Intergovernmental Relations Project

In recent years considerably more attention has been devoted to governance in health care than to governance in public health. Nevertheless, this is a very active time for national initiatives in the area of public health in Canada. Clarification of the roles and responsibilities of federal, provincial and local governments in public health activities is vital to ensure successes in these initiatives that should translate into large health benefits and to prevent failures that often evolve into high profile events. Our project is aimed at helping governments and the public to better understand the effects of different types of intergovernmental public health regimes on the public interest.

A. OBJECTIVES:

• Describe the role of different orders of government in a purposeful sample of public health case studies (e.g., water quality, blood safety, air quality, food safety, health surveillance, immunization policy, public health security, and disease migration) and identify gaps and overlaps in these roles
• Determine the variations in intergovernmental relations that exist in the case studies 
• Determine the strengths and weaknesses of the various combinations of intergovernmental relations 
• Determine the characteristics of a public health problem that make it amenable to a particular type of intergovernmental relationship 
• Provide recommendations on mechanisms to improve existing intergovernmental relations to achieve policy objectives.

B. HYPOTHESIS

Harvey Lazar and Tom McIntosh have advanced a model for describing, evaluating and comparing federal-provincial relations based on the extent of interdependence between the two orders of government and the presence or absence of a hierarchical relationship. Our hypothesis is that their model can be usefully adopted and modified to describe intergovernmental relations in public health and incorporate a third (local) level and potentially a fourth (supranational) level.

C. WORKING PAPERS

Based on the above objectives, a series of Working Papers have been produced. They can be found at http://www.queensu.ca/iigr/working/PublicHealthSeries.html . In addition to the Working Papers, the project has also led to other publications as listed below.

Published Papers 

• Wilson K. Pandemic threats and the need for new emergency legislation in Canada. Healthcare Policy / Politiques de Santé 2006;2:35-42
• Wilson K, MacLennan C. Federalism and Public Health Law in Canada. Opportunities and Unanswered Questions. Health Law Review 2005:14;3-13.
• Wilson K, Lazar H.. Policy Matters 6 (5). Planning for the next Pandemic Threat: Defining the Federal Role in Public Health Emergencies. 
• Wilson K. The Complexities of Multi-Level governance in public health. Canadian Journal of Public Health 2004;95:409-411 
• Wilson K, McCrea-Logie J, Lazar H. Understanding the impact of intergovernmental relations on public health: Lessons from reform initiatives in the blood system and health surveillance. Canadian Public Policy 2004;30:177-194 
• Wilson, K. The Canadian Agency of Public Health. Could it work? Canadian Medical Association Journal 2004;170:222-3.

Related Papers

• Wilson K, McDougall C, Fidler DP, Lazar H. Strategies for Implementing the new International health regulations in decentralized states- Bulletin of the World Health Organization
• Attaran A, Wilson K. Legal and Epidemiological Justification for Federal Authority in Public Health Emergencies. McGill Law Journal 2007;52:381-414.
• McDougall C, Wilson K. Canada’s Obligations to Global Public Health Security under the Revised International Health Regulations. Health Law Review 2007;16:25-32.
• Wilson K, MacDougall C, Upshur R. The new international health regulations and the federalism dilemma. PLoS Med 2006;3(1): e1.
• Mills EJ, Singh R, Ross CP, Ernst E, Wilson K. Impact of Federal Safety Advisories on Health Food Store Advice. Journal of General Internal Medicine 2004;19:269-272. 
• Deber R, McDougall C, Wilson K. Public health through a different lens. Healthcare Papers 2007;7(3):66-71.
• Wilson K, Singer PA. Travel advisories and pandemics. Human Security Bulletin (Human Security and Health edition). July, 2006.
• Wilson K. Can Canada’s two levels of government get it together? Diplomat and International Canada. 2006;3:14-17.
• Wilson K, Lazar H. From SARS to Avian Flu – Why Ottawa must lead Canada’s response. Policy Options 2006; February:31-38.

Newspaper Articles

• Wilson K, Lazar H. A bug in Canada’s ear. Globe and Mail web exclusive comment. June 15, 2007.
• Wilson K. Canada must prepare for new rules for fighting pandemics. Medical Post February 2006;42:17.