Quebec's public health system under seige

Late in September, Quebec took the next leap into health care regionalization by announcing 19 regional health entities, downsizing boards from over 200 to just 28, eliminating 1300 positions and aiming to save $220 Million Montreal Gazette Sept 25  

However, the reductions don’t appear to be evenly distributed across the system and of particular concern the Quebec public health system is under siege.  Canada’s flagship for best practices in public health and shining star amongst mostly dim public health structures, recently was informed of a major structural overhaul and downsizing of nearly 30% legislative debates Sept 25(search on the number “30”)  .  The cost saving measures announced by Health Minister Barette appear to be founded in  that misguided perception that public health is not providing direct health services and the “bureaucracy” can be eliminated.

The besieged Medical Officers of Health (MOH) were first attacked on the issue of on-call support and resulted in several resignations and Montreal Gazette July 10.  The Medical Officers of Health in Quebec are amongst the lowest paid physicians in Canada despite their specialist training.  In the wake of the resignations (?terminations) the need for appropriately qualified MOHs was followed by an Op-Ed by one of Canada’s foremost in the business, Richard Lessard led Montreal for over two decades up to his retirement and earned respect internationally for his work. Montreal Gazette Aug 22.  

As we have seen in many provinces, gone are the independent voices speaking for the health of the public, gone will be the boards focused on preventing illness in a system already besieged for challenges in providing health care and gone will be the supports and assistance needed to front line workers.  The lack of clear and independent public health leadership has crippled health reform in Canada.

We are now looking south of the border for better public health practices.  Under the Health Care Affordability legislation, a specified amount of funding is dedicated to public health services research and monitoring to demonstrate effective and cost beneficial practices.  More recent research comparing local health unit structures based on funding is demonstrating that there is a positive correlation between public health funding and reduced mortality, that reductions in funding lead to increased mortality, that dose of public health intervention is important and that local/community governance of public health improves the effectiveness of the public health programming.   

So, in the light of the developing evidence, and given the horror stories arising from other provinces, the news in Quebec is disconcerting, and the impact on its public health workers undoubtably disempowering and discouraging. That the harvesting of resources by the newly elected Liberal majority government targets the fundamental services that address determinants bodes poorly for the long term sustainability of the Quebec system.  As with many governments that will be in place for four years, the electorate memory will have been erased by the next election round.

As the rock group Queen sings “another one bites the dust”

Canadian public health history is too frequently replete with examples of global best practices, then amputated at the knees by a system that has not and does not want to take the time to understand the value and benefit which public health has brought to sustainability in the past, and continues to contribute to its future success – or perhaps through selective clearing away of the best, to the future demise of a health care system already teetering on collapse.

In the meantime, be aware of the disastrous news and stand up in support of friends and colleagues caught in these beleaguering times.