Tensions and opportunities in the roles of senior public health officials in Canada: A qualitative study
Bibliographic record
Abstract
Although public health emergencies like the COVID-19 pandemic thrust senior public health officials into the spotlight, their day-to-day roles remain misunderstood and under-examined. In jurisdictions that follow the Westminster system of government such as Canada, the United Kingdom, and Australia, Chief Medical Officers of Health (CMOHs) are typically senior public servants who are simultaneously positioned as public health professionals with independent expertise, senior advisors to an elected government, and designated protectors of the public health interest. Using Canada's federal and provincial CMOHs as case studies of this role in Westminster governments, we analyzed in-depth key informant interview data to examine how CMOHs navigate the tensions among their duties to the government, profession, and public in order to maximize their public health impact. We demonstrate that CMOHs are variously called upon to be government advisors, public health managers, and public communicators, and that the different emphasis that jurisdictions place on these roles shapes the tools and pathways through which CMOHs can influence government action and public health. We also elucidate the tensions associated with having CMOHs positioned within the senior levels of the public service and the strategies these officials use to balance their internal- and external-facing roles. Finally, we highlight the trade-offs among different institutional design options to inform decisions about the structure of the CMOH position in different contexts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.003 | 0.006 |
| Science and technology studies | 0.042 | 0.020 |
| Scholarly communication | 0.010 | 0.004 |
| Open science | 0.004 | 0.008 |
| Research integrity | 0.003 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".