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Canadian Journal of Public Health

, Volume 88, Issue 4, pp 246–249 | Cite as

Public Health in Canada: A Comparative Study of Six Provinces

  • Penny A. Sutcliffe
  • Raisa B. Deber
  • George Pasut
Article

Abstract

Purpose

To describe the public health systems and their projected futures in six provinces in the context of two developments: 1) the emerging discourse on population health and 2) the trend toward regionalization of the health care system.

Methods

Telephone interviews with key informants and key document review.

Results and Conclusions

Communicable disease control and health protection are currently the “core businesses” of public health; the population health discourse has not resulted in mandated programming. The reality is a retrenchment of public health scope during a time that should be considered conducive to expansion. Only Ontario has not regionalized its health care system, although public health is already delivered regionally. Alberta, Saskatchewan and Manitoba have either evolved or are evolving toward an integrated health system. There were concerns about the potential impact on public health identity and funding of this “vertical integration”. Regionalization of public health may result in units that are too small to support adequate local expertise and may jeopardize development and enforcement of province-wide programs.

Résumé

Objectifs

Cette étude comparative décrit les systèmes de santé publique et leurs prévisions futures pour six provinces dans le cadre de deux évolutions: 1) le nouveau débat sur la santé de la population et 2) la tendance à la régionalisation du système de soins de santé.

Méthodes

Interviews téléphoniques avec des informateurs-clé et examen des principaux documents.

Résultats et conclusions

La lutte contre les maladies transmissibles et la protection de la santé constituent à l’heure actuelle les principales activités de la santé publique; le débat concernant la santé de la population n’a pas donné lieu à la mise en oeuvre de programmes obligatoires. Dans la réalité, on assiste à un repli de la portée de la santé publique alors même que l’on devrait se diriger vers une expansion de cette dernière. Seule la province de l’Ontario n’a pas régionalisé son système de soins de santé bien que les prestations de la santé publique soient déjà du ressort régional. Pour leur part, l’Alberta, la Saskatchewan et le Manitoba sont déjà passés à un système de soins intégré, ou s’apprêtent à le faire. Des préoccupations ont été exprimées quant à l’impact potentiel de cette „intégration verticale”. La régionalisation de la santé publique pourrait aboutir à des unités trop petites pour disposer de compétences locales suffisantes et mettre en péril le développement et la mise en oeuvre de programmes provinciaux.

