Canadian Journal of Public Health

, Volume 95, Issue 6, pp 409–412 | Cite as

The Complexities of Multi-level Governance in Public Health

  • Kumanan Wilson


This article reviews some of the challenges to developing national public health programs, focussing on the distribution of constitutional authority for public health and governance challenges that arise from this.

Constitutional authority for public health resides primarily with the provinces. The federal government has obtained the authority to legislate in this area primarily through its power over criminal law. Challenges facing the establishment of national public health programs include the ambiguity over constitutional responsibility, challenges in managing externalities and spillovers, and issues related to funding and data ownership. Policymaking is also complicated by the importance of municipal and supranational governments in public health.

National programs need to be structured in a way that balances the advantages of regional approaches to public health challenges with the benefits of a coordinated central response. To do so, policy-makers need to address unique challenges to public health governance.


Dans notre article, nous abordons quelques-uns des défis liés à l’élaboration de programmes fédéraux de santé publique, notamment la répartition des pouvoirs constitutionnels et les défis qui en découlent aux chapitres de la santé publique et de la gouvernance.

Les pouvoirs constitutionnels en matière de santé publique appartiennent principalement aux provinces. C’est surtout par le biais de sa compétence en matière de loi pénale que le gouvernement fédéral a obtenu l’autorité de légiférer dans le domaine de la santé. La création de programmes fédéraux de santé publique pose certains défis, dont l’ambiguïté des responsabilités en vertu de la Constitution, la difficulté de gérer les effets externes et les retombées, ainsi que les questions de financement et de propriété des données. L’importance du rôle des administrations municipales et supranationales en santé publique complique également la formulation des politiques.

Les programmes fédéraux doivent être structurés de manière à équilibrer les avantages des réponses régionales aux défis de la santé publique et les avantages d’une intervention concertée au palier fédéral. Pour cela, les décideurs doivent se pencher sur les défis particuliers de la gouvernance du système de santé publique.


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Copyright information

© The Canadian Public Health Association 2004

Authors and Affiliations

  • Kumanan Wilson
    • 1
    • 2
    • 3
  1. 1.Department of MedicineUniversity of TorontoTorontoCanada
  2. 2.Institute of Intergovernmental RelationsQueen’s UniversityKingstonCanada
  3. 3.9ES-407, Toronto General HospitalUniversity Health NetworkTorontoCanada

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