Recent experience such as SARS and the Walkerton water tragedy focused public, political and media attention on public health services across Ontario. Both federal and provincial governments have responded to these public health emergencies with commissions, reports and new visions for public health. While the response of government has included commitments for additional resources for public health, the new vision focuses almost exclusively on expanding and strengthening the disease control responsibilities of the public health system. As a result, there are very real concerns that the role of public health nurses to implement strategies that promote health and build capacity in individuals, families and communities has been and will continue to be diminished.
The introduction of the Health Protection and Promotion Act and the establishment of the Mandatory Health Programs and Services Guidelines in the 1980’s, and more recently, the downloading of funding of public health to municipalities, resulted in significant changes to public health units. For public health nurses (the largest group of public health professionals) the changes were dramatic and included :
When faced with SARS, a public health emergency like no other, public health nurses demonstrated unique and specialized skills in policy development, advocacy, risk communication, health assessment, health teaching, counseling and contact follow-up case management.ii While public health nurses were able to face the challenges, the experience was stressful and nurses
identified serious concerns about service delivery and workload.
The New Priority for Public Health
Three key reports provide analysis and recommendations to shift the priority activities in public health at both the federal and provincial levels.
These reports and recommendations were the result of very real public health crises that exposed significant weaknesses in the public health system. While it is important that these issues are addressed to monitor and control infectious diseases more effectively, it is imperative that we also consider the broader role of public health and ensure that efforts to strengthen this system balance the health promotion and protection role with the disease control function.
A Comprehensive Vision for Public Health
Ontarians need and deserve a strong and effective public health system. Such a system must have a renewed and revitalized
approach that balances health promotion and disease prevention with the responsibilities of preventing and responding to public health threats.
Canada has a long and very proud history of advocating for a social determinants approach and advancing health promotion
and it is ironic that we have not been able to truly embrace and adopt health promotion as the framework in our own health care system.
As Ontario moves forward to rebuild our public health system, it is essential that we consider how the system will react to new
threats but also that we focus on health promotion in the broadest sense – diminishing poverty and homelessness, fostering health schools, closing the gap between rich and poor through income distribution, increasing access to education, ensuring clean
environments, improving literacy, promoting healthy growth and development, creating supportive communities, building community capacity and taking measures to ensure a clean safe environment.
RNAO’s Vision for Nursing in the New Public Health Environment
Public health nurses must continue to have dual responsibilities. In their practice, they should consider communities at large to address issues in population health while also working on strategies to improve individual and family health. They link the health of the community with the health of individuals and groups who live and work in the community.
Public health nurses practice in practice in a “setting without walls.”iii Their clients self-refer and come from diverse settings including schools, health facilities, work places, the street and community settings. One of the hallmarks of public health nursing is the trust that individuals and communities place in them.
Public health nurses bring a broad range of skills to their practice: counseling, teaching, advocacy and community development. This skill set allows them to make a difference to individuals, families and groups and to effect change at the community level. To move forward on a health promotion agenda, public health nurses must expand the scope of services provided beyond the limitations currently imposed by the Mandatory Health Programs and Services Guidelines.
Examples of public health nursing activities that should be accessible across Ontario include:
RNAO Calls for Action to Sustain a Vibrant Public Health Nursing Workforce
There are three critical factors that must be addressed to maintain and sustain a vibrant public health nursing workforce: positions, education, and leadership.
Please see the PDF version of this document  for footnotes and references.