In what direction is the Canadian healthcare system evolving?

Quebec has a distinctive character among the Canadian provinces not only because of its majority French-speaking population, its culture, its social democratic values, and its institutions, but also because of the flamboyant style of its public policies and legislation. The article by Bernier in the last issue of the Journal stresses this distinctive character as applied to public health and healthcare (1). Leaning on rigorous and meticulous research, Bernier provides an in-depth analysis of the public health infrastructure and mechanisms in Québec to ensure progressive public health policies. The close integration of health and social services and a comprehensive view of public health that encompasses social determinants of health have served as a framework for planning and implementing progressive public policies. Placing the main responsibility for social and economic inequalities on the shoulders of public health can, however, lead to an important unanticipated and adverse outcome, the disengagement of the government's jurisdictions other than health from any responsibility for action on conditions that affect health improvement. As public health is located within the jurisdictional domain of healthcare, there are limits on its potential for action. It lacks the levers to intervene effectively in other jurisdictions. Legislation giving the Minister of Health and Social Services the right to advise other Ministers on their policies that may affect population health is not fully operational. Ironically, the law is not reciprocal. The Minister of Health and Social Services need not seek advice from