Dr. David Mowat

By Sharon Gray
In the wake of the SARS crisis, the federal government established a National Advisory Committee on SARS and Public Health (the Naylor Report). The consensus is that major changes are needed in the public health system.

Dr. David Mowat, director general of the Centre for Surveillance Coordination with the Population and Public Health Branch of Health Canada, was at the medical school Feb. 9 to discuss the implications of this report in a public lecture titled Public Health at the Crossroads.

“After SARS, something has to change,” he said. “It’s not just infectious diseases but the broader problems of health protection and health promotion.”
Dr. Mowat explained that public health services are delivered by the provinces and territories, with delivery taking place though 137 local agencies country-wide. In the case of SARS, the epidemic was confined mainly to Toronto; thousands of people were quarantined and there were 44 deaths. The economic impact is calculated at up to $1.5 billion.

“There were actually two SARS outbreaks – the first from Feb. 23 to April 23 and the second from May 23 to June 5. By the time the travel advisory was imposed, the first outbreak was over and the second originated with infected individuals in Toronto.”

Dr. Mowat said that mortality due to infectious diseases such as SARS is very small, compared to the major killers such as cardiovascular diseases. “Our major public health problems are obesity, physical inactivity and nutrition. Diabetes is a growing problem, affecting 15 per cent of older males and an increasing proportion of the Aboriginal population.”

In terms of infectious diseases, since 1973 more than 30 previously unknown diseases associated with viruses and bacteria have emerged including the Ebola virus, Legionnaire's disease, HIV/AIDS, Hepatitis C, Creutzfeldt-Jakob disease and the avian flu. There’s been a five-fold increase in syphilis and there are now antibiotic resistant variants of diseases such as tuberculosis.

Because the public health system tends to operate in the background, it takes an unexpected outbreak of disease such as SARS or the failure of health protection as occurred with water contamination in Walkerton, Ontario, in 2000 to make people sit up and take notice. Dr. Mowat said national strategies are needed to tackle diseases like diabetes or emerging diseases. “We need modern, harmonized legislation and at a national level we need a federal agency – perhaps Public Health should be set up as a free standing agency separate from Health Canada.”

Dr. Mowat’s vision is of a national network that will link public health with the provinces, the academic community and voluntary groups. “I don’t think we’re going to change by doing the same thing we’ve done for 50 years. We need to tackle chronic diseases by going beyond government.”