from Canadian Medical Association Journal 

The federal government's decision to stop funding the Health Council of Canada as of March 2014 has prompted an outcry from the Canadian Medical Association (CMA) and other health care organizations, which fear the loss of an independent voice to monitor health equity.

Health Canada called Health Council of Canada CEO John Abbott on April 8, saying funding to the council would cease next year as part of federal government spending cuts. The council will receive $6.5 million for this fiscal year and $4 million to cover closing costs and pay severances, Abbott says.

The council was important in 2002 when the CMA first called for a permanent, independent national body to assess performance about the health care system across Canada, and it's important now, CMA President Dr. Anna Reid stated in a news release.

"How are we to transform the health care system to improve patient care if we can't measure what we're doing well and what we need to improve?" asks Reid.

"Canada's health care system needs all the information it can get, but instead we are about to lose one of the few bodies responsible for monitoring and measuring progress toward ensuring the health care system is able to meet the needs of Canadians."

The council was born in 2004, following recommendations by the Commission on the Future of Health Care in Canada (the so-called Romanow report), for a body to assess and report independently on the renewal of Canada's health system, including monitoring equal access. The council also monitors the 10-year accord that Ottawa and the provinces and territories reached on the transfer of federal dollars for health.

The council publishes general progress reports and themed reports on Aboriginal health, wait times, home and community care, health indicators and other topics. The council had no "sunset clause" when it was formed, and still has work to do, Abbott says. "We were under the premise it would continue and that it was seen as an essential element in the intergovernmental healthcare landscape."

For example, the council has been identifying and promoting innovative health care practices, allowing different practitioner groups, provinces and systems to learn from one another.

But the council has fulfilled its mandate, given that the 10-year federal-provincial accord ends in 2014, says Steve Outhouse, spokesperson for Health Minister Leona Aglukkaq. He criticized the CMA's response to Health Canada's decision.

"I believe that the CMA is showing that it is absolutely incapable of having a reasonable conversation on anything with the federal government," Outhouse told CMAJ in an interview. He described Reid's news release as "over-the-top with rhetoric."

Outhouse also complained about ideological attacks from critics of the government's decision, saying Ottawa is still increasing health transfers, as per the federal-provincial agreement, and funding to other organizations, such as the Canadian Institution for Health Information (CIHI).

Other health care advocates are worried that dismantling the council will create a gap in knowledge about how well different parts of the country perform on health care.

"I think it's appalling, but unfortunately not shocking," says Adrienne Silnicki, health campaigner for the Council of Canadians, a citizen's advocacy group. "The federal government is responsible for ensuring equity in health care across the country, and they have walked away from their responsibility."

"The health council produced important reports that offered Canadians a picture of what health care looks like across our country, in remote areas, and to vulnerable populations," she adds. "Their research showed that Canadians are being abandoned by the Harper government when they need care most."

The federal government seeks to respect different provincial and territorial health priorities, says Outhouse. But the Canadian Health Coalition believes that statement is "an admission on behalf of the federal government that they don't want national standards," says Mike McBane, national coordinator for the medicare advocacy group. McBane is worried that killing the Health Council of Canada marks the death of any attempt to create a national approach to health care.

"We've made momentum and progress, and now [the federal government] is saying that we're not committed to the future, we don't want any future plan, and it's now to provinces and territories to do whatever they want," he says.

The federal government may be signalling that having a federal-provincial-territorial health care strategy is now out of the question, says Dr. Michael Rachlis, a Toronto-based health policy analyst.

"The federal government is certainly doing everything they can to say that healthcare has nothing to do with them," says Rachlis. He fears that the government "seems quite content to let the system get into hard times out of neglect."