New splintered public health system in N.B. will hurt, former top doctor says

Changes the Liberal government has made to New Brunswick's public health system will hurt more than help, says a former chief medical officer of health.

"I had a hard time believing that the government was going ahead with this kind of dismantling of public health," said Wayne MacDonald, who spent 10 years as the province's top doctor.

Victor Boudreau, when he was health minister, announced at the end of August that the province was restructuring the office, removing important daily operations and spreading them among them other government departments.

Boudreau did not offer any specific reasons for the move, saying only that it was to "improve collaboration" and allow the province to "pool together similar professional sets of expertise within government."

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The work of public health and agri-food inspectors will now be looked after by the Department of Justice and Public Safety.

The public health practice and population health branch will become part of the Department of Social Development, and the healthy environments branch will be integrated into the Department of Environment and Local Government.

"What that leads to is really, accountability without authority [and] when that occurs that is a systemic failure," MacDonald, who was the chief medical health officer from 1998 to 2008, said in an interview.

A recipe for disaster

When operations fell under the Chief Medical Officer of Health and a public health issue occurred in the province, calls would come into a central office, and inspectors in the various regions were immediately able to supplement a quick response.

Under the Liberal government's new system, the chief will have to make calls to other departments, speak to someone about what's needed, and wait for the message to be forwarded to a manager elsewhere.

"In a crisis mode that's just more bureaucratic hoops to jump through," he said. "You don't have time for that kind of thing in a crisis mode."

No justification

MacDonald said the approach to public health in Canada, including New Brunswick, had been weakened before the SARS crisis in 2003, when 8,000 people around the world were infected with the respiratory disease and 774 died, including dozens in Ontario.

Before SARS, budgets and staff in public health had been reduced, he said, and staff fragmented among several departments. It took a crisis and an inquiry to appreciate the dangers and problems this created.

"That's what it's going to take in this province to realize these changes are not the direction the government should be headed in terms of public health," MacDonald said.

He advised New Brunswick to take a step back and research what's taking place in other provinces and talk to people on the ground about any changes the province might be trying to emulate.

"I'm very concerned about the future of public health in this province," MacDonald said.

The core functions of the Office of the Chief Medical Officer of Health are to promote, assess and protect the health of the population in New Brunswick, to prevent disease and injury and to oversee public health emergency preparedness and response.

MacDonald said he can't see how the office can fulfil this mandate when it lacks control over the staff.

"Public health is kind of like the modem in your home, you don't really notice it … when it doesn't work you notice it and you realize, 'Hey, this is important we've got to fix it."