A modest proposal: Chief Medical Officers of Health should report to their legislature

“The counsel of the CMOH [Chief Medical Officer of Health] is presented as unbiased medical advice, but it is almost inevitably tainted by politics,” said Dr. Jillian Horton in the Globe and Mail this week. Exactly. Here’s why.

Provincial and federal public health officers in Canada are public servants. Like deputy ministers in other, arguably less life-and-death roles, they express their views to the government of the day. The government makes its own decision, and the dutiful public servant must support that decision, even if they privately and professionally disagree. That’s how it works.

Several times I have shaken my head while hearing Dr. Deena Hinshaw, CMOH of Alberta, answer the media’s questions about whether she agrees with Jason Kenney’s latest decision. She doesn’t answer directly. Rather, she describes the process. She gives the government advice; they make decisions; she supports their decisions. Does she agree? Read between the lines.

Should public health decisions be political ones? Hint: the question is rhetorical.

Here’s my proposal to divorce public health from politics: make CMOHs answerable to the legislature rather than the government. They should be autonomous and free to provide evidence-based advice. They could release reports saying, essentially, “Here’s what our projections show if you take the most stringent public health measures, if you keep some measures and relax others, and if you drop all measures. We would recommend such-and-such a course of action.”

The government could say, “Thank you very much, but we’ve decided to go in a different direction from your recommendation and take the flak.” Everyone would know what the projections show and whether the government has followed the scientific advice. Citizens could hold their governments to account in full knowledge of the evidence.

CMOHs could be selected, evaluated and, if necessary, fired through a process similar to processes for other parliamentary officers or, for example, judges.

I would actually prefer it if CMOHs had some superpower to overrule governments, but my democratic ethics tell me final decisions have to be made by elected governments. So the report-to-legislature solution would at least allow them to speak freely and expose the discrepancies between scientific guidance and political decisions to the full light of day.

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