I recently attended a meeting of the medical officers of health from Canada’s Atlantic provinces, and one of the topics discussed was the independence of the medical officer. This is a hot topic in that region, following the firing without cause of the New Brunswick provincial health officer, Dr. Eilish Cleary, in December 2015.
She is but the latest in a string of firings among my former colleagues. One of the more egregious was the firing of Dr. David Swann as the medical officer for Alberta’s Palliser Health Authority in 2002. (He was later reinstated.) Swann’s crime? He had spoken out — on public-health grounds — in support of the Kyoto Accord to limit greenhouse-gas emissions.
What usually marks these firings is that the officer in question has taken a controversial public stance on a matter that is politically sensitive or is opposed to some industry or economic sector. Cleary had investigated fracking and was investigating a controversial pesticide when she was fired; neither, it seems, was popular with the government of the day.
This is hardly a new phenomenon. In writing about public health in Renaissance Italy, Carlo Cipolla noted that the health officers of the day complained about the hostility of the merchants, whose economic well-being was disrupted by the regulation of trade and commerce, including the enforcement of quarantine on people and goods.
Fast-forward to the 19th century, and we find medical officers opposing the industrialists and others whose policies and practices were turning Britain’s industrial slums into hell-holes. And this continues, as we oppose the tobacco industry, the fossil-fuel industry and many others whose activities harm health.
It would be fair to say that it is the job of medical officers to speak truth to power — including the power of governments. Indeed, advocacy is defined as a core competency for public-health professionals in Canada. That is why traditionally it has been made difficult to fire medical officers of health.
Ontario’s 1884 Public Health Act, for example, required a two-thirds vote of the local board of health and the written permission of the minister before a medical officer could be fired, and that protection was continued in the 1984 Health Protection and Promotion Act that replaced it.
Unfortunately, this degree of protection is not available everywhere in Canada, and it does not extend to provincial health officers. So it is unlikely that provincial health officers will readily prepare reports on the health consequences of climate change, the fossil-fuel industry or other politically unpopular topics, because they report to the deputy minister and to the minister.
Much the same is true in health authorities, where the chief medical officer of health reports to the CEO; in effect, they are subject to political direction and control because health authorities usually don’t want to embarrass the government that funds them and appoints their boards.
In New Brunswick, the medical society, responding to the attempted suppression of Cleary’s 2012 report on fracking, issued several key recommendations.
Among other things, it recommended that health officers “need the clear ability to speak to the public, independent of the opinions of the government of the day … should prepare an annual report for the legislature on subjects of their choosing, free from political interference in its preparation and publication [and] must be able to investigate issues of public-health concern, outside of emergencies, at their own discretion.”
While I support these provisions strongly, and believe they should be in legislation in each province and federally, it is not enough. Their final recommendation was that the provincial health officer “should remain as a senior leader within the Department of Health.” I think this is a mistake.
In most provinces, and also in our health authorities, the medical officer of health is not the CEO or the director of public health; that job falls to an assistant deputy minister or some other equivalent staff person.
So in my opinion, the provincial health officer should be an independent officer of the legislature, equivalent to the auditor general — and that protection needs to be extended to all medical officers of health in some form.
That would give them the necessary independence and authority to speak out, report and investigate in the interests of the health of the public, unhampered by political or commercial interference.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.