Evidence map›Paper›PMID 36456399›Full record

ReviewHealth policy (Amsterdam, Netherlands)2023

Centralization and integration of public health systems: Perspectives of public health leaders on factors facilitating and impeding COVID-19 responses in three Canadian provinces.

Robert William Smith, Tamika Jarvis, Harman Singh Sandhu, Andrew D Pinto, Meghan O'Neill, Erica Di Ruggiero, Jasmine Pawa, Laura Rosella, Sara Allin

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Health policy (Amsterdam, Netherlands), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  16. Promise and peril: how health system reforms impacted public health in three Canadian provinces.Canadian journal of public health = Revue canadienne de sante publique · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Robert William SmithDivision of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada. Electronic address: robw.smith@mail.utoronto.ca.
Tamika JarvisDepartment of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: jarvistl@mcmaster.ca.
Harman Singh SandhuInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada. Electronic address: hs.sandhu@mail.utoronto.ca.
Andrew D PintoInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada; Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada. Electronic address: andrew.pinto@utoronto.ca.
Meghan O'NeillPopulation Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada. Electronic address: meghan.oneill@utoronto.ca.
Erica Di RuggieroDivision of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada. Electronic address: e.diruggiero@utoronto.ca.
Jasmine PawaDivision of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada. Electronic address: jasmine.pawa@mail.utoronto.ca.
Laura RosellaDivision of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada; Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada; Institute for Better Health, Trillium Health Partners, 100 Queensway West, Clinical and Administrative Building, Mississauga, ON L5B 1B8, Canada. Electronic address: laura.rosella@utoronto.ca.
Sara AllinInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada; North American Observatory on Health Systems and Policies, Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M7, Canada. Electronic address: sara.allin@utoronto.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The extent to which power, resources, and responsibilities for public health are centralized or decentralized within a jurisdiction and how public health functions are integrated or coordinated with health care services may shape pandemic responses. However, little is known about the impacts of centralization and integration on public health system responses to the COVID-19 pandemic. We examine how public health leaders perceive centralization and integration facilitated and impeded effective COVID-19 responses in three Canadian provinces. We conducted a comparative case study involving semi-structured interviews with 58 public health system leaders in three Canadian provinces with varying degrees of centralization and integration. Greater public health system centralization and integration was seen by public health leaders to facilitate more rapidly initiated and well-coordinated provincial COVID-19 responses. Decentralization may have enabled locally tailored responses in the context of limited provincial leadership. Opacity in provincial decision-making processes, jurisdictional ambiguity impacting Indigenous communities, and ineffectual public health investments were impediments across jurisdictions and thus appear to be less impacted by centralization and integration. Our study generates novel insights about potential structural facilitators and impediments of effective COVID-19 pandemic responses during the second year of the pandemic. Findings highlight key areas for future research to inform system design that support leaders to manage large-scale public health emergencies.

Indexed as

COVID-19CanadaGovernment ProgramsHumansPandemicsPublic HealthCanadaCOVID-19DecentralizationGovernanceOrganizational structurePublic health systems

Identifiers

PMID36456399
PMCPMC9681988

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.