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. 2022 Oct;126(10):988-995.
doi: 10.1016/j.healthpol.2022.07.009. Epub 2022 Jul 20.

Tensions and opportunities in the roles of senior public health officials in Canada: A qualitative study

Adèle Cassola  1 , Patrick Fafard  2 , Ranjana Nagi  1 , Steven J Hoffman  3
Affiliations

Tensions and opportunities in the roles of senior public health officials in Canada: A qualitative study

Adèle Cassola et al. Health Policy. 2022 Oct.

Abstract

Although public health emergencies like the COVID-19 pandemic thrust senior public health officials into the spotlight, their day-to-day roles remain misunderstood and under-examined. In jurisdictions that follow the Westminster system of government such as Canada, the United Kingdom, and Australia, Chief Medical Officers of Health (CMOHs) are typically senior public servants who are simultaneously positioned as public health professionals with independent expertise, senior advisors to an elected government, and designated protectors of the public health interest. Using Canada's federal and provincial CMOHs as case studies of this role in Westminster governments, we analyzed in-depth key informant interview data to examine how CMOHs navigate the tensions among their duties to the government, profession, and public in order to maximize their public health impact. We demonstrate that CMOHs are variously called upon to be government advisors, public health managers, and public communicators, and that the different emphasis that jurisdictions place on these roles shapes the tools and pathways through which CMOHs can influence government action and public health. We also elucidate the tensions associated with having CMOHs positioned within the senior levels of the public service and the strategies these officials use to balance their internal- and external-facing roles. Finally, we highlight the trade-offs among different institutional design options to inform decisions about the structure of the CMOH position in different contexts.

Keywords: Chief Medical Officers; Institutional design; Public health advice; Public health governance; Public health officials.

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Conflict of interest statement

Declaration of Competing Interest Steven J. Hoffman is the Vice-President of Corporate Data & Surveillance at the Public Health Agency of Canada (PHAC) and previously served as the Scientific Director of the Institute of Population & Public Health at the Canadian Institutes of Health Research (CIHR). The views expressed in this article are those of the authors and do not necessarily reflect those of PHAC, CIHR or the Government of Canada.

Figures

Fig. 1
Fig. 1
Modeling the CMOH role.
See this image and copyright information in PMC

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