Simon Kennedy, Deputy Minister, Health Canada: Exclusive Interview

By on 16/01/2017
Simon Kennedy, deputy minister, Health Canada

With health issues rising up the list of emerging global threats, Canada’s health chief has plenty on his plate. But Matt Ross learns that Health Canada boss Simon Kennedy is just as busy on the domestic front – where his challenges include both rolling out the latest technology, and putting right a centuries-old injustice

“Health issues are becoming a much more prominent item on the international agenda,” says Simon Kennedy, the top civil servant at sprawling federal department Health Canada. “In a previous role I was the G20 ‘sherpa’ for Canada, and health issues were occasionally discussed – but they were not front and centre,” he continues. “In 2017, health issues are going to be on the G20 agenda in a significant way for the first time.”

Indeed, globalisation has pushed health matters into an intergovernmental space traditionally dominated by classic foreign policy issues – international relations, trade, defence and security. The Ebola outbreak, Kennedy comments, provided a stark reminder that an “international public health emergency can have knock-on effects across economies and in other fields too.” And climate change creates “a concern that vector-borne diseases [spread by pathogens or parasites] will become a more prominent issue.” Nowadays “authorities around the world are paying increasing attention to health,” he adds. “But I think we have a way to go before we have the right kinds of [international] structures in place – and of course, we have new threats emerging all the time.”

Take anti-microbial resistance (AMR) – the shrinking power of antibiotics, which has its roots in the over-use of a narrow set of pharmaceuticals. “If a strain of a particular disease becomes resistant in one continent, that’s going to be a problem for everyone,” says Kennedy. “And this is an issue that requires engagement internationally, I think, to make progress.”

The drugs don’t work

Coordinated action is required, in part, because “there are complicated issues about how the market works.” Governments, corporations and investors sink billions in pharmaceuticals research in the hope of producing new mass-market drugs, Kennedy explains, “but this is an area where, if we successfully develop a new antimicrobial, then we actually want to use it as little as possible.” There’s “a bit of market failure” here, generating weak incentives for the private sector to invest in research.

Meanwhile, in many countries livestock are routinely given antimicrobial drugs – not only to combat sickness, but also to promote growth. And here too, Kennedy points out, “it makes more sense to move collectively, because there may well be some jurisdictions that will be concerned around competitiveness issues if they’re asked to move and others aren’t.”

Having said that, Canada has already taken strong action – requiring the removal of growth promotion claims for medically-important antimicrobials, and barring farmers from importing these drugs themselves. “And by and large, the pharma sector has been very supportive,” he adds. “I think there’s a real realisation now of the need to move in this direction.”

In many countries, health officials pushing for tighter controls on the use of drugs in farming would encounter fierce resistance from their colleagues in the agriculture department – but in Canada, Kennedy points out, animal health is regulated by the Food Inspection Agency: a fellow health department. “So the minister of health has a role in both human and animal health,” he observes. “That gives us a bit of an advantage in applying a ‘one health’ approach to the issue of antimicrobials.”

The globalisation of medicine

Yet another rapidly globalising aspect of health is that of pharmaceuticals development and production – a sector that falls within Health Canada’s responsibilities for licensing new drugs and assessing medical treatments’ cost-effectiveness. A few years ago, says Kennedy, a single company “would do the R&D, the testing and the manufacturing – it would all happen under one corporate roof.” But now development, trials and production are often spread around the world, requiring overseas inspections and a much better understanding of global supply chains: “If we’re going to maintain the confidence of the public that we’re ensuring compliance, then we have to work with international regulatory partners – because we can’t be everywhere at once, and nor can they.”

Kennedy has long experience of such complex, global supply chains: he served as deputy minister for international trade – overseeing trade talks with the EU and Korea – and brokered the ‘Beyond the Border’ Canada-US agreement to improve security cooperation and streamline border controls. Beyond the Border has attracted much interest in the UK and Ireland since the Brexit vote: keen to avoid reopening the slowly-healing scars of Northern Ireland’s sectarian conflict, both countries are desperate to avoid creating a hard land border between Northern Ireland and the Republic. And the US and Canada have certainly eased cross-border for travel for people and goods, using what Kennedy calls its “trusted traveller” and “trusted trader” schemes.

Under the former, citizens of either country can apply for a ‘Nexus’ card – submitting biometric data and undergoing security checks, with approved individuals allowed to use fast-track lanes at land crossings and airports. And the latter permits approved companies – those whose staff, policies and premises have proved their commitment to security and compliance – to enjoy “a more expedited process going back and forth across the border.” These solutions sound a long way from the digital magic excitedly talked up by Brexiteers such as Northern Ireland’s first minister Arlene Foster; but as the UK leaves the European Customs Union, Kennedy can expect to find delegations of curious British and Irish officials beating a path to his door.

