The previous Public Health Act was inherited from the Northwest Territories and dated back to 1957.It was outdated and based on structures and functions that were no longer applicable. The practice of public health has changed over time and the previous Act did not identify the elements of public health that are now recognized nationally and internationally. In order to deal with these challenges, a new up-to-date made in Nunavut Public Health Act was passed by the Legislature in November of 2016.close
The new Public Health Act:
- Addresses the health of the population as a whole;
- Provides the legal framework enabling public health officials to protect the public and to prevent, detect, manage, and contain health threats without unduly interfering with civil rights and liberties;
- Deals with health promotion, notifiable diseases or conditions, communicable diseases, health hazards (including food safety, safe drinking water, sanitation) and public health emergencies;
- Lays out the duties and responsibilities of public health officials and of the ministers responsible;
- Is consistent with public health legislation in other provinces and territories;
- Accords sufficient weight to ethical values especially individual liberty, protection of the public from harm, reciprocity, and privacy and confidentiality of health information.
The new Public Health Act does not:
- Deal with the structure of the health system;
- Cover all health hazards;
- Deal with occupational health and safety issues that are dealt with by other government
- departments including federal departments and agencies;
- Address health service delivery at hospitals or health centers;
- Address medical travel, health insurance or extended health benefits
Yes, the Act explicitly states that the Minister and the Chief Public Health Officer must ensure that Inuit Qaujimajatuqanngit are incorporated throughout the public health system in Nunavut.close
What is new?
- Strikes a balance between individual rights and the public good and is compliant with the Canadian Charter of Rights and Freedoms;
- Incorporates the provisions of the Diseases Registry Act which will be repealed;
- Includes the reporting zoonotic diseases in animals by a veterinarian, conservation officer or by-law officer;
- Defines Public Health Emergencies and delineates additional powers;
- Provides for an Immunization Registry;
- Provides the authority for health promotion initiatives;
- Requires the CPHO to produce a report on the health status of Nunavummiut every two years;
- Gives the CPHO the ability to set standards and guidelines;
- Creates a process to issue orders that are compliant with the Charter of Rights and Freedoms;
- Provides for Community Health and Wellness Committees.
What has been removed or significantly altered?
- Removes reference to Boards of Health which no longer exist;
- Changes the titles of some public health officials;
- Removes any reference to health care in camps as public health and health care are separate matters. The sections of the old Public Health Act pertaining to health care in camps will be retained in a renamed act, The Camp Health Services Act, when the old Public Health Act is repealed.
All of the regulations under the old Public Health Act have been reviewed and either repealed, updated or replaced with new regulations. Three new sets of regulations have been developed including Reportable and Disease Control Regulations and Public Health Administrative Regulations. Work will continue on updating regulations in the future.close
The Reporting and Disease Control Regulations lay out further detail on the reporting and management of communicable and other diseases and events as well as addressing the development and contents of an immunization registry.close
The Public Health Administrative Regulations provide the information required for issuing orders under the Public Health Act. This includes advising the person who will be subject to the order before issuing it and providing information on how to address the matter, so an order is not required. It also deals with the mechanism for serving the order.close
The new Public Health Act and the Reporting and Disease Control Regulations support the protection and promotion of health. They include provisions for an immunization registry. This means that a health professional administering an immunization or who receives documentation regarding an immunization outside of Nunavut must report it to the CPHO. The purpose is to ensure the immunization history on individuals is readily available during an outbreak of a vaccine preventable disease and vaccine coverage rates for the population can be determined.close
The new Public Health Act refers to the Minister, the Chief Public Health Officer (CPHO), the Deputy Chief Public Health Officer (DCPHO), a Medical Health Officer (MHO) and an Environmental Health Officer (EHO).close
The Minister of Health is responsible for:
- advising the Government on public health matters including those related to Nunavut’s Emergency Plans;
- declaring public health emergencies;
- establishing standards for and creating public health programs;
- ensuring public health laboratories provide services for Nunavut;
- entering into public health agreements with other jurisdictions.
The CPHO (formerly known as the Chief Medical Officer of Health) is appointed by the Minister. The CPHO must be a physician and have qualifications set out by the Minister. The CPHO can act independently and has the powers and the duties needed to protect the health of Nunavummiut including:
- monitoring disease trends and the health of Nunavummiut;
- developing and implementing health promotion programs and immunization programs including an immunization registry;
- carrying out epidemiological studies;
- conducting investigations into health risks;
- receiving reports of communicable and non-communicable diseases and conditions and act on those reports;
- managing communicable diseases and outbreaks including writing orders for a person to be examined, isolated or quarantined and treated;
- managing health hazards;
- managing public health aspects of overall emergency preparedness and response in Nunavut;
- preparing a report every two years on the health status of Nunavummiut including a report on zoonotic diseases and on the immunization program;
- directing public health staff appointed under the Act;
- providing advice to government and public officials on public health matters;
- entering into technical agreements with public health agencies;
- preparing reports on matters of concern and bringing these matters to the attention of the Legislative Assembly;
- issuing guidelines regarding key public health functions;
- ordering an animal to be euthanized and tested for rabies.
