Law and Public Policy

D09 - Public Health Institutions, Evidence and Trust

Date: Jun 13 | Time: 08:30am to 10:00am | Location: Hotel Le Cantlie, 1110 Sherbrooke St West/Ouest, salle Mont-Royal room

Chair/Président/Présidente : Carole Clavier (UQAM)

Discussant/Commentateur/Commentatrice : Carole Clavier (UQAM)

Institutional Design And Public Trust: Why Independent Public Health Officials Will Be Ineffective and Will Do Little to Rebuild Trust in Public Health: Patrick Fafard (University of Ottawa), Jared Wesley (Unversity of Alberta)
Abstract: The COVID-19 pandemic has politicized as never before the public health function of government. This had led to a decline in public trust in public health institutions. Yet such trust is essential if public health measures are too be effective. To rebuild public trust, the design of the public health function of government is a priority in several Canadian provinces. Because they are the most visible public health official in each province, many critics are calling for the advice that chief medical officers provide to the government should be made public. For others, the role of CMO should be much more independent of the government of the day up to and including making CMOs and officer of the legislature similar to the auditor general. Drawing on research on policy advisory systems, science advice, and the role of senior officials in parliamentary systems, we critically evaluate the arguments made in favour of a more independent chief medical officer and argue that a truly autonomous chief medical officer is both unworkable and undesirable. The paper concludes with a discussion of what institutional design of the public health function of government might contribute to (re)building public trust.

Decisions in Crisis: Policy Communities and Political Appeals to Evidence-Based Decision-Making During COVID-19: Adrienne Davidson (McMaster University), Katherine Boothe (McMaster University)
Abstract: School closures were a key element of many Canadian provinces’ responses to the COVID-19 pandemic during 2020 and 2021. These decisions have significant impacts on students, educators, and families, and were at times controversial. They varied among Canadian provinces: in spring 2021, Ontario closed schools for more than ten weeks, while Alberta closed for only two weeks. We found striking differences in officials communication about school closures in the two provinces, particularly in the ways officials referenced evidence. This led to our central research question: Why do governments differ in their use of evidence in public communication during periods of crisis and uncertainty? The use of evidence can be an important tool to justify contested decisions, and this is complicated when evidence is uncertain or changing rapidly. Ontario and Alberta vary regarding how often evidence was referenced, what sources of evidence were used, and which actors took main responsibility for communicating with the public. We also find variation in between the two provinces in terms of the alignment between the content of the evidence cited and the way it is used. We examine how these choices about evidence communication are affected by the relative centralization of public health governance, the size and range of the group of legitimated policy actors, and the legacy of communication choices early in the crisis. This research has important implications for our understanding of trust between governments, experts, and the public in the context of high-stakes crisis decision making.

Populism, Partisanship and Public Trust: The Alberta Chief Medical Officer of Health During COVID-19: Lisa Young (University of Calgary), Duane Bratt (Mount Royal University)
Abstract: In March of 2020, Alberta’s Chief Medical Officer of Health Deena Hinshaw became a celebrity in the province, serving as the public face of the pandemic response. Her catch-phrase “we’re all in this together” morphed from a rallying cry in the early days of the pandemic to an empty promise in later months. Eventually, it served as an ironic epitaph when Hinshaw was removed from the post in November of 2022. This paper examines Hinshaw’s rise and fall to shed light on the role of the CMOH during a public health emergency. It argues that the role assigned to Hinshaw by the provincial government was part of a broader strategy of blame-shifting. It also examines ways in which populism and partisanship shaped public trust in Hinshaw over the course of the pandemic and reflects on what is required to rebuilt trust in the public health system.

Aging with (In)equality: Hard Lessons from the COVID-19 Pandemic and its Aftermath: Poland Lai (York University)
Abstract: Older adults, especially older adults with disabilities, have been disproportionately and negatively affected by the COVID-19 pandemic (for example, Lewis et al 2023). Poor (even deadly) care in Canadian long-term care homes (for example Béland and Marier 2020) is just one example of how government action (or lack of it) worsens systemic inequality. There is a growing body of work that addresses how COVID has exacerbated inequalities by attending to gender, race and other factors related to marginalization (Albader 2022; Germain and Yong 2020; Couture-Ménard, Bernier, Breton and Ménard 2023). Less attention has been devoted to aging and disability. This paper concerns inequality on the basis of age and disability in the health and social care systems in Canada. The focus is on the regulatory aspects of health and social care because states across the globe attempted to respond to the pandemic through rules and regulations. The research methods include review of government documents and legal research. The paper will first highlight measures (implemented via law) that purported to protect older adults. Then it will describe cases where older adults with disabilities and/or their families challenged measures such as 'no visitors' policy in hospitals (e.g. Sprague v. Her Majesty the Queen in right of Ontario) and sought remedies from the courts. It aims to explain how law was mobilized to “protect” older adults from the spread of the coronavirus while undermining their rights under provincial human rights legislation, the Charter and the Convention on the Rights of People with Disabilities.