Deber Raisa B, Millan Kris, Shapiro Howard, McDougall Christopher W
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
Healthc Policy. 2006 Nov;2(2):60-75.
The 2003 SARS outbreak highlighted the importance of maintaining an adequate public health (PH) infrastructure, and cast doubt on the wisdom of basing the system locally without adequate provisions for higher-level oversight and coordination. Structurally, it highlighted the policy legacy of the 1998 Ontario decision to download full responsibility for funding PH services to municipal governments, forcing such services into budgetary competition with the "hard" services traditionally provided by local government. The federal role in PH has traditionally been minimal; PH was never included as a mandatory service in the Canada Health Act, while reform proposals have focused upon such admittedly important directions as pharmacare and home care rather than PH. Although PH has moved up the policy agenda, with a focus on pandemic preparedness, the Ontario events suggest a pressing need for setting national and provincial/territorial standards for PH, and developing mechanisms for enforcing them.
2003年非典疫情凸显了维持充足公共卫生基础设施的重要性，也让人质疑在没有适当高层监督与协调机制的情况下，将公共卫生体系建立在地方层面的做法是否明智。从结构上看，它凸显了1998年安大略省做出的一项政策遗留问题，即把为公共卫生服务提供资金的全部责任下放到市政府，迫使这些服务与地方政府传统提供的“硬”服务在预算上展开竞争。联邦政府在公共卫生方面的传统作用一直很小；公共卫生从未被纳入《加拿大卫生法》规定的强制性服务，而改革提议一直聚焦于诸如药物护理和家庭护理等公认重要的方向，而非公共卫生。尽管公共卫生已被提上政策议程，重点是防范大流行病，但安大略省的事件表明，迫切需要制定国家和省/地区的公共卫生标准，并建立执行这些标准的机制。
