ARCHIVED: Preface: Learning from SARS: Renewal of public health in Canada
The National Advisory Committee on SARS and Public Health was established in early May 2003 by the Minister of Health of the Government of Canada, the Hon. A. Anne McLellan, in the circumstances surrounding the outbreak of Severe Acute Respiratory Syndrome [SARS]. The Committee's mandate was to provide a "third party assessment of current public health efforts and lessons learned for ongoing and future infectious disease control."
The Minister asked the Committee to build on current public health interventions, and to foster and encourage collaboration among jurisdictions, professionals, and institutions. We were urged to work towards integration of all aspects of the containment of SARS (epidemiology, management, communication, and international coordination). The outbreak of SARS in the Greater Toronto Area was contained during our mandate, as expected. Therefore, we extended this integrative approach to our analysis, and recommendations regarding emerging infectious diseases and public health in general.
Most of this report deals with two major elements of our mandate: provision of a short-term assessment of lessons learned from current public health interventions to contain SARS, and advice regarding issues for necessary longer-term action regarding infectious disease control and prevention.
We learned very rapidly that Canada's ability to fight an outbreak such as SARS was tied more closely to the specific strengths of our public health system than to the general capacity of our publicly-funded personal health services system. By public health, we refer to systems that are population-focused, and include functions such as population health assessment, health and disease surveillance, disease and injury prevention (including outbreak or epidemic containment), health protection, and health promotion. Our analysis and our recommendations accordingly set out a plan for a comprehensive renewal of both the public health system in general, and the nation's capacity to detect, prevent, understand, and manage outbreaks of significant infectious diseases.
The Committee went about its data gathering and analysis in the following way.
We reviewed a broad range of source documents, research, and reports from Canada and other countries applicable to SARS, communicable disease control, and public health infrastructure more generally. The chair and a staff member personally interviewed in person or by telephone a range of informants involved in the Toronto outbreak. The Committee's deliberations were also greatly assisted by one full-time policy and research advisor, and two part-time research/editorial associates.
Two key reports were solicited from outside consultants. One, by Prof. Sujit Choudhry of the University of Toronto Faculty of Law, dealt with legal issues, including the difficult question of jurisdictional authorities. With permission, we borrow directly from Prof. Choudhry's report in this document, although it should not be assumed that he would agree in all respects with the conclusions we have drawn from it. The other consultancy, by the Hay Health Care Consulting Group the Hay Group] in Toronto, entailed interviews, a survey, and an analysis of hospital service profiles, to provide an overview of the preparedness of the Greater Toronto Area health system to respond to SARS, the gaps perceived by stakeholders, and the steps that had been or might be taken to improve responses to infectious outbreaks in future. We worked with the Hay Group to incorporate their findings directly into our report. Health Canada's Office of Nursing Policy organized roundtables with front-line health care workers; the findings from that valuable exercise have also been incorporated into the report.
Discourse among members involved about thirty hours of face-to-face meetings, and a substantial amount of electronic and telephone traffic. We live, work, and pay taxes in several different provinces. The members of the Committee represent a multitude of disciplines and perspectives, and several were directly involved in responding to SARS in diverse capacities.
As noted in the Acknowledgements, our work was informed not only by our own experience and that of our colleagues, but by the many non-governmental and voluntary sector stakeholders who wrote briefs, letters, responded to requests for interviews, and provided information that enriched our deliberations and recommendations. In this regard we reviewed approximately 30 written submissions (see report appendix for list).
We also requested preparation of extensive background documents from Health Canada staff in the Population and Public Health Branch. The Committee was allowed direct and unfettered access to leading professionals in the Branch who in turn were given explicit licence to offer their expert opinions and advice, unconstrained by the normal reporting hierarchy. Some senior staff drafted material for the report itself. All such material was first revised by staff as per the Committee's requests, then edited or rewritten extensively by the Committee members.
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