Talking therapies

As well as handling Canada’s end of global health issues, Kennedy’s department manages a bulging domestic agenda – much of it focused on supporting the provinces’ healthcare delivery work through research, public health initiatives, regulation and maintaining health insurance standards. And he has the unenviable job – through the agency Canada Health Infoway – of helping to shape a national healthcare IT infrastructure, giving patients and providers across the country shared access to health records. The number of local doctors using digital records has climbed from 37% to 73% in seven years, says Kennedy, but whilst “the doctor might have an electronic records system in their office, the ability to talk to the hospital or other providers isn’t necessarily there yet. And that interoperability is really critical”.

This has proved a challenging task in many countries, and Canada too has found it hard to strike the right balance between national coherence and local autonomy. “One of the criticisms perhaps in the past has been that when technology has been deployed in the healthcare system, there hasn’t been enough commonality and it hasn’t been necessarily mandatory – and as a result you have different systems deployed in different places, and some folks have not elected to put systems in place,” he comments. “So you don’t really have the seamless integration that you’d want in order to realise the benefits.”

To ensure that different provinces’ and providers’ systems can talk to one another, Kennedy explains, Canada Health Infoway is working to build IT provisions into the emerging Canada Health Accord – ensuring that “all the levels of government agree on what the objectives are.” The aim is not to impose a single model on every health body, he emphasises: Health Canada is not “in a space where we’re dictating that you have to move to one IT solution or one particular outcome.”

Nonetheless, it’s clear that federal agencies do believe there’s a need for more central direction to set common standards, mandate participation and hasten progress: “We want to have interoperability; we want patient access [to records] on your phone or desktop; and ideally we want to move to a system where it’s not voluntary that entities in the healthcare system will sign up for this,” he says. “There would be an expectation that you would be required to do this.”

Beyond health

So Health Canada – along with its sister organisations, the Public Health Agency of Canada and the Canadian Food Inspection Agency – works on transnational health issues, on national healthcare policy, and on related topics such as animal health and food safety. But since the October 2015 election of Liberal PM Justin Trudeau, it’s been asked to consider these fields of work within a wider context – for the new administration has set out a series of cross-departmental performance targets, requiring federal bodies to focus their work around some of the government’s core goals. The first task, explains Kennedy, has been to strengthen Health Canada’s data collection and analysis functions: like all the other departmental chiefs, he’s appointed a manager to “provide oversight on how the department is doing, providing a bit of a ‘dashboard’ function.”

These new cross-government goals and metrics do, of course, bring more scrutiny and pressure for delivery; and meanwhile, notes Kennedy, his department is being asked to do more than ever. On regulation alone, he adds, the government wants to improve the quality of the food supply; move towards plain cigarette packaging; and end the prohibition on marijuana. “So there’s been a significant advance in terms of the workload,” he comments. “The government has set out an ambitious agenda in health, and we have had to rebuild capacity in the health ministry to be able to deliver on those commitments.”

And there’s another area in which Health Canada is, says Kennedy, “being asked to up our game”: healthcare for indigenous Canadians. Whilst the provinces handle most healthcare delivery across Canada, the department funds or provides some frontline services for isolated indigenous communities; and many ‘First Nation’ patients have not been well served by the resultant patchwork of provincial, federal and community-led services. So in British Columbia, Kennedy explains, a First Nations Health Authority was established – giving local communities a powerful role in shaping health provision. This created “a much closer and tighter integration between the provincial system, the First Nations-led system and the federal government”, ensuring that services are “better organised around indigenous priorities and that they have the bargaining power” they need.

Bringing it all together

There is good research evidence that “a measure of self-determination and local control can lead to better outcomes” within indigenous communities, explains Kennedy. The plan is now to give other indigenous communities a much bigger role in shaping healthcare – and not only because it will produce better results. “Frankly, I think there’s a moral imperative to return control to indigenous people,” he says. “In Canada there’s been a tragic history of relations with indigenous people: colonisation, conquests and paternalism, producing a terrible outcome.” Putting those communities back in the driving seat won’t only improve the quality of care, Kennedy concludes; it’s also “the right thing to do.”

Most countries’ health departments have their hands full these days – but Canada’s federal health bodies have a particularly ambitious agenda, leading on matters as diverse as reforming the marijuana laws and improving food quality. The new government’s cross-departmental targets require them to contribute to a new set of social and economic goals. Their responsibilities for supporting provincial service provision include overseeing a complex, multi-layered digital project. Their remits on pandemics, AMR and pharmaceuticals regulation mean working with countries and organisations around the world. And their task on indigenous people is to put right a historic wrong, empowering First Nation communities in order to improve health services.

“Across the major lines of activity, there is more work,” says Kennedy. “There is increased scrutiny from members of parliament and the media around what we’re doing, because these are areas the government has set out as priorities. We need to be able to show we’re up to the task.” That task – or set of tasks – sounds intimidating in its scale and breadth. But as he contemplates his bulging in-tray, Simon Kennedy doesn’t just sound enthusiastic; he sounds really quite happy. After all, the pressures piling up around Health Canada reflect the growing importance of the health agenda at every level – from addressing emerging global threats to reversing domestic injustices. And for the man charged with protecting and improving Canadians’ health, that can only be a good thing.


