ARCHIVED - Formative Evaluation of the National Collaborating Centres for Public Health Program (NCCPH)

Chapter 1: Background

Public Health Renewal in Canada

Public health may be defined as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts of society…[covering] a wide range of topics, including research, disease surveillance and detection, emergency preparedness, risk communication, disease control/containment, and immunization”.^{Footnote 1} Recent public health issues have highlighted the need to strengthen Canada’s public health expertise, capacity, infrastructure, and knowledge transfer abilities.  Several reports, including the Naylor Report, cited insufficient investment in Canada’s public health infrastructure resulting in an inadequate knowledge base to inform the development of public health programs and policies.^{Footnote 2 Footnote 3 Footnote 4 Footnote 5} In addition to increased resources, these reports advocate for increased federal-provincial and inter-agency collaboration.

In response to these issues, the Government of Canada committed to renew and strengthen public health.  As part of this commitment, three public health entities were developed.  In 2004, the Public Health Agency of Canada (PHAC) was created and the Chief Public Health Officer appointed.  At the same time, the creation of the National Collaborating Centres for Public Health (NCCPH) was announced as was the establishment of the International Centre for Infectious Diseases (ICID) in Winnipeg, home of the only Level 4 microbiology laboratory in Canada.^{Footnote 6}

Within seven months of these announcements, the formation of a Pan-Canadian Public Health Network (PHN), comprised of Chief Public Health Officers and senior government public health representatives, was announced in April 2005.  This Network provides a mechanism for information sharing, providing technical advice to the Federal/Provincial/Territorial (F/P/T) Deputy Ministers of Health, and pan-Canadian collaboration in the event of public health emergencies.^{Footnote 7}

Knowledge Synthesis, Translation and Exchange in Public Health

According to informants interviewed as part of this evaluation, the need to address knowledge synthesis, translation and exchange (KSTE) in public health was identified as early as 2000 by senior administrators working within Health Canada and researchers working in the area of public health.  Connections with senior academics in the United Kingdom (UK) served to influence the concept of regionally-based centres that would act as resources for public health, including support for KSTE.

In 2001, the Canadian Institutes of Health Research – Institute of Population and Public Health (CIHR-IPPH), in partnership with the Canadian Institute for Health Information – Canadian Population Health Initiative (CIHI-CPHI), undertook a pan-Canadian consultation on population and public health priorities – Charting the Course – resulting in recommendations for three priority areas of action in relation to KSTE for public health.^{Footnote 8} Subsequent to this, the CIHR-IPPH initiated a literature review in 2002 on the issues and barriers related to KSTE in public health and identified four categories of critical issues that related to the incorporation of research evidence into policy and public health practice:

• Issues of the evidence base – including evidence synthesis;
• Issues of knowledge transfer and exchange;
• Issues of knowledge uptake and utilization; and
• Issues of evaluation – e.g., effectiveness and efficiency of KSTE strategies, and impact on population health outcomes.^{Footnote 9}

To address these issues, Kiefer et al. (2005) proposed a Centres of Excellence model “with specific research units/nodes focussing on particular topic areas…and with each health department in the country being linked formally with a research unit”.^{Footnote 10} Essentially, the proposed structure would function as a “network of networks”. 

With the profile given to public health post-SARS, the opportunity arose to incorporate the early thinking into tangible action when the establishment of the NCCPH was announced.   The NCCPH concept was based on the vision for a “national agency to be comprised of a series of regional hubs, which would be partnered with local academic centres, local/provincial public health systems (including the existing and proposed provincial public health agencies), and other stakeholders”, as proposed in the Naylor Report.^{Footnote 11}

In 2005 and 2006, six National Collaborating Centres (NCCs) were established in regions across Canada with topic specific mandates:

• Aboriginal Health (NCCAH), located at the University of Northern British Columbia (Prince George, British Columbia);
• Health Determinants (NCCDH), located at St. Francis Xavier University (Antigonish, Nova Scotia);
• Environmental Health (NCCEH), located at the British Columbia (BC) Centre for Disease Control (Vancouver, British Columbia);
• Healthy Public Policy (NCCHPP), based at the Institut national de santé publique du Québec (Montréal and Québec City, Quebec);
• Infectious Diseases (NCCID), based at the International Centre for Infectious Diseases (Winnipeg, Manitoba); and
• Methods and Tools (NCCMT), located at McMaster University (Hamilton, Ontario).

While sited in centres or universities in various regions across Canada, each Centre has a national mandate for their topic area.  The priority topics were determined by the then Minister of State for Public Health, in discussion with the Conference of Health Ministers.^{Footnote 12 Footnote 13}