Public health matters for society, and the benefits of prevention have been clearly demonstrated: (1) a healthy population is a social good. Not having a disease or injury in the first place avoids much pain and suffering among patients and their families, as well as premature death. On top of this, there are significant economic benefits from prevention, both in avoided health care costs and in avoided loss of production, income, and tax revenue. (2, 3) Moreover, arguably, quality health care is not possible without a strong public health sector, (4) which contributes in a significant way to all three goals of the "Triple Aim", a widely-used set of overall goals for the health care system: improved population health, improved patient experience of care, and reduced per capita cost of health care. (5, 6)

The Editorial Board of the Canadian Journal of Public Health is thus alarmed by the ongoing erosion of public health capacity in Canada. Those concerns have been expressed in these pages several times in recent years. Public health has been characterized as "under siege" (7) and "under attack". (8) It has been argued that its weakening--characterized by downgrading the status of public health within governments and health authorities; eroding the independence of Medical Officers of Health; limiting the scope of public health by combining it with primary care; and decreasing funding--is a threat to both the health of the population and the sustainability of the health care system. (9)

Moreover, given public health's work on the most basic determinants of health and its commitment to social equity, the erosion of capacity will likely disproportionately impact populations already experiencing unacceptable health disparities--for example, Indigenous populations, who continue to experience health inequities that are rooted in unaddressed basic public health challenges and shame Canada on the international stage. (10, 11)

Public health continues to face challenges. Several further actions that erode public health capacity have occurred in just the few short months since our last editorial. (9) At a national level, the Public Health Agency of Canada has backed away from one of the key reasons it was established--to address concerns about public health capacity in Canada (12)--by eliminating both the Skills Online program (13) and the practicum awards for MPH students established in 2013. This award had "provided over $1.8 M of funding to 17 institutions across Canada". (14)

At the provincial level, the most serious attack on public health has occurred recently in New Brunswick, where the government fired the former Chief Public Health Officer (CPHO) last year for no discernible reason and has moved some 70 of the 110 staff out of the Ministry of Health, spreading them across three different ministries, (15) thus disrupting the cohesiveness of the public health department and undermining its ability to address important public health issues.

The reaction has been strong, with critical comments from public health professionals from across Canada in the local print media, on radio programs, and in open letters from the Canadian Network of Public Health Associations (16) and the Public Health Physicians of Canada. (17) Dr. Wayne McDonald, a former CPHO for New Brunswick, has labeled the changes "a recipe for disaster", (18) while Dr. Jim Talbot, a former CPHO of Alberta, has written that it "makes no sense" and "displays a profound ignorance of what public health is and what it does". (19) Despite these strong expressions of concern, the government of New Brunswick has gone ahead with its changes.

Public health capacity is being undermined in Ontario too, the last bastion of municipal public health in Canada. The recent Report of the Minister's Expert Panel on Public Health (Government of Ontario, 2017) (20) proposes a much closer relationship between public health and the health care system and an erosion of its links to local government. These proposals are problematic because most of what determines our health lies outside of the scope of the health care system. The Council of Medical Officers of Health, the Association of Municipalities of Ontario, the Association of Local Public Health Agencies, and the Ontario Public Health Association have all rejected or raised serious objections to the recommendations of this report. (21-24)

Even Canada's provincial and territorial CPHOs, not known for speaking out critically on government policy, have recently raised the alarm. Pointing to the 2010 Federal, Provincial, and Territorial Ministers' Declaration on Prevention and Promotion, (25) the CPHOs state: "Reviving a national prevention agenda is key to sustainability of health care in Canada" and they "implore health ministers to reaffirm commitment to the principles outlined in the declaration", (26) which include making prevention a priority, recognizing that it is the first step in disease management and a hallmark of a quality health system.

At a time when public health is under an unrelenting attack on its capacity to carry out its central functions, it is vital that the entire public health community--all our many professional/ disciplinary and academic organizations--come together and form a united front to defend and strengthen public health's capacity to promote and protect the health of Canadians in all provinces and territories.

