An Open Letter to the New Brunswick Minister of Health

12 October 2017

The Honourable Benoît Bourque, MLA
Minister of Health
HSBC Place, Floor 5
P.O. Box 5100
Fredericton, New Brunswick
E3B 5G8

Dear Minister Bourque:

Congratulations on your appointment as Minister of Health for the Province of New Brunswick. We wish you every success in managing this complex and diverse portfolio. We write to you to express our concern and to provide our viewpoint on one of these complex issues, notably the reorganization of the Office of the Chief Medical Officer of Health.

On August 31, 2017, your predecessor announced the reorganization of that Office as a means of enhancing the alignment of government expertise, and noted that no lay-offs would result from those changes. We recognize the authority of provinces to organize themselves as necessary to meet their obligations under existing and future legislation, and to be responsible in their use of the available resources. We are concerned, however, that the proposed changes may negatively impact the Province’s capacity to meet the public health program’s direct obligations and the population’s expectations.

This concern is especially true for the movement of the Public Health Practice and Population Health Branch to the Department of Social Development. We believe that this move will eliminate the capacity of the Chief Medical Officer of Health to undertake the prevention and promotion activities that provide exceptional returns on investment over the long term and support society’s resilience. It also reduces the ease of access to these public health resources when they are required for an outbreak response. For example, during the last H1N1 outbreak, members of this branch proved invaluable in providing the surge capacity necessary to mount an adequate response.

The results of a public health system that is not properly organized for such an event can be extracted from our collective response to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002. In Canada, there were 438 cases including 44 deaths attributed to SARS, largely concentrated in the Toronto and Greater Toronto Area (Naylor, 2004). This was the single largest number of cases in any jurisdiction outside of Asia, and the outbreak lowered the Gross Domestic Product in Canada by $1.5 billion (Darby, 2003). The economic effects lingered for over a year. This rather small outbreak also had profound effects on the Canadian public health system resulting in the formation of the Public Health Agency of Canada. The report of the National Advisory Committee on SARS and Public Health called for efforts to address systematic deficiencies that included:

• A lack of surge capacity in the clinical and public health systems;
• Difficulties with timely access to laboratory testing and results;
• Lack of protocols for data or information sharing among governments;
• Uncertainties about data ownership;
• Inadequate capacity for epidemiological investigations of the outbreak;
• Lack of co-ordinated business processes across institutions and jurisdictions for outbreak management and emergency response;
• Inadequacies in institutional outbreak management protocols, infection control and infectious disease surveillance; and
• Weak links between public health and personal health service systems. (Naylor, 2004)

In spite of the implementation of many of the recommendations in the 2004 Naylor Report, these challenges continue today and could be exacerbated by the proposed system re-organization. Adequate organizational approaches and administrative processes must be implemented to foster communication and cooperation among the components of the public health system in New Brunswick. There is also a need for clear outcomes and performance measures on which to measure system performance at the population health and operational levels. To address these concerns we strongly recommend that the Province of New Brunswick pause its reorganization efforts and seriously consider implementing the following recommendations as a means of maintaining the public health system’s current performance, and providing evidence to support program improvements that strengthen the health of the New Brunswick population:

• Implement processes and foster communication among the newly realigned structures within New Brunswick to support the sharing of data and information, and to align operational activities in an effort to maintain or improve the current level of performance;
• Establish a clear and accepted mission, vision and goal to direct the performance of the public health system and clear anticipated outcomes at the population health and operational levels;
• Support these initiatives with a robust performance measurement system; and
• Review the existing public health legislative and policy base to establish and strengthen concurrence between that base and the current cadre of public health programs and activities.

We are concerned that the announced changes to the organization of the Office of the Chief Medical Officer of Health may result in a reduction in the level and efficiency of services provided to the citizens of New Brunswick, as there was scant evidence provided to support the proposed organizational changes. Implementing the recommendations noted above will provide an opportunity to maintain the public health system’s current performance, and provide evidence to support program improvements that will strengthen the health of the New Brunswick population.

Sincerely,

Suzanne Jackson
President
Canadian Public Health Association

Marjorie Allison-Ross
Secretary
Public Health Association of New Brunswick and Prince Edward Island 

Public Health Association of Nova Scotia

Lilianne Bertrand
President
Association pour la santé publique du Québec

Wanda Martin
President
Saskatchewan Public Health Association

Lindsay McLaren
President
Alberta Public Health Association

Gord Miller
President
Public Health Association of British Columbia

Cheryl Case
President
Northwest Territories and Nunavut Public Health Association