SARS: implications for public health care
CBC News Online | April 29, 2003
Q & A with prof. Colleen Flood, Faculty of Law, University of Toronto
Prof. Colleen Flood was co-author of a comparative study into provincial health care systems and funding implications for public health. It was published in March, 2001, in the Canadian Medical Association Journal.
How well did officials in Toronto cope with the SARS outbreak?
Well, from what I have read and my understanding of the SARS crisis, the staff in hospitals has been stretched to capacity. I think everyone agrees that there is not much more that these people could be doing.
Public health officials have done the very best they can under particularly adverse circumstances, but I have a concern about whether or not in the long run our public health-care system will be able to meet the demands placed by new illnesses like SARS, West Nile virus and perhaps illnesses where the mortality and contagion rate would be worse than what we experienced with SARS. So I think the really important question now is not so much how well did our officials cope with SARS but whether or not in the future they'll be able to meet demands placed by new contagious diseases.
We have to wonder about the ability of our beleaguered and much-taxed officials and health-care workers at the frontline to cope with another epidemic.
Many officials have been very outspoken and very visible in the media. What role did that play?
Well that certainly has been my perception, that there has been phenomenal leadership and great sacrifice on the part of health-care professionals and public health officials. We all benefited from wise leadership and guidance from local public health officials, but how much can we expect of people, and how much we really need to think about putting in new resources and new governance structures into our public health-care system, to give them the resources and energy that they need to deal with new crises.
It seems that the public doesn't know who is responsible for what in a situation such as the SARS outbreak. Is that true?
Yes, there very much is a mish-mash of responsibilities between federal, provincial and municipalities. What we would need to see are clear lines of accountability to one provincial agency. I have great concerns that in the past few weeks we've been talking about a lack of overall leadership, and partly that lack of leadership has to do with the fact that no one is directly accountable or responsible for public health. I think the trouble is that it's all too easy for any particular official or elected leader to not take full responsibility and be able to pass the blame to others. I really think we need to think about how to go forward with our public health-care system, to make sure that in the future, Toronto, Ontario and Canada is held up as a model for how to do public health and not as a destination for travellers to avoid.
How much of what did not go well in this situation has to do with health-care funding?
It certainly has highlighted a funding problem. My research indicates there are stark disparities across the country in terms of how much is invested into public health, with for example, Alberta investing 9.4 per cent of health-care spending into public health-care measures, whereas by comparison, Nova Scotia invests 3.3 per cent. Now is the time to question why is that the case, and is there the infrastructure and the needed capacity in a province like Nova Scotia to deal with an epidemic like SARS? I think we can say that Ontario has fared fairly well but we don't know if that would be the case in other provinces that perhaps don't have the level of resources or infrastructure that Ontario has.
Where does the federal government fit in?
If there's one clear place that the federal government fits in at the table it's on an issue like public health
particularly contagious diseases. They are a matter of national concern 2 contagious diseases don't give a fig about provincial boundaries so there is clearly a role for federal leadership, for federal funding, to make sure that we have national standards and a minimum response level on the part of every province. Federal leadership in conjunction with the efforts of the provinces is needed in public health.