Preserving public health: A call for evidence-based policy and collaborative governance in response to Alberta’s Public Health Emergencies Governance Review Panel report

The O'Brien Institute for Public Health underscores the critical role of evidence-based decision-making in responding to public health emergencies. We remain steadfast in our dedication to advancing public health through research excellence and firmly assert that policymakers should give precedence to the most robust scientific evidence, prioritizing public health considerations over political interests.

In Nov., Alberta’s Public Health Emergencies Governance Review Panel released its final report to the public. On Dec. 7, amendments to Alberta’s Public Health Act came into force, which shift decision-making authority during a public health emergency from the Chief Medical Officer of Health to Cabinet and give Cabinet the authority to override orders of a medical officer of health. Although these amendments are consistent with the recommendations of the review panel, the government has not commented on the extent to which they plan to implement additional recommendations contained in the report. Many of the review panel’s recommendations raise significant concerns and, if adopted, Alberta may be less equipped to manage a future public health emergency.

The review panel recommended that “non-scientific evidence” and “alternative scientific narratives and hypotheses”play a role in public health decision-making. While it is important for politicians to listen to the voices of all constituents, ultimately, to preserve hospital capacity and limit morbidity and mortality, a public health emergency response must be driven by the best available evidence rather than by narratives that are not grounded in science, by ideology or by a political desire to appease dissenting groups.

During COVID-19, the self-regulatory bodies for several health professions took actions to discourage their members from providing information or treatments that were not supported by scientific evidence. The review panel made recommendations that could prevent self-regulatory bodies from taking these actions to protect the public in the future, including requiring colleges to protect the freedom of expression of their members and preventing colleges from publishing the names of members who are facing professional discipline until all appeals have been completed. If adopted, this may limit the ability of self-regulatory bodies to fulfill their mandate of protecting the public.  

The review panel's recommendations on self-regulatory bodies and expanding individual rights require careful consideration. Any changes should be implemented with caution to avoid compromising evidence-based care and eroding trust in, and the efficacy of, the healthcare system.

Furthermore, the broad scope of recommendations in the review panel's report, such as expanded privatization, demands thorough consultation with stakeholders and experts. The O'Brien Institute emphasizes the need for a comprehensive and informed discussion before implementing such significant changes to ensure the continued delivery of quality, equitable healthcare.

The review panel has also proposed significant revisions to the Alberta Bill of Rights and procedural amendments to facilitate individuals raising constitutional challenges to public health measures. The Canadian Constitution safeguards various rights and freedoms, permitting limitations only when deemed justifiable. While the COVID-19 public health measures temporarily restricted individual rights, it was a necessary step to safeguard hospital capacity and reduce illness and death—an objective recognized as legitimate by the courts in numerous cases.

If the review panel's suggestions on individual rights are embraced, there is a potential constraint on policymakers' ability to implement effective public health measures during future emergencies. Striking an optimal balance between individual rights and the collective well-being might become more challenging, potentially impacting the capacity to respond adequately to public health crises.

Although the mandate of the review panel was to address public health governance, its report contained various wide-ranging recommendations that they believed would improve health system capacity, including expanded professional scopes of practice, changes to hospital funding models, and a possible expansion of privatization of the health care system. These changes would be significant and have important implications for cost, quality of care, and equitable access to care, none of which were properly addressed by the review panel. As such, they should only be considered in consultation with the appropriate stakeholders and experts rather than being implemented on the basis of the cursory discussion in the report.

Apart from the recent amendments to the Public Health Act, the Alberta government has not indicated which additional recommendations they plan to implement. While we support the review panel’s emphasis on the importance of transparency and effective communication during a public health emergency, we would urge the government to proceed with caution in implementing recommendations which could render the province less able to manage a future public health emergency and have unintended negative consequences for the health system as a whole.

The O’Brien Institute is committed to evidence-informed decision-making. We stand ready to convene non-partisan experts to address issues related to public health in the province. We look forward to optimizing our public health systems for the improved health and well-being of all Albertans.

Author:

Dr. Lorian Hardcastle, SJD, 

Associate professor

Dean's Office - Law