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.