It is equally important that groups and organizations in society that are concerned with the sustainability of the health care system rally round and support public health. They should insist that Canada's Ministers of Health honour their 2010 commitment that "the promotion of health and the prevention of disease, disability and injury are a priority and necessary to the sustainability of the health system" and that "a better balance between prevention and treatment must be achieved". (25)

Finally, all those in Canada concerned with the health of the population and the sustainability of the health care system need to demand that their provincial, territorial, and federal governments cease undermining and instead commit to strengthening public health. The continued erosion of public health capacity in Canada must be reversed, and instead must be reinforced, both to improve the health of the population and to reduce the burden of disease that threatens the sustainability of the health care system. Failure to do so puts at risk both of these highly valued social benefits.

Trevor Hancock, CJPH Senior Editor, On behalf of the Editorial Board of the Canadian Journal of Public Health

doi: 10.17269/CJPH.108.6556

REFERENCES

(1.) Rutty C, Sullivan S. This is Public Health: A Canadian History. Ottawa, ON: Canadian Public Health Association, 2010. Available at: http://www.cpha.ca/ uploads/history/book/historybook-print_all_e.pdf.

(2.) Merkur S, Sassi F, McDaid D. Promoting Health, Preventing Disease: Is There an Economic Case? Copenhagen, Denmark: WHO Regional Office for Europe, 2013.

(3.) Conference Board of Canada. Ameliorer les habitudes de vie : des retombees importantes pour la sante et l'economie du Quebec. Ottawa (Ontario) : The Board, 2014. Available at: http://www.conferenceboard.ca/e-library/abstract.aspx? did=6647 (Accessed November 25, 2017).

(4.) Hancock T. No quality health care without strong public health. CMAJ 2017; 189:E1435. PMID: 29158464. doi: 10.1503/cmaj.171287.

(5.) Institute for Healthcare Improvement. The IHI Triple Aim Initiative, n.d. Available at: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default. aspx.

(6.) Bergevin Y, Habib B, Elicksen K, Samis S, Rochon J, Adaime C, et al. Towards the Triple Aim of Better Health, Better Care and Better Value for Canadians: Transforming Regions into High Performing Health Systems. Ottawa, ON: Canadian Foundation for Healthcare Improvement, 2016.

(7.) Potvin L. Canadian public health under siege. [Editorial] Can J Public Health 2014;105(6):e401-3. PMID: 25560884. doi: 10.17269/cjph.105.4960.

(8.) Guyon A, Perreault R. Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform. Can J Public Health 2016;107(3):e326-29. PMID: 27763850. doi: 10.17269/ cjph.107.5273.

(9.) Guyon A, Hancock T, Kirk M, MacDonald M, Neudorf C, Sutcliffe P, et al. The weakening of public health: A threat to population health and health care system sustainability. [Editorial] Can J Public Health 2017; 108(1):e1-6. PMID: 28425892. doi: 10.17269/cjph.108.6143.

(10.) Truth and Reconciliation Commission. Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada. Ottawa, ON: TRC, 2015.

(11.) United Nations, International Covenant on Civil and Political Rights. Concluding Observations on the Sixth Periodic Report of Canada (CCPR/C/CAN/C0/6). UN Human Rights Committee, 2015. Available at: http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx? symbolno=CCPR%2FC%2FCAN%2FCO%2F6&Lang=en (Accessed November 26, 2017).

(12.) Public Health Agency of Canada. History. Ottawa, ON: PHAC, 2008. Available at: https://www.canada.ca/en/public-health/corporate/mandate/about-agency/ history.html (Accessed November 25, 2017).

(13.) Public Health Agency of Canada. Skills Online. Ottawa, ON: PHAC, 2017. Available at: https://www.canada.ca/en/public-health/services/public- healthpractice/skills-online.html (Accessed November 25, 2017).

(14.) Hoffman S. E-mail to Schools of Public Health from Steven J. Hoffman, Scientific Director, CIHR Institute of Population & Public Health, October 6, 2017.

(15.) Government of New Brunswick. Restructuring to Allow Enhanced Alignment of Government Expertise. Press release, August 31, 2017. Available at: http:// www2.gnb.ca/content/gnb/en/news/news_release.2017.08.1162.html (Accessed September 21, 2017).

(16.) Canadian Network of Public Health Associations. An Open Letter to the New Brunswick Minister of Health, October 12, 2017. Available at: https://www. cpha.ca/nb_openletter (Accessed November 25, 2017).

(17.) Allison S. N.B. public health under siege. Telegraph J. St. John's, NB, October 17, 2017.

