Integration of Public Health & Health Care Governance, Is It Working For Public Health



Over the last 20 years public health organizations in Canada have undergone significant structural changes usually being swept up in the efforts to rationalize healthcare spending. Most often this has meant integration with health care under common governance structures. These structures are seldom evaluated to see if they have achieved the objectives of rationalization. When evaluations occur the focus is primarily on health care indicators such as waitlist. There is concern that under the integrated structure, public health has lost its focus, lost competent resources and lost the capacity to be a strong advocate for public health. Health care by nature and necessity is a rigid, hierarchical structure that limits capacity for independent action by individual practitioners; they must follow “rules” to ensure patient safety. Much of public health work by nature is “messy”, it requires public health practitioners to have skills and competencies that allow them to be creative and sometimes outspoken. This presentation will describe the work done by the Newfoundland & Labrador Public Health Association (NLPHA) to assess the impact of restructuring on public health services 10 years after the creation of integrated health authorities. We will report on a survey of public health workers, a literature review, the development of a position statement and an advocacy strategy for public health services. Key words: Leadership and governance, Evaluation, advocacy Key messages: 1. Governance structures which integrate public health and health care have an impact on public health services and the communities they serve. 2. Public Health workers are in a good position to provide information and guidance on the governance of public health services 3. Public Health Associations are well positioned to be advocates for public health and public health services.


Catherine Donovan

Memorial University of Newfoundland

Public health physician currently working in an academic environment but extensive community based public health experience. Special interests in population health promotion, built environments, social and environmental justice.