INTEGRATING ACTION FOR HEALTH AND WELL-BEING 4.4
Building integrated health systems saves lives
I n Canada, health care is largely delivered by individual provincial governments, with the federal government responsible for Indigenous peoples, corrections, Canadian Forces, veterans and the Royal Canadian Mounted Police. The governance of health and health care in Canada is complex. But there is nothing healthy about fragmentation in complex systems. In 1990, as a family doctor, I became involved in the campaign to protect the autonomy of a hospital in downtown Toronto. We believed we were protecting the future of health and health care. We were fighting the merger of our hospital with the largest teaching hospital. We believed that our vision and values would be submerged. Our strengths were multidisciplinary teams, ambulatory care focused on community-based care, addressing the social determinants of health and firmly committed to the patient as a true partner in their care. The goal was the most appropriate care in the most appropriate place, by the most appropriate provider at the most appropriate time. We won that fight and Women’s College Hospital still leads the
orders of government. From disability issues to childcare to climate change to reducing poverty, fragmentation has hindered progress. In 2003 after the severe acute respiratory syndrome pandemic, I was appointed Canada’s first minister of state for public health. We set up the Public Health Agency of Canada, appointed the first chief public health officer and set up the Public Health Network for Canada to provide a structure for all 13 provincial and territorial jurisdictions to work together to protect the health of Canadians. GERMS DON’T RESPECT BORDERS It was clear that ‘germs don’t respect borders’. We had to do better. We needed an integrated system for public health. The idea of ‘central command and control’ was anathema to our complex federal system, particularly in the province of Quebec. Four Cs had been put forward as principles for public health: cooperation, collaboration, communication and coordination. The last – coordination – was unacceptable in our federal system, and
The severe acute respiratory syndrome pandemic in 2003 was the catalyst for Canada overhauling its complex federal health system and building an integrated, data-led system for public health – one that doesn’t just patch people up, but keeps them well
By Carolyn Bennett, member of Parliament, Canada
healthcare revolution. Since I was elected to Parliament in 1997, I have been involved in conversations about breaking through silos in government departments and the gridlock among all
quickly replaced by ‘clarity of who
does what when’. Top-down central command and control would not work. Learning health systems must be built from the bottom up, respecting local wisdom and local knowledge. Good
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Health: A Political Choice – From Fragmentation to Integration
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