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If you’re like most Canadians, you’ve gotten to know the Chief Public Health Officer of every Canadian jurisdiction during the COVID crisis and probably ranked your favourites. You may also have noticed health ministers lurking in the background during their briefings, sometimes saying a few words of their own or possibly enforcing conventions about Cabinet secrecy. And it’s similar in the US. Who hasn’t been charmed by the interactions between Dr. Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), the US Secretary of Health and Human Services, and the President of the United States?
You probably haven’t wondered much about the relationship between Health Canada and the Public Health Agency of Canada, still less about the difference between the NIH and the Centers for Disease Control and Prevention (CDC) in the US. But you might still have noticed that governments have a lot of different organizations responsible for closely related things, and sometimes for what looks like more or less the same thing. This is true in many policy areas beyond health, be it science, transportation, research funding, or economics and finance. And they’re governed by a wide assortment of rules and degrees of independence. This is to say nothing about comparable agencies at the federal, provincial and even municipal levels.
These arrangements aren’t necessarily inefficient, and they don’t have to impede coordinated policy and service delivery. But in a world where collaboration across organizations and jurisdictions is increasingly needed to tackle complex problems, and where organizations are siloed by our spending and accountability rules, there is good reason to ask whether government machinery needs restructuring, or at least some new ground rules.
In Canada we give prime ministers a lot of personal control over government machinery, which we treat as an extension of the Cabinet system. But the truth is it ossifies over the years, and now might be a time to revisit how we organize to govern.
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