No abstract

Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.KEY WORDS: Public health; public health administration; evidence-based practice; public health practice; Canada; Quebec La traduction du résumé se trouve à la fin de l'article.

This commentary explores public health (PH) investments in Quebec and underlines the challenge of tracking PH resources across Canada. We analyzed governmental data to compare investments across all health and social programs in Quebec from 2004-2005 to 2017-2018. The province's PH budgets suffered from disproportionately low investments and abrupt cuts. These cuts were the largest among all health programs in 2015-2016 (− 7.1%). PH budgets did not keep up with inflation and, in constant dollars, have declined over the last decade. Furthermore, their evolution over the span of 14 years significantly differed from other health programs. On average, programs providing direct services experienced overall budget increases of 81%, whereas PH budgets had the lowest increase of all such programs at only 46%. PH suffers from serious erosion of its capacity. Unfortunately, there is a dire lack of comparable data for provincial, national, and international PH budgets, which further complicates the monitoring of PH erosion. We contend that systematic tracking of PH budgets remains profoundly inadequate across Canada. We recommend (1) regular, comprehensive, and publicly reported analyses of PH budgets; (2) in-depth comparisons of PH investments across Canadian jurisdictions; and (3) a strong PH systems and services research agenda for Canada. Résumé Cet article explore les investissements en santé publique (SP) au Québec et souligne les défis inhérents au monitorage des ressources de SP au Canada. Nous avons analysé les données gouvernementales afin de comparer les investissements dans l'ensemble des programmes de santé et de services sociaux au Québec, de 2004-2005 à 2017-2018. Les budgets de SP au Québec ont souffert de façon disproportionnée d'investissements faibles et de coupes budgétaires abruptes. En 2015-2016, ces coupes ont été les plus importantes parmi celles imposées aux programmes de santé (− 7,1 %). Les budgets de SP n'ont pas suivi l'inflation et, en dollars constants, ont décliné depuis environ dix ans. De plus, leur évolution durant les 14 dernières années diffère significativement de celle des autres programmes de santé. En moyenne, le budget des programmes qui fournissent des services directs a augmenté de 81 %, alors que l'augmentation des budgets de SP a été la plus faible parmi ces programmes, à 46 %. Pendant ce temps, la SP subit une érosion sévère de sa capacité. Malheureusement, il y a un manque criant de données comparables entre juridictions provinciales, nationales et internationales. Cette lacune vient compliquer toute tentative de documenter une telle érosion. Nous considérons que le suivi systématique des budgets de santé publique demeure profondément inadéquat au Canada. Nous recommandons (1) des analyses régulières, détaillées et publiques des budgets de SP; (2) des comparaisons en profondeur des investissements en SP au Canada; et (3) un programme de recherche canadien vigoureux en études des systèmes et services de SP.