A doctor's prescription for healing our ailing health-care system

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Susan Riley The Ottawa Citizen

Dr. David Naylor produced yet another report on our misfiring health-care system yesterday, complete with enlightened, common sense recommendations on how to avoid another SARS fiasco -- and a $700-million annual price tag by 2007.

But will it fare any better than Roy Romanow's more ambitious report (already a fading memory), or than several previous studies that try to untangle Canada's web of un-coordinated, underfunded, health delivery systems? Health care continually leads polls as a primary preoccupation of voters. Every political party -- even the Alliance -- pays lip service to the centrality of medicare; yet nurses continue to be overworked, patients under-served and bureaucratic sclerosis goes untreated.

Naylor, dean of the University of Toronto's medical school, was unsparing in his diagnosis of last spring's SARS crisis in Ontario. The federal government was "invisible" through most of the outbreak, and Ontario's two top officials -- Public Security Commissioner James Young and Public Health Commissioner Colin D'Cunha -- often appeared to be at loggerheads. Further, Ontario refused to release crucial details of the outbreak to federal officials on the spurious grounds of patient confidentiality. Beyond these top-level squabbles, the response to SARS (notwithstanding the courage and stamina of front-line workers) was chaotic at the local level.

At the Ottawa Hospital, for example, some staff wore proper protective gear, but many used flimsy drywall masks -- often lowering them to speak directly to visitors. Visiting hours were sharply restricted, yet outsiders were allowed onto wards after signing a cursory declaration that they had had no contact with SARS and washing their hands (or not, depending on how attentive desk staff was). The result was disruption for patients, added stress for families and untold staff time wasted. The fact that SARS did not strike here was almost certainly luck, rather than effective disease control.

The good news is that Naylor, and others, noticed the confusion (he called Canada's response to SARS "an international embarrassment") and has come up with pointed remedies. The central, and most important, is the designation of a national public health officer who will oversee disease control across the country.

This individual would report direct to the federal Health minister and head a federally funded agency. The agency would dispense money to provinces and municipalities for specific programs, or to respond to crises -- an arrangement that critics say should get the usually factious premiers to co-operate. For the agency to work, its chief will have to be professionally credible, independent of political control and even charismatic, someone of the stature of, say, Auditor General Sheila Fraser.

Some names are already in play, including the fluently bilingual Richard Mass�, head of Quebec's institute of public health, David Mowat, a senior public health official with Health Canada, and John Miller, head of the Canadian Institute for Health Information. Whoever is chosen must have the freedom to make economically damaging decisions -- shutting down an airport, for instance; or imposing travel restrictions -- without being second-guessed by nervous politicians.

Naylor's chief recommendation isn't as far-reaching as the northern version of the Atlanta-based Centres for Disease Control lately promoted by Health Minister Anne McLellan. What Naylor envisions, and what McLellan appeared to welcome yesterday, is a small agency, with no fixed address, but probably centred in Vancouver or Ottawa. It would serve as a control centre during an outbreak and a conduit of new funds to existing laboratories, epidemiology facilities and public health departments in Winnipeg, Vancouver, Toronto and elsewhere.

This approach should stifle an emerging political tussle among the cities for the disease control centre, since the spoils will be shared. But are the feds going to put up $700 million when they are already balking at an additional $2 billion promised to the provinces for medicare generally? McLellan sounds convinced, but the decision could fall to Paul Martin.

His preference, as finance minister, was cautious, incremental funding for new initiatives, and he showed a keen reluctance to commit to ongoing costs. Advocates of better public health would be well advised to hope for a miracle, but to expect half measures.

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