Usher Susan, Allin Sara, Gautier Lara, Fierlbeck Katherine, Sriram Veena, Bodner Aidan, Trapé Camille, Shipton Leah, Montecalvo Alessia, Berman Peter
Dept of Equity, Ethics and Policy, McGill University, Canada.
North American Observatory of Health Systems and Policies, USA.
Health Policy Open. 2025 Jul 22;9:100146. doi: 10.1016/j.hpopen.2025.100146. eCollection 2025 Nov.
Studies of COVID-19 pandemic responses reveal shortcomings that may relate to the organization of public health systems.
This study uncovers the organizational factors that may strengthen pandemic responses in high-income countries through a comparative analysis of four Canadian provinces.
We undertook a qualitative multiple case study, collecting data through document review and 103 interviews with government and non-governmental actors involved in pandemic response. Analysis explored how differences in the organization of provincial public health systems influenced decision-making, advisory, coordination and adaptation processes.
The scale of the pandemic positioned the Premier as legitimate decision-maker in all provinces regardless of the distribution of authority in their public health systems. Capacity for generating public health advice was increased through existing or new organizations and highlighted the advantage of links to university expertise. All public health systems relied on healthcare resources for testing programs despite differences in the integration of public health under healthcare governance structures; centralization of healthcare governance was a facilitator. Adapting pandemic control measures to population needs was supported by linkages between organizations capable of apprehending needs and organizations that made decisions.
This study builds on the literature of pandemic responses across high-income countries and uncovers organizational factors that may enhance agility to rapidly expand capacities, connect actors for emergency responses, and strengthen public health systems.
对新冠疫情应对措施的研究揭示了一些可能与公共卫生系统组织相关的缺陷。
本研究通过对加拿大四个省份的比较分析，揭示可能加强高收入国家疫情应对能力的组织因素。
我们进行了一项定性多案例研究，通过文献回顾以及对参与疫情应对的政府和非政府行为者进行103次访谈来收集数据。分析探讨了省级公共卫生系统组织方式的差异如何影响决策、咨询、协调和适应过程。
疫情的规模使省长在所有省份都成为合法的决策者，无论其公共卫生系统中的权力分配情况如何。通过现有或新成立的组织，提供公共卫生建议的能力得到了提高，并突出了与大学专业知识建立联系的优势。尽管公共卫生在医疗治理结构下的整合程度存在差异，但所有公共卫生系统在检测项目中都依赖医疗资源；医疗治理的集中化起到了促进作用。能够了解需求的组织与做出决策的组织之间的联系，为使疫情防控措施适应民众需求提供了支持。
本研究以高收入国家疫情应对的文献为基础，揭示了可能增强灵活性以迅速扩大能力、连接应急响应行为者以及加强公共卫生系统的组织因素。
