Still Waiting for a Comprehensive National Epidemic Surveillance System: A Case Study of How Collaborative Federalism Has Become a Risk to Public Health
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Authors
McDougall, Christopher W.
Date
2009
Type
working paper
Language
en
Keyword
Public Health 2008
Alternative Title
Abstract
This paper evaluates efforts to establish an integrated and functional countrywide epidemic detection and reporting system in Canada following the 2003 SARS outbreak. The purposes and products of epidemiologic surveillance are reviewed, as are the intersectoral and international dimensions of infectious disease control, and the ambiguity in Canadian law of related public health roles and responsibilities. An analysis of current networks, policies and programs, augmented by key-informant interviews, demonstrates that progress toward developing national real-time capacity in epidemic surveillance has been limited. Although a blend of disentangled and collaborative approaches to this issue was effective in developing consensus between levels of government on the need and agenda for coordinated changes in the pre-SARS era, as well as in the immediate aftermath of the crisis, the same intergovernmental strategy appears to have made little actual progress achieving such changes in subsequent years. Counterproductive respect for jurisdictional boundaries, limited resources at the Public Health Agency of Canada, and the use of weak policy instruments in pursuit of intergovernmental collaboration have done little to alter the reality that epidemic surveillance in Canada is characterized by duplication and competition, conducted within institutional “silos” that use incompatible information systems and produce incommensurable data, and shared through informal and voluntary rather than mandated and automatic mechanisms. The impact of federalism on surveillance policy effectiveness has thus not been positive, and in fact undermines the obligation to protect domestic and international health. A federal trust model, based on the combination of national guidelines and flexible ongoing federal funding, may present a politically feasible option for restructuring intergovernmental relations on this issue. This approach will help secure the transfer of epidemiological information during public health emergencies, the importance of which has been reinforced by more recent infectious disease outbreaks, notably the epidemic of listeriosis in 2008 and the global influenza H1N1 pandemic of 2009.
Description
© IIGR, 2009
Citation
Publisher
Queen's University Institute of Intergovernmental Relations