Promise and peril of a centralized health system

July 10, 2023

In recent years, health systems across Canada have been aiming to centralize power, resources, and responsibilities. However, it’s unclear how these efforts impact public health operations and practice.

A recent study published in the Canadian Journal of Public Health interviewed 58 public health system leaders to understand how the centralization of health systems affects public health.

The findings showed that in Alberta, there were potential improvements in coordinating activities and public health programs. However, challenges were faced in maintaining effective collaboration between different sectors at the local and provincial levels, particularly in Alberta and Quebec, with leaders in Ontario highlighting local support as an area of significant concern. Leaders across all provinces noted the impacts of decreased funding contributed to the erosion of some core public health functions and workforce.

As decision-makers continue to work toward improving efficiency and removing silos within the health system, inclusive decision-making and collaborative governance emerge as crucial elements of health system reform. By involving diverse stakeholders and experts, decision-makers can ensure appropriate expertise and contribution to resource allocation, policy formulation, and planning processes.

This is the first comparative case study to investigate how a centralized health system structure affects public health. The findings underscore the importance of stable public health investments and offer valuable insights for reform strategies: leveraging the strengths of centralized systems while mitigating the unintended consequences.



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