Public health must balance science and society: former top doctor
Public advocacy can mean the loss of public trust, Dr. Andre Corriveau says
A retired top doctor says public health orders have to balance science with society if they are to be effective.
"[Measures] will only work if you have a majority of the population that supports it," said Dr. Andre Corriveau, who was Alberta's chief medical officer of health from 2009 to 2012.
"You can't pass measures that a majority of the public is not supportive of, because it's not enforceable."
Corriveau, speaking from Iqaluit, Nunavut where he was advising territory leaders on how to deal with its COVID-19 cases, made the comments after recordings were released that appeared to show Alberta's current chief medical officer of health, Dr. Deena Hinshaw, expressing concern about politicians watering down her recommendations.
The contents of the secret recordings, reported by CBC News, revealed disagreements and, at times, political interference in Alberta's handling of the pandemic.
In response, Hinshaw insisted that she has always been treated respectfully by politicians and her advice has been considered in final decisions by the government.
- Alberta's top doctor calls secret recordings of pandemic meetings a 'betrayal' of trust
- Secret recordings reveal political directives, tension over Alberta's pandemic response
Those challenges are part of the job, said Corriveau, who also served until last year as the top public health official in the Northwest Territories.
Effectiveness built on trust
Experts such as himself or Hinshaw are responsible for winnowing through scientific evidence — often thin on the ground or hot off the research presses — to come up with the best advice they can. But, said Corriveau, judging what's acceptable or how something should be implemented is a political decision.
"There's a point beyond which you can't enforce any more," he said. "That's the role of the politician — to gauge that."
Nor is it appropriate for the chief health officer to advocate for measures not approved by the government, said Corriveau. The two sides have to trust each other and undercutting political decisions would damage that.
"There's always other people who can advocate," Corriveau said.
"Our effectiveness is built upon trust. If you turn around and you're doing public advocacy, then you've lost the trust and you're not effective anymore."
Alberta has plenty of other voices for that, he said.
'A fine line to travel'
Doctors in the Edmonton zone recently formed a group to provide what they see as unbiased, arm's-length COVID-19 advice. Members of the Edmonton Zone Medical Staff Association felt people were losing trust in officials.
"There's many considerations when you make these decisions — health ones, economic ones, capacity of hospitals," said association president Dr. Ernst Schuster.
"There was a feeling that the political considerations were stronger than some other considerations."
The committee is to hold its first meeting Tuesday.
The legal powers of a chief medical officer of health are delegated by the minister and may not be absolute, Corriveau said.
Hindsight is easy, he noted, and added that everyone involved in the fight against the pandemic is doing it for the first time.
Corriveau said he ran into situations where the final decision diverged from his advice, but he saw it as his job to make it work.
"It's a fine line to travel but I think it can be done.
"It's not necessarily ideal, but I understand the context and why at the political level they might have decided otherwise."