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Health agency has long road ahead



David Butler-Jones is not prone to hyperbole.

After one year at the helm of the Public Health Agency of Canada, the $423-million-a-year entity charged with the twin tasks of preventing disease epidemics and reshaping the way Canadians think about health, he calls the agency a "small player in the grand scheme of things."

He describes the PHAC's achievements in its rookie year as a "pretty good start," and, in his best deadpan, adds: "We even made it on to Air Farce."

Others are far more enthusiastic.

"Both the profile and structure of public health have changed dramatically in the past year," said Dr. Carolyn Bennett, federal minister of state for public health. "We are witnessing the beginning of something great, and monumental."

The Public Health Agency, ironically -- because it is in the business of crisis prevention -- was born of crisis. The 2003 outbreak of severe acute respiratory symptom left 44 dead, and exposed cracks in the foundation of Canada's health system.

When Dr. David Naylor, chairman of the National Advisory Committee on SARS and Public Health, the blue-ribbon panel charged with dissecting the causes of the economically devastating outbreak, issued the committee's final report, he pulled no punches.

The report described Canada's approach to public health as an "international embarrassment." The public health system lacked money, leadership and direction, leaving the country vulnerable to all manner of health disasters.

To a country that had long been a leader in public health, but which had seen local public health units withering and dying from government cutbacks, the report was a bittersweet I-told-you-so.

Dr. Naylor recommended the appointment of a Chief Public Health Officer and the creation of an agency to oversee crucial areas, such as infection control, disease prevention, health promotion and chronic disease management.

Dr. Butler-Jones, a long-time public health officer who had also headed the Canadian Public Health Association, was charged with the responsibility.

The beginnings of PHAC were rocky, largely because of a nasty political squabble about the location of its headquarters.

The head office is in Winnipeg -- chosen because it is geographically central and because it was already home to the National Microbiology Laboratory -- but 1,400 of the agency's 1,800 employees are in Ottawa. In fact, most of the staff was simply transferred (on paper, not physically) from Health Canada to the new agency.

The big change, however, has been in visibility, said Dr. Elinor Wilson, CEO of the association. Dr. Butler-Jones said that new clout has paid off in tangible ways. In the past year, the federal government announced a national immunization strategy and $300-million for a chronic disease prevention and healthy living strategy.

The government has also, with PHAC's prodding, pricked up its ears about the possible threat of avian influenza. It has stockpiled more than 20 million doses of antiviral drugs and has spent $34-million on the production of a vaccine. Ottawa has also built two emergency operations centres and staged a large-scale mock bioterrorism exercise with the United States and Britain.

Dr. David McKeown, public health officer for the City of Toronto, said said the first year of the agency has been good, but it remains to be seen whether PHAC can hold the attention of politicians as memories of SARS fade.

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