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Canadian Journal of Public Health

, Volume 107, Issue 3, pp e326–e329 | Cite as

Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform

  • Ak’ingabe Guyon
  • Robert Perreault
Commentary

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 

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Copyright information

© The Canadian Public Health Association 2016

Authors and Affiliations

  1. 1.Public Health Clinical DepartmentMontréalCanada
  2. 2.School of Public HealthUniversité de MontréalMontrealCanada
  3. 3.Public Health Clinical DepartmentMontrealCanada
  4. 4.Faculty of MedicineMcGill UniversityMontrealCanada

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