(18.) Chilibeck J. 'Recipe for disaster': Former top doc slams changes to medical health office. Telegraph J. St. John's, NB, September 14, 2017. Available at: file: ///Users/trevor/Downloads/dr-wayne-macdonald-office-of-the-chief- medicalofficer-of-health-new-brunswick-restructuring-.html.

(19.) Talbot J. Weakening public health makes no sense. Telegraph J. St. John's, NB, October 25, 2017; A7.

(20.) Government of Ontario. Public Health Within an Integrated Health System: Report of the Minister's Panel on Public Health. Toronto, ON, 2017. Available at: http://www.health.gov.on.ca/en/common/ministry/publications/reports/ public_health_panel_17/expert_panel_report.pdf (Accessed September 26, 2017).

(21.) Council of Ontario Medical Officers of Health. Response to the Provincial Consultations on the Report of the Minister's Expert Panel on Public Health. Letter to the Minister of Health and Long-Term Care, October 12, 2017. Available at: http://c.ymcdn.com/sites/www.alphaweb.org/resource/collection/7BDE5E132838-4DFE- AF52-28F4A4F9A3F3/COMOH_Response_EPPH_FINAL_121017.pdf (Accessed November 25, 2017).

(22.) Association of Municipalities of Ontario. AMO's Response to the Expert Panel on Public Health. Briefing note, October 12. Available at: https://www.amo.on.ca/ AMO-PDFs/Briefing-Notes/2017/Expert-Panel-on-Public-Health-AMO-Response2017- 10.aspx (Accessed November 25, 2017).

(23.) Association of Local Public Health Agencies. Letter to the Minister of Health and Long-Term Care, October 17, 2017. Available at: http://cymcdn.com/

La sante publique importe pour la societe, et les avantages de la prevention sont clairement demontres (1): une population en bonne sante est un bien social. En prevenant les maladies et les blessures, on evite beaucoup de souffrance et de douleur (celles des patients et de leurs familles), ainsi que les deces prematures. La prevention presente aussi d'importants avantages economiques : couts de soins de sante evites, pertes de production evitees, revenus et recettes fiscales (2, 3). Sans compter qu'il est probablement impossible d'offrir des soins de sante de qualite en l'absence d'un secteur de la sante publique vigoureux (4), car celui-ci contribue beaucoup aux trois branches du << triple objectif >> (un ensemble d'objectifs globaux tres utilise dans le systeme de soins de sante) : une meilleure sante des populations et une meilleure experience des services de sante a un meilleur cout par habitant (5, 6).

Le comite editorial de la Revue canadienne de sante publique est donc alarme par l'erosion constante des capacites en sante publique au Canada. Cette inquietude a ete exprimee plusieurs fois en ces pages ces dernieres annees. La sante publique a ete caracterisee comme etant << en etat de siege (7) >> et << en butte a des attaques (8) >>. Il a ete soutenu que son affaiblissement--marque par son declassement au sein des gouvernements et des autorites sanitaires; par l'erosion de l'independance des directeurs de la sante publique/medecinshygienistes; par la limitation de la portee de la sante publique en la combinant avec les soins primaires; et par la reduction de son financement--menace a la fois la sante de la population et la durabilite du systeme de soins de sante (9).

De plus, comme la sante publique s'attache aux determinants les plus fondamentaux de la sante et qu'elle adhere a l'equite sociale, l'erosion de ses capacites aura sans doute un impact demesure sur les populations deja sujettes a des disparites d'etat de sante inacceptables--les populations autochtones, par exemple, subissent encore des inegalites de sante ancrees dans des problemes de sante publique de base non resolus qui font honte au Canada sur la scene internationale (10, 11).

La sante publique a encore des defis a relever. Plusieurs mesures qui erodent encore ses capacites ont ete prises quelques mois a peine depuis notre dernier editorial (9). A l'echelle nationale, l'Agence de la sante publique du Canada a renonce a l'une des principales raisons pour lesquelles elle a ete creee (soit de repondre aux preoccupations concernant la capacite du Canada en matiere de sante publique (12)) en supprimant a la fois le programme Competences en ligne (13) et les bourses de stage qui etaient octroyees aux etudiants de maitrise en sante publique depuis 2013. Par ces bourses, plus de 1,8 million de dollars de fonds ont ete consentis a 17 etablissements canadiens (14).

