Restructuring of New Brunswick’s public health program poses threats

The Brian Gallant government’s plan to dramatically restructure New Brunswick’s public health program flies in the face of advice from Canadian public health experts and poses a significant threat to our health and our economy.

An editorial in the Canadian Journal of Public Health (2017) penned by seven public health leaders from across the country, expressed alarm at the “growing weakness in the country’s public health infrastructure” and suggests “we are at a crisis point.” The experts identify four key problems with current government structural approaches to public health that when taken together constitute a crisis. The New Brunswick government’s announced plan to organizationally restructure the office of the New Brunswick Chief Medical Officer of Health, effective immediately, will target and threatens to make worse, each of the problem areas identified by these experts.

These experts are calling for the Office of the Chief Medical Health Officer of Health to have the same level of authority and independence as provincial Auditor Generals. They are calling for governments to “ring fence” public health staff and thereby not integrate them with other departments and or primary care health programs. They are calling for governments to raise the level of health funding designated exclusively to public health services. Former Minister of Health Victor Boudreau’s announcement in early September is in direct opposition to this advice and thereby threatens New Brunswick’s health and economic security.

Should we as New Brunswickers care about this? Is public health programming really that important? Why? History has taught us that nothing can dismantle an economy and population faster than a public health crisis; take Toronto’s experience with SARS fifteen years ago and the more recent Zika crisis in Brazil.

Public health programs have existed in Canada and New Brunswick since before 1900, initially targeting cholera, sanitation issues, small pox, and typhoid. Public health policy then shifted to influenzas, maternal and child health, nutritional and food safety, tuberculosis, auto accidents and tobacco. Then in the 1950s public health programs shifted again to cover environmental contamination and birth control, while still dealing with persistent and evolving infectious diseases.

Public health has always focused on the health of full populations, staying ahead of health threats, ensuring public health emergency preparedness and response, and in recent years, increased focus has needed to highlight and address population health inequities and environmental health risks. In order to do this work a specialized team of health professionals is needed and they need to have the capacity to not only advise but redirect Ministerial government decisions at a time of crisis.

Canadian experts call for 4-5% of every provincial Health budget to be devoted to public health programing. Back in 2014 New Brunswick devoted less than 2% of its Health funding to these programs. The Gallant Liberals say their plan for restructuring will not reduce resources further, however as time passes normal attrition may result in increased departmental “efficiencies.”

With public health programs underfunded it is now more important than ever for existing services to remain centralized in order to work effectively as a highly expert and nimble planning and operational team. A surgeon cannot perform surgery efficiently and effectively without a well-resourced, devoted specialty team of health professionals. In the same way that the surgeon relies on specialized surgical nurses and anesthetists, so too does the Chief Medical Officer of Health rely on the specialized efforts of public health personnel. The shift toward integrating these staff into other departments jeopardizes the viability of the specialty team to do its work.

So why would the Liberal government recommend such a dramatic restructuring of the New Brunswick public health programs operated by the Office of the Chief Medical Officer of Health? The Minister says the restructuring is not being done to save money. So why do this to an already under resourced department? The move could be a symptom of the Liberal government ideology, taking the advice of an administrative consultant, over the advice of professional experts. It could be a step to reduce the mandate of the office before making the Chief Medical Officer of Health independent from government. No matter the reason for the restructuring this is a bad decision for New Brunswickers, posing a significant threat to our health and economy.

Marilyn Merritt-Gray is a nurse and lifelong advocate for rural health services. She is the Green Party Candidate for Gagetown-Petticodiac.