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In the fall of 2014, the Government of Canada formally split the role of the Chief Public Health Officer (CPHO) into two positions: the CPHO and the President of the Public Health Agency of Canada. Despite concerns raised by the public health community, these changes are consistent with the CPHO's authority. However, the nature of responsible government means that the CPHO cannot simultaneously serve as an independent advocate for policies and programs that might prevent disease and as a senior advisor to the government of the day. A 1'automne 2014, le gouvernement du Canada a annonce le dedoublement officiel du role de l'Administrateur en chef de la sante publique (ACSP) en deux postes : l'ACSP et le president de l'Agence de la sante publique du Canada. Malgre les inquietudes exprimees dans les milieux de la sante publique, ces changements sont compatibles avec le mandat original de l'ACSP. La nature d'un gouvernement responsable suppose que l'ACSP ne peut a la fois s'instituer en champion independant de politiques ou de programmes favorables a la sante et conserver son role de conseiller principal du gouvernement du jour., Introduction On October 24, 2014, the Government of Canada announced a proposed amendment to the Public Health Agency of Canada Act through a budget implementation bill, Bill C-43. This amendment [...]

This article focuses on Quebec's most recent reform in the regionalization of health care to understand why the government chose to transform the regional boards into agencies. This case study used interviews and documentary analysis. Rooted in a political science perspective, the conceptual framework is inspired by the work of John Kingdon (1995) and draws on the four variables that influence the choice of policy: ideas, interests, institutions and events. Results of the case study suggest that Quebec's Commission of Study for Health and Social Services (the Clair Commission) in 2000 and the 2002 pre-electoral environment put the issue on the agenda. In 2003, the newly elected Liberal government passed Bill 25--An Act Respecting Local Health and Social Services Network Development Agencies, which represented a political compromise: originally slated for eradication, the regional tier survived but in a new form. The element that sparked reform was the change in government following the elections. Different inquiry reports spread the reform's ideas, while interest groups articulated contrasting visions on the transformation. Above all, regional institutions showed great resilience in the face of change. From a historical perspective, this regionalization policy is a step backward: the regional tier is now stronger from a managerial and technocratic point of view, but it is politically and democratically weakened. This suggests a government intention, at that time, to maintain the regional level as a means of retaining centralized control over Quebec's health-care system. Cet article se concentre sur la plus recente reforme du Quebec en matiere de regionalisation des soins de sante pour comprendre pourquoi le gouvernement a choisi de transformer les regies regionales en agences. Des entrevues et une analyse documentaire ont ete utilisees pour cette etude de cas. Enracine dans une perspective de sciences politiques, le cadre conceptuel s'inspire des travaux de John Kingdon (1995) et tire parti des quatre variables qui influencent le choix de politique : les idees, les interets, les institutions et les evenements. Les resultats de l'etude de cas laissent entendre que la Commission d'etude sur les services de sante et les services sociaux du Quebec (la Commission Clair) en 2000 et le climat pre-electoral de 2002 ont mis la question a l'ordre du jour. En 2003, le gouvernement Liberal nouvellement elu a adopte le projet de loi 25, Loi sur les agences de developpement de reseaux locaux de services de sante et de services sociaux, qui representait un compromis politique : devant etre initialement abroge, le palier regional a survecu, mais sous une nouvelle forme. L'element qui a suscite la reforme a ete le changement de gouvernement a la suite des elections. Differents rapports d'enquetes ont propage les idees de la reforme, tandis que des groupes d'interet ont formule des visions opposees sur la transformation. Avant tout, les institutions regionales ont montre une remarquable resilience face au changement. D'un point de vue historique, cette politique de regionalisation constitue un pas en arriere : le palier regional est maintenant plus fort d'un point de vue technocratique et managerial, mais il est affaibli sur le plan politique et democratique. Cela donne a penser que l'intention du gouvernement a cette epoque etait de maintenir le niveau regional comme moyen de conserver un contrele centralise sur le systeme de soins de sante du Quebec., Public policy-makers from around the world have moved to decentralize health-care systems in recent years in the hopes of achieving better governance and a more judicious distribution of management and [...]

Interest in finding more effective methods for public involvement in decision-making about health systems is more widespread than ever in Canada since significant aspects of health-care decision-making were devolved from provincial governments to regional health authorities. Involving the public can be risky business, however, as the accountability and legitimacy of decisions made by governing authorities are often assessed against the nature and degree of interaction that occurs with the public. Consequently, decision-makers in a variety of policy domains routinely struggle with questions about when it is appropriate to involve the public, what the most effective means are for doing this, and how to measure their success. The authors analysed these issues by documenting the experiences of health-systems decision-makers in two Canadian provinces (Ontario and Quebec) with public consultation and participation over the past decade. Their findings illustrate that despite the different roles and responsibilities held by Ontario and Quebec decision-makers, decisions to consult with their communities are driven by the same basic set of objectives: to obtain information from and to provide information to the community; to ensure fair, transparent and legitimate decision-making processes; and to garner support for their outcomes. Decision-makers also acknowledged the need to rethink approaches for involving the public in decision-making processes in response to the perceived failure of past public participation and consultation processes. While these experiences have clearly left some participation practitioners feeling beleaguered, many are approaching future community consultation processes optimistically with plans for more focused, purposeful consultations that have clear objectives and more formal evaluation tinged with a healthy dose of pragmatism.