A l'echelle provinciale, l'attaque la plus grave contre la sante publique a ete perpetree recemment au Nouveau-Brunswick, oU le gouvernement a congedie la medecin-hygieniste en chef l'an dernier sans raison apparente et deplace 70 des 110 membres du personnel hors du ministere de la Sante en les repartissant entre trois autres ministeres (15), ce qui a perturbe la cohesion du Service de sante publique et mine sa capacite de resoudre d'importants problemes de sante publique.

Les reactions ont ete vives; des professionnels de la sante publique de tout le Canada ont exprime leur opposition dans la presse ecrite locale, a la radio et dans les lettres ouvertes du Reseau canadien des associations de sante publique (16) et des Medecins de sante publique du Canada (17). Dr Wayne McDonald, ancien medecin-hygieniste en chef du Nouveau-Brunswick, a qualifie ces mesures de << recette desastreuse (18) >>, et Dr Jim Talbot, ancien medecin-hygieniste en chef de l'Alberta, a rencheri en ecrivant qu'elles n'avaient << aucun sens >> et qu'elles etaient la preuve d'une profonde ignorance de la nature et du mandat de la sante publique (19). Malgre ces vives inquietudes, le gouvernement du Nouveau-Brunswick a mis ses changements en oeuvre.

Les capacites en sante publique sont egalement minees en Ontario, le dernier bastion de la sante publique municipale au Canada. Le recent Rapport du comite ministeriel d'experts sur la sante publique (gouvernement de l'Ontario, 2017) (20) propose de resserrer les liens de la sante publique avec le systeme de soins de sante et de relacher ses liens avec les administrations locales. Ces propositions posent probleme, car la plupart des facteurs determinants pour notre sante ne relevent pas du champ d'application du systeme de soins de sante. Le conseil des medecins-hygienistes de la province, l'association des municipalites, l'association des organismes de sante publique locaux et l'Association pour la sante publique de l'Ontario ont tous rejete les recommandations du rapport ou y ont oppose de serieuses reserves (21-24).

Meme les medecins-hygienistes en chef (MHC) des provinces et des territoires du Canada, qui ne sont pourtant pas connus pour leurs critiques a l'endroit des politiques gouvernementales, ont sonne l'alarme dernierement. Invoquant la Declaration sur la prevention et la promotion (25) des ministres federaux, provinciaux et territoriaux publiee en 2010, les MHC ecrivent qu'il est essentiel a la durabilite des soins de sante au Canada de relancer un plan d'action national sur la prevention et implorent les ministres de la Sante de reaffirmer leur engagement envers les principes directeurs de la Declaration (26), c'est-a-dire de faire de la prevention une priorite, de reconnaitre qu'elle est la premiere etape de la gestion des problemes de sante et de reconnaitre qu'elle est une caracteristique distinctive d'un reseau de la sante de qualite.

A l'heure oU les capacites de la sante publique de s'acquitter de ses fonctions centrales font l'objet d'attaques incessantes, il faut absolument que toute notre communaute--nos nombreuses associations professionnelles, disciplinaires et universitaires forment un front uni pour defendre et renforcer les capacites en sante publique, pour que celle-ci puisse promouvoir et proteger la sante des Canadiens dans l'ensemble des provinces et des territoires.

Il est tout aussi important que les groupes et les organisations de la societe qui ont a coeur la durabilite du systeme de soins de sante se rallient pour soutenir la sante publique. Ils devraient insister pour que les ministres de la Sante du Canada respectent leur engagement de 2010, a savoir que << la promotion de la sante et la prevention des maladies, des incapacites et des blessures sont prioritaires et necessaires a la viabilite du systeme de sante >> et que << nous devons atteindre un meilleur equilibre entre la prevention et le traitement (25) >>.

Enfin, les citoyens qui ont le souci de la sante de la population et de la durabilite du systeme de soins de sante doivent exiger de leur gouvernement provincial ou territorial et du gouvernement federal qu'ils cessent de miner la sante publique et s'engagent plutot a la renforcer. L'erosion continue des capacites en sante publique au Canada doit etre inversee; il faut que ces capacites soient renforcees, a la fois pour ameliorer la sante de la population et pour reduire la charge de morbidite qui menace la durabilite du systeme de soins de sante. Sinon, ces deux biens sociaux tres apprecies risquent de disparaitre.

