The need for continuous systems thinking in public health in Canada.

a group of public health leaders in Canada called for the Canadian Public Health Association (CPHA) to establish an ongoing open forum for systematic reflection on public health system(s) elements in Canada as part of its annual conference. This call recognized that health system(s) reform in the country requires systems thinking in public health. CPHA recognized this need and offered us the opportunity to debate these issues at the 2011 conference. The 2011 panel reflected on recent changes in Canada's public health landscape. The federal, provincial and territorial (F/P/T) Ministers of Health and Healthy Living endorsement of a new declaration on disease prevention and health promotion emphasizes the importance of multisectoral partnerships. The Pan-Canadian Public Health Network has been restructured to maximize its efficiency and effectiveness in addressing the most important public health questions. At the provincial level, Québec continues to have health and social services administered by the same ministry, which facilitates systematic integration of public health services across jurisdictions , from local to regional to provincial and across interdependent sectors. In British Columbia, public health, previously under a separate ministry, has been merged into Ministry of Health and Safety. In Ontario, the new public health agency (now called Public Health Ontario) developed a new strategic plan, while the Ministry of Health Promotion and Sport is now folded back into the Ministry of Health and Long-Term Care and the 14 Local Health Integration Networks (LHINs) continue to manage the care system. Alberta has moved away from regional offices to one board and is now back to two zones. In Nova Scotia, a new Health and Welfare Department has been created. In Newfoundland and Labrador, it is the Child and Welfare Service that covers public health. While many of these changes in the landscape are positive, the public health system(s) remains a multilevel and multiplayer puzzle. Recognizing the need for systems thinking and continuous optimization of governance mechanisms to ensure that public health system(s) are coherent, several important points are highlighted below. First, from the example of Québec, where health and social services are integrated into the same ministry, a structure exists that provides both horizontal and vertical integration (provincial, regional and local). Moreover, using the legislative lever of Section 54 of the Public Health Act (1998), additional intersectoral action is achieved by requiring other ministries to undertake health impact assessments (HIA) for any important legislative or policy interventions that …