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The real scandal about Canada’s top doctor: The government won't listen

Everyone knows the philosophical riddle: "If a tree falls in the forest and no one is around to hear it, does it make a sound?"

The equivalent thought experiment in Canadian policy-making circles is this: "If a report by a top adviser is published in such a manner that no one knows, does anyone in power actually want to hear sound advice?"

The Report on the State of Public Health In Canada 2014 is a case in point. To say that it was released with little fanfare is an understatement. There was no distribution, no press release, nary a tweet. It was posted on the Public Health Agency of Canada website, apparently in September, and only a handful of obsessives stumbled upon it.

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That's too bad, because there's some fascinating content, which we'll come back to in a moment.

The Chief Public Health Officer has a legislated responsibility to report annually to Parliament. Here's betting that you can count on the fingers of one hand the number of parliamentarians who know the report exists, let alone its content.

In modern politics, memories are short and the gazes to the future are even shorter. We seem to have forgotten that the PHAC and the CPHO position were created in the wake of the SARS debacle, which exposed massive failings in the country's public health infrastructure.

The CPHO, a public health czar, was supposed to keep us honest, to ensure that we didn't let important, but often politically discomfiting, public health issues fall by the wayside.

But the position has slowly but surely been neutered. Recently, we learned of government plans to remove the deputy minister designation from the CPHO; practically, this means Dr. Gregory Taylor will focus more on giving advice and the administrative burden and budgeting stuff will be handled by someone else, a newly-created position of PHAC president.

A number of people in the health community have denounced these changes, saying that if you don't have a say over budgeting and staffing, you have no real power.

Dr. Taylor, a public health veteran more interested in the scientific than bureaucratic aspects of the job (and, above all, a team player), has defended the changes.

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There is no single best way for top public health officials to work; there are different approaches in countries around the world.

What is indisputable, however, is that for a Chief Public Health Officer to be effective, they must have complete independence to think and say what they like.

The post should, above all, be a bully pulpit.

The problem we have in this country is that the current government doesn't want thoughtful, independent advice, especially on scientific matters. It wants toadies singing the praises of its policies, no matter how ill-conceived or partisan.

The "discreet" (read: contemptuous) manner in which the CPHO's annual report was released is a striking example of this troubling approach.

The annual report was supposed to be an early warning signal, an examination of looming threats to the health of Canadians and the economy so we would not, once again, be caught flat-footed as with SARS.

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Its contents should inspire examinations by parliamentary committees, in Parliament, and in the media. As the report itself notes, ironically in retrospect: "The CPHO's reports are intended to highlight specific public health issues that the CPHO has determined warrant further discussion and action in Canada. As much as this report is a mechanism to increase awareness, it is also meant to inspire action to build upon existing health programs and initiatives and develop new solutions to promote, improve and maintain optimal health and well-being for all Canadians."

None of that is going to happen if the government treats it like a bag of stinky garbage you sneak out to the curb late at night.

Over a decade of service, the first CPHO, Dr. David Butler-Jones, tackled issues like the social determinants of health, Canada's poor record on child health, the resurging threat of infectious disease, the sex and gender inequalities in health outcomes and the impacts of aging, to name a few.

The latest report, follows that tradition. Its theme is the future of public health, but the real gem hidden in there is a chapter on public health impacts of climate change.

The report says, in polite scientific language, that climate change is already having an impact on the health of Canadians – more heat- and cold-related deaths, more infectious disease, more respiratory problems, and significant economic impacts – and it's going to get much worse. Yet, we're doing virtually nothing to mitigate and prevent climate change, and nothing to prepare.

It's the kind of message that the government doesn't want you to hear. But that's exactly why you should hear it.

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We should care as much, if not more about the health of Canadians, as we do about the state of the federal government's finances.

The annual report of the Chief Public Health Officer should have as high a profile as the Auditor-General's report.

It should make government squirm and it should incite them to act – or at the very least justify their inaction.

We should expect nothing less.

When a report of this import falls silently and invisibly, the sound you're hearing is Canadians suffering harm.

André Picard is The Globe's public health columnist.

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Editor's note: An earlier version of this column described a newly-created position of CPHA president. In fact, the new position is president of PHAC (Public Health Agency of Canada) and not of CPHA (Canadian Public Health Association). This version has been corrected.

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