The many human dramas and all the inquest reports1 sent a powerful message about Québec’s multiple shortcomings in its ability to deal with a global public health crisis. The findings over recent months are appalling.
The Québec government threw in the towel years ago. Despite the warning signals, its public health spending per capita has decreased since 2010. In 2019, Québec was spending threefold less per capita ($150) than the Canadian average ($384), an investment deficit of $2 billion.2
To our astonishment, we witnessed many instances of bending the basic rules of risk management: failure to respect the precautionary principle, specifically with regard to ventilation and the wearing of N-95 masks, deficient infection prevention and control measures, insufficient and inaccessible personal protection equipment, a lack of transparency and collaboration with all the stakeholders concerned, among other things.
Decision-making structures that are remote from practice in work settings, which led to excessively long response times and, in some cases, a failure to understand needs and directives, are also singled out. To say nothing of the public health director’s lack of independence and transparency.
At the heart of priorities
In her final report on performance in the provision of care and services to seniors during the first wave of the pandemic,3 the Health and Welfare Commissioner, Joanne Castonguay, is emphatic: public health must be placed at the heart of the priorities of the Ministère de la Santé et des Services sociaux.
The Commissioner formulated many recommendations, including the development of an integrated province-wide public health risk and infectious disease preparation strategy; the design of a crisis management plan in which the chain of command is well defined, meaning the clear definition of responsibilities, roles and functions of all the players; human, informational and financial resources that meet needs and achieve targeted results; and the development of a culture of transparency in terms of public health-related policies and decisions.
And yet transparency has been recognized as one of the guiding principles of risk management since 2003!
Local intervention plans
Piecework management of a public health crisis of this scale in an emergency is no longer an option. Of course, the Commissioner proposes several tangible measures to improve Québec’s intervention capacity: a continuous risk analysis monitoring mechanism, the creation of a crisis management committee within the Ministère, an emergency decision-making process, the development and application of province-wide standards to infection prevention and control in all settings under the responsibility of the Ministère. That’s positive!
Yet our best protection will always be prevention. “We want the government to restore locally, for each of the institutions of our network, public health action plans that will be developed, implemented, assessed and regularly updated by the parties concerned, including the employees who thoroughly understand the shortcomings, the needs and the challenges of their workplaces,” said the President of the Fédération de la Santé du Québec (FSQ-CSQ), Isabelle Dumaine. This was already stipulated in section 14 of the Public Health Act, which was repealed by the Barrette reforms!
“Local planning and timely action will be our best protection in future public health crises.”
– Luc Beauregard, CSQ Secretary-Treasurer and political lead for health
Depoliticize public health
“Public health must be depoliticized asap,” said Luc Beauregard, CSQ Secretary-Treasurer and political lead for health at the CSQ. “Some decisions put lives at stake, and must be based on scientific analysis and without strategic considerations. In tangible terms, the government must restore to healthcare employees and institutions the decisional levers and resources that will enable them to take timely action and ensure their safety. Local planning and timely action will be our best protection in future public health crises.”
1 Inquests carried out by coroners in the long-term care centres (CHSLDs), the Québec Ombudsperson and Québec’s Health and Welfare Commissioner.
2 INSTITUT CANADIEN D’INFORMATION SUR LA SANTÉ (2019).
3 COMMISSAIRE À LA SANTÉ ET AU BIEN-ÊTRE (2022). Le devoir de faire autrement – PARTIE 1 : Renforcer le rôle stratégique de la santé publique, 100 p.