Governments need to loosen muzzles on public-health officers

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If we want a healthy population and healthy public policies that support that goal, we need fearless, independent and outspoken Medical Officers of Health.

We don't need toadies doing the biding of government and business – there are enough of those already. And we don't need more muzzled public employees – there are legions of those already, too.

We need Medical Officers of Health to speak health-care truths to power no matter how uncomfortable it makes the powers-that-be.

That's why governments from coast-to-coast-to-coast should pay attention to a call Thursday by the New Brunswick Medical Society to ensure the independence of the public health doctors in the province and, by extension, in every jurisdiction.

"Communication is one of our most powerful treatments," said Lynn Hansen, president of the society.

"Patients and the public count on us to deliver our best advice – good and bad."

Individual physicians have always valued their independence and autonomy. The patient-physician relationship is sacred.

But, as Dr. Hansen noted, for a Medical Officer of Health, the patient is the population and frank talk is just as important.

"Public health physicians need to speak to their patients too, free of political pressures," she said.

The New Brunswick Medical Society decided to take a stand on the issue after a bizarre incident in the fall of 2012.

Eilish Cleary, the province's Chief Medical Officer of Health, decided to investigate the potential health impacts of fracking – a controversial way of extracting shale gas. The government, looking to expand the energy sector, was none too pleased. There were media stories saying that the report would not be released publicly, which caused an outcry from environmentalists.

The health minister at the time, Madeleine Dubé, made statements to the effect that Dr. Cleary was a government employee and her role was to speak publicly only about imminent public health dangers like outbreaks of disease.

That didn't sit too well with physicians, or with Dr. Cleary herself.

"Should something arise that affects the health of the population, I will speak about it," she said tersely.

Eventually, the report was released. It was eminently reasonable, but the government dismissed some of the concerns expressed. What's important is that public health issues related to fracking were discussed openly, if not heeded.

As the New Brunswick Medical Society notes in its thorough and thoughtful report, Dr. Cleary is not the first such officer governments have tried to muzzle.

Back in 2002, David Swann, a Medical Officer of Health in Alberta, was fired for speaking out in favour of the Kyoto Protocol and for expressing concern about the health effects of burning fossil fuels. (He would go on to become a provincial MLA and Liberal Party leader and remains an outspoken advocate for environmental and health causes.)

In 2012, Toronto Mayor Rob Ford called the city's Chief Medical Officer of Health, David McKeown, "an embarrassment" for suggesting the speed limit in the city should be reduced to lower the risks of injury and death among pedestrians.

Earlier this year, councillors in Cavan Monaghan Township in Ontario demanded the firing of Medical Officer of Health Rosana Pellizzari after she told them there was no link between wind turbines and poor health. (Council wanted the turbines banned.)

In every one of these instances – and many more – elected officials have disgraced and embarrassed themselves; they betrayed the public by putting economic and political concerns ahead of the public's health.

If nothing else, provinces should adopt legislation ensuring the independence of Medical Officers of Health (as has already been done in B.C. and Ontario) to protect politicians from their own short-sightedness.

Public health officials have long taken controversial stands, advocating crazy things like sanitation, water filtration, vaccination, speed limits, seat belts, fire detectors, food inspection, fluoridation, fire safety standards for homes, supervised injection sites and so on – all manner of measures that have saved innumerable lives but also created grief, obligations and costs for governments and private enterprise.

In all the instances and more, Medical Officers of Health have been the chief (and sometimes sole) advocates for public safety and the public good. It's hard to think of many times when the advice of top public health officials has not been sound and forward-looking; their views are controversial, for the most part, because they are ahead of the curve.

We should cherish the independence of Medical Officers of Health, not try to limit it.

As David Butler-Jones, the Chief Public Health Officer said back in 2002: "The first and most important duty of public health is the protection of the public. It is the watchdog of and advocate for the people's health. For all our sakes, it must not be muzzled."

André Picard is The Globe's public health columnist.