Public Good and Individual Rights: A Public Health Perspective

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Public Good and Individual RightsA Public
Health Perspective

•  Security Privacy Conference Synergies in an
  e-Society 
• Jean-François Luc
• A/Director, Health Surveillance Coordination
• Victoria, Canada February 10, 2005

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What is health surveillance?

• TThe ongoing, systematic use of health data to
  guide public health action, in a timely fashion

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An Outbreak
Company Recall 1

Number of Cases
(March 31)
40
Lunchmate (386)
( lt 386 )
35

No Lunchmate (127)
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Outbreak recognized
(March 25)
25
20
Company Recall 2
(April 9)
15
Cheese Recall
(April 15)
10
5
0
05-Apr
12-Apr
19-Apr
01-Mar
08-Mar
15-Mar
22-Mar
29-Mar
N lt 513
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Health Surveillance A CorePublic Health Function

• Population health assessment
• Health surveillance
• Health promotion
• Disease and injury prevention
• Health protection

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Agency Surveillance

• Focus
• national and international surveillance of
  diseases and key health indicators
• Rapid detection and response to disease events
• Development of appropriate targeted progress and
  policies aimed at disease prevention and control

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Data Collection

• Mandatory reporting of communicable diseases
• Repeated surveys
• Administrative data
• Population subgroups and events
• Reports

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Considerations for planning

• Too complex to plan in isolation
• Rely on P/Ts, hospitals, laboratories, physicians
  to provide data
• Limited resources
• External pressures to align partnerships and
  technology, and need to align with relevant
  technical and practice standards
• Need to plan for programs to be able to share
  and/or receive data with/from others (awareness
  of/integration with the broader landscape)

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Considerations for effectiveness

• Requires knowledge of
• Potential actions in response to identified
  concerns
• What does/can the Agency, or others, do about
  this?
• Data that will be required to support decisions
• What is the evidence for taking this action?
• How good is/can be the evidence going into the
  decision? Can it be improved?

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Considerations for effectiveness (2)

• Requires knowledge of
• Legislation/regulations that support or hinder
  surveillance
• Can we collect, use, disclose that data?
• Agreements in place
• Do we have to seek new permission to collect that
  data?
• Partnerships in place or required
• Who else needs to work on this?

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A delicate balancing act

• Life threatening?
• Mode of transmission?
• Diagnostic test?
• Case definition?
• Effective vaccine or treatment?
• Privacy?
• Coercive and/or voluntary measures???

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Report from the National Advisory Committee on
SARS and Public Health
http//www.hc-sc.gc.ca/english/pdf/sars/sars-e.pdf
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What is in place now (Federal)

• Privacy Act
• PIPEDA
• GoC policy on Privacy Impact Assessments
• Pan-Canadian Health Privacy and Confidentiality
  Framework (F/P/T)
• Data sharing agreements for selected diseases
• Growing agreement among F/P/Ts regarding IT
  privacy and security requirements (Infoway)

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Issues/Gaps

• Few authorities to collect, use, retain and
  disclose personal information
• Canadian Charter of Rights and Freedoms
• Lack of harmonized F/P/T legislative framework
  regarding health surveillance, infectious disease
  management and personal information
• Data sharing agreements between F/P/Ts

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Strategy

• Public Health Agency of Canada
• Federal leadership in programs, research and
  surveillance related to
• Emergency preparedness response to disease
  outbreaks
• Prevention control of infectious diseases
• Prevention control of chronic diseases and
  injury
• Health promotion community action
• Strengthen capacity for collaboration on public
  health issues domestically and internationally

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Strategy (2)

• Chief Public Health Officer
• Heads Public Health Agency
• Reports to Minister of Health
• Public Health Strategy
• Pan-Canadian Public Health Network
• National Collaborating Centres

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Preparing for future PH threats

• Considerations
• Need to act upon fragmentary evidence
• Must protect populations against foreseeable
  threats
• Failure to intervene must be justified
• New Legislative Architecture
• Proposal http//renewal.hc-sc.gc.ca

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Merci !Jean-François LucA/Director, Health
Surveillance CoordinationPublic Health Agency of
CanadaE-mail jfluc_at_phac-aspc.gc.caTel (613)
954-6363