging data integration and sharing platforms (such as Health Data Research Network Canada and Alberta’s Connect Care system), and increased public data access and literacy. The power of this landscape to inform action was evident during the pandemic, when the collection and analysis of granular data enabled some public health units to target testing and vaccination strategies to communities that faced heightened risk. Today’s unprecedented advances in data and technology must be leveraged for a more robust, equitable, and coherent public health sector. The federal government should invest in the development of interoperable data sources that can be used to measure, evaluate, coordinate, mobilize, and support public health systems and workforces more effectively as well as research that seeks to understand how to build better public health systems. Participants noted that such efforts should start by considering the purposes for which data will be collected and should emphasize interoperability with other sectors and across jurisdictions. It is also vital that the data infrastructure to achieve these goals is designed in collaboration with frontline practitioners and community members, to ensure that new systems address existing needs, consider privacy concerns, avoid increasing operational burdens, protect community relationships, and produce knowledge systems that are trusted, transparent, and accountable. This process should also involve working with communities to build ethical, equitable, and anti-racist data systems. In addition to data infrastructure, investment in interdisciplinary research on public health systems, services, and governance is critical to increase knowledge about the public health landscape in Canada and assess how governance structures and delivery systems might be improved.

Ensuring the collection of updated and detailed data on Canada’s public health workforce and systems would also enhance the sector’s ability to respond in times of crisis. Although the need for flexibility and surge capacity is most evident during public health emergencies, it is critical to develop this resource well before it needs to be deployed – as the above-mentioned obstacles to the COVID-19 pandemic response laid bare. The post-pandemic period will represent a key moment to build a more flexible and resilient system that can rapidly mobilize appropriately trained human resources with the relevant skills and local knowledge in times of expanded need. Creating this capacity requires having numbers in reserve, increasing public health training opportunities, and would also benefit from dedicating additional capacity within the system to working with communities and building partnerships with community organizations, so that public health professionals’ local knowledge and trust can be brought to bear on activities like case investigation, contact tracing, and mass immunization during emergencies. Moreover, the challenges of linking public health trainees with public health organizations during the pandemic – and the experience of organizations that innovated systems for doing so – can provide important lessons for ensuring more efficient onboarding processes during crisis and non-crisis times.

Deepening the public health system’s community focus is particularly timely as the COVID-19 response demonstrated the power of grassroots initiatives, the benefits of co-planning approaches between public health and community organizations, and the potential for public engagement in decision-making to inform equitable action. Two examples of the impact of community action on public health during the pandemic that participants raised included Vaccine Hunters Canada, a volunteer network that disseminated information about vaccine appointment availability through social media, and the coordination of COVID-19 action plans by community-based organizations with philanthropic funding in several of Montreal’s most-affected neighborhoods. The experience of Toronto’s Board of Health during the pandemic also showed that having public members on governing bodies can bring attention to community priorities, such as collecting race-based data, investing in community organizations, and supporting community leadership. Participants emphasized that rooting public health in community knowledge and relationships requires community organizations to be adequately supported by the public health system and to have the agency to address community issues where appropriate. It also requires structured and well-resourced strategies for engaging with and remaining accountable to communities. In addition, participants noted that truly power-sharing decision-making structures must consider who has voice and authority and must respect principles of self-determination. Fulfilling public health’s commitment to communities also involves integrating multiple knowledge and evidence sources, including Indigenous knowledge systems and the expertise of those with lived experience, in order to address the limits and harms of a system that has its roots in colonialism and was not designed to consider the distinct needs of Indigenous peoples and other groups facing conditions of marginalization. In planning and implementation, public health must therefore centre the voices of those impacted by racism, colonialism, and other forms of structural violence. Building trust with communities and partnering with community organizations and leaders is also essential to improve the targeting of and public receptiveness to public health communications.

Participants also noted that several key pathways exist to enhance connections among public health research, training, and practice, including by building on initiatives that contributed to the pandemic response (such as rapid evidence reviews that supported decision-making processes) and strategies that predated the crisis (such as embedded trainee positions within public health practice). The dialogues highlighted that considerable benefits stand to be gained from strengthening research-practice collaborations, including generating more applied and operational research, enhancing practitioners’ access to academic capacity in times of crisis, and improving knowledge mobilization efforts. Today’s public health system also has a unique resource that can be leveraged towards these goals. The National Collaborating Centres for Public Health, which were established following the SARS crisis, have developed strong relationships with public health practitioners and organizations across the country in the intervening years. Participants identified the National Collaborating Centres as particularly well-placed to facilitate research-practice networks and relationships and improve knowledge mobilization – but noted that they require increased funding to seize these opportunities. Participants also proposed building better links among research and practice communities by including research and education in the mandates of public health authorities and by funding positions that embed researchers in public health organizations and practitioners in research institutions.

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Date modified:

2022-03-23