COVID’s double-edged sword: Canada’s pandemic-driven public health challenges and opportunities
By Marty Pearce, Public Health Epidemiologist, Accenture
It’s no secret: transformation of Canada’s public health functions – the part of the health system that we rely on to improve the health of populations – was drastically accelerated by the COVID-19 pandemic. What isn’t as obvious is that the sudden increase in need amplified both challenges and opportunities. One of these is that the pandemic affected client groups differently depending on race, gender, and socioeconomic status. For example, in some provinces, low-income neighbourhoods in the fifth wave experienced two to two-and-a-half times the mortality rate experienced in the highest income neighbourhoods .
In public health we view the health system through the lens of social determinants of health. The aim is to establish health equity across population groups—to keep them healthy, improve their health and prevent the progression of disease, particularly communicable diseases. Our experience and our reading of the Canadian public health landscape suggest that visionaries will combine technology innovation with human ingenuity to reshape and improve access, experience, and outcomes for all.
Sudden, COVID-19-related changes in the health system meant that all health functions, including public health organizations, had to restructure operations dramatically. Workers adapted to unprecedented working conditions while clients adjusted to new health system service models. Some of these changes were positive, but others have had negative knock-on effects.
With most in-person interactions on hold, the pandemic forced the health system into an accelerated digital transformation experiment. Virtual services promptly exploded. But unprecedented pressure on staff has seen many depart the profession, including staff working within the public and population health sector. Research has shown that for public health workers, symptoms of anxiety, depression, burnout, and poor physical health were widely reported . Health systems are short-staffed and unable to provide the access and engagement needed by their communities. It’s time for organizations to lock in the lessons they’ve learned and view health access, experience, and outcomes through a more empathetic lens.
In COVID-19‘s wake—the opportunity
Despite the challenges, there is a great opportunity for Canada’s public health system to combine technology innovation and human ingenuity. There’s a chance to use empathy, create trust and carve out a new social compact for the 21st century. How? Here are some practical steps:
- Recognize the interconnectedness of public health and primary care: There is a need for both types of approaches. The more they are linked, the more integrated services will be to help ensure that nobody misses out. Imagine a system where shared population-based information (e.g., about prevalent health problems, health risks within the community, and preventive services for particular client groups) could enhance clinical decision-making.
- Enable data access for health professionals to foster 360-degree client-centricity: Give public health professionals a 360-degree view of clients based on appropriate data access principles. The holistic view of the client’s needs will help to prioritize marginalized clients and provide for broad population health status improvement.
- Ensure client data sovereignty to maintain security, build trust and improve adoption: When clients participate in transparent decisions with control over their own records, they are more likely to trust that their well-being is valued, and that the system is working for them.
- Build data ecosystems to enable intelligent business operations within and between public health organizations: Data, analytics and AI are opening the door to new possibilities for how public health organizations can overcome barriers to data sharing across systems and health ecosystem partners (general practitioners, labs, and other facilities), enabling outcomes that exceed the boundaries of any single organization.
- Leverage 360-degree organizational transformation: Public health organizations should take a 360-degree value approach to organizational transformation. Such an approach will help ensure that they meet public and funding agency expectations and build trust, resilience, and sustainability. The ideal is a public health organization with a complete view of key financials, but also citizen and employee experiences, sustainability, talent, inclusion/diversity, and organization-specific innovation and quality metrics.
With these steps, Canada’s public health system can provide clients with truly personalized and relevant experiences. These digital and physical interactions can be crafted to each person’s needs. Public health organizations can also enable public health professionals to increase meaningful client engagement. By reducing and, over time, removing administrative tasks, they can create capacity to focus on clients based on health equity principles. In doing so, public health organizations can finally realize the rhetoric of human centeredness and meet people on their own terms. Leading public health organizations in Canada have said that a well-prepared public health system must have scalable, flexible, and resilient surge capacity. They need to respond to the immediate needs of a public health emergency. They also require enough resources to attend to other existing or emerging health priorities (e.g., the opioid overdose crisis, climate change) without risking workforce burnout.
We’re encouraged that technology and data, used responsibly, can allow the public health system to focus on clients and public health staff. The health system has long wanted to focus on people but has been constrained by the slow pace of technology development and roll-out, as well as core human concerns around trust.
If you are interested in shaping the future of public health, we encourage you to register for Digital Health Canada’s upcoming Winter Workshop on January 17th. You can learn more here: https://www.digitalhealthcanadamembers.com/event-5011514
 Ontario Science Table, March 2022, COVID-19 pandemic still hitting low income areas hardest, https://www.cbc.ca/news/canada/toronto/ontario-covid-19-science-table-low-income-neighbourhoods-hardest-hit-pandemic-1.6390882#:~:text=Cipriano%20said%20lower%20income%20communities,without%20safety%20nets%20in%20place. (Accessed November 1, 2022)  Public Health Ontario; June 2021; COVID-19 – Strategies Adaptable from Healthcare to Public Health Settings to Support the Mental Health and Resilience of the Workforce during the COVID-19 Pandemic Recovery, https://www.publichealthontario.ca/-/media/documents/ncov/ipac/2021/08/covid-19-public-health-workforce-recovery.pdf?sc_lang=en (Accessed November 1, 2022)