Cablegate: Public Health Emergency Governance in Canada

This record is a partial extract of the original cable. The full text of the original cable is not available.









E.O. 12958: N/A
SUBJECT: Public Health Emergency Governance in Canada

Ref. Ottawa 145 (Canada/US health cooperation)


1. In Canada the provincial governments have the
primary responsibility for health matters, including
managing public health emergencies. The federal
authorities do play an important coordination role
between the provinces, with other countries and the
WHO. In addition to that role, the federal authority,
the Public Health Agency of Canada, has specialized
laboratory assets as well as public health specialists,
available to assist the provinces. This cable presents
an overview of public health emergency governance in
Canada, which may be useful to U.S. agencies dealing
with Canadian counterparts. End summary.

Roles are mixed

2. The Canadian Constitution's few explicit references
to health-related matters grant both levels of
government jurisdiction. The Constitution confers
jurisdiction over "hospitals" and "asylums" on
provinces, and jurisdiction over "quarantine" and
"marine hospitals" on the federal government. These
provisions can be interpreted as dividing jurisdiction
over public health, with the provinces governing local
public health matters, and the federal government
attending to public health risks that arise at Canada's
international borders

Provincial Role

3. The SARS crisis in 2003 illustrated that primary
public health monitoring and infectious disease
response is managed at the provincial level. For
example, the Government of Ontario declared Severe
Acute Respiratory Syndrome (SARS) to be a provincial
emergency, and made SARS a reportable disease under
Ontario's Health Protection and Promotion Act. As
well, provincial health authorities extended
restrictive hospital measures to all hospitals in the
province and asked thousands of residents of Toronto to
quarantine themselves at home for 10 days.

4. The courts have held that provinces possess
jurisdiction over public health, including legislation
for the prevention of the spread of communicable
diseases, and sanitation. The provinces have exercised
this jurisdiction to engage in health surveillance
(including reporting and tracking), outbreak
investigations, quarantine, isolation, and mandatory

5. Public health activities in each province and
territory are governed by a public health act (or
equivalent) and its regulations, as well as by other
specific legislation (e.g., Ontario's Immunization of
School Pupils Act). Some public health acts are decades
old. Ontario (1983), Saskatchewan (1994), and Quebec
(2002) all have modernized legislation; British
Columbia, Nova Scotia, Prince Edward Island and the
Northwest Territories are all reviewing or rewriting
their acts. The older acts tend to be mainly concerned
with infectious diseases and specific in the powers
given to public health officials, while the newer acts
are more flexible. All public health acts have
regulations; these vary from province to province. The
planning and delivery of services is mostly devolved to
regional/local structures, with responsibility usually
assumed by elected and/or appointed boards. The
following overview moves from the local to Provincial
and territorial levels.

6. Local service delivery across Canada is typically
through the health departments of regional health
authorities or districts, or (in Ontario) through
health units and municipal health departments. The
populations served by the relevant units range from 600
people to 2.4 million people, with catchment areas from
4 square kilometers to 800,000 square kilometers. There
are approximately 139 such local/regional agencies
serving urban, rural and isolated areas, covering the
population of Canada, exclusive of some Aboriginal

7. Each local/regional public health agency has a
position for a medical officer of health (MOH) - a
licensed physician with post-graduate training in
public health. Some smaller health units find it
difficult to attract medical officers of health or
provide the full range of services. For example, in
Saskatchewan, partly for this reason, adjacent
districts have arranged to share either the medical
officer of health or the entire public health agency.

8. Each province or territory has a chief medical
officer of health (CMOH) or equivalent. The CMOH may
also be the director of the public health branch of the
provincial or territorial government, or these may be
separate positions. The senior public health physician
sometimes also holds an Assistant Deputy Minister
position. In Quebec, the Assistant Deputy Minister for
public health by law is a physician with a specialist
qualification in community medicine. The reporting
relationships of the CMOH within the provincial and
territorial governments vary considerably, as provinces
have balanced a desire to ensure the independence of
the CMOH as a health advocate with the need to
integrate his or her portfolio into ministries of

9. Each province and territory also has public health
staff within the provincial government. This staffs
typically engage in planning, administering budgets,
advising on programs, and providing assistance to local
staff for serious incidents. The British Columbia
Centre for Disease Control (BC CDC), established in
1997, to take responsibility for provincial-level
management of infectious disease prevention and
control, including laboratories, is perhaps the most
sophisticated. Division directors and other key
scientific and medical staff in the BC CDC hold
appointments at the University of British Columbia, and
have protected time to enable academic activities.

Federal Role

10. The federal government has powers relating to entry-
exit controls. For example, after being informed of
the SARS situation, the federal government immediately
activated protocols to track potentially infected
passengers arriving from the epicenters in Vietnam and
China. In instances where a returning passenger
exhibited SARS symptoms, the passenger manifests for
that person's flights to Canada were examined and
provincial or territorial public health authorities
contacted the other passengers to determine if any were
exhibiting SARS symptoms. Health Canada also began
distributing Health Alert Notices to international
passengers arriving in or returning directly to Canada
from affected areas in Asia, which advised passengers
to see a physician if they began to have symptoms
related to SARS.

11. In a worst-case scenario, the federal government
could invoke the Quarantine Act. According to GoC
documents "The Quarantine Act would authorize the
federal authorities to detain persons, goods or
conveyances on suspicion that the persons, goods and
conveyances might introduce a dangerous communicable
disease into Canada. The authority permits detention
without due process for a period of 48 hours in order
to undertake a medical examination of persons, analysis
of goods or inspection of conveyances. If detention is
required beyond 48 hours, the federal authorities must
present evidence for a continuation of the detention in
a federal court. These powers also apply to persons and
conveyances leaving Canada for another country."

12. At the federal level, the most relevant
organization is the Public Health Agency of Canada
(PHAC). Precipitated by lessons-learned from the 2003
SARS crisis, PHAC was formed in September 2004 to
coordinate federal efforts in identifying and reducing
public health risks and to support national readiness
to respond to health crises. Created from elements of
Health Canada's former Population and Public Health
Branch, the organization has dual headquarters in
Winnipeg, Manitoba and Ottawa, Ontario and also has
regional offices across Canada. Its components include
Centers for Infectious Disease Prevention and Control,
Chronic Disease Prevention and Control, Emergency
Preparedness and Response, Surveillance Coordination,
and Healthy Human Development. PHAC has oversight of
the National Microbiology Laboratory in Winnipeg, a
level 4 Bio-containment facility. PHAC also manages the
Laboratory for Foodborne Zoonoses in Guelph, Ontario. A
Chief Public Health Officer, currently Dr. David Butler-
Jones, heads the agency. He reports to the Minister of

12. PHAC is the focal point for Canadian coordination
with the World Health Organization and other
international partners such as the U.S. Centers for
Disease Control and Prevention. PHAC also issues
travel advisories on behalf of the federal government
with regard to travel to foreign locations. Canada's
travel health advisories are available at

13. In addition, Canada's federal food safety, animal
health and plant protection enforcement agency, the
Canadian Food Inspection Agency (which delivers all
federal inspection services related to food; animal
health; and plant protection) would work with PHAC in
those instances where there is a animal, plant, or food-
borne component to the human public health issue.


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