The CPHO, by virtue of his or her office is also an MHO and EHO.close
The Minister appoints the Deputy CPHO (formerly known as the Deputy Chief Medical Officer of Health) who holds office for a five-year term. The Deputy CPHO must be a physician and have qualifications set out by the Minister. S/he acts in place of the CPHO when the CPHO is absent, unable to act or if there is no CPHO in place. By virtue of his or her office, the Deputy CPHO is also an MHO and an EHO.close
The CPHO can appoint a physician as a MHO. A MHO must be a Physician and have qualifications set out by the Minister. This provision is included in the act to allow for another public health physician to be appointed if population growth warrants it in the future or if a situation makes it temporarily necessary.
The MHO may investigate any illness or death and issue orders related to a risk to public health including:
- a communicable disease
- a non-communicable disease or
- a reportable event
EHOs are appointed by the CPHO and must have the qualifications established by directive of the Minister. EHOs have several responsibilities:
- Monitor, audit and conduct risk assessments in relation to health hazards;
- Issue a wide range of orders related to health hazard if required;
- Issue orders related to communicable diseases and a place, premises or thing that may be contaminated with a pathogen;
- Receive notifications from the operator of a water supply system if the water is not safe or fails a water quality test or doesn’t comply with the Regulations. The EHO then reports this information to a MHO;
- Manage an animal that has or is suspected of having a zoonotic disease or exposed to a zoonotic disease including ordering an owner, person in possession of an animal or a conservation officer, a by-law officer or peace officer to take action with regard to the animal;
- Conduct searches with permission or with a warrant and seize items under specific circumstances.
Health care professionals (physicians, dentists, nurses, midwives and laboratory technologists) are required to report virulent and non-virulent communicable diseases, conditions, congenital anomalies and other events such as cancer and adverse events following immunization. Timing of the report is laid out in the regulations.
Other individuals are also required to report to:
- Persons in charge of institutions with respect to outbreaks at the institutions;
- Optometrists for communicable diseases of the eye;
- Staff authorized to administer immunizations with respect to the administration of an immunization, adverse events following immunizations and immunization errors;
- Conservation officers and By-law Officers with respect to zoonotic diseases and animal exposures.
If a health care professional has reason to believe that a person has a communicable disease, they should try, with consent, to get specimens for testing. They must also provide the patient with information about the disease and how to prevent further transmission. If the patient is transferred to another health care professional, the referring person must advise the receiving health care professional of those responsibilities which then become the responsibility of the new health care professional.close
A veterinarian, conservation officer or by-law officer must report a suspected or confirmed zoonotic disease in an animal or human contact with an animal that is known or suspected of being infected with a zoonotic disease. Human contact includes exposure to saliva or neural tissue through a bite, scratch, break in the skin or on the mucosa of a person.
In this situation, an EHO can make an order regarding the animal requiring the owner, person in possession of the animal, conservation officer, by-law officer or peace officer to:
- Take the animal to a veterinarian;
- Seize the animal, isolate or quarantine the animal and ensure that it has sufficient food, water, shelter and protection from other animals.
The CPHO can order the animal to be destroyed.close
The Education Act says that a school principal, when asked by the CPHO, must refuse entry to a child who has a communicable disease that could be passed on to other students. The Public Health Act gives the CPHO permission to send the information to the principal so that the Education Act can be followed.close
Municipal Corporations have several responsibilities including:
- To operate a water supply system that provides a sufficient quantity of water for current and future demand as well as fire suppression. The water supply system must be operated and maintained in a clean and sanitary way with all precautions needed to prevent contamination and other hazards. It must be regularly inspected and tested. If the water is not safe to drink for any reason, this must be reported to the EHO.
- To operate and maintain a sewage system which is adequate to meet current and future demand. It must be maintained in a clean and sanitary manner and in a way that prevents any contamination of food or water and protects the public from any other related hazards.
- To operate a system for the disposal of garbage and other waste.
Camp Operators must notify the CPHO before the camp is set up and opened. The camp must provide safe drinking water, a sewage disposal system and a system for dealing with garbage. The camp operator is required to report to the CPHO any event reportable by regulations.
Personal Service Facility Operators must provide a clean and sanitary environment and technique. These services include hair dressing, manicures, tattooing and piercing, cosmetic treatments, tanning, etc.close
The CPHO can collect health information for a variety of purposes such as monitoring disease trends, assessing and dealing with risks to public health, program planning and evaluation and research. The CPHO must do his or her best to ensure that the health information is as accurate and complete as possible and make the limitations of the information clear. Only non-identifiable information should be released unless specific criteria are met for the release of personal identifiable information. Non-identifiable information includes individual level information that is anonymous i.e. the individual cannot be identified. This may also include information that is aggregated so that it represents a group of people rather than an individual.close
A Public Health Emergency occurs when the usual public health measures have already been applied and it has been determined that special measures are required. Examples of public health emergencies include pandemic influenza and an outbreak of Ebola. The Chief Public Health Officer would advise the Minister of the situation and the Minister would declare a state of public health emergency which can be in place for 14 days but can be extended for another 14 days.
The declaration of a public health emergency provides the Chief Public Health Officer with the authority to take additional measures such as getting additional medical supplies and equipment, using public or private property (except a home) as needed including to quarantine individuals, and restricting travel.close
A health hazard is a very general term that refers to a condition, a substance, a thing or an activity that may threaten public health or interfere with the prevention of diseases, injuries or other risks to public health.
The Health Hazard section of the Public Health Act addresses some specific areas such as food, water, sewage, waste disposal, camps, and personal services.close