US embassy cable - 05OTTAWA2827

UNCLAS SECTION 01 OF 03 OTTAWA 002827 
 
SIPDIS 
 
STATE FOR OES/IHA (CRODDY/FOSTER), WHA/CAN (NELSON), 
WHA/RA (ALLEN) 
 
DHHS FOR ASSISTANT SECRETARY SIMONSON 
 
DHHS FOR KAREN BECKER 
 
DHHS FOR BILL STEIGER AND ROSE BROWNRIDGE, OFFICE OF 
GLOBAL HEALTH 
 
CDC FOR ROBERT BALDWIN, OFFICE OF GLOBAL HEALTH 
 
CDC FOR ROBERT SPEAR, PUBLIC HEALTH LAW PROGRAM 
 
E.O. 12958: N/A 
TAGS: TBIO, KSCA, SOCI, PREL, CA, WHO, KSTH 
SUBJECT: Public Health Emergency Governance in Canada 
 
Ref. Ottawa 145 (Canada/US health cooperation) 
 
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Summary 
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1. In Canada the provincial governments have the 
primary responsibility for health matters, including 
managing public health emergencies.  The federal 
authorities do play an important coordination role 
between the provinces, with other countries and the 
WHO.  In addition to that role, the federal authority, 
the Public Health Agency of Canada, has specialized 
laboratory assets as well as public health specialists, 
available to assist the provinces.  This cable presents 
an overview of public health emergency governance in 
Canada, which may be useful to U.S. agencies dealing 
with Canadian counterparts. End summary. 
 
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Roles are mixed 
--------------- 
 
2. The Canadian Constitution's few explicit references 
to health-related matters grant both levels of 
government jurisdiction. The Constitution confers 
jurisdiction over "hospitals" and "asylums" on 
provinces, and jurisdiction over "quarantine" and 
"marine hospitals" on the federal government.  These 
provisions can be interpreted as dividing jurisdiction 
over public health, with the provinces governing local 
public health matters, and the federal government 
attending to public health risks that arise at Canada's 
international borders 
 
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Provincial Role 
--------------- 
 
 
3. The SARS crisis in 2003 illustrated that primary 
public health monitoring and infectious disease 
response is managed at the provincial level.  For 
example, the Government of Ontario declared Severe 
Acute Respiratory Syndrome (SARS) to be a provincial 
emergency, and made SARS a reportable disease under 
Ontario's Health Protection and Promotion Act.  As 
well, provincial health authorities extended 
restrictive hospital measures to all hospitals in the 
province and asked thousands of residents of Toronto to 
quarantine themselves at home for 10 days. 
 
4. The courts have held that provinces possess 
jurisdiction over public health, including legislation 
for the prevention of the spread of communicable 
diseases, and sanitation. The provinces have exercised 
this jurisdiction to engage in health surveillance 
(including reporting and tracking), outbreak 
investigations, quarantine, isolation, and mandatory 
treatment. 
 
5. Public health activities in each province and 
territory are governed by a public health act (or 
equivalent) and its regulations, as well as by other 
specific legislation (e.g., Ontario's Immunization of 
School Pupils Act). Some public health acts are decades 
old. Ontario (1983), Saskatchewan (1994), and Quebec 
(2002) all have modernized legislation; British 
Columbia, Nova Scotia, Prince Edward Island and the 
Northwest Territories are all reviewing or rewriting 
their acts. The older acts tend to be mainly concerned 
with infectious diseases and specific in the powers 
given to public health officials, while the newer acts 
are more flexible. All public health acts have 
regulations; these vary from province to province. The 
planning and delivery of services is mostly devolved to 
regional/local structures, with responsibility usually 
assumed by elected and/or appointed boards. The 
following overview moves from the local to Provincial 
and territorial levels. 
 
6. Local service delivery across Canada is typically 
through the health departments of regional health 
authorities or districts, or (in Ontario) through 
health units and municipal health departments. The 
populations served by the relevant units range from 600 
people to 2.4 million people, with catchment areas from 
4 square kilometers to 800,000 square kilometers. There 
are approximately 139 such local/regional agencies 
serving urban, rural and isolated areas, covering the 
population of Canada, exclusive of some Aboriginal 
communities. 
 
