Opening Statement to the Standing Committee on Public Accounts

National Health Surveillance: Diseases and Injuries
(Chapter 14 - September 1999 Report of the Auditor General)

Management of a Food-Borne Disease Outbreak
(Chapter 15 - September 1999 Report of the Auditor General)

Mr. Chairman, thank you for this opportunity to present the results of our audit of National Health Surveillance: Diseases and Injuries, and Management of a Food-Borne Disease Outbreak, as reported in chapters 14 and 15 of the 1999 Report, tabled last November.

Health surveillance is particularly critical now, given that global factors have dramatically increased the danger of communicable diseases being transmitted worldwide. Health concerns are no longer always the responsibility of one jurisdiction. Collaboration and co-operation among jurisdictions are vital to effective surveillance.

National surveillance of communicable and chronic diseases and injuries is conducted mainly by Health Canada’s Laboratory Centre for Disease Control (LCDC). But LCDC depends largely on interaction and collaboration with the provinces and territories, and a variety of other federal departments and non-governmental organizations. This includes the Canadian Food Inspection Agency in the event of a disease caused by food.

Chapter 14 covers national health surveillance in general, including the handling of threats to public health. Chapter 15 flows from the audit of national health surveillance and focusses on how a recent outbreak of a food-borne disease was managed. The case illustrates many of the issues discussed in the other chapter.

Our audit found weaknesses in national health surveillance that, taken together, have clear implications for public health. These weaknesses compromise Health Canada’s ability to detect, anticipate, prevent and control health risks associated with outbreaks of communicable disease, and other health threats. They also compromise the Department’s ability to plan, carry out and evaluate programs that deal with the causes and treatment of diseases.

There is no national framework for public health. No specific legislation, policy or agreement exists that links separate components of public health functions at the various levels of government. In fact, there is a void. Current health surveillance activities are largely carried out on an ad hoc basis.

We found few formal agreements and protocols covering roles, responsibilities and procedures for handling threats to public health. The audit identified examples such as controlling diseases at ports of entry, responding to outbreaks of food-borne diseases and dealing with influenza pandemics. The lack of attention to formalizing the way these threats are to be managed places the health of Canadians at unnecessary risk.

There is a need for better management of disease outbreaks. The way the Canadian Food Inspection Agency, Health Canada and provincial agencies handled one of the largest food-borne disease outbreaks in Canada is disturbing. Some important aspects of the response to the outbreak worked well, but others did not. We found delays in the exchange of information to identify the scope of the outbreak. We also found less than full co-operation among the agencies in responding to this outbreak. In addition, we noted that Health Canada and the CFIA need to ensure that they maintain appropriate records on food emergencies.

Finally, key surveillance systems that we looked at were not working as intended. They do not enable Health Canada to effectively monitor communicable and chronic diseases such as influenza, AIDS, tuberculosis and diabetes. Problems in collecting data include a lack of common standards for reporting information at the provincial and territorial levels. We also found significant gaps in surveillance information on certain diseases and injuries.

These weaknesses need to be fixed. Health Canada needs to champion change by ensuring that all players work together to improve the surveillance on which Canadians rely to protect their health. Both Health Canada and the CFIA have agreed with our observations and have committed themselves to implementing our recommendations. We were also encouraged by Health Canada’s timely and comprehensive response published on its Web site immediately following the tabling of our Report.

Work has begun on strengthening surveillance, including the proposal for an integrated national health surveillance network. It is important to maintain momentum in implementing this ambitious and very complex undertaking. The success and timely implementation of the network are vital to address some of the weaknesses that we observed. Mr. Chairman, your Committee may wish to review the progress the Department is making with its commitments, specifically the budgets, milestones, and actions it has taken to date.

Mr. Chairman, that concludes my opening statement and we would be pleased to answer your Committee’s questions.