Challenges in Public Health Governance

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Challenges in Public Health Governance: The Canadian Experience is an examination of public health from a governance perspective.
Part 1 begins with an examination of the fragmented nature of public health in Canada, identifies some major fault lines that characterize the public health realm, and reviews briefly the notion of network governance.
Part 2 looks at specific public health theatres: crisis issues such as SARS and the HlNl pandemic, and the ongoing work of the Canadian Heart Health Initiative. It also examines the Pan-Canadian Public Health Network as the key piece of network infrastructure at the national level. It seeks to demonstrate that current governance structures and mechanisms are inadequate to deal with the governance challenges facing public health, and that network governance, appropriately applied, is a means through which public health in Canada can better achieve its objectives.
Part 3 examines the nature of the relationships with the voluntary sector, and discovers that much of the potential of these organizations to contribute to public health is being lost. Global trends further underline the need for broader, more inclusive forms of governance.
Part 4 deals with the need to develop the tools for network governance to cope with issues related to governability, accountability, and legitimacy. The book ends with a proposal to establish a network governance regime in public health and identifies a series of practical steps that can be taken to achieve this objective.

Claude M. Rocan was born in St. Boniface, Manitoba, and earned a PhD in political science from York University. He held policy/advisory positions within the Government of Saskatchewan and the Government of Canada at the senior professional and executive levels. As Director General of the Centre for Health Promotion at the Public Health Agency of Canada, he had the opportunity to experience directly the complexities and challenges of governance in the public health sector. He was recently a Visiting Fellow with the Graduate School of Public and International Affairs at the University of Ottawa. He lives in Manotick, Ontario and is an independent public policy consultant, specializing in network governance.


Contents

PREFACE by Dr. Trevor Hancock
INTRODUCTION – GOVERNANCE, NETWORKS AND PUBLIC HEALTH 1
I – SETTING THE STAGE
CHAPTER 1 – PUBLIC HEALTH AND FRAGMENTATION: THREE FAULT LINES
• Introduction 13
• The length and breadth of public health 14
• Three major fault lines 16
• Conclusion 31
CHAPTER 2 – LOOKING AHEAD: IS NETWORK GOVERNANCE ‘THE ANSWER?’
• Introduction 33
• Network governance – what is it? 34
• The need for ‘entanglement strategies’ 38
• Weighing the costs and benefits 40
• Conclusion: Applying network governance to public health 42

II – PUBLIC HEALTH GOVERNANCE IN CANADA: THREE THEATRES

CHAPTER 3 – GOVERNANCE AND THE PUBLIC HEALTH NETWORK: TOO MUCH OR NOT ENOUGH?
• Introduction 47
• The Pan-Canadian Public Health Network (2005 edition) 48
• The PHN (2005): A breakthrough towards network governance? 52
• The 2011 Operational Review 59
• The PHN (2011 edition): Increased efficiency, but at what price? 63
• Conclusion 66
CHAPTER 4 – GOVERNANCE IN ‘WAR TIME’: NETWORKS AND PUBLIC HEALTH EMERGENCIES
• Introduction 69
• Brief review of the SARS events 71
• Flawed governance prescriptions in post-SARS literature 72
• Can network governance be applied to emergencies? 81
• Taking stock 88
• Emergency preparedness and response in the Canadian context 91
• The H1N1 pandemic in Canada: What did this reveal? 93
• Conclusion 98
CHAPTER 5 – GOVERNANCE IN ‘PEACE-TIME’: THE CASE OF THE CANADIAN HEART HEALTH INITIATIVE
• Introduction 101
• Analytical framework 102
• The Canadian Heart Health Initiative 104
• Starting conditions 107
• Institutional design 109
• Collaborative process 115
• Facilitative leadership 118
• Conclusion 120

III – EXPANDING THE BASE

CHAPTER 6 – THE VOLUNTARY SECTOR IN PUBLIC HEALTH GOVERNANCE: PARTNERS IN NAME ONLY?
• Introduction 125
• The voluntary sector: Terminology and context 126
• The voluntary sector in Canada 128
• What makes the public health voluntary sector special? 134
• Three types of government-VSO relationships 136
• Conclusion: A base to build on? 152
CHAPTER 7 – GLOBAL DRIVERS
• Introduction 157
• Westphalia and beyond 158
• From international health governance (IHG) to global health governance (GHG) 160
• The drive for collaborative mechanisms 175
• Conclusion: Implications for Canada 179

IV – DEVELOPING THE TOOLS

CHAPTER 8 – FACING THE TOUGH QUESTIONS
• Introduction 183
• Network governance and the ‘governability’ question 184
• Accountability, transparency and legitimacy 187
• Operating in the ‘shadow of hierarchy’ 191

CHAPTER 9 – TOWARDS A NETWORK GOVERNANCE REGIME IN PUBLIC HEALTH
• Introduction 195
• Where to from here? 196
• Conclusion 213

BIBLIOGRAPHY 217

References


Quality Paperback with tables, 6×9” 242 pg, Publication date: June 2012, ISBN 978-0-9877575-8-6: $24.95


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