7. Each local/regional public health agency has a 
position for a medical officer of health (MOH) - a 
licensed physician with post-graduate training in 
public health. Some smaller health units find it 
difficult to attract medical officers of health or 
provide the full range of services. For example, in 
Saskatchewan, partly for this reason, adjacent 
districts have arranged to share either the medical 
officer of health or the entire public health agency. 
 
8. Each province or territory has a chief medical 
officer of health (CMOH) or equivalent. The CMOH may 
also be the director of the public health branch of the 
provincial or territorial government, or these may be 
separate positions. The senior public health physician 
sometimes also holds an Assistant Deputy Minister 
position. In Quebec, the Assistant Deputy Minister for 
public health by law is a physician with a specialist 
qualification in community medicine. The reporting 
relationships of the CMOH within the provincial and 
territorial governments vary considerably, as provinces 
have balanced a desire to ensure the independence of 
the CMOH as a health advocate with the need to 
integrate his or her portfolio into ministries of 
health. 
 
9. Each province and territory also has public health 
staff within the provincial government. This staffs 
typically engage in planning, administering budgets, 
advising on programs, and providing assistance to local 
staff for serious incidents. The British Columbia 
Centre for Disease Control (BC CDC), established in 
1997, to take responsibility for provincial-level 
management of infectious disease prevention and 
control, including laboratories, is perhaps the most 
sophisticated. Division directors and other key 
scientific and medical staff in the BC CDC hold 
appointments at the University of British Columbia, and 
have protected time to enable academic activities. 
 
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Federal Role 
------------ 
 
10. The federal government has powers relating to entry- 
exit controls.  For example, after being informed of 
the SARS situation, the federal government immediately 
activated protocols to track potentially infected 
passengers arriving from the epicenters in Vietnam and 
China.  In instances where a returning passenger 
exhibited SARS symptoms, the passenger manifests for 
that person's flights to Canada were examined and 
provincial or territorial public health authorities 
contacted the other passengers to determine if any were 
exhibiting SARS symptoms.  Health Canada also began 
distributing Health Alert Notices to international 
passengers arriving in or returning directly to Canada 
from affected areas in Asia, which advised passengers 
to see a physician if they began to have symptoms 
related to SARS. 
 
11. In a worst-case scenario, the federal government 
could invoke the Quarantine Act.  According to GoC 
documents "The Quarantine Act would authorize the 
federal authorities to detain persons, goods or 
conveyances on suspicion that the persons, goods and 
conveyances might introduce a dangerous communicable 
disease into Canada. The authority permits detention 
without due process for a period of 48 hours in order 
to undertake a medical examination of persons, analysis 
of goods or inspection of conveyances. If detention is 
required beyond 48 hours, the federal authorities must 
present evidence for a continuation of the detention in 
a federal court. These powers also apply to persons and 
conveyances leaving Canada for another country." 
 
 
12. At the federal level, the most relevant 
organization is the Public Health Agency of Canada 
(PHAC).  Precipitated by lessons-learned from the 2003 
SARS crisis, PHAC was formed in September 2004 to 
coordinate federal efforts in identifying and reducing 
public health risks and to support national readiness 
to respond to health crises.  Created from elements of 
Health Canada's former Population and Public Health 
Branch, the organization has dual headquarters in 
Winnipeg, Manitoba and Ottawa, Ontario and also has 
regional offices across Canada. Its components include 
Centers for Infectious Disease Prevention and Control, 
Chronic Disease Prevention and Control, Emergency 
Preparedness and Response, Surveillance Coordination, 
and Healthy Human Development. PHAC has oversight of 
the National Microbiology Laboratory in Winnipeg, a 
level 4 Bio-containment facility. PHAC also manages the 
Laboratory for Foodborne Zoonoses in Guelph, Ontario. A 
Chief Public Health Officer, currently Dr. David Butler- 
Jones, heads the agency.  He reports to the Minister of 
Health. 
 
12. PHAC is the focal point for Canadian coordination 
with the World Health Organization and other 
international partners such as the U.S. Centers for 
Disease Control and Prevention.  PHAC also issues 
travel advisories on behalf of the federal government 
with regard to travel to foreign locations.  Canada's 
travel health advisories are available at 
www.TravelHealth.gc.ca. 
 
13. In addition, Canada's federal food safety, animal 
health and plant protection enforcement agency, the 
Canadian Food Inspection Agency (which delivers all 
federal inspection services related to food; animal 
health; and plant protection) would work with PHAC in 
those instances where there is a animal, plant, or food- 
borne component to the human public health issue. 
 
Dickson