Abstract

Although public health in Canada faces concerns similar to those noted by Tilson and Berkowitz in the US, a review we conducted of how public health is financed and delivered in Canada also highlights some key differences. In both systems, public health labours under similar disadvantages: it is invisible when it succeeds; it has overtones of a "nanny state" and it focuses on often unpopular vulnerable populations. Prevention is always at risk of being raided to finance treatment. Yet, Canada, because there are fewer financial barriers to receiving medically necessary personal services, can focus more attention on what Tilson and Berkowitz term "the ecology of health." We highlight some of the strengths and ongoing challenges of the Canadian public health system. We conclude that the issue appears less the need to measure performance, than the recognition that one size does not fit all. In particular, for threats to public health that transcend borders, local failure can affect wider populations and suggests a need to look beyond local, provincial or national sovereignty. Public health is heterogeneous, and many roads may lead us to the promised land.