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References

  1. 1.
    Cassel J. Public health in Canada. In: Porter D (Ed.), The History of Public Health and the Modern State. Amsterdam: Rodopi, 1994.Google Scholar
  2. 2.
    Canadian Public Health Association. Focus on Health: Public Health in Health Services Restructuring. Ottawa: CPHA Issue Paper, February 1996.Google Scholar
  3. 3.
    Porter D. Introduction. In: Porter D (Ed.), The History of Public Health and the Modern State. Amsterdam: Rodopi, 1994.Google Scholar
  4. 4.
    Afifi AA, Breslow L. The maturing paradigm of public health. Annu Rev Public Health 1994;15:223–35.CrossRefGoogle Scholar
  5. 5.
    Chah CP. Public Health and Preventive Medicine in Canada. 3rd ed. Toronto: University of Toronto Press, 1994;3–26.Google Scholar
  6. 6.
    Last JM, Wallace RB, (Eds.). Maxcy-Rosenau-Last Public Health and Preventive Medicine. 13th ed. Connecticut: Appleton and Lange, 1992; chapters 1,3,69,73.Google Scholar
  7. 7.
    Roemer MI. The meanings of social medicine and public health. Scand J Soc Med 1993;21(2):63–5.CrossRefGoogle Scholar
  8. 8.
    Walsworth-Bell JP, Rees JH, Binysh JK. The status and tasks of public health medicine in England in 1991 and 1993. Public Health 1994;108:447–55.CrossRefGoogle Scholar
  9. 9.
    Frenk J. The new public health. Annu Rev Public Health 1993;14:469–90.CrossRefGoogle Scholar
  10. 10.
    Holland WW. Changing names. Scand J Soc Med 1994;22(1):1–6.CrossRefGoogle Scholar
  11. 11.
    Fineberg HV, Green GM, Ware JH, Anderson BL. Changing public health training needs: Professional education and the paradigm of public health. Annu Rev Public Health 1994;15:237–57.CrossRefGoogle Scholar
  12. 12.
    Detels R, Breslow L. Current scope. In: Holland WW, Detels R, Knox G (Eds.), Oxford Textbook of Public Health. London: Oxford University Press, 1984.Google Scholar
  13. 13.
    Le Riche WH. Seventy years of public health in Canada. Can J Public Health 1979;70:155–63.Google Scholar
  14. 14.
    Hancock T, Best EWR, Le Riche H. Education of the medical officer of health in Canada. Can J Public Health 1982;73:35–8.PubMedGoogle Scholar
  15. 15.
    Lalonde M. A New Perspective on the Health of Canadians: A Working Document. Ottawa: Government of Canada, 1974.Google Scholar
  16. 16.
    Ottawa Charter for Health Promotion. Can J Public Health 1986;77:425–27.Google Scholar
  17. 17.
    Hancock T. The evolution, impact and significance of the healthy cities/healthy communities movement. J Public Health Policy 1993;Spring:5–18.Google Scholar
  18. 18.
    Federal, Provincial and Territorial Advisory Committee on Population Health. Strategies for Population Health: Investing in the Health of Canadians. Nova Scotia, 1994.Google Scholar
  19. 19.
    Evans RG, Barer ML, Marmor TR. Why Are Some People Healthy and Others Not? New York: Aldine de Gruyter, 1994.Google Scholar
  20. 20.
    Frank JW. Why “population health“? Can J Public Health 1996;86(3):162–64.Google Scholar
  21. 21.
    Labonte R. Population health and health promotion: What do they have to say to each other? Can J Public Health 1996;86(3):165–67.Google Scholar
  22. 22.
    Hamilton N, Bhatti T. Population Health Promotion: An Integrated Model of Population Health and Health Promotion. Ottawa: Health Promotion and Development Division, Health Canada, February 1996.Google Scholar
  23. 23.
    Frank JW, Mustard JF. The determinants of health from a historical perspective. Daedalus 1994;123(4):1–15.PubMedGoogle Scholar
  24. 24.
    Coborn D, Poland B, et al. The CIAR vision of the determinants of health: A critique. Can J Public Health 1996;87(5):308–10.Google Scholar
  25. 25.
    Dorland JL, Davis SM. Regionalization as health care reform. In: Dorland JL, Davis SM (Eds.), How Many Roads? Regionalization and Decentralization of Health Care. Queen’s-CMA Conference on Regionalization and Decentralization in Health Care. Kingston: Queen’s University School of Policy Studies, 1995.Google Scholar
  26. 26.
    Lomas J, Woods J, Veenstra G. Devolving authority for health care in Canada’s provinces: 1. An introduction to the issues. Can Med Assoc J 1997;156(3):371–77.Google Scholar
  27. 27.
    Deber R. International experience with decentralization and regionalization: Northern Europe. In Dorland JL, Davis SM (Eds.), How Many Roads? Regionalization and Decentralization of Health Care. Queen’s-CMA Conference on Regionalization and Decentralization in Health Care. Kingston: Queen’s University School of Policy Studies, 1995.Google Scholar
  28. 28.
    Gordis L. Education for public health medicine. J Public Health Med 1992;14(1):3–8.PubMedGoogle Scholar
  29. 29.
    Osborn JE. The nature of public health after reform. Acad Med 1993;68(4):237–43.CrossRefGoogle Scholar
  30. 30.
    Walker B. The future of public health. Am J Public Health 1992;82(1):21–3.CrossRefGoogle Scholar
  31. 31.
    Estimated expenditures for core public health functions: Selected states, October 1992-September 1993. MMWR 1995;44(22):421,427–29.Google Scholar
  32. 32.
    Champagne F, Leduc N, Denis JL, Pineault R. Organizational and environmental determinants of the performance of public health units. Soc Sci Med 1993;37(1):85–95.CrossRefGoogle Scholar
  33. 33.
    Bhatia V, Dibert S. Devolution and Decentralization of Health Care Systems. Premier’s Council on Health, Well-being and Social Justice, Government of Ontario, June 1993.Google Scholar
  34. 34.
    Crichton A, Hsu D, Tsant S. The debate on regionalization. In: Canada’s Health Care System: Its Funding and Organization. Ottawa: Canadian Hospital Association Press, 1994; Chapter 23.Google Scholar
  35. 35.
    Sinclair D. Introduction. In Dorland JL, Davis SM (Eds.), How Many Roads? Regionalization and Decentralization of Health Care. Queen’s-CMA Conference on Regionalization and Decentralization in Health Care. Kingston: Queen’s University School of Policy Studies, 1995.Google Scholar
  36. 36.
    Toughill K. Health program costs shift to cities. Toronto Star, January 14, 1997.Google Scholar
  37. 37.
    Leatt P, Pink GH, Naylor D. Integrated delivery systems: Has their time come in Canada? Can Med Assoc J 1996;154(6):803–9.Google Scholar
  38. 38.
    Verlaan-Cole E. Integrated health systems: From vision to action. Managing Change 1996;summer:1–19.Google Scholar

Copyright information

© The Canadian Public Health Association 1997

Authors and Affiliations

  • Penny A. Sutcliffe
    • 1
  • Raisa B. Deber
    • 2
  • George Pasut
    • 3
  1. 1.University of Toronto Community Medicine Residency ProgramCanada
  2. 2.Department of Health AdministrationTorontoCanada
  3. 3.Simcoe County District Health UnitBarrieCanada

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