Global Government Forum: Five Thoughts for Better Government

Simon Kennedy on learning from overseas

To help our readers get the best out of Global Government Forum, we ask interviewees five standard questions – four seeking practical advice and opinions, and one to reveal something a little more personal. This is an edited version of Simon Kennedy’s answers – click below to watch his full answers in a Global Government Forum video.

https://www.youtube.com/watch?v=kuVAp_lV_u8

Can you name one lesson or idea from abroad that’s helped you or your colleagues?

“One thing that’s been really helpful to us over the last year or so has been to look at the experience of other jurisdictions when it comes to the issue of medical aid in dying. Obviously this is a subject that is very sensitive for a lot of people, so we were very grateful to be able to look at the experience in jurisdictions such as California but also the Netherlands, Switzerland and so on: it was very helpful to look at the kinds of protocols that other jurisdictions have put in place.

“Another one would be that we’re very interested in looking at how to improve the effectiveness and efficiency of the Canadian healthcare system. We’re a relatively high spender compared to the OECD average, but our outcomes are perhaps a little bit lower than we would like – so to watch what the UK has done in terms of its healthcare system, to look at some of the reforms that have been underway for a number of years now in the US, has been very helpful in trying to figure out what we could do to bring those models to Canada.”

Are there any projects or innovations from Canada that you think might be useful to your peers overseas?

“There’s a couple. One of the things that we face a challenge with in Canada has been relatively high drug costs. In our country we don’t have a single purchaser: our provinces and territories all do their own purchasing, and then we have private insurers who are also providing coverage. So our provinces set up the Pan Canadian Pharmaceutical Alliance, which combines the purchasing power of the federal, provincial and territorial governments to negotiate with drug companies for all publicly-funded drug plans. We’ve saved about $700m [UK £440m/US $530m] in spending by having all the public drug plans come together and negotiate as one. That may be relevant to jurisdictions that have this fragmented purchasing, as we have in Canada.

“The other area is that we’ve had really significant success reducing smoking rates: the number of Canadian who smoke daily has been cut from about 33% in 1980 to about 15% in 2013. Canada was one of the first countries in the world to introduce graphic warnings on cigarette packages. We’re the first country to ban flavours like chocolate and bubble gum in cigars and cigarettes. And under this government, we’re going to put in place plain packaging. So I think tobacco control is probably another area where historically we’ve shown leadership.”

How can we improve the ways in which senior public officials work with and learn from their colleagues overseas?

“There are a lot of fora where Canada engages, and where my advice to senior officials in other jurisdictions would be to look to those organisations as good sources of advice. So we are – I would like to think – a key player in the World Health Organisation; we engage regularly with the Pan American Health Organisation; and there’s a lot of good studies and analysis coming out of organisations such as the OECD. We actively engage bilaterally with partners such as China, Mexico and Australia.

“My organisation is also a major regulatory body, so we regulate drugs, medical devices, other therapeutics products – and so we participate in international regulatory organisations as well. For example, the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, ICH, which strives to work towards regulatory harmonisation worldwide and to improve safety and efficiency in pharmaceuticals. So there are a lot of fora in the health space where there is an opportunity to work with and learn from others.”

What are the biggest global challenges in your field over the next couple of years?

“Well, there’s a number. One of them is the issue of anti-microbial resistance: the WHO estimates about 480,000 people develop multi-drug-resistant TB each year. This is a really serious emerging problem, and certainly something that in Canada we take very seriously. We have developed an action plan on antimicrobial resistance, looking not just at human health but obviously animal health issues because agriculture is a big part of this.

“Another area that we think is really important is problematic opioid use. We have seen in Canada a significant increase in opioid use over the last 20 years, and increasingly there is evidence that the people who perhaps were initially prescribed opioids for pain or for injury then develop an addiction and turn to the street. The US also has a very serious issue around opioids, so this is an area where we think there may be opportunities to work with colleagues in other jurisdictions.”

Finally, what is your favourite book?

“I’m reading right now Being Mortal by Atul Gawande: a book about how the healthcare system works, and how perhaps it doesn’t serve people very well at the end of their life. I’m finding that fascinating.

“In terms of fiction books I really enjoyed Cold Mountain, which is about a Civil War soldier who becomes disillusioned and returns to his home in the Blue Ridge Mountains. It’s like a 21st century version of Thomas Hardy.”

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About Matt Ross

Matt is a journalist and editor specialising in public services, policymaking, government and management. He was the editor of trade title Civil Service World from 2008 to 2014, serving an audience of senior UK officials; and the features editor of weekly news magazine Regeneration & Renewal between 2002 and 2008, covering urban regeneration, economic growth and community development. He has also been a motoring and travel journalist, and now combines his role as editorial director of Global Government Forum with writing for other publications including The Guardian and Planning magazine.

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