Trevor Hancock, redacteur, Au nom du comite editorial de la Revue canadienne de sante publique

REFERENCES BIBLIOGRAPHIQUES

(1.) Rutty C, Sullivan S. La sante publique: une histoire canadienne. Ottawa (Ontario) : Association canadienne de sante publique, 2010. Sur Internet: https://www. cpha.ca/fr/cyberlivre-historique.

(2.) Merkur S, Sassi F, McDaid D. Promoting Health, Preventing Disease: Is There an Economic Case? Copenhagen, Denmark: WHO Regional Office for Europe, 2013.

(3.) Conference Board du Canada. Ameliorer les habitudes de vie des retombees importantes pour la sante et l'economie du Quebec. Ottawa (Ontario): Le Board, 2014. Sur Internet: http://www.conferenceboard.ca/e-library/abstract.aspx? did=6647 (consulte le 25 novembre 2017).

(4.) Hancock T. No quality health care without strong public health. CMAJ 2017; 189:E1435. PMID: 29158464. doi: 10.1503/cmaj.171287.

(5.) Institute for Healthcare Improvement. The IHI Triple Aim Initiative, n.d. Sur Internet: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx.

(6.) Bergevin Y, Habib B, Elicksen K, Samis S, Rochon J, Adaime C, et al. Towards the Triple Aim of Better Health, Better Care and Better Value for Canadians: Transforming Regions into High Performing Health Systems. Ottawa, ON: Canadian Foundation for Healthcare Improvement, 2016.

(7.) Potvin L. La sante publique canadienne en etat de siege. [Editorial] Can J Public Health 2014;105(6):e401-3. PMID: 25560884. doi: 10.17269/cjph.105. 4960.

(8.) Guyon A, Perreault R. Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform. Can J Public Health 2016;107(3):e326-29. PMID: 27763850. doi: 10.17269/cjph.107.5273.

(9.) Guyon A, Hancock T, Kirk M, MacDonald M, Neudorf C, Sutcliffe P, et coll. L'affaiblissement de la sante publique: une menace pour la sante des populations et la viabilite du systeme de soins de sante. [Editorial] Can J Public Health 2017;108(1):e1-6. PMID: 28425892. doi: 10.17269/cjph.108.6143.

(10.) Commission de verite et reconciliation du Canada. Honorer la verite, reconcilier pour l'avenir : Sommaire du rapport final de la Commission de verite et reconciliation du Canada. Ottawa (Ontario): CVR, 2015.

(11.) United Nations, International Covenant on Civil and Political Rights. Concluding Observations on the Sixth Periodic Report of Canada (CCPR/C/CAN/C0/6). UN Human Rights Committee, 2015. Sur Internet: http://tbinternet.ohchr.org/_ layouts/treatybodyexternal/Download.aspx?symbolno=CCPR%2FC%2FCAN %2FCO%2F6&Lang=en (consulte le 26 novembre 2017).

(12.) Agence de la sante publique du Canada. Histoire. Ottawa (Ontario) : ASPC, 2008. Sur Internet : https://www.canada.ca/en/public-health/corporate/ mandate/about-agency/history.html (consulte le 25 novembre 2017).

(13.) Agence de la sante publique du Canada. Competences en ligne. Ottawa (Ontario) : ASPC, 2017. Sur Internet: https://www.canada.ca/en/public-health/services/ public-health-practice/skills-online.html (consulte le 25 novembre 2017).

(14.) Hoffman S. E-mail to Schools of Public Health from Steven J. Hoffman, Scientific Director, CIHR Institute of Population & Public Health, October 6, 2017.

(15.) Government of New Brunswick. Restructuring to Allow Enhanced Alignment of Government Expertise. Press release, August 31, 2017. Sur Internet: http://www2. gnb.ca/content/gnb/en/news/news_release.2017.08.1162.html (consulte le 21 septembre 2017).

(16.) Canadian Network of Public Health Associations. An Open Letter to the New Brunswick Minister of Health, October 12, 2017. Sur Internet: https://www. cpha.ca/nb_openletter (consulte le 25 novembre 2017).

(17.) Allison S. N.B. public health under siege. Telegraph J. St. John's, NB, October 17, 2017.

(18.) Chilibeck J. 'Recipe for disaster': Former top doc slams changes to medical health office. Telegraph J. St. John's, NB, September 14, 2017. Sur Internet : file:///Users/trevor/Downloads/dr-wayne-macdonald-office-of-the-chief- medicalofficer-of-health-new-brunswick-restructuring-.html.

