Now, more than ever, the public health community needs to be pulling together

Dear Editor,

The guest editorial by Hancock and McLaren (2021) describes a background document published by the Canadian Institutes of Health Research (CIHR) Institute of Population and Public Health (IPPH) (Institute of Population & Public Health, 2021, p. 2) as “narrow and reactive.” The purpose of the IPPH document, however, was not to be a fulsome exploration of public health services but “to inspire a detailed discussion on what Canadian public health systems of the future could look like.”

Despite the perceived limitations enumerated by Hancock and McLaren, the dialogue background document served as the basis for discussions at seven public dialogue events during which hundreds of participants shared their views on the full range of issues identified by Hancock and McLaren. This opportunity created by CIHR-IPPH to discuss the future of public health will help our community prepare for the anticipated “season of inquiries” during which public health systems are likely to come under much greater scrutiny than other actors in the health sector.

The dialogue process was one opportunity to consider the modern role and functions of public health services and to discuss how they fit into broader government systems. Public health services have evolved into complex adaptive systems that reflect more than 150 years of federal/provincial/territorial laws and regulations intended to address complicated issues that are intersectoral in nature. If we break down some of the component parts into more manageable pieces, we can make progress in addressing the bigger puzzles.

The goal of the CIHR-IPPH consultations (as identified in the dialogue background document) was “to identify unified priorities and accompanying strategies” on which to focus our efforts. By definition, this means tackling specific issues in focussed ways. Such an approach does not preclude a discussion of the totality of issues comprising population and public health concerns. Both approaches are valuable and necessary. CIHR IPPH, however, in the middle of a global pandemic and with finite resources made a tactical decision to proceed in a more focussed manner.

Hancock and McLaren’s call for a more comprehensive report on the future of public health in the twenty-first century will be answered by the Canadian Public Health Association. We are developing a discussion paper the purpose of which is to create, through a consultative process, a description of the desired design and operation of public health systems for Canada. We will conduct consultations and prepare a discussion document that describes a suite of services, functions, standards, competencies, training, and accountability mechanisms that should be part of Canada’s approach to protecting and improving the health of all who live here. We invite everyone to be part of developing this discussion document. Bring your ideas to the table in the spirit of building up, not tearing down.

The leadership of CIHR-IPPH have publicly committed to publishing a “what we heard” report this fall while the Chief Public Health Officer of Canada’s 2021 annual report will discuss the system-level changes needed to strengthen public health. These will be great opportunities to reflect on what others are saying and further develop a common vision for public health services in Canada.

Public health has a long tradition of encouraging healthy debate and discussion. It is unlikely, however, that we would have the opportunity to spotlight the need for investment in public health without a communicable disease crisis as the catalyst. As Hancock and McLaren accurately described, public health has detractors who would like to keep us in “our lane,” so we need to pursue multiple avenues to achieve our goal—a healthy and just Canada.

Ian Culbert

Executive Director

Canadian Public Health Association