Iwona A. Bielska

The Canadian health care system is a publicly financed system administered by ten provincial and three territorial governments. The purpose of this article is to provide an overview of the universal health care system in Canada, including its history, the health status of Canadians, health care funding and spending, and health research and data collection. Health care spending in Canada amounts to 11.6% of the country’s gross domestic product and is estimated to have been $200.5 billion Canadian dollars in 2011. Hospitals account for the largest source of health care spending (29%), followed by drugs (16%) and physician spending (14%). Of the total health care spending, 70% is paid for by the public system. Due to the Canadian population being covered by the universal health care system, health data are being collected and can be used to monitor the health care system and inform evidence-based medicine.

The public health system in the province of Ontario in Canada is a publicly funded system that is responsible for addressing the health status of the population. Public health involves the combined effort of all levels of government (federal, provincial, municipal) in the country to strengthen the health system and promote the health of Canadians. The federal Canada Health Act guides the delivery of health services, with the administration of the health system a provincial responsibility. There are multiple organizations involved in public health including the Ontario Ministry of Health and Long-Term Care, Local Health Integration Networks, local Boards of Health, Public Health Ontario, and the Ontario Public Health Association. Public health program costs at Ontario’s 36 public health units are shared between municipal and provincial governments. Public health initiatives undertaken by public health units and governmental agencies are aimed at addressing and improving the population’s determinants of health.

In late January 2020, the first COVID-19 case was reported in Canada. By March 5, 2020, community spread of the virus was identified and by May 26, 2020, close to 86,000 patients had COVID-19 and 6,566 had died. As COVID-19 cases increased, provincial and territorial governments announced states of public health emergency between March 13 and 20, 2020. This paper examines Canada’s public health response to the COVID-19 pandemic during the first four months (January to May 2020) by overviewing the actions undertaken by the federal (national) and regional (provincial/territorial) governments. Canada’s jurisdictional public health structures, public health responses, technological and research endeavours, and public opinion on the pandemic measures are described. As the pandemic unravelled, the federal and provincial/territorial governments unrolled a series of stringent public health interventions and restrictions, including physical distancing and gathering size restrictions; closures of borders, schools, and non-essential businesses and services; cancellations of non-essential medical services; and limitations on visitors in hospital and long-term care facilities. In late May 2020, there was a gradual decrease in the daily numbers of new COVID-19 cases seen across most jurisdictions, which has led the provinces and territories to prepare phased re-opening. Overall, the COVID-19 pandemic in Canada and the substantial amount of formative health and policy-related data being created provide an insight on how to improve responses and better prepare for future health emergencies.

The outbreak of the COVID-19 pandemic has resulted in various public health responses around the globe. Due to the devolved powers of the United Kingdom, the response has been centralized but simultaneously greatly differing across England, Wales, Scotland, and Northern Ireland. The following article examines the governmental responses to the outbreak, the public health measures taken, data collection and statistics, protective equipment and bed capacity, the society’s response, and lastly, the easing of the lockdown restrictions. In terms of the governmental response, the COVID-19 pandemic was initially met with less urgenon/populacy and social distancing, along with the development of herd immunity, were first mentioned. As the virus continued to spread, the government started imposing stricter measures and a lockdown was implemented. Tests were conducted using a five pillar typology. The collection of information, particularly on COVID-19 associated deaths, varied across the United Kingdom and among the governmental organizations due to differing definitions. In term of hospital bed availability, the rate of hospitalizations was the highest from late March to early April of 2020. Temporary hospitals were constructed, however, they mostly went unused. The United Kingdom society was generally compliant in adapting to the lockdown and trust in the government rose. Nonetheless, as the lockdown progressed, trust in the government began to fall. After several months, the rate of infection decreased and the lockdown in the United Kingdom was lifted in accordance with ‘Our plan to rebuild: The United Kingdom Government’s COVID-19 recovery strategy’. The slogan ‘Stay at Home. Protect the NHS. Save Lives’ was replaced with ‘Stay Alert. Control the Virus. Save Lives’.

Ankle sprains are common soft-tissue injuries that are often treated in emergency departments. These injuries can have significant consequences for the patient, including long-term morbidity and loss of productivity. The objective of this study was to examine the direct and indirect health resource utilization associated with ankle sprains. 296 adult patients with acute ankle sprains participated in the study in Kingston, Ontario, Canada. Data were collected using a one-month productivity questionnaire. Overall, 11% (95% CI, 8-15%) of the participants visited a physician following the initial emergency department visit. Almost all (95%; 95% CI, 92-97%) of the participants used medications or supportive treatments and 55% (95% CI, 50-61%) reported taking time off from work, school, or housework. The use of unpaid assistance was indicated by 56% (95% CI, 50-62%). Findings from this analysis highlight the significant patient-related and health care system burden of acute ankle sprains.

The first positive case of COVID-19 in Canada was reported on January 25, 2020, in the city of Toronto, Ontario. Over the following four months, the number of individuals diagnosed with COVID-19 in Ontario grew to 28,263 cases. A state of emergency was announced by the Premier of Ontario on March 17, 2020, and the provincial health care system prepared for a predicted surge of COVID-19 patients requiring hospitalization. The Chief Medical Officer of Health and the Minister of Health guided the changes in the system in response to the evolving needs and science related to COVID-19. The pandemic required a rapid, concerted, and coordinated effort from all sectors of the system to optimize and maximize the capacity of the health system. The response to the pandemic in Ontario was complex with some sectors experiencing multiple outbreaks of COVID-19 (i.e. long-term care homes and hospitals). Notably, numerous sectors shifted to virtual delivery of care. By the end of May 2020, it was announced that hospitals would gradually resume postponed or cancelled services. This paper explores the impact of the COVID-19 pandemic on multiple health system sectors (i.e., public health, primary care, long-term care, emergency medical services, and hospitals) in Ontario from January to May 2020. Given the scope of the sectors contributing to the health system in Ontario, this analysis of a regional response to COVID-19 provides insight on how to improve responses and better prepare for future health emergencies.

Public health is comprised of services, programs, and policies aimed at promoting health, preventing injury and chronic diseases, and responding to health emergencies. Public health professionals include front line providers, consultants, and specialists from various disciplines and professions, such as medicine, nursing, and epidemiology. Public health in Canada is provided through the collaboration between three levels of government, namely municipal, provincial or territorial, and federal. While public health is a shared responsibility of all levels of government, the volume and direction of allocated resources for related activities varies between the provinces and territories. Canada’s public health history predates its founding in 1867. A turning point in public health in the country occurred following the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. The following year, the federal Public Health Agency of Canada (PHAC) was created. Its role is to improve and maintain population health in Canada. The Chief Public Health Officer is the deputy head of the PHAC and is the government’s lead public health professional. The public health landscape in Canada will continue to evolve to meet the growing needs of its population and to address existing health challenges including adverse health events related to chronic diseases and unhealthy lifestyles. Moreover, it will further adapt to respond to new public health threats, such as the emergence of tropical illnesses, the northward spread of infectious agents due to climate change, and disease transmission related to international travel.