(19.) Talbot J. Weakening public health makes no sense. Telegraph J. St. John's, NB, October 25, 2017; A7.

(20.) Government of Ontario. Public Health Within an Integrated Health System: Report of the Minister's Panel on Public Health. Toronto, ON, 2017. Sur Internet : http://www.health.gov.on.ca/en/common/ministry/publications/reports/ public_health_panel_17/expert_panel_report.pdf (consulte le 26 septembre 2017).

(21.) Council of Ontario Medical Officers of Health. Response to the Provincial Consultations on the Report of the Minister's Expert Panel on Public Health. Letter to the Minister of Health and Long-Term Care, October 12, 2017. Sur Internet : http://c.ymcdn.com/sites/www.alphaweb.org/resource/collection/7BDE5E132838-4DFE- AF52-28F4A4F9A3F3/COMOH_Response_EPPH_FINAL_121017.pdf (consulte le 25 novembre 2017).

(22.) Association of Municipalities of Ontario. AMO's Response to the Expert Panel on Public Health. Briefing note, October 12. Sur Internet: https://www.amo.on. ca/AMO-PDFs/Briefing-Notes/2017/Expert-Panel-on-Public-Health-AMOResponse-2017- 10.aspx (consulte le 25 novembre 2017).

(23.) Association of Local Public Health Agencies. Letter to the Minister of Health and Long-Term Care, October 17, 2017. Sur Internet: http://cymcdn.com/sites/www. alphaweb.org/resource/collection/7BDE5E13-2838-4DFE-AF52-28F4A4F9A3F3/ alPHa_Expert_Panel_Response_171017.pdf (consulte le 25 novembre 2017). sites/www.alphaweb.org/resource/collection/7BDE5E13-2838-4DFE-AF52-28F4A 4F9A3F3/alPHa_Expert_Panel_Response_171017.pdf (Accessed November 25, 2017).

(24.) Ontario Public Health Association. OPHA's Response to the Expert Panel's Report on Public Health. Toronto, ON: OPHA, 2017. Available at: http://opha.on.ca/ getmedia/66950878-ccd9-4be2-aee8-6633615fcac6/OPHA-Response-to-Reportby-Expert- Panel-October-31-2017.pdf.aspx?ext=.pdf (Accessed November 30, 2017).

(25.) Ministers of Health and Health Promotion/Healthy Living. Creating a Healthier Canada: Making Prevention a Priority--A Declaration on Prevention and Promotion from Canada's Ministers of Health and Health Promotion/Healthy Living. Ottawa, ON: PHAC, 2010. Available at: http://www.phac-aspc.gc.ca/ hp-ps/hl-mvs/declaration/pdf/dpp-eng.pdf (Accessed September 22, 2017).

(26.) Strang R, Kendall P, Corriveau A, on behalf of the provincial/territorial chief medical officers of health with the exception of Quebec. Reviving a national prevention agenda is key to sustainability of health care in Canada. CMAJ 2017;189:E1250-51. PMID: 29018083. doi: 10.1503/cmaj.170694.

(24.) Ontario Public Health Association. OPHA's Response to the Expert Panel's Report on Public Health. Toronto, ON: OPHA, 2017. Sur Internet: http://opha.on.ca/ getmedia/66950878-ccd9-4be2-aee8-6633615fcac6/OPHA-Response-to-Reportby-Expert- Panel-October-31-2017.pdf.aspx?ext=.pdf (consulte le 30 novembre 2017).

(25.) Ministers of Health and Health Promotion/Healthy Living. Creating a Healthier Canada: Making Prevention a Priority--A Declaration on Prevention and Promotion from Canada's Ministers of Health and Health Promotion/Healthy Living. Ottawa, ON: PHAC, 2010. Sur Internet: http://www.phac-aspc.gc.ca/ hp-ps/hl-mvs/declaration/pdf/dpp-eng.pdf (consulte le 22 septembre 2017).

(26.) Strang R, Kendall P, Corriveau A, on behalf of the provincial/territorial chief medical officers of health with the exception of Quebec. Reviving a national prevention agenda is key to sustainability of health care in Canada. CMAJ 2017; 189:E1250-51. PMID: 29018083. doi: 10.1503/cmaj.170694.