One of Canada's longest-serving public-health leaders is warning that Ottawa's move to take some powers away from the country's chief public health officer threatens to "weaken" the post, a view he says is shared by other veteran doctors in the field.
"The change runs the risk of weakening the [Public Health Agency of Canada] and weakening the role of the chief public health officer," Perry Kendall, British Columbia's provincial health officer since 1999, said in an interview on Wednesday.
Dr. Kendall delivered the same warning on Nov. 5 before a Senate committee that is reviewing the proposed change, which is in the Conservative government's most recent omnibus budget bill. Dr. Kendall testified that the other long-serving public-health professionals he consulted echoed his position.
"We are actually unanimous in advising you not to proceed with this amendment," he told the committee.
The proposed legislative changes would demote the chief public health officer from his role running the agency to an "officer" or employee who would continue to advise the government, communicate health messages to Canadians and co-ordinate with the provinces and international bodies like the World Health Organization, especially during outbreaks of infectious diseases.
The overhaul would create a new post of president of the agency who would oversee day-to-day operations, a job Prime Minister Stephen Harper has recommended be filled by Krista Outhwaite, the civil servant who filled in when the chief public health officer job was vacant.
The agency grew out of a recommendation from the National Advisory Committee on SARS and Public Health in 2003 that Ottawa create a national body for public health and appoint a top doctor to lead it.
The new structure – with a bureaucrat instead of a public-health professional in charge – flies in the face of the intent of that recommendation.
But David Naylor, the former University of Toronto president who chaired the SARS committee, said on Wednesday he is open to seeing how the new structure works – especially since the current chief public health officer, Gregory Taylor, supports it.
"We really did create a bear of a job," Dr. Naylor said by e-mail. "The chief public health officer of Canada has been the chief executive with a huge administrative load, chief medical and scientific officer, key liaison with Health Canada at high levels, front-line leader for emergency responses, and the face and voice of public health. One can imagine, for example, that with Ebola as a pressing global concern, Dr. Taylor has not had a lot of time to run the agency day to day. That reality is part of the reason why I can live with some division of roles."
The Conservative government's move puts Canada in step with some other wealthy, developed nations and out of step with others.
The director of the U.S. Centers for Disease Control and Prevention is a doctor. The same goes for Finland's National Institute for Health and Welfare and for Germany's Robert Koch Institute, which is responsible for disease control and prevention. But in those countries, other public-health responsibilities are embedded in government, too.
But, as Dr. Naylor pointed out, none of those organizations are exactly analogous to the Public Health Agency of Canada.
"We tried looking at international comparisons in 2003. They didn't help much, and they still don't," he said. "There is still no global consensus on the right way to govern public health."