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While the report by Drs. Danielle Martin and Pierre-Gerlier Forest plays down the actual answers to the problems of  the lack of coherence in national organizations to advance and change health care, their efforts to advocate for cohesion by framing the efforts for these evidence developing organizations as a suite is refreshing.  Clearly the devil is in the details but its important that the federal government places itself as having a critical role in contributing to research, practice, policy in Canadian health care.

The suite is listed here, in chronological order of founding:

  • Canadian Centre on Substance Use and Addiction (CCSA)
  • Canadian Agency for Drugs and Technologies in Health (CADTH)
  • Canadian Institute for Health Information (CIHI)
  • Canadian Foundation for Healthcare Improvement (CFHI)
  • Canada Health Infoway (Infoway)
  • Canadian Patient Safety Institute (CPSI)
  • Canadian Partnership Against Cancer (CPAC)
  • Mental Health Commission of Canada (MHCC)

… The PCHOs are self-governed, non-profit organizations. Although the federal government provides the majority of their funding, they operate as arm’s-length bodies. They were set up between 1988 and 2007 to respond to disparate health policy issues affecting the country. …

“Fit for Purpose: Findings and Recommendations of the External Review of the Pan-Canadian Health Organizations – Summary Report”


The terms of reference for this review made it clear that there is a pressing need for the PCHOs to help citizens, providers, administrators, and policy makers address the vulnerabilities of today’s health systems. These vulnerabilities include issues related to fragmented and inadequate pharmaceutical policy; the need for robust health data governance and digital infrastructure; the desire to scale-up successful health innovations; the need to modernize the basket of publicly funded services to promote equity; the critical importance of strong primary care systems across the country; the need for more meaningful patient and public engagement in health care; and the imperative of working in partnership with Indigenous organizations and communities to improve Indigenous health outcomes.

But beyond the vulnerabilities of today, a successful PCHO suite must be designed to support the emergence of health systems of the future across Canada. Therefore, before recommending a future set of PCHOs, we endeavoured to understand what these 21st century systems will look like. A consensus vision emerged both across the country and in Canada’s international commitments. It is clear that Canada’s future health systems must be shaped by federal government partnership with the provinces and territories, as well as with Indigenous partners. The need to balance local and regional priorities against the need for a shared architecture and framework across Canada’s health systems will be ongoing. But there is also a set of global trends and an emerging international consensus that will set the broader context for health system reform.

The World Health Organization’s model of Integrated, People-Centred Health Services, endorsed by countries the world over – including Canada – is presented as the framework to guide Canada to 21st century health care. It puts people at the centre of the health system and promotes care that is universal, equitable, and integrated. The framework emphasizes a seamless connection to other sectors, notably those focused on the social determinants of health. This framework also promotes providing a continuum of care that requires high-performing primary care.

Learning health systems are also an essential foundation for effective health systems of the 21st century. Their goal is patient care that is continuously informed by the meaningful use of data, evidence, and research, with research and practice connected through a continuous feedback loop. This vision requires fully electronic and inter-operable health systems in which data are collected, openly shared, and accessed quickly and efficiently. ...

See the report here:

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Andre Picard, explains the political context of the report.


It is also clear that, in all the scenarios, three organizations come out big losers: the Mental Health Commission of Canada, the Canadian Partnership Against Cancer and the Canadian Centre on Substance Abuse and Addiction.

Dr. Martin said it is not because issues such as cancer, mental health and addiction are unimportant – on the contrary, these problems are so pervasive they need to be tackled on a broader scale, not merely by small, stand-alone organizations. ...

I'd advocate that Accreditation Canada  be figured into this, maybe it is in the report and I missed it? 

It is such a key driver of  individual organizations trying to measure and improve themselves and have front line: worker, client, family, manager, community -- involvement and inter-exchange.  It would benefit from a greater focus beyond itself, yes it's practically a creature unto itself; if we are to have a whole system approach.


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After reading the August 2016 "Early Years Evidence Brief, I thought some additional references might be useful, as the World Health Organization (WHO) adopted [and expanded upon] the US CDC/Kaiser-Permanente ACE [Adverse Childhood Experiences] Study Screening Tool (the WHO ACE International Questionnaire)--which it used in their 2013 (WHO) Assessment of the world's healthiest children (Netherlands ranked #1, U.S. A. ranked 25th, and Canada ranked 26th, ...) as they examined the factors which contributed to the "Toxic Stress" and C/PTSD which can effect neurodevelopment of prenatal and perinatal infants and children, as well as adolescents.

In 2000, I attended a "Grand Rounds" continuing [medical] education session at [then Dartmouth, now] Geisel Medical School, by an Epidemiologist entitled: "52% of Detroit Metropolitan Area Schoolchildren met the DSM-IV criteria for PTSD". Being this close to Windsor, Ontario, I thought subsequent reports in the  U.S. of similar numbers of schoolchildren in Philadelphia, Baltimore, Atlanta, and in June of this year [2018] at five charter schools in New Orleans, might prompt at least Windsor, Ontario to assess their schoolchildren in case this 'Epidemic' is spreading from the U.S. into Ontario, and perhaps other locations in Canada--if there was any validity to the 2013 WHO Assessment of the world's healthiest children.

The Alberta Family Wellness Initiative, funded by the Robert Wood Johnson Foundation, was intended to address both the 'Resilience Building' benefits for children, as well as the trans-generational aspects of parent's own childhood trauma/'toxic stress'. The Alberta Family Wellness Initiative was noted in the "Community Resilience Cookbook"-also funded by the Robert Wood Johnson Foundation.

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As an addendum to my previous comment, which didn't address the addiction concerns, it may help to peruse the US CDC/Kaiser-Permanente ACE Co-Primary Researcher's subsequent paper (first published in german language in 2003 in Kinderpsychologie und Kinderpsychiatrie, and in english in 2004 in the Permanente journal), entitled: "The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study". I don't know if the World Health Organization addressed any aspect of it, but I have yet to find or be made aware of any refutation of Vincent Felitti, M.D.'s paper on Addiction and Adverse Childhood Experiences. I believe a Canadian physician, Gabor Mate, M.D., has presented similar concerns.

Although copies of the [forthcoming] Canadian Indigenous People's Atlas aren't expected to be available, in the US, until September 25th of this year, I got the distinct impression it also had value as a 'Resilience Building' tool for both children and adults. I was hoping to see where the former independent "Republic of Indian Stream" was located between Quebec and New Hampshire, before the Sheriff of Coos County, N.H. 'annexed' it in 1896, as part of Pittsburg, N.H.

One additional Health Care System resource may note the 'trans-generational nature of trauma model' in use in pediatrician Nadine Burke-Harris' California Bay Area clinic. She also has a you-tube TED Talk video explaining how 'toxic-stress' in childhood affects physical and 'mental' health throughout the life course.

To the extent that the Flexner Report on Medical Education (recommending the German [male-only] model of medical education) may have impacted or contributed to any particular 'health care system factor' in Canada, as well as it's use and influence on medical education and practice in the U.S., I trust that its mention may also be a valid concern.

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