Responding to SARS: The Reform of Canada's Health-care System

Severe acute respiratory syndrome (SARS), a new coronavirus, was first identified in China in November 2002. Within weeks the potentially fatal virus had spread throughout the world. According to the Swiss-based World Health Organization (WHO), a total of 8,098 people worldwide became infected with SARS during the outbreak, and 774 people died from it. As of July 2003 no new cases of SARS had been reported, and the outbreak was believed to have been contained (although a lone case from December 2003 caused some concern among officials). Canada was hard hit by SARS, reporting more cases than any nation outside of Asia, with the highest concentration of cases occurring in and around Toronto, Ontario. According to the WHO, there were 251 probable cases of SARS in Canada, 43 of which were fatalities.

In April 2003 the Canadian federal government appointed an 11-member panel to examine the Canadian public health system's handling of the SARS outbreak. Called the National Advisory Committee on SARS and Public Health, the panel was headed by the University of Toronto's dean of medicine, Dr. David Naylor. In October the committee issued a 224-page report entitled "Learning from SARS: Renewal of Public Health in Canada," which detailed the events surrounding the SARS outbreak in Canada, provided a comprehensive analysis of the Canadian health system, and outlined a series of recommendations on ways in which Canada might handle future outbreaks of significant infectious diseases.

One of the numerous inadequacies cited in the report was the long-standing shortage in funding and personnel in the field of public health care. In addition the panel noted that frontline health-care employees experienced a lack of governmental cooperation and received conflicting responses from the various levels of government. For example, the Ontario Ministry of Health and Longterm Care (OMHLTC) did not share information with infectious disease experts at the National Microbiology Laboratory in Winnipeg, Manitoba, citing potential violations of patient confidentiality as the primary reason. Another problem with Ontario's provincial health-care system was the conflict between the offices of the province's chief medical officer and commissioner of public health, Dr. Colin D'Cunha, and the commissioner of public safety, Dr. James Young. Both officials later acknowledged that the dual leadership structure was confusing, and they advocated the position that a single official should have been in charge. The panel also found that the WHO-mandated airport screening for SARS was executed ineffectively by Canadian airports.

The committee called for a restructuring of the Canadian public health system with the aim of addressing these deficiencies. The committee advocated an overhaul of the nation's public health system in order to include the creation of a central agency modeled on the United States's Centers for Disease Control and Prevention (CDC). The aim of this body would be to provide information that enhances health decisions and promotes and facilitates the sharing of health information. Currently, Canada's disease control mechanism is divided between Winnipeg's National Microbiology Laboratory and the OMHLTC.

The new agency, the Public Health Agency of Canada, was established in 2004. It was headed by the Chief Public Health Officer of Canada, who reported directly to the Minister of Health. The agency was composed of four branches: Infectious Disease and Emergency Preparedness, Health Promotion and Chronic Disease Prevention, Public Health Practice and Regional Operations, and Strategic Policy, Communications and Corporate Services. The stated goal of the Public Health Agency of Canada was to "work closely with provinces and territories to keep Canadians healthy and help reduce pressures on the health care system."