Abstract
Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health’s resources, interventions and outcomes when they need to be celebrated or defended.
Key Words: Public health, public health administration, evidence-based practice, public health practice, Canada, Quebec
Résumé
La santé publique est présentement en voie d’être affaiblie dans plusieurs provinces canadiennes. Les coupes arbitraires imposées au budget de la santé publique au Québec en 2015 en sont un exemple frappant. Afin de soutenir les dirigeants et les citoyens dans leur capacité à plaider en faveur de réformes appuyées par des données probantes, nous dressons ici une synthèse des éléments des systèmes de santé publique qui sont associés à une meilleure performance. Quatre de ces éléments sont associés de façon récurrente et significative à une augmentation de la productivité d’un système de santé publique: 1) des ressources financières accrues, 2) un ratio accru de professionnels de santé publique par habitant, 3) une taille de population desservie entre 50 000 et 500 000 personnes, et 4) des mesures organisationnelles et administratives fondées sur des données probantes. Soulignons que des ressources financières accrues et une augmentation du ratio de professionnels de santé publique par habitant sont significativement associées à des améliorations de la santé de la population. Aussi, toute tentative d’amélioration d’un système de santé publique devrait au moins être guidée par ces quatre éléments probants. Le Canada possède déjà un réseau d’expertise sur les systèmes et services de santé publique. Le renforcement de ce réseau et des expertises professionnelles permettrait aux diverses organisations canadiennes de santé publique de: s’inspirer des meilleurs modèles de pratique; mieux argumenter en faveur de ressources accrues; et mieux présenter nos interventions de santé publique et leurs résultats concrets quand vient le temps de célébrer ou de défendre les acquis.
Mots Clés: santé publique, administration de la santé publique, pratique fondée sur des données probantes, pratique de la santé publique, Canada, Québec
Footnotes
Conflict of Interest: None to declare.
Acknowledgements: Our thanks to Drs. Brent Moloughney, David Kaiser and David-Martin Milot.
References
- 1.Potvin L. Canadian public health under siege. Can J Public Health. 2014;105(6):e401–3. doi: 10.17269/cjph.105.4960. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ad Hoc Committee on the Future of Public Health in Canada. The Future of Public Health in Canada: Developing a Public Health System for the 21st Century. Ottawa, ON: Canadian Institutes of Health Research, Institute of Population and Public Health; 2003. [Google Scholar]
- 3.Allin S, Mossialos E, McKee M, Holland W. Making Decisions on Public Health: A Review of Eight Countries. Brussels, Belgium: European Observatory on Health Systems and Policies; 2004. [Google Scholar]
- 4.Manuel DG, Creatore MI, Rosella LCA, Henry DA. What Does it Take to Make a Healthy Province? A Benchmark Study of Jurisdictions in Canada and Around the World with the Highest Levels of Health and the Best Health Behaviours. Toronto, ON: Institute for Clinical Evaluative Sciences; 2009. [Google Scholar]
- 5.Scutchfield FD, Ingram RC. Public health systems and services research: Building the evidence base to improve public health practice. Public Health Rev. 2013;35(1):1–19. doi: 10.1007/BF03391693. [DOI] [Google Scholar]
- 6.Core Public Health Functions Research Initiative: Advancing Public Health Systems Research in BC: Renewing the Agenda, 2014; Advancing Public Health Systems and Services Research in Canada: Developing a Pan-Canadian Agenda, 2011; Renewal of Public Health Systems in BC and Ontario. Available at: http://www.uvic.ca
- 7.Handler A, Issel M, Turnock B. A conceptual framework to measure performance of the public health system. Am J Public Health. 2001;91(8):1235–39. doi: 10.2105/AJPH.91.8.1235. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Rechel B, Brand H, McKee M. Organization and financing of public health. In: Rechel B, McKee M, editors. Facets of Public Health in Europe. 2014. pp. 233–54. [Google Scholar]
- 9.Allutis CA, Chiotan C, Michelsen M, Costongs C, Brand H. Review of Public Health Capacity in the EU. Luxembourg: European Commission Directorate General for Health and Consumers; 2013. [Google Scholar]
- 10.Scutchfield FD, Bhandari MW, Lawhorn NA, Lamberth CD, Ingram RC. Public health performance. Am J Prev Med. 2009;36(3):266–72. doi: 10.1016/j.amepre.2008.11.007. [DOI] [PubMed] [Google Scholar]
- 11.Brownson RC, Allen P, Duggan K, Stamatakis KA, Erwin PC. Fostering more-effective public health by identifying administrative evidence-based practices. Am J Prev Med. 2012;43(3):309–19. doi: 10.1016/j.amepre.2012.06.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Singh SR. Public health spending and population health: A systematic review. Am J Prev Med. 2014;47(5):632–40. doi: 10.1016/j.amepre.2014.05.017. [DOI] [PubMed] [Google Scholar]
- 13.Hyde J, Shortell SM. Am J Prev Med. 2012. The structure and organisation of local and state public health agencies in the U. S.: A systematic review; pp. 42–41. [DOI] [PubMed] [Google Scholar]
- 14.Mays GP, Smith SA, Ingram RC, Racster LJ, Lamberth CD, Lovely ES. Public health delivery systems: Evidence, uncertainty and emerging research needs. Am J Prev Med. 2009;36(3):256–65. doi: 10.1016/j.amepre.2008.11.008. [DOI] [PubMed] [Google Scholar]
- 15.Erwin PC, Greene SB, Mays GP, Ricketts TC, Davis MV. The association of changes in local health department resources with changes in state-level health outcomes. Am J Public Health. 2011;101(4):609–15. doi: 10.2105/AJPH.2009.177451. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Mays GP, Smith SA. Evidence links increases in public health spending to declines in preventable deaths. Health Aff (Millwood) 2011;30(8):1585–93. doi: 10.1377/hlthaff.2011.0196. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Champagne F, Contandriopoulos AP, Picot-Touché J, Béland F, Nguyen H. Un cadre d’évaluation de la performance des systèmes de services de santé: le modèle EGIPSS (Évaluation globale et intégrée de la performance des services de santé) Montréal, QC: Groupe de Recherche Interdisciplinaire en Santé, Université de Montréal; 2005. [Google Scholar]